Had this done on june 13 2023. Changed my life! Not bad at all for me. Catheter worse part and it was removed after 20 hours. My dr keeps all his patients overnight for observation. Removed 69 grams, benign. Instant relief. Blood for 3 days. Slight urge incontinence but almost all gone now. Bladder has learned the new situation and it is glorious. Dry… but couldn’t care less. Everything is functional. Im 62. No reason anymore to suffer with this condition. Dr Gridley at Duke health in Raleigh performed the procedure😁
Thank you Dr Sobol!! You are one of the best physicians I have ever dealt with. I am in awe that you care about the “whole” patient not just the problem. You made a difference today in mine and my husband’s life simply by caring!
I will be getting the HoLEP procedure in about a month. I have watched numerous videos on the subject but this one was particularly helpful in understanding the goal of the procedure and possible side effects. Thank you!
I just got a consult referral from the V.A. to your office today Dr. Sobol, so I hope that you and I will be able to schedule an appointment soon. I also have a prostate biopsy scheduled 13 Nov that will be performed by my V.A. urologist.
Thank you Dr. Sobol for a very informative video. I was referred to you by Dr. Slade in Iowa as i am in Burkeville, VA. He said to say hello. I’m a Humana Medicare patient and 67 years old. It’s more of a lifestyle problem for me. We have 7 kids still at home, aged 3-17 (out of 13), and every year we take a 30 day cross country camping road trip with all the kids. The frequent stops to urinate is getting me weary as well as the rest of my family. I hope to make an appointment with you soon as time permits. How far out are your appointments? I had an MRI done two years ago at Virginia Urology (instead of traditional biopsy). Results came back negative. Dr. Nelson at Virginia Urology was great to work with.
Thank you Dr. Sobol for this video. Most urologist posted videos about this procedure but do not explain relationship between the bladder and the prostate like you did. (i.e. overactive bladder and enlarged prostate)
Thanks for your comment James. It is important to remember that that is not always a relationship. Although more rare in men, it is possible to have a true overactive bladder without an obstructive prostate. In those men doing a prostate surgery will not improve their symptoms. It is the task of the urologist to figure out based on objective data whether the obstruction is the cause of the overactivity. We usually utilize cystoscopy, transrectal ultrasound with a good clinical history and physical examination with or without either a UroCuff or a formal urodynamics to answer that question. Most men do not require urodynamics but sometimes I use that to help understand about obstruction. Thanks again for your comment and I’m glad you find this video helpful.
@@ilya85 Thank you for your explanation on this topic. To be honest, the information you provided is very educative on this topic. Please just one more question, am due for this procedure very soon and can't remember the urologist performing cystoscopy and transrectal ultrasound on me. Although he did recommend me for an MRI scan of my prostate and lots of blood test including physical tests through the back passage. He discussed the result to be cancer-free but that prostate was very big over 100cc and recommended HoLEP. So the question is it at the point of the surgery that they perform cystoscopy? Would this not be too late if they found out the prostate although may be big but actually not the issue but the overactive bladder? This is taken into consideration that I have all the symptoms of the BHP. And in this case would the surgeon continue with the procedure or stop the procedure. I understand you may not be able to speak for other doctors but what is the normal practice in this case. Many thanks
Although my prostate is only estimated at 47 gms my urologist has suggested HOLEP as there is scar tissue present from a TURP op 10 years ago.Would you agree with that or are there less invasive,better treatments i can consider please ?
@@eddierubio2796 hi there it was a NHS doctor in Manchester.. U have to find a doctor that has the Holep Lazer available.. Not the turps that seems to be standard.. I was offered Turps operations but turned it down because of impotence risks. I can assure you the Holep is fantastic and quick recovery.. I am perfect again after years of suffering from prostitius pain in rectum and unable to pass. courses of antibiotics at least 4 x . I was taking the shouted about great prosta genix that is supposed to be a wonderful pill. cost me lots of money and useless along with all these potions on the market. once the damn prostrate gets pressing on the bladder there is no cure but surgery.. The camera doesn't lie I saw mine and it was blocking my bladder entrance.. Best of luck. I think Birmingham has a clinics probably better than London
I've heard from multiple sources, that there is an ejaculation preservation HOLEP. Basically they leave tissue untouched 1-2 cm from the verumontanum, area where your ejaculation ducts are located. The procedure has also been successful with TURP.
Absolutely. I routinely do redo surgery for other failed procedures such as urolift, rezum, Turp, PVP, Aquablation. Holep is the most maximally effective procedure for optimal De-obstruction and is a great option for salvaging a previously ineffective procedure.
GA. It’s how I was trained and makes same day discharge easier because up and ambulating immediately, usually can discharge < 2 hours post op. Also less variable case to case, decreases movement during case. LMA usually but of course up to anesthesia team. I know there are folks who do HoLEP under spinal and do well also.
I just had this done 2 months ago and I would say proceed with caution and take note that the sell sheet for this procedure is misleading for most. Im still having issues with some of the side effects and was advised by my surgeon that recovery is more like 4 months. In addition, they say the ejaculation sensation is pretty much the same with retrograde. Far from it Id say about 1/4 of the original feeling and feels incomplete. Only get Holep if you absolutely need it. So far 2 months of major peeing pain and which shoots up the rectum and piercing pain in the urethra. The Dr does point out the bladder has been conditioned so for it to adapt to the procedure will probably take a year. Knowing what I know now I probably would have waited.
I definitely support folks thinking through their decision before proceeding. The trade off to curing (not treating as other procedures do), but truly curing BPH is AT LEAST 3 months of frequency, urgency, possible burning, possible leakage. There is no free lunch in life. For the most durable and curative BPH procedure there is absolutely a price to pay. There are other procedures that have less recovery but are LESS effective especially in long term. Like all things in life - there are no solutions, only trade offs. I would love to hear how you are recovering once you get to 6 months post op. And especially would love to hear from you 20 years from now when you are still doing great with no meds, no more surgeries, no elevated psa, no urology visits. Ultimately you are correct though- gotta make sure it’s right for the person. If the disease is not that bad - no need for cure. Treatment might be enough.
@@ilya85 well I'm just saying the SELL sheets floating about need to be changed. Even my hospital release notes with what to expect say 4 weeks, and when you say no change in ejaculation sensation that needs to be changed, there is a HUGE difference in sensation. HUGE. As for the future, we will see if future issues happen. Post surgery i ended up with a hydrocele. This didn't show in the MRI, pre operation, I was told it had nothing to do with the surgery. But it could have happened with the cath treatment or when i had cath blocks and they had to irrigate me which then came with a bladder spasm. Infection could have happened. These things Im told are common cept you do not see that anywhere until i happens to you. Then all of a sudden you have new complications. Seems like lots of things can go wrong post op and theres no real discussion about that. The drugs I have been prescribed seem ridiculous and would cause more problems.I'm now taking Alfuzosin, this is something that one takes as a solution to avoid getting the procedure if it works. My peeing habits had very little issues before the operation. I did have a great surgeon but he only has control of the operation which im told went well. Youre right there is no Free lunch and that should be strongly stated not for shadowed by the sell sheet especially the sensation part. WRONG .. sorry if you feel I've offended you. Ill come back and let you know how things are progressing. So far im not one of the super success stories.
sounds like it’s been rough. I hope it turns around and you have a good outcome in the end. Agree with you we should undersell and overdeliver. I do quite a bit of counseling personally before and after surgery that is not reflected into video to ensure people are prepared. There’s no such thing as disappointment in life - only inappropriate expectations
I was seriously considering HoLEP as my procedure of choice until it was mentioned that retrograde ejaculation is a common and permanent side effect. I had RE as a result of some medication I was taking for BPH and it's not pleasant at all, and I changed meds because of this side effect. I will have aquablation instead, even if I have to repeat down the line.
The incidence of retrograde ejaculation after Aquablation is only 15% which is much lower than Holep, but still a possibility. There is also increased bleeding risk and transfusion risk with Aquablation, as well as increased need for possible re-operation In the future. That being said, preservation of ejaculation is probably the only reason not to have a Holep. A recent study suggested that loss of ejaculation does not have significant impact on quality of sexual function and satisfaction for majority of men. Of course, if you find that this was important to you, then Holep is not the correct procedure for you. Glad you were able to find a good option that suits your needs and goals of care.
@@ilya85 Thank you so much for the communication. After my appointment today with my Urologist today he did suggest the HoLEP procedure. I have chronic prostatitis and recurrent infections because I can not empty my bladder completely because of BPH. He said due to the inflammation and infections they like to remove as much tissue as possible to prevent these symptoms from coming back. He will try and not cut the bladder neck to preserve forward ejaculation if possible. He said he has a pretty good track record doing this. I hope I am one of the lucky ones! Thanks again for your informative video!
@@LALRGuy RE is not painful but I didn't have the same sensation during orgasm. I decided on "Aquablation" and I had the procedure one month ago. I'm very pleased with the results and no retrograde ejaculation.
I had the holep procedure at Yale New Haven 6/23. My BPH was so bad it put me in stage 5 kidney failure.. A urinary catheter was put in 2 weeks before the procedure. Dr. Kellner and his team was very professional. I was the 3rd procedure of the day . The irrigation catheter was very uncomfortable. Opium took care of that the next morning the catheter was removed. When I was able to urinate I was discharged. I had no problems , no pain after and now pee like a 25 year old. I was incontinent for a couple months and it gradually went away. My kidney function has improved to where it is stable. Glad I had it done.
I've heard from multiple sources they have an ejaculation preservation HOLEP. Basically they leave tissue untouched 1-2 cm from the verumontanum, area where your ejaculation ducts are located. The procedure has also been successful withTURP.
Absolutely 100%. Would say based on AUA guidelines anything over 80gm. Furthermore, if loss of ejaculation as a side effect is not a concern, then Holep is gold standard for BPH- independent of size.
Had this done on june 13 2023. Changed my life! Not bad at all for me. Catheter worse part and it was removed after 20 hours. My dr keeps all his patients overnight for observation. Removed 69 grams, benign. Instant relief. Blood for 3 days. Slight urge incontinence but almost all gone now. Bladder has learned the new situation and it is glorious. Dry… but couldn’t care less. Everything is functional. Im 62. No reason anymore to suffer with this condition. Dr Gridley at Duke health in Raleigh performed the procedure😁
Thank you Dr Sobol!! You are one of the best physicians I have ever dealt with. I am in awe that you care about the “whole” patient not just the problem.
You made a difference today in mine and my husband’s life simply by caring!
Thanks so much for your kind words.
I will be getting the HoLEP procedure in about a month. I have watched numerous videos on the subject but this one was particularly helpful in understanding the goal of the procedure and possible side effects. Thank you!
I just got a consult referral from the V.A. to your office today Dr. Sobol, so I hope that you and I will be able to schedule an appointment soon. I also have a prostate biopsy scheduled 13 Nov that will be performed by my V.A. urologist.
Thank you Dr. Sobol for a very informative video. I was referred to you by Dr. Slade in Iowa as i am in Burkeville, VA. He said to say hello. I’m a Humana Medicare patient and 67 years old. It’s more of a lifestyle problem for me. We have 7 kids still at home, aged 3-17 (out of 13), and every year we take a 30 day cross country camping road trip with all the kids. The frequent stops to urinate is getting me weary as well as the rest of my family. I hope to make an appointment with you soon as time permits. How far out are your appointments? I had an MRI done two years ago at Virginia Urology (instead of traditional biopsy). Results came back negative. Dr. Nelson at Virginia Urology was great to work with.
Thank you Dr. Sobol for this video. Most urologist posted videos about this procedure but do not explain relationship between the bladder and the prostate like you did. (i.e. overactive bladder and enlarged prostate)
Thanks for your comment James. It is important to remember that that is not always a relationship. Although more rare in men, it is possible to have a true overactive bladder without an obstructive prostate. In those men doing a prostate surgery will not improve their symptoms. It is the task of the urologist to figure out based on objective data whether the obstruction is the cause of the overactivity. We usually utilize cystoscopy, transrectal ultrasound with a good clinical history and physical examination with or without either a UroCuff or a formal urodynamics to answer that question. Most men do not require urodynamics but sometimes I use that to help understand about obstruction. Thanks again for your comment and I’m glad you find this video helpful.
@@ilya85 Thank you for your explanation on this topic. To be honest, the information you provided is very educative on this topic. Please just one more question, am due for this procedure very soon and can't remember the urologist performing cystoscopy and transrectal ultrasound on me. Although he did recommend me for an MRI scan of my prostate and lots of blood test including physical tests through the back passage. He discussed the result to be cancer-free but that prostate was very big over 100cc and recommended HoLEP. So the question is it at the point of the surgery that they perform cystoscopy? Would this not be too late if they found out the prostate although may be big but actually not the issue but the overactive bladder? This is taken into consideration that I have all the symptoms of the BHP. And in this case would the surgeon continue with the procedure or stop the procedure. I understand you may not be able to speak for other doctors but what is the normal practice in this case. Many thanks
@@jamesshall5160 for that question recommend you speak to your urologist
Although my prostate is only estimated at 47 gms my urologist has suggested HOLEP as there is scar tissue present from a TURP op 10 years ago.Would you agree with that or are there less invasive,better treatments i can consider please ?
Could you elaborate on the use of botox during the Holep procedure? When is it indicated and why would you use it? Thanks for a great video.
Had my Holep operation in UK . All I can say it's brilliant 3 days on I'm up and about.. Passing excellent no problem at all..
Who was the doctor ? I am in London and looking
@@eddierubio2796 hi there it was a NHS doctor in Manchester.. U have to find a doctor that has the Holep Lazer available.. Not the turps that seems to be standard.. I was offered Turps operations but turned it down because of impotence risks. I can assure you the Holep is fantastic and quick recovery.. I am perfect again after years of suffering from prostitius pain in rectum and unable to pass. courses of antibiotics at least 4 x . I was taking the shouted about great prosta genix that is supposed to be a wonderful pill. cost me lots of money and useless along with all these potions on the market. once the damn prostrate gets pressing on the bladder there is no cure but surgery.. The camera doesn't lie I saw mine and it was blocking my bladder entrance.. Best of luck. I think Birmingham has a clinics probably better than London
I've heard from multiple sources, that there is an ejaculation preservation HOLEP. Basically they leave tissue untouched 1-2 cm from the verumontanum, area where your ejaculation ducts are located. The procedure has also been successful with TURP.
Turp is painful and needs to be redone on a regular basis. No thanks.
How many have you done and do you do yourself and not a trainee and would you have it done and by whom?
How do compare this to GreenLight laser?
So you have increased the bladder size? What happens to your bladder neck? Or internal sphincter?
It would be useful to improve audio ,
I think you need to make appointment with surdology doctor or clean your ears at least once a month 😅.
Can you have a HoLep procedure after three years, of a failed Rezum procedure? And do you go home with a Cath?
Absolutely. I routinely do redo surgery for other failed procedures such as urolift, rezum, Turp, PVP, Aquablation. Holep is the most maximally effective procedure for optimal De-obstruction and is a great option for salvaging a previously ineffective procedure.
Which method do you use to stop any pain ? Ga or spinal tab and why?
GA. It’s how I was trained and makes same day discharge easier because up and ambulating immediately, usually can discharge < 2 hours post op. Also less variable case to case, decreases movement during case. LMA usually but of course up to anesthesia team. I know there are folks who do HoLEP under spinal and do well also.
I just had this done 2 months ago and I would say proceed with caution and take note that the sell sheet for this procedure is misleading for most. Im still having issues with some of the side effects and was advised by my surgeon that recovery is more like 4 months. In addition, they say the ejaculation sensation is pretty much the same with retrograde. Far from it Id say about 1/4 of the original feeling and feels incomplete. Only get Holep if you absolutely need it. So far 2 months of major peeing pain and which shoots up the rectum and piercing pain in the urethra. The Dr does point out the bladder has been conditioned so for it to adapt to the procedure will probably take a year. Knowing what I know now I probably would have waited.
I definitely support folks thinking through their decision before proceeding. The trade off to curing (not treating as other procedures do), but truly curing BPH is AT LEAST 3 months of frequency, urgency, possible burning, possible leakage. There is no free lunch in life. For the most durable and curative BPH procedure there is absolutely a price to pay. There are other procedures that have less recovery but are LESS effective especially in long term. Like all things in life - there are no solutions, only trade offs. I would love to hear how you are recovering once you get to 6 months post op. And especially would love to hear from you 20 years from now when you are still doing great with no meds, no more surgeries, no elevated psa, no urology visits. Ultimately you are correct though- gotta make sure it’s right for the person. If the disease is not that bad - no need for cure. Treatment might be enough.
@@ilya85 well I'm just saying the SELL sheets floating about need to be changed. Even my hospital release notes with what to expect say 4 weeks, and when you say no change in ejaculation sensation that needs to be changed, there is a HUGE difference in sensation. HUGE. As for the future, we will see if future issues happen. Post surgery i ended up with a hydrocele. This didn't show in the MRI, pre operation, I was told it had nothing to do with the surgery. But it could have happened with the cath treatment or when i had cath blocks and they had to irrigate me which then came with a bladder spasm. Infection could have happened. These things Im told are common cept you do not see that anywhere until i happens to you. Then all of a sudden you have new complications. Seems like lots of things can go wrong post op and theres no real discussion about that. The drugs I have been prescribed seem ridiculous and would cause more problems.I'm now taking Alfuzosin, this is something that one takes as a solution to avoid getting the procedure if it works. My peeing habits had very little issues before the operation. I did have a great surgeon but he only has control of the operation which im told went well. Youre right there is no Free lunch and that should be strongly stated not for shadowed by the sell sheet especially the sensation part. WRONG .. sorry if you feel I've offended you. Ill come back and let you know how things are progressing. So far im not one of the super success stories.
sounds like it’s been rough. I hope it turns around and you have a good outcome in the end. Agree with you we should undersell and overdeliver. I do quite a bit of counseling personally before and after surgery that is not reflected into video to ensure people are prepared. There’s no such thing as disappointment in life - only inappropriate expectations
I was seriously considering HoLEP as my procedure of choice until it was mentioned that retrograde ejaculation is a common and permanent side effect. I had RE as a result of some medication I was taking for BPH and it's not pleasant at all, and I changed meds because of this side effect. I will have aquablation instead, even if I have to repeat down the line.
The incidence of retrograde ejaculation after Aquablation is only 15% which is much lower than Holep, but still a possibility. There is also increased bleeding risk and transfusion risk with Aquablation, as well as increased need for possible re-operation In the future. That being said, preservation of ejaculation is probably the only reason not to have a Holep. A recent study suggested that loss of ejaculation does not have significant impact on quality of sexual function and satisfaction for majority of men. Of course, if you find that this was important to you, then Holep is not the correct procedure for you. Glad you were able to find a good option that suits your needs and goals of care.
@@ilya85 Thank you so much for the communication. After my appointment today with my Urologist today he did suggest the HoLEP procedure. I have chronic prostatitis and recurrent infections because I can not empty my bladder completely because of BPH. He said due to the inflammation and infections they like to remove as much tissue as possible to prevent these symptoms from coming back. He will try and not cut the bladder neck to preserve forward ejaculation if possible. He said he has a pretty good track record doing this. I hope I am one of the lucky ones! Thanks again for your informative video!
@@LALRGuy RE is not painful but I didn't have the same sensation during orgasm. I decided on "Aquablation" and I had the procedure one month ago. I'm very pleased with the results and no retrograde ejaculation.
I had the holep procedure at Yale New Haven 6/23. My BPH was so bad it put me in stage 5 kidney failure.. A urinary catheter was put in 2 weeks before the procedure. Dr. Kellner and his team was very professional. I was the 3rd procedure of the day . The irrigation catheter was very uncomfortable. Opium took care of that the next morning the catheter was removed. When I was able to urinate I was discharged. I had no problems , no pain after and now pee like a 25 year old. I was incontinent for a couple months and it gradually went away. My kidney function has improved to where it is stable. Glad I had it done.
I've heard from multiple sources they have an ejaculation preservation HOLEP. Basically they leave tissue untouched 1-2 cm from the verumontanum, area where your ejaculation ducts are located. The procedure has also been successful withTURP.
Is this procedure OK for someone that has a 200 gm prostate.
Yup. It is size independent.
Mine was 180 gm … was done 12 August 2024 …. Now I piss like a horse …. 650 ml no problem
You can not spare the sperm ducts?
Are
Dr. Sobol: Would you agree that HOLEP is currently the "gold standard" for prostates larger than 120 grams?
Absolutely 100%. Would say based on AUA guidelines anything over 80gm. Furthermore, if loss of ejaculation as a side effect is not a concern, then Holep is gold standard for BPH- independent of size.