Best doctors for HOLEP surgery

Wow, you beat me my prostate was 213 grams. I had been on a catheter for about 3 months.

Let us know about your recovery.

This technically off topic but it is the latest research on prostate therapies.

onlinelibrary.wiley.com/doi/full/10.1111/bju.12868

I strongly recommend Dr. Bandi at Georgetown. I found him on this forum. I had BPH for years managed ‘poorly’ with medications. When symptoms became intolerable, my urologist performed Urolift. That didn’t help much either. My doctor recommended TURP. I took the train from NYC and visited Dr. Bandi. He immediately asked me if I’d ever had a prostate size measurement. My urologist had done cystoscopy but no imaging. He did a Rectal ultrasound and measured my prostate at 109cc. I never knew my prostate was this large, He recommended Holep as the preferred option. He performs TURPs, Urolift and Rezum but recommends them mostly in patients with small prostate to avoid future failure. My surgery was scheduled in 4 weeks. There were 3 more Holeps scheduled the same day. I went home next morning and took the train back that evening. I had minimal leakage lasting about 1 month.

Wow, this is impressive. I have always read that some procedures work for smaller prostates but HoLEP will work for any size. You have been blessed to have minimal leakage.

I would like to share my experience.

On doing my research here, I found a well reported doctor here in phialdelphia. My prostate measured 135 cc on ultrasound before the operation. I underwent a 'laser enucleation'. Symptoms were better after the procedure but not the improvement I expected. I got a second opinion and found that my prostate still measured 94 cc after the procedure. i got my operative reports which suggested that 37 grams of tissue was removed. The laser used was Protouch laser.

I seeked out a HOLEP surgeon to see why my prostate was still so big. He explained me the procedure in detail. He explained how prostate is like an orange with me peeing through the center. During a HOLEP or simple prostatectomy, the surgeon goes in the plane between the rind and the pulp and enucleates 'all' of the central (transitional) zone. This usually accounts for 60-80% of prostate tissue. This is not possible using the Protouch or the Thulium laser as the laser melts and charrs the tissue making it hard to see the plane. Most surgeons just carve out some tissue and never get to the surgical plane. He was very patient and showed me youtube videos of Holep (holmium laser enucleation), Thulep (thulium laser enucleation) and Prolep (Protouch laser enucleation). He performed a Holep and removed additional 46 grams of tissue and the response was great.

Please make sure you surgeon is a true 'HOLEP surgeon' and not a Prolep or Thulep surgeon.

Would you mind sharing who the surgeon was who did these? I had HoLEP done in Philly with Dr Das on my 150 cc prostate and I am assuming he was the one doing the HoLEP since he is one of the pioneers here in the states (I now pee like a fire-hose btw though I do still suffer from what I now assume is permanent, slight stress incontinence after close to 2 years, otherwise I am quite satisfied).

My first treatment was a microwave treatment. It was what I wanted at the time. I was in my 50s and I wanted to avoid side effects. My HoLEP was when I was 72. It certainly has done what it supposed to do. The 8 months of incontinence was not fun.

Your doctor that went into a explanation sounds great. My doctor is part of the IU health network in Indiana. Her goal was to do as many surgeries as possible. In fact she has been working on a drive through HoLEP. By that I mean one where there is no overnight stay, in and out in the same day. She was expert but not very good at explaining everything.

I hope you don’t mind my jumping in here. Urinary control in the long term is one of my concerns. As we age our muscles become weaker and if you are on a statin your muscles may weaken even more.
Because of this I am still doing Kegel exercises two years after my surgery. Occasionally I will leak. Just the other day I bent over to tie my shoelaces and had an incident. This is not a regular event but it does happen. When I am working out I still wear a pad, just in case.
Some HoLEP surgeons will remove more of the inner sphincter than others. My surgeon removed about 90% of mine, leaving the outer sphincter to pick all of the control function.

I went to couple of second opinions at Indiana and Mayo and had a disappointing experience. These places have high volume but no one has time to go over the procedure and post operative expectations. Felt like an assembly line!!! Will have to find someone who is more personable and treats me like an individual..

Two years ago I went to IU and had the same experience. I was told they had too many patients that needed their services so they rushed through. Of course they were had many ads promoting HOLEP at IU. IMHO IU is more interested in $ than patients.

After my surgery I was told the surgeon removed 90% of my bladder sphincter. The doctor then told me her colleague at Vanderbilt typically removes 65% of the bladder sphincter. Other reports are that Dr. Das in Philadelphia removes even less. I suspect the more that is removed the greater risk of leakage.

Take your time and read through the comments on this bulletin board.

Hi, I am considering ThuLEP treatment due to my P size being 220ml. Was wondering if you had a procedure and which did you choose? 69YrOld - BPH n Infections w bleeding; 2 Bouts of Bladder stones n 1 retention ER; CT 7/2019 shows no cancer as well as DREs w large P. Understand ThuLEP is better for large P up to 300g. Mike - Louisiana

I had HoLEP at age 73. My prostate was over 214 grams. I was told there was no upper limit on the size of prostate for HoLEP surgery.

I just did a brief search for ThuLEP and found that the occurrence of EJD is significantly lower with ThuLEP. With HoLEP the incidence of EJD is virtually 100%. ThuLEP brings that down to 50%.

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I will check that site out Buster. What y say is what I have been reading about. ThuLEP might have some advantage on HoLEP for large P. Mike in Louisiana

I had a TUMT that carried me for about 12 years. I will never regret that decision. Personally if I knew about PAE I would have tried that before HoLEP. PAE has a 20% failure rate. If it didn’t work I could always have HoLEP after the PAE.

What n where did you eventually go and what procedure? I am deliberating what procedure to do. I can do HoLEP at Indiana U or I can do ThuLEP at univ of Illinois at Chicago. My P size is 220ml. Mike- Louisiana