I just realized that there are 3 lasers used for prostate enucleation I would like to share my experience. On doing my research here, I found a well reported doctor here in phialdelphia. My prostate measured 135 cc on ultrasound before the operation. I underwent a 'laser enucleation'. Symptoms were better after the procedure but not the improvement I expected. I got a second opinion and found that my prostate still measured 94 cc after the procedure. i got my operative reports which suggested that 37 grams of tissue was removed. The laser used was Protouch laser. I seeked out a HOLEP surgeon to see why my prostate was still so big. He explained me the procedure in detail. He explained how prostate is like an orange with me peeing through the center. During a HOLEP or simple prostatectomy, the surgeon goes in the plane between the rind and the pulp and enucleates 'all' of the central (transitional) zone. This usually accounts for 60-80% of prostate tissue. This is not possible using the Protouch or the Thulium laser as the laser melts and charrs the tissue making it hard to see the plane. Most surgeons just carve out some tissue and never get to the surgical plane. He was very patient and showed me youtube videos of Holep (holmium laser enucleation), Thulep (thulium laser enucleation) and Prolep (Protouch laser enucleation). He performed a Holep and removed additional 46 grams of tissue and the response was great. Please make sure you surgeon is a true 'HOLEP surgeon' and not a Prolep or Thulep surgeon.
as a urologist I agree 100% with your assessment of HoLEP vs Protouch . I am seeing a pt now with significant amount of residual tissue and elevated PSA , while my HoLEP pts, have very little residual tissue and PSA drops to normal