HoLEP vs other BPH prostate procedures (TURP, Aquablation, UroLift, Rezum, GreenLight)
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- Опубликовано: 5 фев 2025
- Learn what HoLEP is, how it compares to other procedures, impact on sexual function and ejaculation preservation, risks, need for a Foley catheter, and recovery after surgery.
Learn more: DrAustenSlade.com
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In Dec 23 I had a Holep surgery done in Ichilov Hospital Tel Aviv Israel done by Professor Mario for BPH with a large prostate . In April 24 I was completely healed and can urinate normally with a 100% success.I was very pleased with the results of this type of surgery and will not hesitate to recommend it any senior patients with similar symptoms...
Thanks for sharing your experience
I'm going to have HOLEP in 6 months at HaSharon Hospital in Israel. My brother had it done there 3 years ago and he's peeing like a horse.
Kudos to Dr. Austen Slade for a thorough discussion of side effects and risks. Most of the videos describing BPH procedures skip the risks
Thanks for your insights, I agree patients should be aware of any potential permanent changes. Not something folks like to find out after the fact
Great 1:23 presentation Dr. Slade. I just recently had the HOLEP procedure performed by Dr. Amy Krambeck at Northwestern Hospital in Chicago.The surgical result went beyond my expectations. My urine flow is the strongest it has been in over a decade. My flow is so strong that I'm making bubbles when I urinate.
I went home that day without having to wear a catheter. I experienced blood in my urine for twenty-four hours post surgery. Still having a bit of post urinary leakage (about a tablespoon full) and a little bit of stress incontinence two weeks later.
I went into surgery at full retention. I had to self-catheterize four to five times a day for thirty days. In 2018, I had a button turp and six years later I had to go back into surgery to remove the prostate tissue that had regrown That's why I'm so happy that I found out about HOLEP. All of the prostate tissue has been removed so I never have to get surgery again. 5:10
Thanks for sharing your experience, I’m glad you can ditch those catheters!
I did holep in Nashville at vanderbuilt urology with dr miller who is one of the best in the world! went in at 5:30 for preop and at 11 o’clock left. No postop pain catheter out almost immediately just minor blood in urine for a couple weeks little bit of bleeding Pee like a camel instantaneously I’m 76 years old. I’ve had BPH for 15 years this is an amazing result!
That is great to hear.
I'm 68 and I remember what it was like to pee like a camel 🤓
The best presentation I have ever seen on HoLEP and other BPH procedures. I wish Dr. Slade operated in Australia.
Thanks for watching. Visiting Australia is high on my bucket list!
I had my hoLEP procedure done at the VA hospital in Las Vegas. Six months and I feel like a normal guy. Great procedure!!!.
Nice presentation,very informative. I started nursing career in the late 80’s. I recall taking care of TURP patients and it was always a bloody ordeal.
I am in awe what can be done now. Thank you for educating the public.
This is an extremely accurate video on a complicated subject - well done! I had the HoLEP procedure last April. I was 63 at the time and I must say, I am very happy with the results, I can urinate like I did 40 years ago. I was first very unhappy with the dry climaxes, but, on balance, having a super strong flow, being able to sleep through the night and being able to hydrate myself without having to worry about urinating constantly, is well worth it. I will say, my only complaint was having to wear the catheter for 8 days, but that was because my urine was not completely clear, my bladder was still healing, my urine was gradually going from blood red to clear, and every once in a while, I'd see a small clot come out, which is what it should do. All around, I'm extremely happy.
Thanks for sharing your experience!
Well explained and presented. One of the best I’ve seen. HoLEP for me in one month at Mayo
Tell them hello from me, I wish you the best.
Thanks very much for this info! Of course my local urologist does not offer this and since they do not sell it they did not mention it to me. I found an MD that did his fellowship in Chicago. I had investigated the other options, and was not happy with any of them. I have an appointment to meet with the MD, and hope to have this procedure done. Thanks again!
You're fortunate to have close options, I wish you the best.
Thank you for a very professional, yet, simple video. And for discussion on sex.
Holep was definitely one of my choices but I chose Aquablation because I didn't care for retrograde ejaculation possibility that Holep presents. I'm only 68, so I imagine that re-treatment is a real possibility. Maybe by that time I won't care about RE, or there will be more options available for me. Holep is an excellent procedure and I'm glad there are doctors like you still offering it.
It’s great having lots of options! I hope you have an excellent outcome.
@@austenslade126 Thank you. I had Aquablation a little over a year ago. My IPSS went from a 27 down to a 2. To say that I'm pleased is an understatement. 🙂
Very good Doctor.! You answered all my questions before I even asked them. Holep seems the way to go.
Thank you for such an informative video. I had a TURP done eight years ago (age 61) and last weekend I ended up in ER due to a super enlarged prostate. Obviously it had grown over the past 8 years, so much so that the first hospital ER that I went to couldn't put a catheter in on three attempts. So I was ambulanced to another hospital ER (120 mi away) where a urologist was waiting for me and did a scope procedure (of the urethra, bladder and prostate) and then a catheter placement. Based on his findings he is recommending the HoLEP which brought me to your video. Thank you for giving me the reassurance that I was looking for! I sincerely appreciate it! I hope to have the HoLEP done in next couple of weeks.
Sounds like you're in good hands, I’m glad you found this helpful!
How big was it before the procedure?
Thank you for this explanation.
I've read a lot about the side effects. It would be helpful to show the percentage of patients experiencing each of the side effects as found in the various studies; it helps your viewers make well-informed choice. Afterall, they are the ones taking the risk.
Dr Slade thank you for an extremely useful and well presented explanation. I have very recently had HoLEP surgery in the UK and it has been a total success. Incidentally some wives prefer retrograde ejaculation during oral sex. The men should ask their wives before rejecting HoLEP!
Very good information, very well put together. I had thuliam laser surgery back in April 2024 it is now November 2024. 2 months after surgery my flow did not seem to be getting better and also had some new symptoms. I started having a burning and at time shooting pain when sitting. I also had numbness in the genitalia. I am a healthy 61 year old male not on any medication other than Tamsulosin. I scheduled appointment to tell the doctor of the post surgery symptoms I was having. He listened and scheduled MRI, lab work and ct scans and performed a cystoscopy and saw that the opening to the prostate was wide open. He put me on antibiotics and pain medicine, but could not offer a diagnosis. I scheduled an appointment with a different doctor to get a second opinion. This doctor did a basic examination and asked questions but he didn’t really seem interested to offer any help. I then made an appointment with another Dr. and he also ordered cystoscopy lab work and MRI and did a urine flow test. The flow test confirmed it was weak. Then I did an MRI. He called me in to discuss the results of the MRI and said there was some blockage in the lower area of the prostate and suggested he do surgery specifically a HELOP. I have since researched this procedure and that’s how I came across this video (great video by the way) I’m wondering why the Dr that did the surgery in April did not offer or at least suggest the HELOP. I had a green light surgery about 5 years prior to the one in April. I wish I would have done more research, I could have saved me a lot of money and misery. My question to you, I live in the Houston area, is the a reputable Dr that does this procedure in the Houston area that you could recommend. Thank you for any help.
Sorry to hear about all the troubles in your journey. In Houston I would have to recommend Ricardo Gonzalez at Houston Methodist
Is there maybe another recommendation, I called his office and they said the first available appointment for new patients wasn’t until July 2025. Any help is appreciated. Thank you
I'm sorry, not that I'm aware of. Marawan El Tayeb is another great Texas option, he's in Temple but is likely booked out as well.
Ruben, why don't you schedule an appointment with Dr Slade and travel to Boise? He is very accommodating for out of state patients. I traveled to Boise because there were no providers in my area that performed HOLEP.
I would definitely consider this. I will have to get with him and see if he could work me in to his schedule. Thank You. Was he able to fix you up?
I will need one of these procedures soon. My BPH meds are no longer working. After doing some research I decided that I like Holep the best. Problem is that my current urologist does not do it. I will have to pick another one.
I'm at that point now at 71 yo, decision wise I'm leaning towards the Holep vs the others mentioned. I favor the idea of it's longevity given my age as I do not relish the idea of having to live on medication for the remainder of my life dealing with this issue.
That was a brilliant presentation. Thank you!
Glad you enjoyed it!
Post procedure complications: unable to feel legs from waist down due to lumbar puncture, severe short term memory loss for 3-4 weeks, inability to urinate the next day. Make absolutely sure the clinic performing the procedure provides good post-op support.
At 4 1/2 years post-GLL procedure I began getting repeat BPH symptoms, especially hesitancy. There are very few Urologists in my state. Imo, the original GLL was a slipshod experience done in a make-shift "Urology clinic"...which ultimately shut down.
Dr. Slade, thank you you for the most concise and clear explanation I’ve seen. You convey a calm confidence which is what we patients desire in our surgeons. I’m 67 and the frequency of having to urinate is getting bothersome. You’ve convinced me that Holep is the right procedure for me. I’m in Virginia. Is this covered by Medicare?
Thanks for your kind words. This is covered by Medicare and Dr. Ilya Sobol would be who I recommend seeing. Be sure to tell him hello for me
@@austenslade126Wow! What a quick response. Thank you!
Excellent and informative video. Thank you for posting this!
Excellent presentation. three questions. 1) If one were to have had Proton therapy for prostate cancer, would HoLEP still be an option for LUTS post proton therapy? 2) both proton therapy and, I presume, HoLEP would lower the PSA level after treatment. So how does one continue active cancer surveillance? base on relative PSA level rise as indication for possible recurrence of ca? 3) If you were to preserve the ejaculatory duct region of the prostate to reduce chance of retrograde ejaculation, would this not mean an increased likelihood of BPH recurrence due to remaining tissue regrowth? Thank you so much for answering my questions?
Thank you Dr Slade ..very informative and helpful ..
A couple of things I don't understand both for HoLEP and TURP. 1) I picture the urethra as a tube that runs from the bladder to the tip of the pennis. When you go into the prostate and you remove material...don't you also remove the tube...the urethra? 2) During HoLEP when you remove all the internal material from the prostate (the inside of the orange) does it fill with urine then? 3) Couldn't you use HoLEP to remove cancer from the inside of the prostate? Thanks, and this is a great video.
Thanks for watching, I hope you found it useful. To answer your questions:
1) Yes the urethra tube gets removed where it travels through the prostate, this segment is referred to as the "prostatic urethra", a new lining forms inside the hollowed out prostate and becomes the new prostatic urethra.
2) Yes, the emptied orange does fill with urine, this area contracts down a bit with time and doesn't hold very much urine or act as a "second bladder", it usually empties well along with the rest of the urine in the bladder.
3) Most prostate cancer arises inside the peel of the prostate (the peripheral zone), if the tumor were located on the inside with "the pulp" (the transitional zone) then yes, it would be removed.
@@austenslade126 Thank you so much for you answers. I live in Dayton, Ohio and if I were closer to you I'd be having you do my operation. Thanks again for answering my questions so thoroughly.
@@stone8597 Matt Lee at Ohio State is a great HoLEP surgeon if you haven’t already been connected with him
@@austenslade126 Thank you so much.
Glad you asked that question, I was wondering the same thing.
This is a great information. Thank you!
Glad it was helpful!
The procedure I am going to get is the PAE - Prostate Artery Embolization. It makes the most sense and is the least disruptive.
That's another option, hopefully it's successful for you. Retreatment rates are similar to TURP and other non-enucleation techniques.
HOLEP procedure is superior!
I had a PAE and it did nothing for me. Pre-surgery I had a die study to determine the viabilty of my arteries. It was determined that I was a good candidate for PAE. Had the PAE and when I woke up I was told that because my arteries were too small on one side they could only perform the PAE unilaterally. It would have been nice to have been informed about my arteries pre-surgery and therefore not wasted a bunch of money , time, and anxiety. My current urologist said that this happens relatively frequently, and the unilateral PAE's do not have good outcomes. (BTW, I also developed a blood clot in my arm post surgery which was another nightmare in and of itself).I urge you to ask your doc about the viability of your arteries before undergoing PAE!
Had a PAE last year. My middle lobe is now larger than before, due to the Dr choosing not to embolize it then. Strange. Looking at HOLEP for a final solution, at age 64. Good luck.
I wonder why a stent is not used to open up the urethra just as a stent would do in an artery?
There used to be such a device "UroLume", it worked well for some but caused some serious problems for others and has been discontinued. There are some newer similar devices being developed but none that currently available in the US.
I had this done 12 months ago by Dr Julie Riley at UAMS in Arkansas. I had a weak stream, difficulty starting and stopping, frequency for years. Prostate was over one hundred grams. Absolutely no side effects other than I can now urinate like I was a teenager again.
That's great news, she's a great doctor!
Great video. Thank you!
Dr. Slade, thank you for the excellent video. Do you have any recommendations for doctors in the Dallas/Fort Worth Texas area who are very competent to perform the HoLEP? I'm 70 years old and have had an enlarged prostate for years. Am currently taking Tamsulosin. My urologist is pushing me toward Greenlight Laser.
I'm sorry, I looked into this recently and wasn't able to identify anyone.
Great presentation. I am scheduling the procedure. My Urologist also found a stone in my bladder. Can the stone be removed at the same time? Thanks
That's great news! Yes, bladder stones are often removed at the same time.
Thanks for the quick response Doc. I'm in Maryland. My Urologist (who is pushing for the Urolift) detected the stone by cystoscope on Monday 12-9. So far I don't feel any symptoms from it. I couldn't get an appointment with a Holep Specialist in John's Hopkins until mid February. Should I have the stone removed asap or try to wait for the Holep procedure. Thanks again.
@@frankorcel4902 Hard to say without knowing the specifics of your case, in most cases the bladder stones are safe to wait a few months
I was wondering about PAE to fix my BHP , you had not mentioned it . I see quite a few Urologists using the method and it does not effect any body functionns and there is no bleeding or need for cathater at all.
PAE can be helpful for some patients, there are certain shapes and sizes it doesn't treat as well and durability is on par with TURP at best. If preserving ejaculatory function is a priority, it may be a good fit for you
I had pae for a 250cc prostate, now 4 years later had a check and it is back to 250cc. Am considering asking about hoLEP
@@Jhjhjh121a great option for you to fix things once and for all!
So if you have Holep, when you pee, does the urine just slosh around where the “prostate pulp” was? Like there is no urethra anymore but hollow area. Does the urine ever get trapped in there?
Great question, that space does contract down a little in time, but remains much wider than it did before treatment. a very small amount of urine may now reside in this space, but doesn't create sensations of sloshing around and usually empties well at the time of urination. Next opportunity I get I'll have to upload a video of what things look like after they've healed.
@@austenslade126 thank you!
That would be very helpful! I had HoLEP recently, and overall I am happy with the results but I do wonder about details like these.
I had HOLEP one year ago, excellent results, right out of the surgery. My question is; why do I ejaculate a considerable amount of liquid ?
@@drrubi04 does it still feel normal? I thought there would be retrograde ejaculation because the ejaculatory ducts are gone? Is it semen or urine?
Dr. Slade, do you know of any urologists in the San Francisco Bay area who specialize in the HoLEP procedure and has done at least 100 cases of it? I have a 120 cm3 prostate (no cancer) and was offered open simple prostatectomy (non-robotic) by my urologist, but, having done my research, I strongly prefer HoLEP. Thank you.
I know there are a couple who are starting to learn but not sure about any with at least 100 cases. Lots of direct flights to Boise though 😉
Thank you for the video. I am 56 and I have been struggling with a large prostate since I was about 48. I had aquablation Sept 2023. My prostate was 90 grams. The recovery was awful. When I took the catheter out after two days, I couldn't urinate and I started spasming. I eventually had to go to the doctor to get another one for 4 additional days. I never urinated well after. I am back on Silodosin and now I am taking Finesteride too. Eventually I found a new urologist who did a cystoscopy. He found strictures at the bladder neck. He also measure my prostate to be 120 grams. So, I think that the aquablation did nothing for me. The prostate was still blocking urine flow. He says that it is pressing against my bladder and it will damage my bladder if I dont do the RASP asap. He wanted to do RASP this coming Monday, but I cancelled it today. I decided that I wanted a second opinion. Anyway, my urologist says that the RASP would allow him to do the Bladder Neck Reconstruction at the same time. I have a questions for you. If I had Holep, would they still be able to work on my bladder neck (if needed) at the same time, or would it be a separate procedure?
What a tough situation to be in. I have done HoLEP in similar cases and after aquablation, I can't speak to your case specifically, but HoLEP usually opens the and fixes the bladder neck very well in these scenarios.
I live in Florida. I’ve had 3 Turps. The first two were not good. The last was 3 years ago & so far so good.
In your opinion; would someone like me be wise to have this done to ensure no issues moving forward?
I’m 62 & in good health.
I have done HoLEP as a definitive treatment after 3 TURPs before with good outcomes. If a work up shows there is residual obstructive prostate tissue or "pulp" then it may be a solution for you.
Thank you for responding. I had scar tissue that was the problem. I’m very interested. I don’t want issues in the next few years. I’ll see if anyone in Florida offers this but if not - do you accept out of state patients?
I routinely see out of state patients, Dr. Spencer Hiller may be a great more local option for you.
What about pain meds or antibiotics post surgery for the patient? It's hard to imagine no worries about clotting, to keep the Catheter in 1-2 days. I would assume to stay on Flomax if on it for at least a few months. Finally is there a month follow up with patients?
Clotting is a small risk but rare in patients not taking blood thinners. Catheter is usually removed immediately after the procedure or within 24 hours. Tamsulosin can be thrown away immediately following HoLEP. I usually follow up after 3 months when most of the healing has finished, but sometimes checking in at 1-2months is recommended.
My urologist suggests a Suprapubic prostatectomy. How does that compare to the other treatments you mentioned here? My prostate is 140 grams and I’m 73 years young.
The suprapubic approach means an incision is made on your abdomen to get to your bladder, then the bladder is cut open to access the prostate. From there the prostate is unpeeled or “enucleated.” Long term it has similar outcomes to HoLEP, but this approach likely requires a Foley catheter for one to two weeks after surgery, at least 6 weeks of lifting restrictions, and not to mention more pain after surgery because of the incisions.
140g is a very common size for HoLEP, most my patients with that size go home the same day without a catheter and without incisions to recover from.
I am a 74 y.o. with a 71gr. prostate. I’m currently self-cathing. Also, I’m on Warfarin due to pulmonary hypertension and am due for balloon angioplasty in late April. In great health otherwise. Now that I’ve seen this video, I’ve added HoLEP to my list of considerations in addition to Rezūm and aquablation. My main concern is post operative bleeding. What would you do considering these variables?
That's a tough scenario and worth discussing with a HoLEP surgeon in your area. HoLEP is one of the few procedures that can be done while patients are on warfarin but there may be other factors to determine if this is the best option for you.
Justice, don’t even consider Rezum. It is a brutal and extremely painful procedure that is temporary at best. Read the comments on Rezum videos from men that had Rezum. Most Rezum videos are nothing more than a commercial.
@
Thanks for that. I think I’ve narrowed it down to HoLEP or aquablation, leaning towards the former. But i’m seeing the doc tomorrow so we’ll see what happens.
@@justicegusting2476 You might research Aquablation. There is a lot of bleeding. It isn’t as long lasting as HOLEP. Do lots of research before making your decision.
You addressed the loss of ejaculate. What about sexual sensitivity of the prostrate? Is that lost also?
That's not something anyone has mentioned to me and it hasn't been studied, unfortunately I don't have a clear answer for you
@austenslade126 At least you are honest about that. Truthfully, it generally isn't discussed. Everybody focuses on peeing first, then any ED effects and not much else. Thanks for such a quick response?
WOW. I wish I was in Boise. Best explanation I have heard. I had radition treatment for prostate cancer. The radiation played havoc with my bladder. I completed the radiation treatments Dec 23. I have had severe bladder spasms while in radiation treatment and after. Many UTI's. I hope my Urologist does this procedure.We think my bladder has healed and will be doing a Urocuff study and then hopefully surgery to reduce/remove the prostate blocking uretha canal. Best to you doctor.
Sorry to hear about your troubles, radiation may change your treatment options but I’m glad you’re getting help.
@@austenslade126 Thank you for your reply. My doctor who I trust is willing to talk about surgery even though I had the radiation. I am just tired of having this catheter and the problems it brings. May I ask one question and I understand if it can not be answered. Can I have surgery? Thank you for your kind response.
@@dskinner2542there are increased risks with surgery after radiation. Depending on your specific situation it may be an option but I would defer to your urologist who is familiar with your details
Which surgery would be advisable for a 67 year old diabetic male? Between HoLEP, Greenlight or TURP?
HoLEP is likely the treatment of choice among those options, the only downside may be availability depending on where you’re located.
@@austenslade126 Thanks. It’s available near my place (Delhi, India)
This gives me confidence to opt for HoLEP. Thank you so much…🙏🏻🙏🏻
Excellent and informative video, Dr. Slade. My history is BPH with an obstructing median lobe, prior prostate surgery (TUIP, 1997), and history of significant post-procedure bleeding both from the TUIP and a later prostate biopsy. I assume that HoLEP would afford the lowest risk solution based on these conditions. Do you know if there is a HoLEP qualified surgeon in the Memphis TN area? My initial research has not located one thus far. Thanks.
@@mike_jenkins HoLEP may be a great option for you. I’m not personally aware of anyone who offers this in Memphis. Your closest options would likely be Charley Nottingham in St. Louis or Nicole Miller in Nashville. Best of luck!
@ Thanks
Social support to facilitate out-of-state patients for lodging, etc.?
There are many hotel and lodging options near the hospital, please give my office a call if you’re considering travel to Boise. I regularly treat patients who fly in for a HoLEP
Calvin, I am traveling to Boise in Sept. from Colorado for the Holep with Dr. Slade. There is a LaQuinta just blocks from the clinic and hospital. I walked from the hotel to the office for the initial visit. This office is very professional and beyond helpful. Good luck.
@@garygrow8373 thank you!
My Dr has recommended Holep after a failed Rezum. If I travel to your facility for Holep, is it necessary for ANOTHER scope? Also, what is your suggestion for driving home 10 hr to an adjacent state? Many thanks for an informative video.
Thanks for watching. A repeat scope is unlikely to be necessary. I have several patients fly or drive out of state after this procedure, usually 1-2 days later but a specific plan would be discussed with you.
@@austenslade126 I have filled out the form with your clinic. Thanks for the prompt response.
Can you recommend a doctor for HoLEP in St Louis, MO please? I was considering PAE but am leaning towards HoLEP for it's efficacy and durability. Thank You! Excellent video!
Thanks for kind words. I’d recommend Charlie Nottingham at Mercy Hospital www.mercy.net/doctor/charles-upshur-nottingham-md/
Dr. Slade, excellent comparison of different procedures. After CABG seven weeks ago, my urinary system wanted to get into the act. I do suffer from BPH. Without all the details, I presently have had a Foley in for two weeks. I meet with my urologist later this week to discuss next steps. The issue is I am presently on Eliquis for two weeks due to a PE in my right lung. They have stated that I cannot have any type of prostate surgery for three months until the PE is cleared up. HOWEVER, during your video you mentioned HOLEP can be performed when on anti-coagulants due to blood control. Is that true for a situation like mine? Thank you. P.S. Too bad I am in Ohio, and not Idaho! :(
You have Dr. Matt Lee in Ohio which is great! HoLEP can be done while on anti-coagulants but anesthesia may not be safe or ideal while you have a PE.
@@austenslade126 Thank you for your kind reply. This morning we lined up several procedures over the next week: Transrectal Ultra Sound; Fill and spill; Urodynamics - CMG and a Cystoscopy. the combined results of which should provide a plan to move forward. I appreciate the referral for Dr. Lee. I am concerned that the choice of procedure, if one is necessary, will be dictated by the relatively small size (7 physicians) of the group. Thanks again.
@@austenslade126 BTW, I just looked up Dr. Lee and his location is very accessible to us. He will be incredibly helpful for a second opinion and actual surgery if necessary.
I’d prefer this but live in a state with limited access sadly. I’m almost certain we don’t offer this locally ( Hawaii)
I wish I could come out there and offer this for you, unfortunately I'm not aware of anyone in Hawaii performing HoLEP.
@ that I know. It’s resume,pvp or turp
@ I’d be willing to travel to your state if my insurance covers the procedure
@@jhonnyroxhollywood9938 Insurance coverage is almost a guarantee. If you submit a request we can look into that for you draustenslade.com/contact-dr-slade
@@austenslade126 I just saw this reply. I’ll start working on this asap. Mahalo. And happy holidays
Thank you Doctor for this awesome report. I’d never heard of Holep before and a google search indicates that Holep procedure is offered by the University of Florida at Gainesville about an hour and a half from my home. It’s a big facility and I don’t know where to begin. Do you know any of the surgeons there and their history? Some information on where to begin would be appreciated. Thank you for this informative report.
Glad it was helpful! Yes they have experienced HoLEP surgeons there
@@austenslade126 Hello doctor, are you familiar with the Henry Ford Health System based in Detroit, Michigan? I'm going to be seeing a Dr. Leavitt for HoLEP consultation, at the West Bloomfield location.
@@JoeCooper-b4t I'm sorry I'm not familiar with this location
Does Medicare cover this procedure...excellent video BTW
Thanks for giving it a watch. I’ve never had any patients denied coverage from Medicare or any Medicare Advantage plan
Thank you for your super timely and thoughtful response. I believe time is of the essence on my end as well. I can schedule a flight from the Baltimore area to Boise at your convenience. What would be the earliest that you would be able to schedule surgery in my situation? I can have my medical records sent to you that include a TRUS test from 10/31/23.
As early as September 20, please submit a contact request www.DrAustenSlade.com and we can look into your case.
@@austenslade126 As I am finalizing my plans to make the trip to your clinic, I'm wondering how many HoLEP surgeries, on average, do you perform per month, per year and/or in total?
And that includes how often your surgeries include super-enlarged prostates in the 150g and greater category.
I perform 25-30 per month on average, and have performed almost 500 total
Around 20% of my cases are around 150g or greater. I have done many over 200 and even 300g.
Very useful video. I had a ThuLEP procedure 2 weeks ago with Dr Karpman in Silicon Valley. I assume it is very similar to HoLEP, just slightly different laser equipment? Stayed overnight in the hospital with Foley catheter but sent home without it the next morning. Minor blood in urine for 5 days, then clear after that. A little pain after urination but just for 1-2 minutes. Still having the various symptoms - urgency, waking up 3-4 times per night to pee (my main annoyance before the surgery), and minor leakage after peeing, but hopefully they will continue to subside over time. Able to go back to the gym for some light lifting 10 days post-op, so that was quicker than expected.
Having watched a few too many videos, my main concern is scarring around the bladder neck. Kind of wish I had investigated Optilume more seriously since that apparently has less risk of scarring as well as retrograde ejaculation. Plus my prostate was "only" 70g in size. Anyway, curious if Optilume as a follow-up procedure to open the bladder neck and fix scarring would be the best, versus the prior techniques like cutting the bladder neck and injecting steroids to discourage forming more scar tissue.
Thanks for your kind review. Yes a ThuLEP is a very similar approach, just a different laser (Thulium instead of Holmium). The risk of bladder neck contracture or complication down the line is still very low. Optilume BPH hasn't been studied as a treatment for bladder neck scarring but theoretically may be a treatment option for those scenarios.
Excellent presentation. Thank you so much. I have a super enlarged prostate (177g) and now I have a urinary block and a Foley catheter since knee surgery on 8/6/24. Can you recommend several docs in the Annapolis/Baltimore/Washington DC area? Unfortunately, I’ve contacted a referred doc in Delaware, but his surgery schedule is several months out. Thanks.
I’m sorry to hear about your troubles, it may be challenging finding anyone who can offer this within 2 months. I know it’s performed at John’s Hopkins but don’t have specific recommendations for your region. I make availability within a month for patients with a catheter, hopefully there are others out your way with similar openings.
Dr Slade. I have 3 options to choose from for prostate surgery (my prostate is around 60ml in size) after being catheterised for retention issues. REZUM, GREEN LIGHT OR TURP. I've discounted TURP pretty much instantly so it's now a question of REZUM or GREEN LIGHT. May I have your thoughts? My thoughts are REZUM doesn't appear to reduce a prostate by a significant amount but has a good side effect profile, whereas GREEN LIGHT reduces the prostate by quite a lot more but perhaps more side effects likely.
Rezum and Green light have 80-90% success rate of allowing most catheterized men to void again, a little lower than 98% with HoLEP. Rezum will take longer to improve symptoms (up to 2-3 months) and may entail several weeks of pelvic/prostate discomfort but does have advantages with potential sparing of ejaculatory function and can be done without anesthesia. Greenlight will have quicker results and lower need for retreatment than Rezum but is more invasive. The right choice for you will depend on your preferences and the council of your urologist who is familiar with the particulars of your case. I wish you well on your treatment journey.
@@austenslade126 unfortunately I haven't been offered HOLEP
@@austenslade126 and I'm correct in saying Green Light means retrograde ejaculation?
@@davidshaylor2449 in most cases yes
@@davidshaylor2449
HoLEP is always an option, where do you live? I may be able to steer you toward resources
Very informative! Thank you for sharing. Is HoLEP used for treating prostate cancer?
There are times where HoLEP may be performed in patients with prostate cancer, but it is not a prostate cancer treatment.
@@austenslade126 Thank you
One thing you didn't mention, does the size of the prostate determine if these procedures can be done? Such as one that's 300cc?
Great question, I owe a separate video dedicated to this topic. Most of the procedures mentioned are indicated for prostates
@austenslade126 thank you so much!
Thank you for your very clear explanation. If a surgeon is able to preserve semen ejaculation, does that mean that fertility and being able to father children would also be preserved? Would it also mean that urine would less freely travel through the urethra?
Preserving ejaculation would increase the odds of being able to father a child in the future if that were desired. In order to preserve ejaculation, part of the prostate must be left behind which can interfere with urine passage. Many men do well with ejaculatory preserving procedures, but it will never be as open or last as long as a HoLEP.
Thanks Dr. for a great video. I'm considering HoLEP and live in the Dallas/Fort Worth area. Can you recommend anyone as good as you?
I believe Dr. Jeff Gahan at UT Southwestern is offering HoLEP
Where do you practice, Dr. Slade?
I'm out in Boise, Idaho. We regularly have patients fly in from out of state, happy to accommodate.
Have had the UroLift TWICE and it only lasted about 3 years each time as you correctly stated that the prostate just swells up around and past the pins holding back the prostate. How will this complicate the HoLEP procedure with those pins & lines left in there? I'm on Xarelto blood thinner as well. Do you know if this is available in the "Piedmont Healthcare" network in the metro Atlanta GA area? Emory does it, but its a long trip for me to that hospital.
I have treated many patients after UroLift, the implants can jam the tool we use to remove the prostate tissue but this can be remedied. Xarelto increases the risk of bleeding after HoLEP once you start back up on your medication but is not a contraindication. Unfortunately I don’t know of anyone closer to you.
@@austenslade126 Thanks for your reply
I had the HoLEP procedure at Emory Hospital in downtown Atlanta almost 3 weeks ago. Dr Brendan Browne was my surgeon, and everything went perfectly! Went home,(to my Daughters house, because I live close to Savannah), same day without a catheter. Had bleeding which got to be less and less and by morning, my pee color was like pink lemonade. I haven't had any bleeding at all, since the first week, my flow is very strong, however, still have some urge incontinence, but hopefully will heal soon. I've worn protection way before the surgery, so wearing now doesn't bother me. I could probably go without protection, as long as I'm at home or close to a bathroom, but what the heck, it's just more convenient, and is part of my daily dress routine. It just takes the worry out of it. I highly recommend Dr. Brendan Browne as a HoLEP surgeon!!
@@hotrodhomefree I may have to go to Emory for the op, apparently no docs in the Piedmont Healthcare group do the thing.
HoLep can be done for Bladder Neck High ?
Yes, it corrects this too
Hello Dr. Slade,
In November, a 3x4 mm lesion was detected on MRI, I was diagnosed with Grade 1 adenosarcoma after biopsy Gleason 6 (3+3) 0.25 Decipher (middle of low risk range) PSA 5.7 but have been taking finasteride for ~15 years. I am 72 years old, otherwise healthy, and considered a good candidate for active surveillance. I forgot the size of prostate but was told it is large. The lesion is contained within the prostate at this point. Irregular cells noted in 30% of just one of the 10 cores taken.
I am bothered by waking every 3 hours to urinate and daytime urgency likely due to incomplete emptying of bladder.
Would I be a good candidate for HoLEP?
While I am providing my specifics, the question is whether in general, if cancer is already detected, if HoLEP is still appropriate.
In the process of enucleating the prostate, is there a concern for removing the "pulp" , disturbing and spreading the irregular cells noted on biopsy?
Thank you for sharing your expertise.
HoLEP has a great track record when performed in patients on active surveillance without concern for causing spread. Fortunately it can treat prostates of any size. I can't offer individual medical advice on this platform, but it would be worth consultation with a HoLEP surgeon.
@@austenslade126 I appreciate your reply. Idaho is somewhat of a long road trip but I did find a local HoLEPer at Yale. Looking forward to a consultation.
Sincere thanks for posting and your dedication to the profession.
Thanks doctor. Do you know of any site in Houston that offers this procedure and that you recommend? A name of a doctor would be helpful. I appreciate any help you can give.
My friend Ricardo Gonzalez at Houston Methodist
@@austenslade126 thanks doctor!!!
Why can't the Aquablation take out the whole pulp?
The water jet cannot rotate 360 degrees around and instead is directed posteriorly which leaves anterior prostate tissue behind. It rarely reaches all the way to the prostate capsule which is required to prevent regrowth. It also doesn’t have the precision to treat the pulp at the apex of the prostate (where the prostate meets the sphincter). Anywhere pulp is left behind there is an increased risk that treatment will be required again in the future.
Hi Dr Slade
I hope you can help I’m in United Kingdom
Iv struggling to urinate for 5 years very weak stream if I can get it to go
I’m having to self cafeteria it’s got so bad
The Dr is trying to tell me to have a euro lift
I’m only 58 and very active I run 10k in 37 mins
I’m frightened the clips will come adrift and Iv also been told it’s not a good option looking at a lot of reviews
Can you tell me about euro lift please ??
Thanks
I have just had an extremely successful HoLEP in the UK by an excellent surgeon. I can thoroughly recommend the procedure. I retained a catheter for one week after the surgery to ensure everything had healed but I had virtually nil blood in urine after the second day and only minimal discolouration of the urine in the first two days but absolutely no pain post operation. I found drinking a good volume of liquid as recommended by my surgeon really helped reduce the heamaturia. Immediately on removing the catheter I had total bladder control, no leakage or difficulty starting or stopping flow. There is at least a 30 weeek waiting list currently on NHS uK HoLEP 😊treatment so I elected to go privately at a total cost of £11845 and it was money very well spent!
Is Holep and the green lazer VERY SIMILAR ?
Both are done through the urethra, but the green laser will have outcomes and retreatment rates similar to TURP as it doesn’t remove all of the prostate “pulp” like HoLEP does
@austenslade126 Thankyou for your time in getting back to me.
Which one would be less invasive as far as retro ejaculation
There are various techniques for minimizing retro risk including Optilume BPH, Rezum, Aquablation, UroLift, or PAE. The best option for you may depend on things like prostate size and shape, as well as bladder function.
Is there a way to find a urologist in my area who is trained in HoLEP?
There's not an organized registry yet, but I may know who your nearest option is. What state or city are you looking in?
@@austenslade126 Clearwater, Florida
@@williamcroom4482 Dr. John DiBianco in Gainsville and Dr. Chandler Dora in Jacksonville would be your closest options I'm aware of.
@@austenslade126 Thanks
Who would qualify for Holep?
Almost everyone. If the prostate is determined to be the problem with urination and the patient is safe to undergo anesthesia then HoLEP is likely a great option. There are no prostate size limitations unlike many other procedures.
Thanks for your answers to my questions. I have 1 more: Why does the Prostrate gland enlarge? If it is no longer needed for it's purpose (for semon production), shouldn't it just shrink and wither away?
@@jk3horn We'll never know the cause for any one individual but age, genetics, hormone balance, diet, and other lifestyle factors can call impact its growth. I'd be nice if it just withered away since it's no longer needed but it decides to do the opposite in most cases :(
@@austenslade126 Thanks again for answering my questions so quickly. LOL 2 more: What diet and other lifestyle factors (if any) can prevent Prostate enlargement? I understand taking supplements such as Lycopene and Saw Palmetto can help. Do these help prevent cancer or enlargement?
Would you know if PAE procedure impacts the normal flow/discharge of ejaculate that would avoid retrograde ejaculation? Any stats on PAE and the probability of having another procedure.
PAE usually preserves ejaculatory function. Its success rates are similar to TURP, 10-15% failure in the first 1-3 years, 25% by 6 years
I had a PAE and it did nothing for me. Pre-surgery I had a die study to determine the viabilty of my arteries. It was determined that I was a good candidate for PAE. Had the PAE and when I woke up I was told that because my arteries were too small on one side they could only perform the PAE unilaterally. It would have been nice to have been informed about my arteries pre-surgery and therefore not wasted a bunch of money , time, and anxiety. My current urologist said that this happens relatively frequently, and the unilateral PAE's do not have good outcomes. (BTW, I also developed a blood clot in my arm post surgery which was another nightmare in and of itself).I urge you to ask your doc about the viability of your arteries before undergoing PAE!
@@paulhartshorn8880same here. Only did “one side,” on lobe. Prostate size reduced just 18% after 8.5 months. Looking at HOLEP now for this troublesome middle lobe.
Do you use a spinal or a ga? And why?😊
I have the most familiarity with ga but would offer spinal for interested patients or when it’s medically appropriate
I have the most familiarity with ga but would offer spinal for interested patients or when it’s medically appropriate
Sitting here at Midnight, just went thru my first Cystoscopy yesterday and it was very traumatizing procedure. i don't want to sit thru that again so i'm going with the HoLep. I live in Minnesota. My doctor seems fine but should i be seeking out someone whos perform many of these procedures. Dr Bergersen recommnded this procedure. but i'm not far from the mayo clinic. just wondering if i should consider making the drive.
Lots options in Minnesota, Dr Agarwal and Dr Borofsky at the University of Minnesota are both exceptional if that's closer to you, Mayo has a great crew as well.
I am in Orlando. Any HOLEP Surgeons here you would recommend?
@@hankhalbert6542 Spencer Hiller with Advent Health
@@austenslade126 Borofsky did mine 6 weeks ago & he's awesome!!!
@@austenslade126 Borofsky did mine 6 weeks ago & he's awesome!!!
What I dont' get (with any procedures): isnt the urethra destroyed with all those procedures?
the part of the urethra that travels through the prostate may be removed or altered depending on the procedure, but a new lining grows in over a span of 3 months and replaces any lost urethra
general anesthesia, I would assume?
Usually done under general but spinal may be an option if the circumstances require.
What about stents ¿
Urethral stents fall into a temporary treatment category, there are only a couple options on the market with more coming soon. I don't have any experience using them yet. This topic would be worth a future video, thanks for mentioning it.
Eurolift. 'permanent clips'. that is a joke. Those clips are anything but permanent. As the prostate continues to grow those clips can snap and end up in your bladder requiring surgery to remove them. Why is this still even consider as a treatment?
How does this effect your sex life? You are pretty much eliminating the prostate with this procedure.
If you have already had a Urolift procedure, is HoLEP possible?
Yes, this scenario comes up all the time. The laser is great at cutting through the UroLift material and is unlikely to impact healing or recovery
Rezum is supposed to be a barbaric horror show. So we can skip that one..........
The experience is variable from person to person but is usually well tolerated.
@@austenslade126 - Appreciate your candor and attempt to 'ease' ....what is already a well-known, very painful, uncomfortable, and possibly un-necessary procedure.
Recently I have been diagnosed with large prostate and the doctor mention the green light, later I learn about the Holep procedure than will be more a one time and done and no retouch ever again. Why anyone will want to do a procedure, than is not permanent? I am ready to do something more like the Holep but why the doctor will want to push for green light?
I did holep in Nashville at vanderbuilt urology with dr miller who is one of the best in the world! went in at 5:30 for preop and at 11 o’clock left. No postop pain catheter out almost immediately just minor blood in urine for a couple weeks little bit of bleeding Pee like a camel instantaneously I’m 76 years old. I’ve had BPH for 15 years this is an amazing result!
Dr. Miller is great, I'm happy to hear about your great outcomes. She's also a graduate of the Indiana University fellowship where I trained.