Which is the best surgical treatment for benign prostatic hyperplasia?

Men's health
1

I'm sixty two years old and have been catheterized (for now just over six weeks ) after being hospitalized for urosepsis following a cystoscopy. I'm waiting for the TURP procedure on the NHS although I believe there may be better surgical procedures and I am prepared to pay privately to get the best result. Any thoughts, information and/or weblinks would be most welcome. Thanks. P

2

I'd be reluctant to go with TURP when there are better options available, and i'd be wanting to avoid the place that left you with urosepsis following your cystoscopy.

3

Thanks Dan. Which options are considered the best? Are there any reliable evidence-based comparisons readably accessible on the internet? Moreover what is the consensus here - which procedure gets the most positive comments from the guys here and which gets the least?

4

Miracles Brother....- are what we are All looking for....
And only a few guys on this site profess to have benefited from being a recipient of such.
I am 61 and have been dealing with issues associated with BPH for several years. I too, am on this site looking for the "Perfect" procedure/miracle. I am doing intermittent CIC to help lessen any bladder stretching and help get a little better flow, pending my long research and numerous visits to Health Care Professionals, during my lengthy search.

Good Luck Sir, and if you do find any Miracle, PLEASE let the rest of us know.

Decorously, Chuck

5

There are several versions of TURP now but Uro's tend to generalise. I even had one call GL TURP and when challenged said they re all just boring a hole. Procedure availability can also vary depending where in the UK you are. I had GL in Newcastle in 2004 and Thulium/Holmium laser in Sussex in 2013. Both were good and recovery trouble free and life back to normal in a couple of days though others have different tales to tell. There is no doubt that procedures performed in British hospitals are superior to those done in Uro's 'Offices' in America.You are entitled to ask for the procedure you want to be done in the area of your choice. I lived in Scotland and had GL in Newcastle as it was new at the time and not widely available. Best results with all come if your median lobe is not the problem area and your surgeon does a bladder neck sparing procedure to prevent retrograde ejaculation. If you look for the NICE ( National Institute for Health and Care Excellence ) site all the procedures are detailed. We can't post direct links here.

6

Are you concerned with retro ejaculation ?

7

If you wait for a miracle you will die waiting. When my BPH was first diagnosed in 1994 TURP was the only show in town apart from having it totally removed. I waited for a good laser procedure to arrive and GL took ten years to appear. In that time my prostate grew from 35 to 75 grms and my PSA went from 5.0 to 9.8 and I had two negative biopsies in that time.

8

in USA, maybe FLA

9

Thanks Chuck. Much appreciated! And if by a miracle I find one I will certainly not keep it to myself. :) Best. P

10

He told he is in the UK and has been treated by the NHS but will consider private treatment. Usually the advice that holds good for one country does not for another. UK NHS patients are often given a take it or leave it choice and cannot easily see other Uro's for options or the newer or more expensive procedures. The NHS in the main want to use the cheapest option and to free up the bed for the next patient at the moment that is Rezum. Google will tell you that PAE is now approved but the system is in no way set up to offer it widely available.

11

Thanks Derek - I've already looked at the NICE site but haven't found direct comparisons. I'll have a look again. Thanks again. Good to know that you've had no issues.

12

I'd love to keep everything working just fine but I accept that this is probably out of the question. My wish list starts with being able to pee normally with some sexual function preserved. Retro ejaculation I'd prefer to avoid but it isn't the priority. Considering this what would you suggest Hank?

13

I'm in the UK but thanks for the info, andrew

14

I take it that PAE is also included on the NICE site derek

15

If RE is not your concern, hoLEp is by far the best procedure. Very high success rate. Very effective. Great longevity. Well documented and proven. Bipolar TURP (not regular TURP) is next. Followed by GL. If RE is important to you, Rezum or FLA is your best shot. Not as effective but much lower risk of RE. Urolift has even lower risk of RE but much less effective, and there are more and more reports of problems with the clips used. Then again, there is self cathing, which is not a procedure.

16

JerryR had a HoLAP procedure done 5 weeks ago: https://patient.info/forums/discuss/i-just-had-a-holap-for-my-bph-708123

From what I see from internet research HoLEP has a 70%+ chance of RE and HoLAP in one study showed a 36% chance.

"Retrograde ejaculation of sexually active patients was reported in 36.3% of the HoLAP "

"Patients after HoLEP and TURP reported retograde ejaculation in 75% and 62%, respectively "

HoLAP appears better for small prostates with less likelihood of tissue regrowth and another operation, whereas HoLEP is better for large prostates, presumably because more tissue is removed.

Maybe someone who knows more than I can weigh in the difference between HoLAP and HoLEP.

17

This is from Mayo clinic: There are several different types of prostate laser surgery, including:

Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel. Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser. Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.

18

Excellent information hank. Many thanks for this. P

19

Well, I AM one of the miracles on this forum.

I am 54 years old and very FIT and active at the gym and yoga. I don't know why the PAE procedure worked so well for me, but it has. I am back to my normal self without taking any medication. My car and travel kit still have emergency catheters at the ready because of old fears, but thank God I have not even come close to needing since my procedure.

Before PAE, my daily nightmare was EXTREME urgency followed by dribble, dribble, and 3 times full retention. I would be driving my car and the urgency would hit, if I was in traffic sometimes I would use a pee bottle...but that took a lot of practice to not piss myself! When on a plane, the urgency would hit and the fasten seatbelt sign came up, I would dance in my seat with impending doom! A living hell as many here have experienced!

Now, I can hold it in for several hours if need be. The urgency has completely vanished. All BPH symptoms have vanished. I am my normal self. I have zero side effects, retro, etc. I had started to "leak" before the procedure and that is gone! I am very LUCKY!

I wish the best of luck to you and all.

Here is my experience https://patient.info/forums/discuss/my-pae-at-ucla-april-2019-700378

20

The best procedure for everyone has not yet been invented so doctors tend to choose what is best for themselves not the patient. Suggest you get as many opinions as you can. Prior to any procedure you will be asked to sign a waiver of liability which gives you no recourse.