Connect
← Return to HoLEP vs TURP: Looking for guidance
Discussion
HoLEP vs TURP: Looking for guidance
Men's Health | Last Active: Jun 17 6:43am | Replies (45)Comment receiving replies
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.
Replies to "Hello, @jyuhanick. I hope to be of some help to you in deciding about how to..."
@tlk1951, you raise a good question about whether morcellation might be used in your laser surgery using HoLEP to remove excess prostate tissue. The answer must come from the physician who knows -- your Mayo surgeon.
In my case, a large piece of my prostate was cut up and removed through my urethra in a TURP procedure over 9 years ago. A small malignant tumor on my bladder lining (hidden by the excess prostate tissue) also was removed, and six weeks later a dozen more small tumors on the lining of the bladder were removed in a TURB procedure. Since then (over 8 years) periodic cystoscope examinations of my bladder and urethra have detected no new tumors, and those exams are now performed once a year.
I don't know of any comments by Mayo physicians on the Prevention article, but I'm confident that no medical teams are better than those at Mayo to answer your question. I know that your urologist will provide any information you feel the need for before you undergo the HoLEP procedure in February. Best wishes for a successful procedure. Please remember that we'll be rooting for you.
Martin
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.
Connect
@predictable Has any doctor from the Mayo Clinic commented on this article as it might relate to a HoLEP procedure? The article focuses on morecellation of the uterus with pieces floating throughout the body. In the case of HoLEP, the pieces are pretty contained in the bladder and are immediately flushed out. Might that make a difference?