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

Hi DL0808. Since your prostate is not as huge as mine, I would assume Dr Das would have no issues but I would ask him, based on the tests he has for the size and shape of your prostate, if he has any concerns. I would also ask him about what to expect in your case in regards to incontinence. Every situation is different, and of course no Dr can guarantee results, but I would ask him his outlook in regards to what you can expect for incontinence for your case specifically. That has been the only issue I still deal with (I am now past 8 months, and though I continue to see slow improvement, I still have daily small dribbles/leaks depending on how active I am) and so if I were you, I'd ask as much as I could about that. You might also want to talk to him and his nurse Darlene about kegels and what help they can provide to be sure you do them right to get the best benefit. Hope this helps and good luck!

And I also second what Buster said, be sure to bring your own pants and shields with you to his office for catheter removal. I'd be ready to wear pants the 1st week, and definitely when you leave his office to give you the best protection and confidence.

During the first week or two I had to wear pants with a moderate to heavy duty guard. Maybe it was overkill butithelped my confidence. Remember I had a very large prostate and I am 73 so I had two strikes against me.

Thanks for yours and Buster's advices.

I may have constraints different than others. One concern is Insurance keep changing, I can not afford to wait too long such that HOLEP, GLL, etc. all of a sudden no longer cover. Also, this could be the only operation I have so I want durability, possible lasting for 10 years. I do understand the growth unpredictability.

As far as I know DL, HoLEP is one of the best procedures in that regard. You'd have to live past 100 (or more) for your prostate to grow back enough to negatively impact you. The same cannot be said of TURP and some other procedures needing frequent re-treatment according to what I have read. If your worried about that, definitely ask Dr Das. As far as insurance, my BC/BS had no issue paying for it. I found it curious that Dr Das and Jefferson called the procedure "TURP with laser" and NOT HoLEP. I assume this was done to help insure (pun intended) insurance paid. Just my guess.

I agree. That is my thinking too. That is what I got out from the literature too. After 10 years, older age will make it more difficult to have surgeries. In addition anesthesia carries risk as well. Thus, one has to consider the situation after 10 years. Perhaps, the insurace is not there anymore or risk f rom surgeriy will be greatly increased due to aging.

I am not concerned BCBS will change in 2-3 months. But many months then Won't bet on it. benefits at work keep decreasing, it seems unwise to keep waiting for a better technology to emerge.

Ur posts are helping reader like me. When I first read ur post, I said to myself why was this person not going to Indiana or mayo? Was he uninformed? Why he said such a good thing about Das? So I re-read Dr. Das experience more carefully and learned that he did his fellowship at tauranga hospital. It rang a bell as I had read several GIlling's (one of the inventors of HoLEP ) papers on HoLEP and aquablation and vaguely remembered the hospital where he worked. So I googled Das GIlling then realized that das was working with GIlling for several years during the early days of HoLEP development. Then I also realized he is one of the most experienced HoLEP surgeon, if not the most experienced HoLEP surgeon in the east coast. So my worry that I might have to go to Indiana in order to be operated by the most experienced surgeon vaporized.

So thanks again!

My pleasure DL. Yes Dr Das's experience was definitely the major factor for me (plus the unhesitating endorsement from my local urologist, who actually lost a potential surgical patient by doing so). Then once I met him and saw how accommodating he is and easy to talk to, that cinched it. Being in Philly, not far for me from DC was a plus, but I would have gone to Indiana or Tennessee if necessary, which of course was not once I met Dr Das and felt fully reassured. All the best to you!

Drs. Amy Krambeck and James Lingeman.: for those who care considering having a HoLEP by them may be interested in the following article.

"Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia", by
Amy E. Krambeck, Shelly E. Handa and James E. Lingeman*
From the Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana.
Published in j of urology 2010.

Dr. Lingeman learned HoLEP and was one of the first doctors to perform the surgery in this country. He has the taught other doctors. Among them was Dr. Amy Krambeck.

Dr. Krambeck performed HoLEP on me in January 2018. She is a highly skilled surgeon following the classic technique precisely. As a result for the first week or two I had NO URINARY CONTROL WHATSOEVER. Others have reported reported that Dr. Nicole Miller of Vanderbilt has modified HoLEP so that there is little or no incontinence. This would have been a great plus for me since I still have some leakage. Dr. Miller also trained under Dr. Lingeman.

In addition I felt like I was on an assembly line at IU health urology. I was given minimal time with the doctor and she didn’t even talk to me the morning of the surgery, she sent another doctor.

At the six month follow up she said that they needed to be brief because they had too many patients. My question is if they are doing such a booming business why are they advertising on Facebook and in google search results for new patients?

3 month checkup today.  PSA 1.3.  Flow rate 25 (not sure the measure, just told it was 2.5 times better than men my age average. 58 years old. )  27 mls. urine left in bladder.  All great numbers!! Some dribbles, still wear the thin pads. Need to be more faithful with the kegels. Highly recommend Holep!  

"At the six month follow up she said that they needed to be brief because they had too many patients."
--- it is inexcusable for any physicians to act like that.

So u have doubt about ability and ethic?

Just wondering if u know what is this Miller modified technique?

The Miller avoid-incontinence Holep technique : i vaguely remember reading a post about it. It involves a loop near the bladder neck, yes?

This is hearsay but I understand that Dr. Miller leaves some prostrate tissue surrounding the bladder neck.

My understanding is that in the classic HoLEP no tissue is left surrounding the bladder neck. In doing so the bladder neck sphincter is injured.

Maybe one of Dr. Miller’s patients could comment.

Yes Buster, this is what I recall reading re; Dr Miller from her patients here: "Dr. Miller leaves some prostrate tissue surrounding the bladder neck".

My understating of how enucleation works is that, in the three lobe technique, two cuts are made from the bladder neck towards the verumontanum , one cut at 5 o'clock and one at 7 o'clock. Then a lateral cut in front of the veru. The medium lobe is then a kind of peel off starting from the veru towards the bladder neck. At the bladder neck, the entire piece of medium lobe is "pushed off or tear off" and drops into the bladder. It is possible that the tearing off injures or damages the internal sphincter. To avoid the "tearing off", at the bladder neck, a lateral circular cut must be made leaving several mm of tissue between the bladder neck and the circular lateral cut.

Obviously, this will not work if the patients has a large medium lobe protruding into the bladder.