Best doctors for HOLEP surgery

Ben. I think part of it is that I had Urolift with 6 clips about 3 years ago. It was a big failure. These had to be removed. I know that’s why my total operation time was longer. These had to be removed, so a lot of in and out. If anyone reads this just say NO to urolift. Wish I had gone straight to HoLEP, but honestly I didn’t know. I boude two more dime sized clots last night but seems to be all good today and I have a very strong stream - thank the Lord. I never knew going to pee could be so much fun. Big reversal from my last three years. I’m also controlling the bladder better today. I’ve had on the same pad all day. And been drinking a lot of fluids. How many fluid ounces you consume a day. Nate

Thanks Philip. I want call her as long as I’m can have this good stream. It was just a surprise, like you said, after so man days. Urine is a lot clearer today. Have a great week.

Nate here. By the way, I have read a lot of HoLEP surgeon offices discharge instructions online and the majority of them recommended not drinking carbonated drinks. That was never communicated to me. In fact, I was told to drink whatever I wanted. I think Coke has been a problem for my bladder/urethra postop. Anyone told not to drink carbonated drinks or had problems with them? I guess I’m gonna have to let those go.

Nate, glad to hear that you are doing well. As we talked, the clots should not hurt you, as long as you don't have other problems. Actually, I went directly to HoLEP. More than three years ago, my local doctor recommended several options, but no one mentioned HoLEP. I was not able to accept any of them that time, or I was not ready for any of them. I was trying to do some research my self, hoping to find some more suitable options. During the past three and half years, I spent lot of time on searching. There were limited information in US, I found some information in some foreign country, then use some key words to look back to US, I found there is HoLEP here. I thought if I need to do surgery, the HoLEP sounds like an idea option. I saw few doctors in US are doing it, but again, there was very limited information with patient experiences. I couldn't go forward until I found this web about 6 month ago, "SteadyHealth". I found sufficient information here, I could see many patients' experience during almost past 20 years. I want to thank Philip here again, he contributed lot of valuable information. When I have any questions, Philip is always there. He actually influenced me. Decided to do HoLEP, and go Vanderbilt was a quick decision after more than three years waiting and searching, I finally did what I need to do. After the surgery, I still think I chose the best option or most suitable surgery to my prostate problem. My question is why the information about the HoLEP is so limited even after it's been there for 30 years.
In first week, I consume about 3-4 gallons water every 24 hours, not counting the fluid in the meals, (the most frequent day I rush to restroom on 1/22 was 36 times, not a joke), then gradually reduce to 2 gallons. From tomorrow, I may start consuming water as usual, since the urine is almost clear now. I feel like I have already come back to normal. I will do a two week wrap up on next Thursday.

I drank clear water

Nate, I had one dime size clot came out this morning. So we have not done yet, possibly we will see it again, but one day it will be all gone. I walked two miles yesterday, I was told that walking is helping the clots get out.. I have no problem at all to walk.

Nate, sorry I calculated wrong for the water intake. I think it 's about one gallon or 8 to 10 bottles, now I reduced to half. Hope it's not miss leading you.

Ben and Philip. If I recall, I read about HoLEP and then located these forums on a Google search. That’s when I encountered Philip’s comments about Dr Miller on a separate thread. Philip, You are very prolific on this website. Can’t imagine how many men you have helped. I then researched Dr Miller’s background and training (second to none) and was excited she was just 2 hours away. It was interesting that my urologist, a Vanderbilt grad, tried to suggest the TURP, anfter the rectal ultrasound and even made me an appointment. But I was sold on HoLEP after reading these forums. As for clots, I actually had way more clots and larger ones, with Urolift. People don’t know what they are getting into with that procedure. It basically robbed me of 2 1/2 years or I should say the urologist who performed it. My prostate was way too large for the urolift procedure. But I am loving the results of HoLEP. Hope it last. Dr Miller told me it’s “one and done.” Praying that’s so. Ben I’m drinking 64 to 80 oz a day. I’m now just waiting for the incontinence, that’s much improved, to resolve. And I’m trying to walk. That’s going to require building back some stamina. Before my prostate revolted a in 2019, I was doing a 10k almost every day. With the Lords help I’ll make it back. Counting down now to my visit with Dr Millers PA on 2/25/23. Will let y’all know how it goes.

I think I’m a bit of an anomaly, unfortunately, because I had six urolift clips (3 in each lobe) that had become inflamed and fibrotic according to Dr Miller. These had to be removed. Dr Miller had to cut these out.

Once cut out, the clips and all get pushed into the bladder and have to be removed with a grasper. This means more ins and outs. Plus Dr Miller had to “clean up” the fibrosis. So, Dr Miller explained to my wife that it would take me eleven weeks to totally heal. Thank God Dr Miller is so dedicated that she can correct what other urologist have totally mucked up. So, word to the wise, stay away from urolift. Doesn’t really matter that they call themselves a COE (center of excellence). Nothing excellent about doing the wrong procedure on a prostate to big for the procedure. HoLEP can treat any size prostate with a much much lower redo rate and minus the fibrosis. I spent 2 1/2 years suffering from urolift and I can believe the difference now.

_removed_

Ben. Here’s a book that was recommended on another thread. Thought you might be interested

Vanita Gaglani
Life after Prostatectomy and Other Urological Surgeries: 10 Weeks from Incontinence to Continence

I ordered off Amazon. There is a Kindle version too

She lays out three counter intuitive benchmarks for incontinence:
1. Drink more not less water
2. Wear smaller pads
3. Do less Kegels and less often

Some guys swear by it.

I had my first telephone visit with Dr Amy Krambeck at Northwestern in Chicago.  It was $500. I'm a self pay (no insurance).  The HoLEP surgery is $43,000.  The pre-op visit is another $500.  They scheduled me for surgery about 5 weeks after my visit.  I had to decline and wait until I have insurance in a few months.

Dr Krambeck said someone is in training with her during the surgery, but she will be watching him carefully.  She had looked at my ultrasound images.  She answered a few questions.  The phone call (not video) was 23 minutes.

My prostate is 100 ml and the PA said they don't recommend Rezum for such a large prostate and also probably because I have been in retention for one year.  If I get the Rezum I cannot do HoLEP until 6 months later for healing to finish. 

Northwestern requires a nasopharynx COVID test 2-3 days before surgery.  The assistants get back to me quickly via MyChart.

After watching over 100 videos and reading lots of information about Urolift, Rezum, TURP, Aquablation and HoLEP, I chose HoLEP and Dr Krambeck.  I don't have a PhD in this field and no previous surgeries, so it's still an educated guess.  There are way too many marketing videos that don't tell you about the patient's experience.

Dr Krambeck said 1) Strictures are extremely rare, 2) Incontinence is rare, only 1% after one year, 3) Retrograde ejaculation affects 90% of patients (unfortunately), 4) After 2 weeks I should be doing OK.   I think, I cannot be back to normal completely until the 3 month mark, from what I have read.

 

 

LALR. This is Nate. Are you near Chicago? I have heard great things about Dr Kramneck. She and Dr Miller, I think, trained together with Dr. J. Lingeman in their Fellowships. He is the “father” of HoLEP in America. I will say, in my case at least, the HoLEP procedure at Vanderbilt was much less money - I have insurance. But I don’t blame you for waiting for insurance. Vanderbilt also did not require a Covid test before surgery. I’m less that two weeks post HoLEP so of course I’m still suffer from some incontinence- wear depends. But it is getting better. Less blood in urine. Weeks away from sex. And I have read many men who have experienced improved erections and have claimed that retrograde ejaculation is not a really big deal. Find that hard to believe, (no pun intended) but I can confess that the improved urinating is so magnificent that I will gladly deal with the other stuff. I marvel at what HoLEP gives the patient. And to your point, Dr Miller told my wife that complete healing would require 13 weeks. Hope it all works out for you. I pray I’ll be back and better before Summer. Report back when you can

Nate, I don't really have incontinence, I can hold my urine much better than before the surgery. But I do agree the book says: Drink more water is always good, exercise and train the bladder's ability to hold more water: I still wear a thin pad for small dripping after voiding, I don't know how long it will take to stop dripping or small leaking: For Kegel exercise, we need to do some, but is not the more the better. I read an article, If you do too much, it may cause congestion while you train the sphincter of urethra。

It's ben, sent above message