I believe that the itnernal sphincter could be totally preserved and not to be touched at all by HoLEP but then in that case not all the blockage will be removed.
This is the same situation as the ejaculation preservation technique. The cut or enucleation could avoid all the tissues far ahead of the verumontamum, but the blockage by this otherwise should be cut tissue could be a problem down the road that is it will have higher reoperation rate.
This is the same situation as the ejaculation preservation technique. The cut or enucleation could avoid all the tissues far ahead of the verumontamum, but the blockage by this otherwise should be cut tissue could be a problem down the road that is it will have higher reoperation rate.
My thinking is that I am 73 years old I don’t think the blockage would grow back before I die. My goal is NOT to pee like a 20 year old but maybe a 50 year old and to sleep through he night. I have not achieved the latter.
Have time to elaborate what is ur situation and why HoLEP hasn't give u what u had wanted?
I’m the kind of person that wants to have my goals met. The Dr. never apaadme of RE before surgery. I was never asked what my goals were. I was still recovering from two previous surgeries leaving me in a very weakened state. Dr. Das treated you as a person. I had to submit my questions in writing before my consult, bear I was weak and had not been able to do my research. I found out latter about Dr. Miller and he bladder sphincter sparing technique. I would have much preferred that to the surgery that I got. IU bills them self as leading edge, they are not! The technique is 20 years old, Dr. Miller has made advances as well as Dr. Scarfone.
Enough of my rant.
Enough of my rant.
U are not ranting but try to point out to readers how important to find a caring urologist!
I didn't do any better with my urologist and in fact a bit worse than u. At least u could submit written questions., but for me I spent about $5000 on three tests and after that never got a call from my urologist to tell me the results. I called his office a couple times to request explanation of results,but at the end still no explanations even at in-office consultations. I had an earlier urologist who also behaved similarly.
I bought all my document from my uro's office to Jefferson with the intention of telling Dr. Das that I had done these tests and no need to do them again and want them to be placed in my account at Jefferson. Had never expected Dr. Das to explain the results to me. But he did which caught me by surprise. All the complications, both short and long term, were explained to me using his own patients data at Jefferson. He also made sure that I indeed wanted HoLEP and not Urolift. So he was not trying to convince me to select the technology which he offers.
To readers reading this threads, please find an urologist like Dr. Das who would explain the procedure carefully to u so u know what are u getting into even if u have to spend a lot of time to find such a person
To me, The bladder neck preservation is not an advance but it is common sense. But the low power en bloc no touch in my view is indeed an advance. There was a Russian study using this technique and had gotten very good results.
Are u still suffering from any other complications? Are u happy with the results from HoLEP?
I didn't do any better with my urologist and in fact a bit worse than u. At least u could submit written questions., but for me I spent about $5000 on three tests and after that never got a call from my urologist to tell me the results. I called his office a couple times to request explanation of results,but at the end still no explanations even at in-office consultations. I had an earlier urologist who also behaved similarly.
I bought all my document from my uro's office to Jefferson with the intention of telling Dr. Das that I had done these tests and no need to do them again and want them to be placed in my account at Jefferson. Had never expected Dr. Das to explain the results to me. But he did which caught me by surprise. All the complications, both short and long term, were explained to me using his own patients data at Jefferson. He also made sure that I indeed wanted HoLEP and not Urolift. So he was not trying to convince me to select the technology which he offers.
To readers reading this threads, please find an urologist like Dr. Das who would explain the procedure carefully to u so u know what are u getting into even if u have to spend a lot of time to find such a person
To me, The bladder neck preservation is not an advance but it is common sense. But the low power en bloc no touch in my view is indeed an advance. There was a Russian study using this technique and had gotten very good results.
Are u still suffering from any other complications? Are u happy with the results from HoLEP?
Good Day to all who have posted here for the last three years. I have found out and validated a lot of information. I am 57 BPH with LUTTS-4/5 on my score in the Milwaukee Wisconsin area. My prostrate is 160-CC so rather large. MRI and 4K Score Test. Time for intervention and it appears heLOP is my best option with a local Dr. that has performed over 400 of these with good results at the regional medical center. She trained under linguist in Ind for 6 month fellowships. PAE was offered at another local provider but appears to be very questionable procedure based on the latest reviews. Link attached.Read this information it is a large review of the current data and rated for good decision making on all procedures. The local uro told me under no conditions get the PAE based on this latest information but go with the hoLEP for my best results. So like many I question all the information and results. But it is time to pull the trigger today and schedule this heLOP for November time line as my next step. It sure is a lot to wrap your mind around with all the data and mixed results of each person that posted here over the years. I guess I need to move forward the situation needs intervention and will only get worse as I age and cause further damage to my bladder and kidneys.
https://www.auanet.org/guidelines/benign-prostatic-hyperplasia/lower-urinary-tract-symptoms-(2018)
Has anyone here had heLOP performed in Wisconsin or any other words of wisdom.
Scott
For 160cc prostate, from what I have learned from results from various trials, HoLEP is the best choice vs open prostatectomy.
If u read this forum as well as patient.info, u would find that quite a few patients didn't have good results with PAE. I would say that u make a good decision.
I remember reading HoLEP has a steep learning curve and it was recommended that the surgeon has at least 150 operations in training before operating alone. So 400 cases is a very good number. As u had mentioned Lingerman(spelling?) in Indiana has done thousands of HoLEP and is a favorite among BPH patients. So training under him definitely is very reassuring.
Beaware that the chance for retrograde ejaculation for HoLEP is 88%, transient incontimence could be as high as 17% unless the HoLEP surgeon practices bladder neck preservation then it reduces to less than 2%
Also beware that the larger the prostate, the more severe the complications. Blayneb of this thread had a 150cc prostate and it took him 9 months to recover from incontinence.
Good luck!
If u read this forum as well as patient.info, u would find that quite a few patients didn't have good results with PAE. I would say that u make a good decision.
I remember reading HoLEP has a steep learning curve and it was recommended that the surgeon has at least 150 operations in training before operating alone. So 400 cases is a very good number. As u had mentioned Lingerman(spelling?) in Indiana has done thousands of HoLEP and is a favorite among BPH patients. So training under him definitely is very reassuring.
Beaware that the chance for retrograde ejaculation for HoLEP is 88%, transient incontimence could be as high as 17% unless the HoLEP surgeon practices bladder neck preservation then it reduces to less than 2%
Also beware that the larger the prostate, the more severe the complications. Blayneb of this thread had a 150cc prostate and it took him 9 months to recover from incontinence.
Good luck!
Thanks DL808. Correct spelling Lingerman in Indiana. I fully expect RE from the procedure. I reread Blayneb responses ouch that gives some thought. I expect some transient incontinence short term but hoping on the statistics in my favor. I need to check now that this surgeon can perform the bladder neck preservation that is a great data point and thanks for pointing that out. That would highly improve my possible out comes.
Thanks Much, Scott
Thanks Much, Scott
160 cc is a very large prostate! There is no better option than HoLEP that I know of. The highest record for HoLEP is 800cc. Dr. Das told me that he just did a HoLEP on a 200+cc prostate and it took him about 4hrs (seems a bit too long). For such a long operating time, the tissues inside would be subjected to much stress from the instrument. It would be unwise to expect it is a piece of cake.
It is fortunate that u have a good urologist who advised against PAE. There was a post on patient.info in which the author greatly regretted that he did PAE which didn't help him at all. But later went for HoLEP and was very happy with the result (I vaguely remember that he said it was the best decision he had made.)
The unknown long term effect of starving the blood vessels is unsettling. In cases that work, the functional outcome of PAE is not great.
It is fortunate that u have a good urologist who advised against PAE. There was a post on patient.info in which the author greatly regretted that he did PAE which didn't help him at all. But later went for HoLEP and was very happy with the result (I vaguely remember that he said it was the best decision he had made.)
The unknown long term effect of starving the blood vessels is unsettling. In cases that work, the functional outcome of PAE is not great.
Hi Scott. As DL states, the size of my prostate was a factor and as stated, the larger they are, usually the longer the surgery can be resulting sometimes in longer incontinence recovery. Another factor for me however was the length of my prostate which made my surgery somewhat difficult (for the instruments) and longer in duration. However, my understanding is that HoLEP is probably the state of the art procedure for larger prostate's such as yours and mine and is much preferred with less complications than an open prostatectemy. Yes, even though I've had a longer than normal recovery from incontinence, the improvement in my life, as in being able to urinate normally, no threat of urinary retention, etc. has made it for sure worth it. We're all different, and of course you need to go the route that is best for you (with a well qualified, experienced HoLEP surgeon) and assess whether you can deal with retrograde ejaculation in particular but for me, it was the only way to go and I'm very glad I did it. If I can be of any help, don't hesitate to ask, and good luck.
Hi Scott,
I think I had the largest prostate of the group at 214 grams. I am 73 so I had that going against me as well. On the plus side my surgery only took one hour including morcellation. The surgery took place Jan. 31, 2018. Dr. Krambeck (a protege of Dr. Lingeman) said it simply fell apart. I am going without a pad unless I am in a group situation. I still don’t have total confidence back.
Dr. Das seems to take the time to really explain what is going to happen. This is really important. It is a confidence builder. I would say that the incontinence is really NO FUN. A friend had prostrate cancer. His surgeon removed the entire prostate without leaving him incontinent for months on end. It seems like this surgery should be done in a similar manner. In fact Dr. Nicole Miller at Vanderbilt is known to have developed a technique that virtually eliminates incontinence. DL says that Dr Das is using a bladder neck preservation technique that will reduce or eliminate incontinence for is patients.
I hope things go well for you.
I think I had the largest prostate of the group at 214 grams. I am 73 so I had that going against me as well. On the plus side my surgery only took one hour including morcellation. The surgery took place Jan. 31, 2018. Dr. Krambeck (a protege of Dr. Lingeman) said it simply fell apart. I am going without a pad unless I am in a group situation. I still don’t have total confidence back.
Dr. Das seems to take the time to really explain what is going to happen. This is really important. It is a confidence builder. I would say that the incontinence is really NO FUN. A friend had prostrate cancer. His surgeon removed the entire prostate without leaving him incontinent for months on end. It seems like this surgery should be done in a similar manner. In fact Dr. Nicole Miller at Vanderbilt is known to have developed a technique that virtually eliminates incontinence. DL says that Dr Das is using a bladder neck preservation technique that will reduce or eliminate incontinence for is patients.
I hope things go well for you.
Buster,
My prostate was also large 125 cc. My Holep vas done by Dr Miller she used the bladder Neck preservation technique. I asked her how long the surgery lasted. She said it was just little over an hour. I really never had any incontinence but for a few days.
My prostate was also large 125 cc. My Holep vas done by Dr Miller she used the bladder Neck preservation technique. I asked her how long the surgery lasted. She said it was just little over an hour. I really never had any incontinence but for a few days.
Buster,
have you checked your PSA, since you had your surgery, if you did, did you had it done at your local Uro.
have you checked your PSA, since you had your surgery, if you did, did you had it done at your local Uro.
Hi Buster,
U made a very good point that even when the whole prostrate was removed, the patient did not suffer from incontinenence. I suspect (a) the surgeon preserved the bladder neck when he removed the prostate, and (b) the patient did not have BPH, that is there was no BPH overgrown tissue, and the internal sphincter was In its prestine state.
U made a very good point that even when the whole prostrate was removed, the patient did not suffer from incontinenence. I suspect (a) the surgeon preserved the bladder neck when he removed the prostate, and (b) the patient did not have BPH, that is there was no BPH overgrown tissue, and the internal sphincter was In its prestine state.
Did Dr. Miller take any part of the bladder sphincter? I ask because DL reported that Dr. Das said that his surgery would take about 40% of the internal sphincter.
I would much prefer a few days of incontinence to 6-7 months.
I would much prefer a few days of incontinence to 6-7 months.