I have been thinking that someday In the future I am might need a TURP or something. I am 60 and having urinary issues from enlarged prostate. I have had labs to check for cancer and urine culture to rule out infection. I have not followed up with my primary dr but the labs were all normal.
I guess there is the drug Flonase.
Anyhow, thank you for prompting the discussion and information about the other procedure.
30 Days POST HoLEP Laser. Surgery: May 3, 2024
Anesthesia General: Propofol & Rocuronium (paralytic for ease of intubation and non-movement)
25g prostate size 105CC
MRI in leu of biopsy result: PIRADS II (not probable = INCONCLUSIVE)
Primary DX: BPH
Secondary DX: Hydronephrosis CKD 1, between eGFR: 69 & 75
61 year-old caucasian American in Barcelona, Spain. Aries.
I’ve been keeping an 8 liter- more than I need- water bottle near the bed for nighttime urination. It’s a simple roll-over, cap the bottle, go back to sleep. Just make sure that your protrusion is properly parked wishing the bottle or else you’ll have to reawaken, do a quick sheet change before anything gets to the mattress.
I bought some Chuck’s pads, which came in handy, but I only had to use them a few nights.
I also bought some “light” Men’s Brand underwear liners, which I still use while sleeping, but otherwise do not need. I have been going out of the house via “Commando-Style” to re-assure myself and stiffen my resolve. No dripping. I am able to stop the flow at-will. Masturbation is more comfortable, yet my urine is still cloudy in appearance, said to be normal according to online sources, I will confirm later by visit for blood and urine labs.
By week three, no more ache or pain. Sometimes an intermittent ache in the perineum area for a day, then it goes away. It’s nothing worth taking a Tylenol over, yet worthy of mention nevertheless.
DIETARY- POST SURGERY May 3-Present:
During the last three weeks I have been maintaining a diet high in fiber, mainly veg protein from garbanzos, black beans, white rice (for kidney) arugula, mixed lettuce, sweet potato, Sauerkraut (rinsed of salt), chicken tender sandwiches, yogurt unsweetened, whole grain bread, avocado, butter unsweetened, extra virgin olive oil, water and a weekly homemade electrolyte solution of bottled water, 2 TBSP lime juice, 1/16 Tsp. salt, 1/16 Tsp. raw sugar.
Weeks 3 & 4 No visible blood in the urine. Walking daily, although feeling tired and shakey. Insomnia, staring, mental fatigue, situation stress brought on by outside circumstances resulting in inflammatory response = high cortisol. Dark night of the soul.
Masturbation can bring on little pin-pricks during urination after retrograde ejaculation. Otherwise, it is satisfying, yet the sensual feeling of sperm coming through the urethra is missing. Confirmed today by the surgeon: the presence of pre-semen fluid is common because there are extra ducts located in the urethra, this may be due to existing inflammation (his conclusion).
Overall, I do not regret the HoLEP procedure and HIGHLY RECOMMEND it for BPH for acute urinary retention.
Here’s my reason: HoLEP is a “one and done” procedure. With TURP, or other prostate preserving procedures, there will ultimately be regrowth resulting in a repeat surgery WITHOUT Dutasteride or other shrinking medications that are shown to increase the incidence of Prostate cancer.
The procedure will, for most men, not require a blood transfusion (for those concerned with mRNA DNA insertion). The heat of the laser cauterizes the exposed areas of bleeding.
The HoLEP is the ULTIMATE BIOPSY. A normal biopsy can miss a small tumor malignancy, whereas the leftover ENTIRE morcellated (think- liver pate or peanut butter) prostate sample can be sent for pathology.
It’s important to demand an MRI prior to biopsy to determine if anything is significant to target a potential biopsy rather than suffer the complications of biopsy with the possibility of a negative when in my case, was a positive because it was not visible on MRI. Which is good news.
MY POST HOLEP PROSTATE PATHOLOGY RESULTS:
A finding of a 0.5 mm malignant tumor contained within the prostate was found.
How they can determine what the location was after the prostate was ground up into a pasty spread, maybe someone here can expound upon that?
Remember, the MRI was PIRADS II, which I came to the determination to be (we don’t know) INCONCLUSIVE.
The cytology of the whole prostate could be analyzed to the most minute increment at 0.5 mm.
Followup is determined after a routine PSA test for the prostate CAPSULE 4 months from today June 3, 2024.
The Gleason Score for this pathology is: T1a - detectable, non-palpable tumor undetected on imaging until after pathology.
Prognosis: Routine followup PSA, approx. 78% of men usually will not go on to develop progressive cancer detected during a period of X amount of years- I forgot the number of years.
Conclusion: Until four months from now at first PSA, I have no cancer spread of the 0.5mm that was found in the 25 gram prostate itself. Any rise in PSA will determine if there is any cancer that migrated to the capsule. Even though there is only a small tumor, it can still spread by way of the blood, because the prostate is a very vascular area even though it is less than 5% in most cases unless a higher PSA is detected. So I will live healthfully, try to recover from the two-year trauma of catheterization and waiting, death of mother, divorce from toxic person, threat of homelessness and lack of income anxiety that has aged me five years since this debacle. The upshot is that I made it, alone with no one’s help, I got this laser treatment through Spanish health that I would not otherwise get in the USA until too late and they caught this so far as they can detect, at 0.5mm. It’s important to be realistic for me, this isn’t ancient Rome and I don’t subscribe to Marcus Aurelius self-censorship.
I am looking forward to reclaiming a new life.
Here is a video I found that elaborates on this topic:
Hello, @jyuhanick. I hope to be of some help to you in deciding about how to address benign prostatic hypertrophy (BPH). I had the condition and my urologist performed a transurethral resection of the prostate (TURP), under anaesthesia in a hospital, about 10 years ago. I had two prominent results:
First, my urinary incontinence ended promptly and remains out of my life to this day. Second, removal of prostate tissue that was protruding into my bladder exposed a tumor in the bladder lining, which turned out to be a low-grade malignancy. Without the operation, I suspect that tumor -- and a dozen more that appeared within the following year -- would have taken my bladder (if not my life) by now. Instead, I'm in pretty good shape. The tumors all were growths in the superficial lining of my bladder; they were readily removed with a follow-up transurethral resection procedure. I would not hesitate to recommend that you choose a TURP if your urologist believes it is appropriate and that is reaffirmed by a second physician's opinion, preferably one from Mayo Clinic.
As to a HoLEP, I have no personal experience with it. However, I recently came across an article from Prevention magazine that you may wish to read and consider. Find it at http://www.prevention.com/health/health-concerns/morcellation-surgery-when-cutting-edge-kills. If the procedure would include morcellation of prostate tissue, there may be a risk of spreading diseased tissue around the inside of your bladder or along the urethra carrying urine outside your body. In my case, morcellation might very well have sliced up the hidden tumor in my bladder and seeded more tumors in my urinary system. In this case, as in connection with TURP, I recommend that you get a second opinion from Mayo Clinic before undergoing a HoLEP.
Unfortunately, there's no other way to bring the prostate out through the urethra. However, the outcome is not as equal as to say, if it were another procedure that missed the tumor.
After HoLEP, the chunks of prostate that were initially cut and pushed into the bladder are morcellated AFTER they are aspirated through the morcelletor scope, not morcellated within the bladder. The bladder is then irrigated for 24 hours with liquid, removing clots and remnants, not all. So, anything is possible, but the other risks of bleeding, transfusion to name a few are less with HoLEP. The morcellated prostate is the ultimate biopsy because they have the entire prostate to study rather than core samples that can miss something as small as mine at 0.5 mm. Also, the risks and complications of the transrectal biopsy are eliminated in the scenario, bleeding, infection, sepsis and elevated PSA.
I'm glad you posted that link, because as I mentioned in my post holep prostate pathology, 0.5mm tumor can still spread in a highly vascular area, and that part of the prostate can infiltrate the blood supply in the bladder, or through the capsule, especially if the surgeon is not skilled. Otherwise, I would do HoLEP again, if I had the choice. It appeared to be the best option for me.
I would suggest you also look into a PAE (prostate artery embolization). I had proton therapy which took care of my two tumors but still was on FloMax twice a day. The PAE that I had 18 months ago cured most of my symptoms. Normal flow but still get up 2-3 times per night. I'm 85 so that is somewhat normal for a bladder of my age. The PAE was a miracle for me as alpha blockers dangerously lowered my BP with any vigorous exercise (tennis). A urologist will seldom mention a PAE since it competes with their roto-router procedures. PAEs are done by the same doctors that put in stents. They went into my thigh, up into my aorta and then down to the two arteries going to my prostate and put small beads in them to block blood going to the prostate and therefore causing it to shrink. I was in and out in about 4 hours and was out walking my dog that evening. There was some minor pain urinating for about a week.
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I have been thinking that someday In the future I am might need a TURP or something. I am 60 and having urinary issues from enlarged prostate. I have had labs to check for cancer and urine culture to rule out infection. I have not followed up with my primary dr but the labs were all normal.
I guess there is the drug Flonase.
Anyhow, thank you for prompting the discussion and information about the other procedure.
Dr Dora did my Holep February 8th, 2024. No regrets.
From my understanding there is less chance of a future procedure following Holep.
My experience is logged here
https://connect.mayoclinic.org/discussion/holep-log/
30 Days POST HoLEP Laser. Surgery: May 3, 2024
Anesthesia General: Propofol & Rocuronium (paralytic for ease of intubation and non-movement)
25g prostate size 105CC
MRI in leu of biopsy result: PIRADS II (not probable = INCONCLUSIVE)
Primary DX: BPH
Secondary DX: Hydronephrosis CKD 1, between eGFR: 69 & 75
61 year-old caucasian American in Barcelona, Spain. Aries.
I’ve been keeping an 8 liter- more than I need- water bottle near the bed for nighttime urination. It’s a simple roll-over, cap the bottle, go back to sleep. Just make sure that your protrusion is properly parked wishing the bottle or else you’ll have to reawaken, do a quick sheet change before anything gets to the mattress.
I bought some Chuck’s pads, which came in handy, but I only had to use them a few nights.
I also bought some “light” Men’s Brand underwear liners, which I still use while sleeping, but otherwise do not need. I have been going out of the house via “Commando-Style” to re-assure myself and stiffen my resolve. No dripping. I am able to stop the flow at-will. Masturbation is more comfortable, yet my urine is still cloudy in appearance, said to be normal according to online sources, I will confirm later by visit for blood and urine labs.
By week three, no more ache or pain. Sometimes an intermittent ache in the perineum area for a day, then it goes away. It’s nothing worth taking a Tylenol over, yet worthy of mention nevertheless.
___________________________________________________________________________________________________________________________________________________
DIETARY- POST SURGERY May 3-Present:
During the last three weeks I have been maintaining a diet high in fiber, mainly veg protein from garbanzos, black beans, white rice (for kidney) arugula, mixed lettuce, sweet potato, Sauerkraut (rinsed of salt), chicken tender sandwiches, yogurt unsweetened, whole grain bread, avocado, butter unsweetened, extra virgin olive oil, water and a weekly homemade electrolyte solution of bottled water, 2 TBSP lime juice, 1/16 Tsp. salt, 1/16 Tsp. raw sugar.
__________________________________________________
Weeks 3 & 4 No visible blood in the urine. Walking daily, although feeling tired and shakey. Insomnia, staring, mental fatigue, situation stress brought on by outside circumstances resulting in inflammatory response = high cortisol. Dark night of the soul.
Masturbation can bring on little pin-pricks during urination after retrograde ejaculation. Otherwise, it is satisfying, yet the sensual feeling of sperm coming through the urethra is missing. Confirmed today by the surgeon: the presence of pre-semen fluid is common because there are extra ducts located in the urethra, this may be due to existing inflammation (his conclusion).
Overall, I do not regret the HoLEP procedure and HIGHLY RECOMMEND it for BPH for acute urinary retention.
Here’s my reason: HoLEP is a “one and done” procedure. With TURP, or other prostate preserving procedures, there will ultimately be regrowth resulting in a repeat surgery WITHOUT Dutasteride or other shrinking medications that are shown to increase the incidence of Prostate cancer.
The procedure will, for most men, not require a blood transfusion (for those concerned with mRNA DNA insertion). The heat of the laser cauterizes the exposed areas of bleeding.
The HoLEP is the ULTIMATE BIOPSY. A normal biopsy can miss a small tumor malignancy, whereas the leftover ENTIRE morcellated (think- liver pate or peanut butter) prostate sample can be sent for pathology.
It’s important to demand an MRI prior to biopsy to determine if anything is significant to target a potential biopsy rather than suffer the complications of biopsy with the possibility of a negative when in my case, was a positive because it was not visible on MRI. Which is good news.
MY POST HOLEP PROSTATE PATHOLOGY RESULTS:
A finding of a 0.5 mm malignant tumor contained within the prostate was found.
How they can determine what the location was after the prostate was ground up into a pasty spread, maybe someone here can expound upon that?
Remember, the MRI was PIRADS II, which I came to the determination to be (we don’t know) INCONCLUSIVE.
The cytology of the whole prostate could be analyzed to the most minute increment at 0.5 mm.
Followup is determined after a routine PSA test for the prostate CAPSULE 4 months from today June 3, 2024.
The Gleason Score for this pathology is: T1a - detectable, non-palpable tumor undetected on imaging until after pathology.
Prognosis: Routine followup PSA, approx. 78% of men usually will not go on to develop progressive cancer detected during a period of X amount of years- I forgot the number of years.
Conclusion: Until four months from now at first PSA, I have no cancer spread of the 0.5mm that was found in the 25 gram prostate itself. Any rise in PSA will determine if there is any cancer that migrated to the capsule. Even though there is only a small tumor, it can still spread by way of the blood, because the prostate is a very vascular area even though it is less than 5% in most cases unless a higher PSA is detected. So I will live healthfully, try to recover from the two-year trauma of catheterization and waiting, death of mother, divorce from toxic person, threat of homelessness and lack of income anxiety that has aged me five years since this debacle. The upshot is that I made it, alone with no one’s help, I got this laser treatment through Spanish health that I would not otherwise get in the USA until too late and they caught this so far as they can detect, at 0.5mm. It’s important to be realistic for me, this isn’t ancient Rome and I don’t subscribe to Marcus Aurelius self-censorship.
I am looking forward to reclaiming a new life.
Here is a video I found that elaborates on this topic:
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Like -
Helpful -
Hug
2 ReactionsUnfortunately, there's no other way to bring the prostate out through the urethra. However, the outcome is not as equal as to say, if it were another procedure that missed the tumor.
After HoLEP, the chunks of prostate that were initially cut and pushed into the bladder are morcellated AFTER they are aspirated through the morcelletor scope, not morcellated within the bladder. The bladder is then irrigated for 24 hours with liquid, removing clots and remnants, not all. So, anything is possible, but the other risks of bleeding, transfusion to name a few are less with HoLEP. The morcellated prostate is the ultimate biopsy because they have the entire prostate to study rather than core samples that can miss something as small as mine at 0.5 mm. Also, the risks and complications of the transrectal biopsy are eliminated in the scenario, bleeding, infection, sepsis and elevated PSA.
I'm glad you posted that link, because as I mentioned in my post holep prostate pathology, 0.5mm tumor can still spread in a highly vascular area, and that part of the prostate can infiltrate the blood supply in the bladder, or through the capsule, especially if the surgeon is not skilled. Otherwise, I would do HoLEP again, if I had the choice. It appeared to be the best option for me.
-
Like -
Helpful -
Hug
1 ReactionI would suggest you also look into a PAE (prostate artery embolization). I had proton therapy which took care of my two tumors but still was on FloMax twice a day. The PAE that I had 18 months ago cured most of my symptoms. Normal flow but still get up 2-3 times per night. I'm 85 so that is somewhat normal for a bladder of my age. The PAE was a miracle for me as alpha blockers dangerously lowered my BP with any vigorous exercise (tennis). A urologist will seldom mention a PAE since it competes with their roto-router procedures. PAEs are done by the same doctors that put in stents. They went into my thigh, up into my aorta and then down to the two arteries going to my prostate and put small beads in them to block blood going to the prostate and therefore causing it to shrink. I was in and out in about 4 hours and was out walking my dog that evening. There was some minor pain urinating for about a week.
-
Like -
Helpful -
Hug
1 Reaction