—Also there is a bonus of just 10% Anejaculation.-
Did you mean 10% chance of retrograde ejaculation or 10% have antegrade ejaculation (normal)?
Did you mean 10% chance of retrograde ejaculation or 10% have antegrade ejaculation (normal)?
oops! It is 10% anejaculation. I believe this is a more precise definition. Actually, the WATER trial devided the prostates into two groups 30-50'and 50-80 cc. the former had anejaculation rate of 10% whereas the latter 2%. Don't understand why it favor 50-80. A logical explanation has been absent.
I double check the original papers. In the fist paper, it used the term retrograde ejaculation, the second paper, it used anejaculation.
1)WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia
Author links open overlay panelPeterGillinga∗NeilBarberbMohamedBidairePaulAndersong∗MarkSuttonhTevAhocEugeneKramolowskyjAndrewThomasdBarrettCowankRonald P.KaufmanJr.lAndrewTrainernAndrewArthernGopalBadlanioMarkPlantepMihirDesaif∗LeoDoumanianfAlexis E.Tem∗MarkDeGuentherq∗ClausRoeh
2) Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial
Mark Plante Peter Gilling Neil Barber Mohamed Bidair Paul Anderson Mark Sutton Tev Aho Eugene Kramolowsky Andrew Thomas Barrett Cowan … See all authors
1)WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia
Author links open overlay panelPeterGillinga∗NeilBarberbMohamedBidairePaulAndersong∗MarkSuttonhTevAhocEugeneKramolowskyjAndrewThomasdBarrettCowankRonald P.KaufmanJr.lAndrewTrainernAndrewArthernGopalBadlanioMarkPlantepMihirDesaif∗LeoDoumanianfAlexis E.Tem∗MarkDeGuentherq∗ClausRoeh
2) Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial
Mark Plante Peter Gilling Neil Barber Mohamed Bidair Paul Anderson Mark Sutton Tev Aho Eugene Kramolowsky Andrew Thomas Barrett Cowan … See all authors
If u are wondering what is the advantages and disadvantages of the enucleation technique (which is used in HoLEP) vs ablative techniques, the perfect vehicle to answer this question is the green light laser because it can do both.
I came across the following study which gives us the answers.
Summary of key results:
A) Operating time
"The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes). "
--- enucleation removes tissue a big block at a time and thus much quicker. 22 min is a very long time for BPH surgeries.
B) Complications
"Complication rates were comparable between the groups. "
--- I would have thought 82 min of PVP should have more complications.
"PVP Group had a higher rate of unplanned hospital readmission, " because " the surgical time was longer in the photoselective prostate vaporization group"
--- this makes sense.
C) Incontinence (seems to be transient)
"At 2 months the rate of urinary incontinence was significantly higher in the GreenLight laser prostate enucleation group (25% vs 3.4%) "
--- 25% incontinence seems to be the same as in HoLEP (17-23%, assume the worst case, it would be about 25%.)
"but incontinence rates were similar at 6 months (3.4% vs 0%)."
-- 3.4%/25%=0.14 that means that 84% of the 25% had recovered after 6 months. In HoLEP, 80% of those incontinence patients would recover after three months. So the two numbers agree with each other. It suggests that incontinence is due to the use of the enucleation technique.
D) Functional outcomes
"the maximum urinary flow rate had greatly improved, significantly favoring the GreenLight laser prostate enucleation group (+78% vs +64%)"
--- this is an objective parameter and it makes sense as enucleation( it peeled off the adenoma from the prostate capsule) removes more tissues than PVP
"At 6 months International Prostate Symptom Score quality of life and post-void residual urine volume had similarly decreased in the 2 groups after the procedure (compared to baseline)"
--- these two are subjective parameters, they are not sensitive.
"PVP Group had lower decreases in prostate size and prostate specific antigen"
--- this make sense as enucleation removes more tissues.
J Urol. 2016 Apr;195(4 Pt 1):1027-32. doi: 10.1016/j.juro.2015.10.080. Epub 2015 Oct 17.
Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a Study of 120 Patients.
Misrai V1, Kerever S2, Phe V3, Zorn KC4, Peyronnet B5, Rouprêt M3.
Results
The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes, p
I came across the following study which gives us the answers.
Summary of key results:
A) Operating time
"The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes). "
--- enucleation removes tissue a big block at a time and thus much quicker. 22 min is a very long time for BPH surgeries.
B) Complications
"Complication rates were comparable between the groups. "
--- I would have thought 82 min of PVP should have more complications.
"PVP Group had a higher rate of unplanned hospital readmission, " because " the surgical time was longer in the photoselective prostate vaporization group"
--- this makes sense.
C) Incontinence (seems to be transient)
"At 2 months the rate of urinary incontinence was significantly higher in the GreenLight laser prostate enucleation group (25% vs 3.4%) "
--- 25% incontinence seems to be the same as in HoLEP (17-23%, assume the worst case, it would be about 25%.)
"but incontinence rates were similar at 6 months (3.4% vs 0%)."
-- 3.4%/25%=0.14 that means that 84% of the 25% had recovered after 6 months. In HoLEP, 80% of those incontinence patients would recover after three months. So the two numbers agree with each other. It suggests that incontinence is due to the use of the enucleation technique.
D) Functional outcomes
"the maximum urinary flow rate had greatly improved, significantly favoring the GreenLight laser prostate enucleation group (+78% vs +64%)"
--- this is an objective parameter and it makes sense as enucleation( it peeled off the adenoma from the prostate capsule) removes more tissues than PVP
"At 6 months International Prostate Symptom Score quality of life and post-void residual urine volume had similarly decreased in the 2 groups after the procedure (compared to baseline)"
--- these two are subjective parameters, they are not sensitive.
"PVP Group had lower decreases in prostate size and prostate specific antigen"
--- this make sense as enucleation removes more tissues.
J Urol. 2016 Apr;195(4 Pt 1):1027-32. doi: 10.1016/j.juro.2015.10.080. Epub 2015 Oct 17.
Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a Study of 120 Patients.
Misrai V1, Kerever S2, Phe V3, Zorn KC4, Peyronnet B5, Rouprêt M3.
Results
The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes, p
In my previous post, I neglected to include the following info:
Two groups of 60 consecutive patients with enlarged glands (greater than 80 ml) underwent GreenLight laser prostate enucleation or photoselective prostate vaporization (performed by the same surgeon and including the learning curve) and were retrospectively evaluated.
Two groups of 60 consecutive patients with enlarged glands (greater than 80 ml) underwent GreenLight laser prostate enucleation or photoselective prostate vaporization (performed by the same surgeon and including the learning curve) and were retrospectively evaluated.
You’re much more knowledgeable than I am on this. I know that Dr. Miller’s technique still leaves the patient with RE.
Does Aquablation leave a hole in the center of the prostate like HoLEP does? I had a TUMT, it did not the prostate healed slowly and thus no hole. I did not have instantaneous results but I had none of the side effects. I have had the thought that because the prostate healed more naturally it was less likely to have side effects. I have no scientific evidence to support my thinking.
Not sure about more knowledgeable. We read what interests us.
Definitely, the Miller technique should give the same probability of RE as regular HoLEP I.e.m70-80%.
Why? There was an scientific experiment. 30+ men were asked to masturbate with TRUS inserted and recorded the tissues responsible for ejaculation. It was found that the tissues were those within a cm from the verumontanum. It had nothing to do with the bladder neck at all. Since then The technique of ejaculation preservation was born. The effectiveness of EP were proven in several TURP and GLL studies. It is called EP TURP, EP GLL,mets. Unlike TURP, GLL can control cutting tissues prcisely, EP-GLL had achieved 90% ejaculation preservation or 10% RE. And the 10% RE is identical what is being claimed by aquablation. In aquablation, the cutting contour is programed to pare tissues near the verumontanum. So this is all science.
The bad news is that in HoLEP, the encleation technique makes it difficult to avoide tissues near the verumontanum. The encleation technique removes a big block of tissue at a time and thus makes it difficult to do fine countour in such a way to miss all the tissues within 1 cm from the veru. The 70-80% RE from HoLEP is due to the use of the enucleation en block technique. Thus, the same 70-80% is also applied to GLL using the encleation technique.
All the numbers are consistent and there is no mystery.
Definitely, the Miller technique should give the same probability of RE as regular HoLEP I.e.m70-80%.
Why? There was an scientific experiment. 30+ men were asked to masturbate with TRUS inserted and recorded the tissues responsible for ejaculation. It was found that the tissues were those within a cm from the verumontanum. It had nothing to do with the bladder neck at all. Since then The technique of ejaculation preservation was born. The effectiveness of EP were proven in several TURP and GLL studies. It is called EP TURP, EP GLL,mets. Unlike TURP, GLL can control cutting tissues prcisely, EP-GLL had achieved 90% ejaculation preservation or 10% RE. And the 10% RE is identical what is being claimed by aquablation. In aquablation, the cutting contour is programed to pare tissues near the verumontanum. So this is all science.
The bad news is that in HoLEP, the encleation technique makes it difficult to avoide tissues near the verumontanum. The encleation technique removes a big block of tissue at a time and thus makes it difficult to do fine countour in such a way to miss all the tissues within 1 cm from the veru. The 70-80% RE from HoLEP is due to the use of the enucleation en block technique. Thus, the same 70-80% is also applied to GLL using the encleation technique.
All the numbers are consistent and there is no mystery.
My understanding of Aqua and HoLEP is that they both do not leave a hole at the center of the prostate. May be u have a different definition for hole that I don't understand.
Wow this is an excellent description of the reason for RE in HoLEP.
Thanks
Thanks
I have had this discussion with Dr. Krambeck and my local uro and have not received a totally satisfactory answer. Here are my stats 214 grams to start with 110 grams removed leaving about 100 grams. My local uro says I have a “wide spot” in my urethra. With 100 grams it seems like a mini bladder?
Dr. Krambeck says the prostate will shrink to about 20 grams but no one has told me where the approximately 80 grams goes?
Dr. Krambeck says the prostate will shrink to about 20 grams but no one has told me where the approximately 80 grams goes?
So 110 gram is removed from a prostrate originally 214 gram or cc. Leaving a wide spot seems to make sense.
So the remaining tissue is 104 grams. Overtime, I can see the prostate may shrink. I agree with u, I also don't see how it could shrink to 20 grams. There is no mechanisms that the 104grams will self destruct. These are not dead tissues.
So the remaining tissue is 104 grams. Overtime, I can see the prostate may shrink. I agree with u, I also don't see how it could shrink to 20 grams. There is no mechanisms that the 104grams will self destruct. These are not dead tissues.
Here is Dr. Krambeck’s office response to my question about prostate post op.
“The HoLEP removes the benign tissue and leaves you with your true prostate, regardless the size measurement. The HoLEP removes enough tissue that you have a large opening to urinate more freely.“
Still does not seem logical to me. The stats that I quoted earlier are my operative report.
“The HoLEP removes the benign tissue and leaves you with your true prostate, regardless the size measurement. The HoLEP removes enough tissue that you have a large opening to urinate more freely.“
Still does not seem logical to me. The stats that I quoted earlier are my operative report.
It certainly was not logical to me.
Likely The nurse won't be able to answer this question and the doctor didn't want to be bothered.
I found this paper .
It said, "After 4 months prostate size reduction was significantly higher in the holmium laser enucleation of prostate group (74.3%....)"
That is after 4 months, there is only 25% of the original prostrate size left.
214cc/4=54cc. We are getting closer.
As u know, in HoLEP , all the adenoma mass is Enucleated, I.e. Only the capsule is left.
So it could be more than 110gram was removed. Or Dr. K was thinking about an average prostate size.
RESULTS:
Overall 50 and 53 patients were included in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively. Operative time, hospital stay and time to catheter removal were comparable between the groups. There was significant, comparable improvement in I-PSS and post-void residual urine volume at 1, 4 and 12 months. After 4 months prostate size reduction was significantly higher in the holmium laser enucleation of prostate group (74.3% vs 43.1%, p=0.001). At 12 months maximum urine flow rate was significantly higher in the holmium laser enucleation of prostate group (26.4 ±11.5 vs 18.4 ±7.5 ml per second, p=0.03). Re-intervention was needed in 2 and 3 cases in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively (p=1.0). Mean estimated cost per holmium laser enucleation of prostate procedure was significantly lower than per photoselective vapo-enucleation of the prostate procedure.
J Urol. 2015 Mar;193(3):927-34. doi: 10.1016/j.juro.2014.09.097. Epub 2014 Sep 28.
GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study.
Elshal AM1, Elkoushy MA2, El-Nahas AR3, Shoma AM3, Nabeeh A3, Carrier S4, Elhilali MM5.
I found this paper .
It said, "After 4 months prostate size reduction was significantly higher in the holmium laser enucleation of prostate group (74.3%....)"
That is after 4 months, there is only 25% of the original prostrate size left.
214cc/4=54cc. We are getting closer.
As u know, in HoLEP , all the adenoma mass is Enucleated, I.e. Only the capsule is left.
So it could be more than 110gram was removed. Or Dr. K was thinking about an average prostate size.
RESULTS:
Overall 50 and 53 patients were included in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively. Operative time, hospital stay and time to catheter removal were comparable between the groups. There was significant, comparable improvement in I-PSS and post-void residual urine volume at 1, 4 and 12 months. After 4 months prostate size reduction was significantly higher in the holmium laser enucleation of prostate group (74.3% vs 43.1%, p=0.001). At 12 months maximum urine flow rate was significantly higher in the holmium laser enucleation of prostate group (26.4 ±11.5 vs 18.4 ±7.5 ml per second, p=0.03). Re-intervention was needed in 2 and 3 cases in the holmium laser enucleation and photoselective vapo-enucleation of the prostate groups, respectively (p=1.0). Mean estimated cost per holmium laser enucleation of prostate procedure was significantly lower than per photoselective vapo-enucleation of the prostate procedure.
J Urol. 2015 Mar;193(3):927-34. doi: 10.1016/j.juro.2014.09.097. Epub 2014 Sep 28.
GreenLight™ laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study.
Elshal AM1, Elkoushy MA2, El-Nahas AR3, Shoma AM3, Nabeeh A3, Carrier S4, Elhilali MM5.