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I'm at the decision stage of prostate surgery.  Has anyone had experience with a HoLEP?  If so, why did you choose it over a PVP?    What has your experience been in terms of symptom improvement?  What about sex after you have fully healed?

 

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Have attended demo's of green laser PVP and also read a lot of comments of people that had the procedure. Since this laser burns deeper than the physician can see, the chance for unwanted damage is larger. Also it only clears a channel and does not prevent the prostate from growing further. In my case the prostate was approx 150 gram and already pushing into the bladder. With HOLEP there is no further growth. Actually it was explained to me that it will shrink from grapefruit size to orange size.

I had HOLEP surgery (Mayo Clinic). It's been 3 weeks since my surgery. Was discharged the next day after surgery. No pain to speak of, some burning or occasional stab. Urine was clear after 10 days. Can do anything, no physical limitation. Had no sex yet, since most sites recommend 3-4 weeks waiting time and I can live with that.

However, I am almost 70 and I presently get quite a few strong erections during the day (including of course every morning). This was not the case before the surgery.

I am glad I went that route.
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SHE24,

 

Thanks for your reply.  While I live in Chicago, last May I went to Mayo for a consultation.  As it turns out, I'm borderline for surgery now but will likely end up having to get it done.  Dr Mynderse was the consulting doctor.  I felt that it was an excellent consult with various tests over the course of 3 days.

 

Who was your surgeon?

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I had acute urinary retention. Wore catheter for 6 mos. while testing drug solution and searching for non surgical alternative. When surgery was only option available researched surgical alternatives. Net result was that Holep was the most effectve, with the least collateral damage too prostate and surrounding tissue, and, least post op complications and pain.

Surgery performed by Dr Ramsay Kuo, at St Peters Hospital in Albany, NY. Dr Kuo has a reputation for being not only highly proficient in the Holep procedure, but, painstakingly thorough.

Checked in on A.M. of 4/16/12. Had procedure in P.M. Catheter removed next A.M. Once successful urination, with insignificant retention was demonstrated, was released from hospital. No pain or discomfort whatsoever. Most post op conditions (blood in urine, leakage, clots) cleared up in less than 10 days. Am already easing myself back into normal physical routine. Net net, Holep, as practiced by Dr Kuo, was not only very effective, but, patient friendly.
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Steve, Are you fully recovered now? Any side effects? What due diligence did you do to to choose him with such confidence? I'm considering going to him but i'd love to have more fact supporting his proficiency. I appreciate your taking the time to reply.

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Sorry for what may be a late reply. Dr, Kuo is not like the journeyman urologists who generally practice in anytown usa. He has written extensively re; holep, and, practiced with Lindemann in Indianapolis until moving to Albany. Professionally, he has a reputation among his colleagues for being very thorough and painstaking. I can attest to this personally because he dedicated significant extra time to my procedure because of the difficulty encountered in macerating(?) my prostate tissue. Recovery was smooth,discomfort free, and progressive. Within 1 month I had resumed all activities without restriction. Net net, my research established that the holep procedure was the most reliable and least intrusive surgical option available. Additionally, by both reputation and my experience, Dr kuo is the man to engage if the logistics allow it.

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Dear Steve,

The possibility of long term urine incontinence with HoLEP is 10% short term and 2% long term.

What made you brave enough to accept those odds?

Thanks,
Fiddler
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fiddler: Was not brave at all. Wore catheter for months and made several attempts at self urination. .These were not successful enough to continue. Even tried self catheterization. While doable this was not a process that had long term potential for me. Looked for non invasive alternatives. They were not available in this country. Left with surgical options, holep was the best of available options. I was at the point of having "to fish or cut bait". Of the limited number of holep practitioners available I ultimately engaged Dr Kuo in Albany, because of his reputed skill and patient centric attitude. He proved to have both. If the logistics work for you, you might want to meet with him. Hope this helps. Steve

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Hi Steve,
Thanks again for your input.
May I ask how large was your prostate?
And did you have any incontinence? If so, how long did it last?
Thanks,
Fiddler
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Hi Fiddler;



prostate size came in about 125cc. Wore pads as insurance for a while, but, in fact, had no discernable incontinence. Things went very smoothly for me. I hope this helps.



Good luck!



Steve
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Hi, can I ask what did this cost you?
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PLEASE RECONSIDER other options for BPH treatment. The retrograde Ejaculation is terrible and not worth any price. Please pick an option that does not cause RE. I have it from HoLEP and I would give anything to go back and undo it.
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I had the HoLEP prostate surgery in Indianapolis with Dr. James Lingeman on 05 Aug 2013. After 4 weeks, I am completely satisfied with the results. Very little bleeding in the beginning, no leakage (except if I don't empty the urethra), some discomfort with a BM (proximity to the prostate) which is improving, flow is great and the frequency is reducing. I have had several erections and intercourse is not a problem. In fact, I think it this going to be a lot better than before. I have AM erections more frequently now. The retrograde ejaculation (RE) was not a surprise, because I was taking Rapaflo Rx for 3-4 years before and it produced the same RE effect as the surgery did. I opted for the HoLEP over the Green Light Lazer because the fix would be permanent solution.
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JohWhal, I am really happy you are satisfied with your results. I am happy with everything but the RE. And I think I could get used to it if I was not missing that rush of endorphins that gives such a calm relaxed feeling after the orgasm.

That is what I really miss. It used to relax me so much and I felt calm for days. Now I do not get that anymore. And I feel high strung and hyper all the time. I thought RE would include that feeling also. 

Do you mind if I ask you if you still get that calm relaxed "afterglow" now with your RE? If so did it take a while to come back. I sure hope mine is not gone forever.

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I would say that I still have the sensation that goes with the ejaculation and the "relaxed afterglow" feeling. Like I said it may be because I took RapaFlo Rx for 3-4 years which produces the same RE effect as the HoLEP surgery and I got used to it. Hope this helps you.
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