About choice of technology, all I was saying was that if I picked a technology, which after 5 yrs, I would need another operation. By then, my insurance may not cover the operation, also age would be age +5 yrs. the severity of complications is strongly dependent on age. Thus, it won't be a good decision. A good decision would be the one that would last 10 yrs or more.
I had my HoLEP done at Vanderbuilt clinic in Nashville in March. Dr Nicole Miller was my surgeron. I was recommended to go with her by Phillip another patient of hers, he had his HoLEP done in January.
I had planned to do it in Indianapolis, but I am so glad that I took Phillips recommendation. Both Phillip and I had no problems with incontinence after the surgery, well i had little for 4-5 days, but was fine thereafter.
Dr Miller explained to me that she used a special technique to save the urethral sphincter, by leaving a small donut of prostate tissue there.
Phillip who has written many posts on this forum, have many helpful posts read them and you can get more info about Dr Miller.
I highly recommend her if you are going the HoLEP route. Why settle for another surgeron which will give you incontinence, because they are not using her technique.
Sunshine
Thank u for providing a discription of dr Miller's bladder neck preservation technique. I appreciate it
It is a remarkably useful technique! It might have been very helpful to buster and Blayneb who seem to be having long term incontinence. But they have usually large prostrate and I am not sure the miller's technique works for such large prostrate.
I suppose the donut shape of tissue is part of the adenoma? Do u know what is the width of the donut? Does she has a solution for retrograde ejaculation?
Thank u for suggesting dr. Miller. I am from the east coast so logistically will be a problem for me. But I will think about it.
Merck Manual on incontinence.
WWW.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/overview-of-voiding
Overview of Voiding
By Patrick J. Shenot, MD, Associate Professor and Deputy Chair, Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University
Voiding disorders affect urine storage or release because both are controlled by the same neural and urinary tract mechanisms. The result is incontinence or retention.
For normal urinary function, the autonomic and voluntary nervous systems must be intact, and muscles of the urinary tract must be functional. Normally, bladder filling stimulates stretch receptors in the bladder wall to send impulses via spinal nerves S2 to S4 to the spinal cord, then to the sensory cortex, where the need to void is perceived. A threshold volume, which differs from person to person, triggers awareness of the need to void. However, the external urinary sphincter at the bladder outlet is under voluntary control and usually remains contracted until a person decides to urinate.
The micturition inhibitory center in the frontal lobe also helps control urination. When the decision is made, voluntary signals in the motor cortex initiate urination. These impulses are transmitted to the pontine micturition center, which coordinates simultaneous signals to contract detrusor smooth muscle throughout the bladder (via parasympathetic cholinergic nerve fibers) and to relax the internal sphincter (via alpha sympathetic nerve fibers) and striated muscle of the external sphincter and pelvic floor (see Figure: Normal micturition occurs when bladder contraction is coordinated with urethral sphincter relaxation.). In addition to normal urinary function, continence and normal voiding require normal cognitive function (including motivation), mobility, access to a toilet, and manual dexterity.
Damage to or dysfunction of any of the components involved in voiding can cause urinary incontinence or retention.
Normal micturition occurs when bladder contraction is coordinated with urethral sphincter relaxation.
The CNS inhibits voiding until the appropriate time and coordinates and facilitates input from the lower urinary tract to start and complete voiding. The sympathetic system contracts the smooth muscle sphincter. The parasympathetic nervous system contracts the bladder detrusor muscle through cholinergic fibers. The somatic nervous system contracts the striated muscle sphincter through cholinergic fibers from the pudendal nerve.
My prostate was 125-150 in size, so it was fairly large. No I didn't ask her about the size she left at the bladder neck. No she has no solution for retrograde ejaculation it comes with HoLEP. In my case, I already had retrograde ejaculation. That is due to the two medications Tamsulosin and Finasteride. I did take them for years for my enlarged prostate.
So everything has only been positive for me, I don't regret a minute that I did HoLEP.
Any idea how I can search posts by ur friend Phillip?
Is it a case that the outer sphincter takes on the additional work to compensate for a weakened internal sphincter? That may be the case now but 10 to 15 years down the road will the muscles of the outer sphincter weaken and lead to incontinence? I don’t think there has been a study on that question.
There are studies that followed a large number of HoLEP patients for more than 10 years. I remember that The rate of stress incontinence did not increase at year 10. That is all the evidence we have.
I was concerned when Dr. K seemed to say that my outer sphincter would have to pick up the work of the inner sphincter.