I am not promoting any this just looking at current options. HoLEP offers instant results where other treatments will not. Each of us are made differently, for me I do not need to pee like a horse, all I needed to do is pee without a catheter. I know I am in the minority.
You are very thourough in your research! I should not have mentioned the other options.
Your experience is the kind of representative posts about HoLEP that I have read. Short but very positive about HoLEP, but for other technologies this kind of posts appears less frequently. For other technologies, there are always several advocates strongly advocating that technology. the opinions from just several persons do not adequately reflect the true situation.
On the science side, HoLEP is the most studied technology. One can find out whatever he wants to know by just googling HoLEP.
I believe that this kind of discussions is healthy as it informs other readers factors influencing thier decision in choosing a technology .
55% is similar to Buster.
I have been doing research on HoLEP and have been reading and following posts in this thread. I am aware for HoLEP having an experienced HoLEP surgeon is critical to having a successful HoLEP. I am aware of the most sought after doctors at Indiana university, mayo clinics and Vanderbilt at Nashville.
From the results of my research and knowledge accumulated so far, I believe that the low power en bloc no touch is the most advanced technique, the science behind it is very logical and convincing.
In a paper by scoffone and colleagues, after doing holep on three hundreds plus patients "There were neither long-term nor transient stress urinary incontinences (only urgent micturitions during the first 10-15 days after catheter removal. )"
This techniue generates a lot less heat than other HoLEP techniques. And as a result, The reduced heat damage produces less post operation hemostasis and no incontinence in addition to the reduced operation time.
Retrograde ejacualtion is an independent issue. RE is caused by removing tissues responsible for normal ejacualtion. These tissues are located near and next to the verumontanum. Ejaculation preservation technique involves not cutting tissues proximal to the verumontanum. EP technique can be used together with other techniques, possibly including the en bloc no touch techinque. Only scoffone can answer this question if there is incompatibility.
My insurance may pay for the operation in Italy. However, I will still need to pay for airfare and hotel stay, which is still a burden as hotels in Europe is very expensive.
Forget retrograde ejaculation for a moment, do u expect HoLEP success rate is 100%? If not what is the odd that u will among the lucky ones?
Table 3 in this paper will give u a little known but important fact about HoLEP.
I came across this interesting paper that investigated patients' satisfaction after HoLEP and would like to share with readers who are considering HoLEP and those who already had HoLEP, but wondering what improvements to expect.
Main results:
"Among 331 patients, 304 (91.8%) patients were satisfied. The reasons for dissatisfaction from the combined "dissatisfied" and the "neutral" groups, are: transient incontinence, increased daytime frequency, incomplete voiding, and slow stream."
The last three side effects are not what we expected.
82% of patients reported symptoms improved markedly.
The paper is:
"Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study"
By Young Ju Lee, Shin Ah Oh, Sung Han Kim, Seung-June Oh
Published: August 9, 2017.
doi.org/10.1371/journal.pone.0182230
[add the usual header htt....// to the link]
Useful information
"Through improvements to the holmium laser and morcellator technologies [4], significantly better postoperative results were obtained with holmium laser enucleation of the prostate (HoLEP) than with TURP [5]. Although HoLEP has a steep learning curve [6], it is the only laser treatment that has considerable supporting level 1 evidence and has been recommended by the American Urological Association and European Association of Urology. The efficacy of HoLEP is comparable with that of TURP for smaller prostates and comparable with that of open prostatectomy for larger prostates with a lower risk of complications [7]. HoLEP is suggested to be a new gold standard for BPH treatment [8]."
Patients
"A total of 397 patients who underwent HoLEP at our institution from May 2012 to December 2014 were enrolled in a database registry...The Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry is a prospectively collected database of BPH patients ... Digital rectal examination, 3-day voiding diary records, IPSS, overactive bladder symptom score (OABSS), urinalysis, prostate-specific antigen (PSA), uroflowmetry, transrectal ultrasound of the prostate, urodynamic study, and cystourethroscopy were performed as a baseline study. Surgery data including surgery duration and enucleated tissue weight were recorded. Data for IPSS, OABSS, 3-day voiding diary records, urinalysis, and uroflowmetry were obtained at follow-up visits at 2 weeks, 3 months, and 6 months postoperatively. At 6 months postoperatively, the PSA levels were determined and patient satisfaction questionnaires were administered. The self-administered questionnaires composed of a ‘satisfaction with treatment question’ (STQ), an ‘overall response assessment’ (ORA), and a ‘willingness to undergo surgery question’ (WSQ) (S1 Table). "
The HoLEP procedure
The surgical procedures were performed by a single surgeon.....After the initial incisions in the 5- and 7-o’clock directions, a transverse incision was made just proximal to the verumontanum. After the removal of the median lobe, the lateral lobes were removed, completing the enucleation process. After careful haemostasis, morcellation was performed by using a 26-Fr nephroscope and a tissue morcellator...A 22-Fr 3-way urethral catheter was placed with continuous normal saline irrigation (≥60 gtt) and removed on postoperative day 1 or 2. Patients were usually discharged at postoperative day 1 unless there was significant hematuria or unless the surgery was performed late at night. Follow-up visits were made at 2 weeks, 3 months, and 6 months postoperatively on an outpatient basis.
Results for functional outcomes
Table 2. Perioperative change of clinical parameters after the surgery.
doi.org/10.1371/journal.pone.0182230.t002
[add the usual header htt....// to the link]
" Qmax increased significantly after the surgery, while the PSA levels, the postvoid residual volumes, and the IPSS scores decreased significantly. QoL improved significantly after the surgery." [see table 2]
Results from "satisfaction" questionnaire [see fig 1]
Fig 1. The results of the self-administered questionnaires.
(a) Satisfaction with treatment question (STQ), (b) overall response assessment (ORA), (c) willingness to undergo surgery question (WSQ)
doi.org/10.1371/journal.pone.0182230.g001
[add the usual header htt....// to the link]
1)Among the 331 patients, 304 (91.8%) patients were satisfied.
2) Only 11 (3.3%) patients responded that they were ‘dissatisfied’ and no patients responded with ‘very dissatisfied’.
The reasons for dissatisfaction were as follows: postoperative transient incontinence (n = 3) including 1 stress urinary incontinence, increased daytime frequency (n = 6), feeling of incomplete emptying (n = 1), and slow stream (n = 1).
Additionally, it is noteworthy that patients who had previous BPH surgery or preoperative CIC were all satisfied after the surgery, and this reflects the importance of patient expectations.
3) Responses of ‘neutral’
with the following reasons: postoperative incontinence (n = 3) including 1 transient incontinence and 1 minimal wetting, 1 urgency incontinence which was improved at 6 months, increased daytime frequency (n = 7), feeling of incomplete emptying (n = 1), slow stream (n = 3), and retrograde ejaculation (n = 1), occasional urgency (n = 1).
4) Patients who could not void spontaneously and required clean intermittent catheterisation (CIC) preoperatively (n = 8) or those with a previous history of BPH surgery (n = 16) were all satisfied after HoLEP. History of diabetes, cerebrovascular disease, cerebral or spinal disease, and Parkinsonism were not associated with patient satisfaction (p 0.05). "
[note: the combined dissatisfaction from the "dissatisfied" and the "neutral" group, are: transient incontinence, increased daytime frequency, incomplete voiding, and slow stream. The last three are not what we expected.]
For the ORA, only 2 (0.6%) patients reported no change, of which one was dissatisfied due to persistent nocturia and the other patient responded with ‘neutral’ because of postoperative transient urinary incontinence. Most patients reported an improvement after the surgery. No one reported symptom aggravation after the surgery. For the WSQ, 311 (94.0%) patients expressed willingness to undergo the surgery, whereas 20 (6.0%) patients did not want the surgery. The levels of satisfaction for the 20 unwilling patients were as follows: very satisfied (n = 5), satisfied (n = 5), neutral (n = 5), and dissatisfied (n = 5).
[note: should have been "very unsatisfied", etc.]
Who are those who are unhappy with HoLEP?
Table 3. Clinical characteristics of patients according to patient satisfaction.
doi.org/10.1371/journal.pone.0182230.t003
[add the usual header htt....// to the link]
Table 3 shows the patient characteristics according to patient satisfaction levels. Dissatisfied patients tended to have more severe voiding symptoms postoperatively. The IPSS and OABSS scores at 6 months postoperatively were significantly higher in the dissatisfied group than in the satisfied group, although the preoperative values did not differ between the 2 groups. The improvement in maximal flow rate, IPSS voiding and QoL scores, and nocturia was significantly higher in the satisfied group than in the dissatisfied group. Dissatisfied patients were more likely to have worse ORA (OR 11.92, 95% CI 6.10–23.28, p
These were complications (according to the Clavien-Dindo classification) from HoLEPs, a 13 years of follow up of 1000 patients from Dec 2003 to October 2016. It was a presentation to a conference in May 2017.
Main results:
Early complications: failed initial voiding trial (10.8%), stress incontinence (6%), frequency and dysuria (5.7%), urinary tract infection (5.2);
Late complications: urethral stricture(4.9%), re-operation (2.7%)
The presentation is: PD27-05
"COMPLICATIONS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTRE CASE SERIES WITH 13 YEARS OF FOLLOW-UP"
By Danielle Whiting*, Thomas Smith, Branimir Penev, Mark Cynk, Maidstone, United Kingdom
Journal of Urology, May 2017
www.jurology.com/article/S0022-5347(17)31450-7/pdf
"Holmium laser enucleation of the prostate (HoLEP)... As a relatively new procedure long-term outcomes for patients undergoing HoLEP are still being studied. We describe the complications of a large single centre case series with up to 13 years of post-operative follow-up."
"RESULTS:
969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p
"RESULTS:
969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p
Below are complications (according to the Clavien-Dindo classification) from HoLEPs, a 13 years of follow up of 1000 patients from Dec 2003 to October 2016. The presentations were given in 2017 and 2018.
Main results:
(A) Early complications: failed initial voiding trial (10.8%), stress incontinence, (6%), frequency and dysuria (5.7%), urinary tract infection (5.2);
(B) Late complications: urethral stricture(4.9%), re-operation (2.7%);
(C) For prostate of big and small sizes: "the speaker determined that HoLEP is a safe and effective procedure for LUTS in patients with small and large prostates."
When the patients were divided into prostate resected weight of 80g:
"preoperative retention was found in 69.2% of patients with 80 grams of resected tissue as compared to 39.6% in ≤ 80 gram patients. Additionally, there was a significant amount of urethral strictures in patients with ≤ 80 grams, but the stricture rate was comparable to TURP.
There are two presentations: in the first presentation prostates are not divided into size group, whereas in the second presentation, HoLEP results for prostates are divided into 80g.
(I) The first presentation is: PD27-05
"COMPLICATIONS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTRE CASE SERIES WITH 13 YEARS OF FOLLOW-UP"
By Danielle Whiting*, Thomas Smith, Branimir Penev, Mark Cynk, Maidstone, United Kingdom
Journal of Urology, May 2017
www.jurology.com/article/S0022-5347(17)31450-7/pdf
"Holmium laser enucleation of the prostate (HoLEP)... As a relatively new procedure long-term outcomes for patients undergoing HoLEP are still being studied. We describe the complications of a large single centre case series with up to 13 years of post-operative follow-up."
"RESULTS:
969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p 80 grams, and 105 patients (10.3%) had no weight recorded.
Of the majority of the procedures performed, preoperative retention was found in 69.2% of patients with 80 grams of resected tissue as compared to 39.6% in ≤ 80 gram patients. Additionally, there was a significant amount of urethral strictures in patients with ≤ 80 grams of prostate tissue resected. Postoperative flow rates were shown to be significantly greater in both groups following HoLEP. In closing, Miss Whiting determined that HoLEP is a safe and effective procedure for LUTS in patients with small and large prostates. Furthermore, she explained that the stricture formation rate of HoLEP in this study is comparable to TURP. With the known benefits of HoLEP and its low complication rate, this procedure should be considered the gold standard for all LUTS operations.
Presented by: Danielle Whiting
Co-Authors: Guest K. , Penev B. , Cynk M.
Author Information: Maidstone and Tunbridge Wells NHS Trust, Dept. of Urology, Maidstone, United Kingdom
-----------
Appendix
Explanation of the Clavien Classification of Surgical Complications:
Grade I
Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions
Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.
Grade II
Requiring pharmacological treatment with drugs other than such allowed for grade I complications.
Blood transfusionsand total parenteral nutritionare also included.
Grade III
Requiring surgical, endoscopic or radiological intervention
- IIIa Intervention not under general anesthesia
- IIIb Intervention under general anesthesia
Grade IV
Life-threatening complication (including CNS complications)* requiring IC/ICU-management
- IVa single organ dysfunction (including dialysis)
- IVb multiorgandysfunction
Grade V Death of a patients
A portion of text in the previous post did not show up. Will repost at a later date.
My previous attempts of posting HoLEP complications had failed. Below is anohter attempt to post in its entirety.
This post reports complications (according to the Clavien-Dindo classification) from HoLEPs, a 13 years of follow up of 1000 patients from Dec 2003 to October 2016. The presentations were given in 2017 and 2018. This is the most recent compilation of HoLEP complications in the form of modern classification. With a 1000 patients, it is stastically significant snd trustworthy.
Main results (RE and other sexual dysfunctions were not reported):
(A) Early complications: failed initial voiding trial (10.8%), stress incontinence, (6%), frequency and dysuria (5.7%), urinary tract infection (5.2);
(B) Late complications: urethral stricture(4.9%), re-operation (2.7%);
(C) For prostate of big and small sizes: "the speaker determined that HoLEP is a safe and effective procedure for LUTS in patients with small and large prostates." The functional outcomes of HoLEP is as good as TURP and open prostatectomy but with fewer complications.
When the patients were divided into prostate resected weight of 80g:
"preoperative retention was found in 69.2% of patients with 80 grams of resected tissue as compared to 39.6% in ≤ 80 gram patients. Additionally, there was a significant amount of urethral strictures in patients with ≤ 80 grams, but the stricture rate was comparable to TURP.
There are two presentations: in the first presentation prostates are not divided into size group, whereas in the second presentation, HoLEP results for prostates are divided into 80g, which lead to the conclusion that HoLEP is as good as TURP and open prostatectomy but with fewer complications.
(I) The first presentation is: PD27-05
"COMPLICATIONS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTRE CASE SERIES WITH 13 YEARS OF FOLLOW-UP"
By Danielle Whiting*, Thomas Smith, Branimir Penev, Mark Cynk, Maidstone, United Kingdom
Journal of Urology, May 2017
www.jurology.com/article/S0022-5347(17)31450-7/pdf
"Holmium laser enucleation of the prostate (HoLEP)... As a relatively new procedure long-term outcomes for patients undergoing HoLEP are still being studied. We describe the complications of a large single centre case series with up to 13 years of post-operative follow-up."
"RESULTS:
969 cases of HoLEP were performed at our centre between December 2003 and October 2016. There was a statistically significant improvement in both urinary flow rate and post-void residual volumes (p 80 grams, and 105 patients (10.3%) had no weight recorded.
Of the majority of the procedures performed, preoperative retention was found in 69.2% of patients with 80 grams of resected tissue as compared to 39.6% in ≤ 80 gram patients. Additionally, there was a significant amount of urethral strictures in patients with ≤ 80 grams of prostate tissue resected. Postoperative flow rates were shown to be significantly greater in both groups following HoLEP. In closing, Miss Whiting determined that HoLEP is a safe and effective procedure for LUTS in patients with small and large prostates. Furthermore, she explained that the stricture formation rate of HoLEP in this study is comparable to TURP. With the known benefits of HoLEP and its low complication rate, this procedure should be considered the gold standard for all LUTS operations.
Presented by: Danielle Whiting
Co-Authors: Guest K. , Penev B. , Cynk M.
Author Information: Maidstone and Tunbridge Wells NHS Trust, Dept. of Urology, Maidstone, United Kingdom
-----------
Appendix
Explanation of the Clavien Classification of Surgical Complications:
Grade I
Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions
Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.
Grade II
Requiring pharmacological treatment with drugs other than such allowed for grade I complications.
Blood transfusionsand total parenteral nutritionare also included.
Grade III
Requiring surgical, endoscopic or radiological intervention
- IIIa Intervention not under general anesthesia
- IIIb Intervention under general anesthesia
Grade IV
Life-threatening complication (including CNS complications)* requiring IC/ICU-management
- IVa single organ dysfunction (including dialysis)
- IVb multiorgandysfunction
Grade V Death of a patients