Prostate Surgery, HoLEP or Green Light laser?

I have a prostate >90 grams and am in my 50's. I tried Flomax 6 years ago which did nothing (I call it FloMin). I had green light 5-6 years ago and it did just an ok job. I also heard some laser procedures can burn good prostate tissue more deeply than some lead you to believe. I then had a TURP procedure ~3 years ago which has worked fairly well. But I have had 2-3 incidences where my prostate or bladder completely shuts down. In 2 of the cases a good party with excessive alcohol was an active ingredient. Interestingly, in the most recent incident I associated this as being prostatitis (on top of an already troublesome prostate) but am surprised to discover no bad bacteria in my urine which I would've thought went along with it. Regardless, I am almost certain I either need another round of TURP, or HoLEP, or something else. I have 1 name of a doctor in Chicago, Doreen Chung, who does HoLEP. I am looking for a few very good doctors to get an opinion on what I should do. Thanks for your recommendations.

TsTJohn,

My father in law is in dire need of a Urologist who engages in HOLEP/Greenlight anywhere in the Tampa, Sarasota, or Orlando area. Any help you can provide would be so much appreciated.

Rich

With respect to HoLEP, stick only with major well known academic institutions. The only two I know of that perform a very large number of HoLEP procedures are the Mayo Clinic (Rochester, Mn & Phoenix, Az) and Indiana University (Indianapolis). The procedure is just two difficult to trust someone in private practice. This is not only my opinion but was reinforced when I got a second opinion from a urologist with large major national institution that does not offer HoLEP. The risk of a small error causing a lifetime of problems is just too great.

Barry,

I thank you from the bottom of my heart for your valued and constructive input. I think there is (or was) a Mayo Clinic in Clearwater which is contiguous to Tampa. Anyway, I'll look into it. Again, thank you so much!

Rich

Thank you for your encouraging words .

I'm 64 years old and am having my HoLEP on 11th October in London UK. Will let you know the outcome

cedar88,

I'm flying in from NYC to have Holep surgery with Dr. Lingeman soon. I'm very nervous about having timely access to the restroom on the return flight.I'm afraid I'll be incontinence or I'll "I won't be able to hold it in" symptoms when the "Occupied" sign is up in the restroom. What was your experience like on the return flight? Also, did you have a local or general anesthesia? Your experience is reassuring and I wish you continued good health. Thanks for your story and your input.

I had HoLEP surgery at the Mayo (Dr. Amy Krambek) on Tuesday, September 17. I was released from the hospital the next day (Wednesday), and flew home from Rochester, Mn to Palm Beach, Fl on Thursday. We originally planned to fly home on Wednesday but the Mayo asked we wait until the day after, which we did, and this was probably the much better decision.

Flying was not a problem at all. I used the restroom once during the flight from Chicago to Palm Beach but not at all during the one hour flight from Rochester to Chicago. There was never even a remote issue with time or a sense of uncontrolled urgency on the airplane. I remember feeling a strong sense of urgency when at O'Hare after the short flight from Rochester to change planes but it was not anything I could not handle and never thought I was going to lose control. I think you will find your concern about flying is unfounded.

Gross incontinence was never a problem. There has been and still is some minimal linkage but absolutely nothing a minimal pad can easily handle. The hospital gave me some absorbent cups (these were funny to see) and diapers. I did wear the diaper the first day or two, including on the airplane, because I had no feel for what to expect. Other than filling silly wearing the damn thing it turned out the diapers and/or cups were gross overkills with respect to the minimal leakage that did occur.

The Mayo used a general anesthesia.

Fiddler, from my perspective, the HoLEP procedure and experience afterwards has not exactly been a non-event but it is certainly nothing to be anxious about. You will be out cold during the procedure and miss everything with zero memories so nothing to stress out about there. I woke in the recovery room with some distracting discomfort but the recovery room dealt with it immediately and very aggressively with an industrial strength pain killer, Fentanyl. I was not bursting with energy for the next 24 hours or so but there was no pain or anything else unpleasant during that period of time. The catheter, was removed the next morning but there was zero pain when that happened. The last four+ weeks of recovery has been nothing more than a minor pain in the butt at times due to how often I need to pee (every hour or two and sometimes even sooner) but this is easy to deal with. There also has been burning when I pee but again nothing that cannot be very easily dealt with. The minor soreness was gone within a week, the bleeding stopped by the end of the third post week, and the burning and frequency has started to lessen too now. Trust me, this is not a procedure to get uptight about; a pain in the ass yes but that is all. Oh yes, I now pee like the proverbial race horse but only for about ten seconds.  

 

If anyone paid for this procedure out-of-pocket, please tell me about how much expense I am looking at to have the HoLEP procedure. If you used Medicare, can you please tell me your share of the costs when taking that route ?  I realize that this is personal information, but I am trying to assess whether or not this procedure is even possible for me in financial terms. Thanks so much if you can help to at least give me a general idea.

 

ZainaK wrote:

TstJohn,

You can find a list of physicians here:


If you can tell me which area you are in, I might be able to help you narrow your search for the most experienced HoLEP physician in your area.

***edited by moderator*** web addresses not allowed

I am livin in Las Vegas,NV I appreciate if you send me doctor's name
and address

 ***Post is edited by moderator *** Private e-mails not allowed***Please read our Terms of Use

Mietekw8, just my two cents. I am not a member of the medical community but I do have opinions from the large amount of research i did prior to having a HoLEP done at the Mayo.

As has been discussed previously, the HoLEP procedure is a very challenging procedure to learn and there is risk of consequential life long issues if a mistake is made. To be proficient and safe, a surgeon must have a substantial amount of experience with this specific procedure under someone who is experienced before they can go out on their own. As a result, there are only a handful of surgeons/institutions that offer the procedure. Even some large and very respected institutions like Johns Hopkins, Cleveland Clinic do not offer HoLEP.

I am only aware of HoLEP being available at:

-Mayo Clinic (Rochester, Mn + Phoenix, Az but not Jacksonville, Fl)

-Indiana University Health Methodist Hospital (Indianapolis)

-Vanderbilt University Medical Center (Nashville, Tn) -McGill University (Montreal)

There may be others but these are the few I know about.

I believe there may be a few urologists in private practice that offer the HoLEP procedure. It is my very strong opinion, and that of the professional advice I received when I researched this for myself, to ONLY stay with large respected academic type institutions if you are going to consider HoLEP. I traveled 1600 miles to the Mayo. I did hear of a guy in private practice only 120 miles from my home but did not give him even the slightest consideration.

I doubt you are going to find anyone locally (Las Vegas) that offers HoLEP. But, if you do, and he/she is in private practice and not practicing at and with a large respected academic institution, it is my opinion to stay far away from that surgeon. That does not mean someone in private practice is not competent, it means the probability of a bad outcome, in my opinion, increases considerably compared to having it done at a large nationally respected academic hospital and would not be something I would ever consider for myself.

I live in Las Vegas too and I'm almost sure that there is nobody here performing this procedure. There may be some private practice docs doing it in LA, but for a Vegas guy, the best bet would probably be the Mayo Clinic in Phoenix.

Just to reiterate my previous question, does anybody know what the total cost of their HoLEP procedure was ?

If you can't answer that one, does anybody know if there is any way to get a Medicare Advantage plan that only allows treatment from local physicians to partially pay for this procedure at the Mayo Clinic ?

 

As I suggested previously, talk to the Mayo about the insurance issue. They will probably be able to accurately tell you exactly what is and is not available from your insurance carrier.

Barry wrote:

dusty wrote:

Barry wrote:

Cedar, I am in a similar position. I have a 130 gram prostate and my local urologist is recommending an open prostatectomy. I live in Florida and, surprisingly, none of the major medical institutions in Florida, including the Florida branches of the Cleveland and Mayo Clinics offer HoLEP. An OP impresses me as a very unelegant and brutal technique, at least compared to HoLEP.

I would be interested to hear your about your experience prior to the surgery in Indianapolis. Did you have to fly to Indianapolis for a "consulation visit and tests" prior to the trip for the surgery?

The Mayo Clinic in Rochester is telling me the high majority of their HoLEP patients are from out of town but they require two trips. They will not allow an evaluation at the Jacksonville Mayo Clinic which is in reasonable driving distance so it is necessary to make two round trips to Rochester.

there are doctors ln south florida.contact lumenis for names

Dusty, thanks for the advice. I do not want to use a surgeon in private practice. Although there are certainly some that are very competent, I strongly believe the best probability of a good outcome is to use a surgeon associated with either an academic institution or a large respected facility such as the Mayo Clinic.

If it were not for the fact that the Mayo Clinic offers HoLEP, I would not be considering the technique at all because it apparently has not been widely adopted. The Mayo Clinic has such an outstanding reputation I am willing to put my trust in them. I know the HoLEP procedure is a very difficult technique to master but this cannot explain why so few institutions offer it as there are other difficult techniques that have received wide acceptance.

I am also seriously considering Dr. James Lingeman in Indianapolis (Indiana University) as Indianapolis is a much friendlier location for me due to being significantly closer than Rochester and we have close relatives there. However, Dr. Lingeman apparently has some significant financial ties with Lumenis. That is probably not a real problem but it does raise a big red flag so I will probably default to the Mayo Clinic.

My Holep story was a nightmare. I awoke from this "simple outpatient procedure and was hospitalized for a week. 10 days post op, they removed the catheter, then returned me to the nursing home I went to after the hospital discharged me. Ten days later I was back into another hospital where I remained one week. Then another week in a nursing home. 5 weeks post op, I call the surgeon daily (a University of AZ physician) and he does not return my calls. It is as though the earth swallowed him up. I still wear adult diapers and my feet are crippled from the six hour surgery (I was told it would take 2-3 hours) during which my legs were elevated and in stirrups. (I have statin induced myopathy and so the HOLEP was likely contra-indicated.) I still have an infection. Does anyone know of a good medical malpractice attorney in AZ? Seriously.

Wow, that is VERY scary and I am so sorry to hear of your plight !  You said your HoLEP was done by a U of A surgeon, so I am curious where the surgery was done. Did he do it at the U of A, out of a private clinic in Tucson, or where ? This wasn't done at the Mayo Clinic in Phoenix, was it ?  Again, I am very sorry to hear that you had such a terrible experience and I wish you the best of luck.

 

I am 1 4days out of Holip surgery. Like many other members I had read just the good news fr easy surgeries . I was told I had BPH and a canidate for surgery. The coast in Washington state was estamated to be around $18,000 so you know it would have climbed from there. That was the "Green lite"  not Holminum laser which I understand is much more powerful. 100 watts conpared to 40 watts. I have no insurance so had to look else where. My reasearch took me to Mumbai India. There is a group that has 9 clinics and this is what they do. Hundreds of procedures. It was estamated to cost $4,000. ended just under $2,000 that is surgery, 2 nights hospital, private room, all lab work, new ultra sound everything. Not to include the airfare. My Dr. has done hundreds of these and I beleive him as I so 2 other people come out of surgery while I was there. As I stated I am 14 days out and now sit in Thailand. When I left India I was felling fine in good spirit. A small amount of blood in urine but no pain or other complaints. The flight from India to thailand was 6 hours of sitting. the day after arrival my testicals had swollen up and become painfull. I went to the hospital here, one of the cleanest I have ever seen, and received Cipro antibiotic plus pain pill and anti inflamitory. I blame it on the sitting. Now 4 days after treatment my swelling has gone done quite a bit but now I am having blood at the begining of my urination. Bright red blood. The blood stops after a second and it is pretty clear. No pain or urgency. I have not done any lifting or heavy exercise just walking and driving a car 1 hour a day.  after reading all the other post I think I need to heal up. I am 64 and thought this to be a mild procedure. IT IS NOT. Do your home work and read every thing you can find. We are all put together diferantly and react differant to all situtations. Yes at this time I would do this again from the benifits I have had up until now and if they continue. Good luck