Prostate Surgery, HoLEP or Green Light laser?

I live in Virginia Beach VA need to find a doctor that uses gree light lazer Turp surgeory. _[removed]_
THANKS

Hi,
I did costing in the Seattle area and the best I could find for out pataient surgery was $18,000. Checked Costa rica and it was $7,000 Vancouver Canada private clinic name False Creek Medical is $6,500. Had mine done in India for $2,000 Good luck

Have had continuous blood in urine, dribbling bloody urine after bowel movements, pain at end of urination, burning after urination, continuously since the GreenLight procedure five weeks ago. Saw surgeon today for follow-up and he considers the bleeding normal.

Also having retrograde ejaculation (i.e. no fluid ejaculated). Whether you will have retro or not, and how long it lasts, depends on how your surgeon does the procedure. The Greenlight promo brochure states 30% of patients will experience retro ejaculation for up to three months post-op but that usually goes away. Various other web sites about the procedure have that same info. I'm five weeks post op, am experiencing the retro thing accompanied by significant pain in the final parts of the retro ejaculation, and today the surgeon told me that the way he does the procedure the retro thing is 100% guaranteed and worse yet it will be permanent. Direct quote: permanent retro ejaculation is the price you paid to have a better stream.

Don't know why he does it this way but he didn't make it clear before the procedure. Had he done so I would have found a different surgeon. I'm only 57 and my sex life is now over thanks to this procedure.

If you're considering having GreenLight done, think of it as emasculation light. You won't be a fully functional male afterwards.

Dr. Gregg Eure of Urology of Virginia has done over 1000 green light surgeries.

Whoa, frankly, from my perspective, you do not have a lot of credibility after making a statement like that.

Retrograde ejaculation simply means nothing squirts out anymore when you have an orgasm. If you had no problem getting it up before the procedure, performing, and achieving orgasm, you will not have a problem now. So, if you can get it up, have sex, and achieve an orgasm, how the hell can you say your sex life is over simply because you no longer ejaculate?

From experience I can tell you not ejaculating does not detract one iota from the intensity and pleasure associated with having sex either for me or my wife. True, you ain't making babies anymore but at 57 I doubt that is an issue.

I also know, from having researched what to expect to expect prior to my HoLEP procedure, the fact that permanent retrograde ejaculation is associated with all of these procedures is common knowledge and stated in virtually every reference I found. So, frankly, if this is something you did not know you need to be honest with yourself and acknowledge you went into having the procedure with blinders on. You did not do even the slightest due diligence with respect to being accountable for the decision you made to have the procedure.

I am in my late sixties and have been around the block over the years a whole bunch of times. If you perceive your sex life is over simply because you cant make a mess anymore, then you should be seeing a psychiatrist, not a urologist. Sorry for being so blunt but your statement about your sex life being over and emasculation light is indeed way over the top.

Hi Barry,

Thank you for your thoughtful posts, both before and after your procedure.

I'm a 52 YO with a 65 gram prostate. I've been experiencing weak, intermittent stream for five years. I finally decided to have the HoLEP procedure at Mayo Clinic Hospital in Scottsdale AZ, with Dr Mitchell Humphreys. He trained directly with Dr Lingeman and told me that he trained Dr. Krambeck.  He's done hundreds of HoLEPs over the past 20 years.

My Procedure is scheduled for Tuesday and I'm scheduled to fly home the following day to San Francisco.

Can you or anyone else address the following concerns for me?

1. Retrograde Ejaculation. I'm done having kids, but my medication sometimes caused total RE and it felt really weird.  I've been ejaculating liquid for 40 years and having an orgasm with no fluid felt like dry heaves. Does it ever get to the point where it doesn't matter or you forget the old sensation?  I asked a few of my female friends and they said there would be way more oral sex in my future if women knew they could expect no mouthful of not-delicious fluid.

2. Flying the day after? I've booked my tickets already. Should I change them or give it a go? I'll be with a friend who's accompanying me for the whole trip and it's a two hour flight.

3. I know Mayo is a teaching hospital.  I only want Dr. Humphreys performing the surgery, not a student or even a resident.  Is it reasonable to have him certify that he will be the only person performing any surgical procedure on me?  This is a deal breaker for me.

Please advise and wish me luck!

 

Joe

I had my HoLEP on 24th October - 42 days ago - and all went quite well . I was getting progressively better in all departments every day , slowly but surely , until I had my son’s wedding last night , when I had to be on my feet all night. My urine turned to pink as in my first post operative days , with pain around the groin . It all improved again this morning after sleep and rest . Has anyone had a similar experience ? Hamzamale

Hi, Joe, very good questions. I also had concerns about the same things and I suspect so does every other red blooded guy with at least a few testosterone molecules still floating about.

1. RE - The days of you making a mess will be over - no two ways about it. The procedure, out of necessity, damages the muscle between the bladder and the prostate. As a result, when the time comes to ejaculate, that muscle no longer closes off the path into the bladder. The fluid takes the path of least resistance (Fluid Dynamics 101) and flows into the prostate instead of taking a path with more flow resistance to the outside world (reminds me of an old Woody Allen Movie from 1972 called with a somewhat relevant but very funny skit). I stressed out about RE (unnecessarily as it fortunately turned out) for many years and refused to do anything because I felt, based on the same experience as you from taking the various drugs, without having an ejaculation the intensity and pleasure associated with an orgasm would be reduced. It finally got to the point, at 66 with a 150 gram prostate, I either did something or risked retention. Obviously I had no choice. The pleasure and intensity of an orgasm is unchanged and just as strong as it always was or wasn't, depending on the specific situation. In my opinion, the sensation is slightly different because you do not feel the high pressure fluid fluid but this difference is truly inconsequential. Bottom line - you will have RE but it will not be a problem (unless your a porn star and can no longer get paid for the "money shot").

2. It was originally my intent to fly back the day after the procedure (the day I was released from the hospital). Dr. Krambeck asked that we wait until the day after I was released (procedure +48 hours), so we did. In retrospect, this was probably very good advice. Waiting gives you a little more time at the clinic in case of something unexpected (e.g. excessive bleeding) and, overall, I was not bursting with energy the day after. It also gave me a little more time to get a feel for leakage, sense of urgency, and frequency. Turned out none of these concerns were of a magnitude to be an issue but I was concerned knowing I was going to fly 1600 miles and be stuck on airplanes for extended periods. I suggest changing your reservation and not flying the day after. It probably will not be the end of the world if you don't wait but it seems to me waiting is the more prudent decision.

3. I specifically told Dr Krambeck I did want anyone but her to perform the procedure. She stated she would be the only one handling the laser but her assistant would do the morcellation, with Dr Krambeck present. I was satisfied with this so apparently that is what happened.

My timeline went as follows:

Monday: Pre-surgical exam in outpatient clinic.

Tuesday: Procedure mid-morning.

Wednesday: Catheter removed at 0500 and released from hospital before 1000.

Thursday: Flew home (Rochester to Chicago, Chicago to West Palm Beach, 40 mile drive home)

Monday: Returned to work (Professional office environment in large industrial facility so much walking required). The first few days after returning to work I found myself big time exhausted by mid afternoon. By the end of the week this was no longer an issue.

December 18 will be three months post procedure for me. I naively thought I would be back to normal within a few weeks but that was far from being realistic on my part. At three months I still pee every hour or two, still have a very intense almost painful sense of urgency sometimes, and still have bursts of discomfort at the start and stop of flow. However, it does not effect my activities or what i do in any way and the discomfort is very easy to deal with. Advil seems to do a very good job relieving these symptoms and I am sensing they are slowly trending toward normal. However, I pee like the proverbial racehorse, something I was not able to do since 1994 or so.I hope this answers your questions. If you think of anything else I will respond again.

I certainly do wish you luck and think you will find you made the right decision assuming HoLEP is appropriate for your 65 gram prostate.

Barry,

You just said that you still have to pee every hour or two but that your flow is like the proverbial racehorse. If the flow is like it used to be in our youth, it would seem to me that peeing would be much less frequent, but there is a lot about this subject that I am still trying to understand. Please explain. Thanks.

 

 

 

My first BPH symptoms became apparent about 1993. I remember a pee, with a very full bladder, prior to noticing BPH symptoms, lasted 25 to 35 seconds. A typical pee probably was about 20 seconds in duration. My first awareness something was wrong was when one night I noticed it took an exceptionally long time to take a leak after watching a movie. So, this is my basis for my definition of a "standard leak".

I appear to pee with excellent flow but for shorter times with overall less volume than what I would think would be normal. I understand 500 ml is more or less a normal leak. I am doing 200 to 250 and sometimes less. Flow duration varies from about 4 seconds to a max of 10 seconds.

Also, the need to pee is sudden with a great sense of urgency, even painful at times requiring a focused but always successful effort to control. There is little or no ramp up of an awareness of the need to pee, it just hits suddenly.

There is a short burst of discomfort (might be called burning) at the initiation and cessation of flow. There is no discomfort associated with steady state flow.

I explained this in detail in another post but I found Advil is very effective at relieving the discomfort. 600 mg (three tablets) once or twice a day seems to greatly minimize the discomfort but does not effect frequency.

Now, before anyone panics with respect about what to look forward to, I have never come close to loosing control and the discomfort is very easy to tolerate, primarily because it is usually such a short duration. Over the past two weeks or so I finally am beginning to perceive that these symptoms are starting to trend toward goodness but this might also be because I am more or less taking Advil. The important point here is that knowing what I know now before I had the procedure would not, in any way, have caused me to make any different decision.

Ten years ago I had a three level cervical fusion. It was essentially a non-event and, except for the collar I wore for six weeks, there was an essentially instant recovery. I very mistakenly equated the magnitude of the trauma associated with the HoLEP procedure to that of the cervical fusion and that was a very wrong thing to do. The fusion was really a very minor event compared with the internal trauma associated with slicing up almost an entire gland with a high energy laser, internally dicing (morcellation) the sliced tissue into tiny pieces, and then flushing it out through a flow path intended only for a relatively small stream of liquid. Nothing to show on the outside of the body but lots of internal trauma to a system that is constantly in service and cannot be placed on standby waiting for everything to heal.

While typing this I have sensed a need to pee but have been putting it off because I am focused on responding. The need finally got to the point a few minutes ago where the discomfort trumped my desire to ignore it. I just probably peed for well over ten seconds with flow to be proud of and minimal discomfort. Last time I took Advil was early this afternoon, probably 8+ hours ago. My point is, I went about ten or so weeks post procedure with little or no improvement in symptoms and even think I lost ground at times. Now, over the past week or two, I am perceiving things are definitely starting to improve.

I hope this answers your question.

Barry,

I don't know what I could possibly say to make you understand how hesitant I am to make this comment that to you probably sounds disrespectful, but please be assured that I don't mean it that way. From your description of your circumstances back in 1993 and those that you are facing now, I would have to conclude that you still have BPH, but now the pee is just coming out faster than it once did. Was it really worth all that this procedure has put you through, and if so, how ? Please don't be insulted by my bluntness, but it doesn't sound like the risk/reward for this procedure is all that favorable for reducing the symptoms of BPH.

 

46Goat, I think you are reading something into my comments that I am certainly not saying.

I first noticed BPH symptoms in 1993. Until approximately the early 2000s they presented no real problem. I probably should have considered one of the minimally invasive procedures such as TURP starting around 2005 but for multiple reasons I made a conscious decision (that I do not regret) to wait as long as possible to due something. Finally this past year it seemed it would not be prudent to wait longer without undue risk of retention. I had a choice of an open prostatectomy or HoLEP. Be assured, the relatively minor issues I have been discussing are trivial compared to the recovery from having my lower abdomen cut open.

The HoLEP procedure in my opinion is the best technology has to offer now. The minimal problems I am having now are typical and my local urologist (Cleveland Clinic) is not concerned. I am also not concerned and fully expect the truly minor issues with frequency, etc. to resolve with time. It was clear to me before the procedure that some symptoms take months to resolve. I just decided, based on a previous experience that was not equivalent, that I would recover faster than most people.

I do not know why you seem to be so focused on worrying about the issues I reported on but they are truly trivial and will resolve with time. They do not effect my life style in the slightest and they represent nothing more than a minor pain in the ass that is easily dealt with.

One more time; bleeding, frequency, leakage, urgency, burning, etc are all expected symptoms after one of these procedures and all will resolve with time, and in some cases that time is measured in months. In addition, there is no comparison between now and 1993. In 1993 my symptoms were almost guaranteed to get worse as my prostate continued to enlarge. Now, very much the opposite, my symptoms are can very reasonably be expected to continuously get better as my body continues to recover from the trauma of the surgery. In fact, based on the past week or two I am seeing more than marginal improvement.

To be blunt, I get the impression you seem very uptight about having the procedure. Unfortunately, I don't think anything I can say will change that. However, I feel very strongly if you use a competent surgeon at a very well respected institution, like the Mayo, the whole experience will be nothing more than a pain in the ass and you will recover without issue. There are certainly better things to do in life but at our age we have all exceeded the design basis for our bodies and we are of the age where we have to deal with things such as this. The best technology now to treat advanced BPH is far from perfect but fortunately we live in an age where what can be done is very safe, very effective, and any resultant discomfort/pain can be quickly and easily dealt with.

Not sure what else to tell you but I will try to respond to what ever questions you still have.

Barry,

I had to laugh when you said, "To be blunt, I get the impression you seem very uptight about having the procedure."

To use the vernacular of some young people today, "Well, DUH ?"

After reading your posts and those of other guys on this forum who have had HoLEP and are still leading far from normal lives, I don't know who the heck wouldn't be uptight when contemplating having this done on oneself !

I understand the seriousness of that word "retention", but for now, let's just focus on the word "symptoms", specifically the symptoms of BPH. Since we're being blunt with each other, with the exception of reduced flow rate, you still have all of those symptoms plus a few more you never had before. You say this is all just a minor pain in the ass and that the symptoms will go away in time. I certainly hope that's true, but perhaps you could try to put yourself in my shoes for a minute and you might see how this could possibly be just wishful thinking on your part. I don't mean that disrespectfully, but I am trying to weigh facts here, not hopeful expectations for the future. Currently, the facts are that this operation has only gotten rid of one of your past symptoms and has given you a few additional complications. Given this situation, surely you can see why one who has not had the procedure would be skeptical of its efficacy.

Assuming I haven't pissed you off to the point of your not wanting to continue the discussion, please explain what evidence you have for being so hopeful about all these symptoms vanishing over time. I am sure your doctors have led you to believe this, and I don't mean to imply that you are gullible or that they are con artists, but after reading many posts on this subject on this forum, it's very difficult for me to not be somewhat skeptical about how this procedure would significantly change my life for the better.

It is very clear to me you are reading and interpreting what what you want to hear and are ignoring what I am clearly saying. For example:

In my previous post I said, referring to my remaining post surgical symptoms,  "... they are truly trivial and will resolve with time. They do not affect my life style in the slightest and they represent nothing more than a minor pain in the ass that is easily dealt with.". Yet, in your response you used the words "... still leading far from normal lives ...". I think we might be in two different galaxies speaking two different languages as my life from work to play to sex etc., from my perception, is disgustingly normal.

Retention is a true medical emergency that is certainly life threatening, to say nothing about the associated pain and suffering. So, aside from everything else, if your BPH is sufficiently severe that there is a possibility of retention, then that one driver trumps all the truly minor other stuff. If you are considering a surgical approach because the BPH symptoms are only effecting the quality of your day to day activities, then you have a personal value judgement to make where only you can decide what and when is best.

Knowing last summer before the procedure what I know now would not have changed a thing. Without hesitation, I would have made exactly the same decisions. The symptoms I have now are relatively trivial, are resolving, and, again, have zero effect on my quality of life. Before the procedure my symptoms did effect the quality of my life. For example, among other things,I was awakening three or four times during the night sometimes,

I do not know how to say this any clearer or more precisely. The issues I am having now are minor and inconsequential and I have no reason to believe they will not fully resolve in a reasonable period of time. They do not affect the quality of my life or the decisions I make with respect to day to day activities. In fact, they have started to resolve, slowly, but nevertheless improving. I do not understand why you insist on focusing on these issues when they are of no consequence and certainly much improved than prior to the procedure.

I do perceive it is your nature to have a high level of angst when approaching any medical procedure. I doubt there is anything I or anyone else can say to make you more comfortable. I can only speak from my experience. Certainly, having ones prostate removed with a high energy laser is not something to take lightly and there was certainly some unpleasant experiences associated with it. Overall, it was something I would have preferred to avoid but it was far from terrible. The very few times I did have pain, as when awakening in the recovery room, the pain was dealt with instantly and very effectively and, although distracting, was never really so bad to allow me to get very dramatic about it. The post surgical discomfort was almost non-existent (except for burning when peeing) and the little that did exist the first week or so was not even a distraction. The procedure itself was truly a non event because I was out cold the entire time and all the unpleasant preps (catheterization, intubation, etc.) were all, without exception, done while I was asleep. I am saying all this because I want to try to assure you that you are not in for a nightmare experience, not even close.

Anyway, I do not know what else to tell you. The procedure accomplished exactly what it was supposed to do and the post surgical annoyances I mentioned are certainly improving. It did take 2 1/2 months for me to see a consequential positive trend but I am clearly seeing improvement over the past few weeks. I just stopped from typing this to pee, peed for 14 seconds without any real discomfort, and had a flow rate to brag about. I also have not taken any Advil since yesterday. I cannot see how my experience can be interpreted as anything but an endorsement.

I truly hope the best for you. I also hope you find a way to become less anxious about it. However, I am also not saying a healthy level of concern is not appropriate. Please keep posting as I do want to know how you do and it is also probably healthy for you to talk about it.

Hi Barry,
May I ask what the urine residual left in in your bladder after urinating was before your Holep surgery
and what the urine residual left in in your bladder after urinating is now?
Thank you.
Fiddler