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Dr. Lingeman saw me the day before performing the HOLEP, as is his practice, but I didn't have a cystoscopy. My procedure went well (it was 7 months ago, December 2016) and I don't believe the cystoscopy would have improved anything in my case. So, no, I have no regrets. I had considered having the procedure done at the Mayo Clinic but: 1. I wanted the best surgeon, who had done the most HOLEPS, and whom his patients pretty much universally thought was great, and that was clearly Dr. Lingeman, and 2.I live in Virginia and really didn't want to go to Minnesota twice if I didn't have to.
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Honestly, I feel like repeating the cycstoscopy is more for CYA than anything (er, I mean liability mitigation) as well as additional justification to ensure coverage from the insurance company, i addition to serving as yet another 'billable procedure.' I cannot speak to the medical necessity. I hope others will...
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Since Dr. Lingeman doesn't see the need for a pre-op visit, neither did i, and I felt like I was in good hands from my visit to his office the day before all the way through the operation and his subsequent visit to my hospital room the next morning. Because he works in a research hospital, I had tissue evaluation within just a couple of days. I was perfectly satisfied with his procedures, all the way from beginning to end and would not hesitate to recommend his services. He has a way of making you feel like you're with one of the very best doctors in the field. (And you are!)
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Contributor
149 posts

8/3/2017

A question for recent patients of Dr Lingeman:

Dr Lingeman is on my short list of possible HoLEP surgeons.  In your opinion is Dr Lingeman still "at the top of his game"?????  I see no questionable comments in this forum, yet we all eventually suffer from the inevitable aging process.   Should I be concerned, considering that the good Dr is getting up there in years?? 

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I had the HOLEP from Dr. Lingeman at the end of December 2016. Everything went fine. From my observation, he is still vigorous and capable. He looks healthy and I saw no sign of weakness. I would not hesitate to use his skills.
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No. Could Paul Newman race cars? Dr. Lingeman can perform this operation perfectly. (He did mine in January.) He's an outstanding leader in his field; he'll retire when he knows it's time. In the meantime I'd have full confidence in his ability, expertise, and judgement.
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Contributor
149 posts

Greetings:

As a person considering HoLEP surgery for my 70 gram prostate one of my biggest concerns is that I wish to be as certain as possible that I do not have any prostate cancer going into the procedure.  My question to those of you who have had the procedure is: what tests or procedures did you have performed that put your mind to rest in regards to the possible CA issue???

My situation:  So far I have had a Digital Exam which was reported to be normal.  I have also had an Ultrasound which was reported to be normal.  At the time I also had a Biopsy (12 samples) which came back cancer free.  That said, what concerns me is that my PSA = 9.4 ---- Free PSA = 1.05 ---- resulting in a Ratio = 11% ----> hence the concern since ratios below 25% are considered an increased risk for CA.

What other tests or procedures should I consider discussing with my local urologist in order to be more certain that I do not have prostate CA??  ------- Or should I just accept the normal tests done so far as conclusive evidence and not worry so much?

I thank you for any personal insights or opinions that you may have.

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Perhaps you can ask your urologist if you should have an MRI guided biopsy where they take out around 24 samples. You may have to be sedated for it. I'm not sure. Then, you would have had 36 biopsy samples taken and if they were all negative, that should give you more reassurance. You can also ask the urologist if there are some newer sophisticated tests that can be done [blood tests, etc.] that could help rule out prostate cancer. All the best.
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Hello Phillip,
Hoping to set your mind at ease.
My PSA initially came back at 17. I waited about 6 weeks and tested again. It came back at 13. Was I concerned? Yes.
After the 13 results, My Dr. gave me options of waiting to see if it would come down, or have the biopsy. I decided on the biopsy. The sonagram indicated no cancer. At this point I had two DRE by Two different Drs. Both indicated normal. The results of the biopsy came back normal. On my first visit with Dr Lingeman, I was examined by DRE the third time by Dr Lingeman's intern ,this made the third DRE, by three different Drs.

The high numbers were because of the size of my Prostate, not cancer. 110 grams.

Most Prostate cancer forms in the area that is accessible during a DRE.

If you a dealing with Dr Lingeman for surgery, you are dealing with the best. He is internationally Know, and a classmate of my urologist. I was very impressed with his bedside manner, knowledge, and staff. One must consider insurance and deductible with the approaching end of the year. Any Dr skilled enough to do a Holep will be in demand enough, you will have to wait to get in. I waited from The first week of July until the last of October to have my surgery.

Something to think about.

By the way, the biopsy on the tissue removed all 92 grams of it , tested normal and my PSA went down to .36
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This last post was posted by an old Veteran of the procedure.
Just me
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This last post was posted by an old Veteran of the procedure.
Just me
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Contributor
149 posts
Thanks so much for your detailed reply. Was curious what your PSA Ratio was pre-op? Mine is 11% which is what gives me cause for concern despite all the other negative findings. I don't know if or how prostate size can affect the ratio. Thanks
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A normal size Prostate will produce a certain amount of PSA.
A larger Prostate will produce more just because it is larger.
Any time the Prostate is irritated, or stimulated it will produce more PSA. Even an ejaculation will raise the PSA level.
My urologist informed me the PSA test can be a useful test, but it is not a foolproof test for cancer, it can also indicate , a large prostate, or recent ejaculation.
I sounds to me you have taken several Reasonable precautions.
If your Dr is a good responsible Dr. , he will make a good recommendation.
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My Preop PSA was initially 17. My GP Dr is a very good , compassionate man. I could see a very concerned look on his
Face when he told me the results.
I was passed on to my urologist, who is also a member of my church. That relationship was very beneficial as well. He reassured me by relating to me as a Dr , and a patient that also endured the same situation.
I am not a doctor, but I have been there, and I have heard from a Doctor who was also a patient for the same thing. If I can help you, I consider it a privilege.
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I'm the long time girlfriend (20 years) of someone that had holep at mayo 4-5 years ago. He & I after research decided to go this route, local treatment was almost no sex life, holep 50/50, we have no sex life. I've researched myself afterwards to figure out what's going on, best I can surmise, he still gets off immediately while I'm left to wonder what and if anything happened. Needless to say, I'm not satisfied & wondering if I ever will be again...
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