Experiences with Holmium Laser Enucleation of the Prostate, HoLEP, Laser Surgery

Certainly experience is the most important factor but there may be other factors as well. Some doctors remove more of the bladder sphincter than others. My doctor took 90%. On report is that the doctor at Vanderbilt routinely removes on 65%. This means that there is less incontinence. It may also help in the long term. Just yesterday I was tying my shoe and when I bent forward I had some leakage. It doesn’t happen every time but it does happen. My doctor is very experienced but if I had know the details I might have chosen a different doctor.

Indeed, health care in the US is very expensive. Drugs are very expensive as well. Once you enter a hospital because of an emergency, u never know how much it will cost you. Recently, I was in the hospital for 9 days treated by antibiotic (not a surgery), when the bill came, it was $200,000. Routine primary care doctor visits typically cost about $100, doctors who are specialists cost $300 upward. Insurance from an employer for a family of three could cost $10,000 per year, so the real cost of that insurance could be $20,000. Not sure how much public insurance the so called Obamacare (which subsidize low income insurers) would cost.

People who do not have medical insurance will go to the hospital emergency room and get treated but unable to pay the high cost, so the hospital will charge those who have insurance more to recoup.

It is hard to change anything related to healthcare because the lobbyists are well funded and strong. Also there is a lot of disinformation to prevent the voters to truly understand the healthcare issues.

Hi Cedar, 69 yr old w BPH - infections w bleeding; 2 bouts of Bladder stones; 1 bout of ER for retention; Considering ThuLEP laser treatment; How are you doing from your procedure: HoLEP is similar - one pulsates light n one is constant light (ThuLEP) and good for P up to 300ml; Mine measure 220ml - Think HoLEP max is 180ml; CT in 7/2019 n DREs show no cancer. Thank you - Mike (Louisiana-Go Tigers!)

Can you advise what type of procedure you dad did? Where? Is he satisfied. Was his P large? Mine is 220ml size...

There is no max on holep. My prostate was 330g. I Went home next day. Thulep is new and not established

That true. The same goes for PAE and Focal Laser Ablation for BPH. Both have no negative side effects.

69 yr old here contemplating HoLEP w Dr Miller. Have y completed recovery? Are y glad y did it? Any experiences y can advise of. Tips for the surgery n recovery period? Thanks in advance

Great to hear....my P is 220g; they claim she has done larger ones w success.

On February 26, 2020, at the age of 71, I finally had surgery done on my severely enlarged (110 ml) prostate. While it is only 15-days post surgery, I am elated to report that everything has proceeded fabulously, so far: absolutely NO PAIN! and no adverse or unpleasant complications. Everything has gone flawlessly and comfortably as projected. It is so nice to be able to piss again w/o using a catheter. 

After my research revealed how much the laser option simplified and reduced the complexity and adverse consequences of the traditional “Gold Standard” TURP approach, we chose the more patient friendly, Holmium laser enucleation (HoLep) option combined with the new, state of the art, Moses laser technology. 

My surgeon, Dr. Nicole Lara Miller, at Vanderbilt Urology, was/is brilliant. She is evolving to be a pioneer in the cutting edge use of laser technology in urological medicine. The new Moses laser refinements and enhancements she used on me, had just become officially available the week of my surgery. She was all over it. Because of the newness of the technology, she kept me in the hospital overnight for observation. Otherwise, the procedure was so outwardly benign, straight forward and physically trauma free, I could have gone home the same day. I didn't even need a catheter.

According to my research, the Holmium Laser Enucleation of the Prostate (Holep) laser surgery option, was first introduced in 1996. The technique is said to be the most rigorously studied, minimally invasive technique used in the treatment of prostatic obstruction. The technology is widely used outside the United States, but American doctors, by and large, have avoided the technology because they say the learning curve is too steep and it’s too hard to learn.  

Thank you, Dr. Miller, for caring about us enough, to do what you needed to do, to qualify yourself, to make the incredible technical improvements and medical benefits of this new technology available to your patients. Because of you, my wife and I are looking forward to being able to enjoy, a tremendous improvement in the quality of my life, without having had to suffer or endure the adverse issues associated with the outdated TURP procedure. God bless you.

Certainly you have one of the best doctors in this field.

Dr. Miller reportedly doesn’t remove as much of the bladder sphincter as other doctors. Do you think that will reduce the incontinence that accompanies this surgery?

I certainly hope so. Time will tell.

Check out Dr. Joe Klein with Potomac Urology in northern Virginia. He performed my HOLEP surgery in June 2020 and I am very pleased with the results.

Having Holep surgery Friday. ER two weeks ago. Had bladder retention.  Three liters urine in bladder. Kidney failure. Wearing a catheter for 2 weeks. Large prostate 120 grams. Glad I discovered HoLEP. Only found one Dr in north Texas who knows the procedure. So excited to get this done. Hate wearing this catheter. I am 67 years old and am still active with my wife, so hope the only side effect is retroactive ejaculation. Any advice what to expect after waking up from surgery and afterwards?