Just send out a post that explains how ejaculation preservation is done for resective BPH surgeries. It confirmed what u said, "Actually, Dr. Miller’s technique at Vanderbilt is reported to preserve the bladder sphincter but it still results in RE."
The Miller's bladder neck preservation HoLEP technique seems to only minimize stress incontinence and it does not preserve ejaculation..
The Miller's bladder neck preservation HoLEP technique seems to only minimize stress incontinence and it does not preserve ejaculation..
Music to my ears DL. I am really counting on my continence back in 12 months. I am at 8+, slow steady improvement, but no more than maybe 80% continence. Still have to wear shields daily.
Hello Blayneb, literature reports the average results of thousands of patients. As long as u and Buster continue to recover that means that u both are following the same trajectory reported in the literature. At 12 months, only fraction of a percent of patients still suffering from incontinence.
I remember U had a 150 cc prostate which was huge And would have required open protatectomy if HoLEP was not available. With such a large prostate, the HoLEP operating time increased proportionally and more energy was used. Both would contribute to more complications and longer recovery time.
Both of u had very experienced HoLEP surgeons. U both couldn't have done any better.
If u both are recovering albeit slowly and are happy with the outcomes, I believe that mean HeLEP did what u both wanted.
Not sure if u both agree.
I remember U had a 150 cc prostate which was huge And would have required open protatectomy if HoLEP was not available. With such a large prostate, the HoLEP operating time increased proportionally and more energy was used. Both would contribute to more complications and longer recovery time.
Both of u had very experienced HoLEP surgeons. U both couldn't have done any better.
If u both are recovering albeit slowly and are happy with the outcomes, I believe that mean HeLEP did what u both wanted.
Not sure if u both agree.
You echo my thoughts pretty well DL. Not only was my prostate large (your recollection is accurate), but Dr Das had warned me it was long, maybe too long for his instruments. He was nevertheless still able to complete the procedure but with some degree of difficulty and extra time which mirrors what you say, hence the slower recovery time. I am trying however to remain confident I will be in the vast majority that recover within 12 months. Regardless, I doubt any other option at the time would have been any better, and am satisfied with the outcome. I continue to see slow progress (as Buster appears to be) which is key. I am sure he, as I do, really appreciate your support.
I absolutely agree that stress incontinence is controlled by the bladder sphincter. What is important is the technique for preserving the bladder sphinkter. To eliminate this side effect would be a great step forward. I can remember standing in a super market unable to stop leaking and thinking is my pad going to hold? While technically not stress incontinence the whole experience of incontinence is disturbing.
I certainly can echo having the ability to hold my water will be a joy. Dr. K predicted that I would recover control in 6 months. Too bad it is taking longer. Yesterday, Monday, was difficult. I had issues during my workout and continuing throughout the day. It never seems to be a steady improvement. Some days are good and then others are not so good.
What I find exciting is the work that is being done to reduce or eliminate the side effects. Wheather it is improved HoLEP or other totally different techniques. Men that come after us will not have to make difficult decisions. I hope that surgeons such as Dr. Das and Dr. K will pursue these innovations.
I am hopeful that in the next several months I will have full control. I still do my kegals every day, since there is nothing I can do exercise the bladder sphincter. i am fortunate that my surgery did not go longer that one hour.
Agree Buster, my situation has been similar to yours. Over the long haul I have seen slow improvement, but just like you, I have some real good days where I leak just a little, and other days where I leak a disturbing amount. It is never usually more than 1 shield can handle in a day, but it can be pretty significant (last week I actually had some dribble down my leg when I was working around the house). The key seems to be my activity level. If I am really active, lifting, working on my feet and moving a lot I have a bad day. If I am less active, I have better days. I think we need to measure our progress week to week or month to month and not days. I try to do that to keep my spirits up at least! And yes as you, daily kegels. All the best to you.
For readers who want to understanding why BPH resective surgeries might give them retrograde ejaculation and whether there is a way to avoid it, may be interested in watching this You Tube video : youtu.be/lPsqWeKMJJU
Endoscopic Encleation of the prostate (EEP) En Bloc ~ 26W low power HoLEP by sat yots
Needed background: (1) as the microscope enters the prostatic urethra The first structure encountered that looks like a cannon (or a little hill) is the verumontanum. Two ejaculation ducts are situated on top of the verumontanum. (2) tissues that are within 1 cm of the verumontanum are responsible for having normal ejaculation or called Antegrade ejaculation.
In the video, Within the first minute the surgeon cut away tissues within the forbidden zone and also damaged the verumontanum. For this patient, his surgeon gave him retrograde ejacualtion within the first minute.
Endoscopic Encleation of the prostate (EEP) En Bloc ~ 26W low power HoLEP by sat yots
Needed background: (1) as the microscope enters the prostatic urethra The first structure encountered that looks like a cannon (or a little hill) is the verumontanum. Two ejaculation ducts are situated on top of the verumontanum. (2) tissues that are within 1 cm of the verumontanum are responsible for having normal ejaculation or called Antegrade ejaculation.
In the video, Within the first minute the surgeon cut away tissues within the forbidden zone and also damaged the verumontanum. For this patient, his surgeon gave him retrograde ejacualtion within the first minute.
I also notice that in addition to my workouts that I have more leakage in the afternoons and evening. I have been skipping a pad at night but then I dribble after voiding. I am impatient I just want it to stop.
DL your research has been nothing short of amazing.
I have read about RE and HoLEP for some time but I never found this information. I was always lead to believe that it to do with cutting the prostate away from the bladder neck.
How is this impacting your decision about HoLEP? Will you be talking with Dr. Das about your research? When is it that you see him?
I have read about RE and HoLEP for some time but I never found this information. I was always lead to believe that it to do with cutting the prostate away from the bladder neck.
How is this impacting your decision about HoLEP? Will you be talking with Dr. Das about your research? When is it that you see him?
Feel the same Buster. Just want it to stop, but since it is moving so slowly, I have decided to cope by just accepting where it is, deal with it by wearing a shield 24x7 (I could probably be OK at night, but am afraid to take a chance), and target 1 year for it to run its' course. I use to assume the next month it will end (and the next and the next), but since that is not happening (after 8+ months), I am just going to focus on the 1 year mark and if it improves/ends before then, It will be a bonus (sigh).
I guess it wouldn’t be so frustrated but Dr. K said the incontinence would be over by now plus Dr. Miller can do the procedure with little or no leaking. I will have to be patient.
IU advertises they are leading edge but they seem to be falling behind.
IU advertises they are leading edge but they seem to be falling behind.
My appt with Dr Das is in late September. Definitely, I will ask him all the questions that we had discussed in this thread.
I have been oscillatiog between aquablation and HoLEP, each has its advantages and disadvantages. Durability is important to me because insurance benefits keep Declining and if there is Reoperation, it will happen when one is older. Result from My research suggests that HoLEP's outcomes will sustain 10 or more years and Aqua is new and thus durability is an unknown. So currently leaning on HoLEP which comes with RE sadly.
These two days I have been following ur lead and been doing research on en bloc no touch HoLEP. Fascinating technology. Will send out result when I have more time.
I have been oscillatiog between aquablation and HoLEP, each has its advantages and disadvantages. Durability is important to me because insurance benefits keep Declining and if there is Reoperation, it will happen when one is older. Result from My research suggests that HoLEP's outcomes will sustain 10 or more years and Aqua is new and thus durability is an unknown. So currently leaning on HoLEP which comes with RE sadly.
These two days I have been following ur lead and been doing research on en bloc no touch HoLEP. Fascinating technology. Will send out result when I have more time.