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I am considering different options for Prostate surgery and would like to know about some of these. I was diagnosed with severe BPH. My prostate measured 130cc. I have trouble Urinating including weak stream and getting up 4 times a night.

My local urologist recommended Open simple prostatectomy. I got a second opinion and was recommended robotic simple prostatectomy. From what I see this has less risk of blood transfusion and faster recovery than open prostatectomy. I will still have a catheter for 7 days and stay in hospital 1-2 nights. There will be 5-6 tiny incisions to heal. 

I did some research and came across Holep and PAE. Looking to get some feedback. It’s seems like Holep has no incisions, no pain, minimal bleeding, overnight hospitalization and catheter. PAE is an outpatient procedure, but is considered experimental. 

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I somewhat agree with your research and would like to add a few comments.

Robotics and open simple prostatectomy And laser the nucleation of the prostate are basically the same procedure using different techniques. All these procedures involve enucleation of all of the inner transitional zone of the prostate. About 60-80% of the total prostate is physically removed and the results are instantaneous. Both open and robotic surgery involve going through and abdomen and making a hole in your bladder to perform the procedure. This leads to more blood loss, hospital stay and catheterization. The recovery is painful and prolonged due to abdominal incision. You need to have a catheter for a few days as the hole in the bladder needs to heal. I do not see any reason why anyone should be performing these procedures. Holep is the more advanced and equally effective procedure with minimal hospital stay and catheter time. It is the gold standard procedure for BPH and does not have a size limit. From what I hear, you can even perform this in patients who are on blood centers. So please do yourself a favor and find a surgeon who does Holep

I also researched prostate artery embolization. It is a minimally invasive procedure where they go through a blood vessel in your groin and clog up the blood vessels to your prostate. The main risk is hematoma from bleeding in the groin. I Have heard mixed answers on whether it can cause erectile dysfunction as the same blood vessels are responsible for maintaining erections. It is still considered experimental in United States due to lack of strong clinical Evidence supporting its efficacy. Most of the literature comes from Europe and Brazil. I got an opinion from a local tertiary care hospital where they had a clinical trial. My prostate was too large for the clinicals trial. I believe they had to close the Trial as they were not able to recruit enough patients and the outcomes were poor. It does not work right away. It takes a few months to work as the prostate shrinks about 20 to 30% over these three months. I believe you can also get this amount of shrinkage from medications like finasteride and dutasteride. It has not been proven to be effective in men with urinary retention. It may be a good option if you are not a candidate for prostate surgery. I would rather take a medication to shrink the prostate over doing a procedure.

Hope this helps.
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