Connect
HoLEP vs aquablation vs ? which is best procedure to preserve all func
60 yr male. 15+ years ago Total colectomy with reattachment. Salt kidney stones a couple of times, lithitripsy. 1 small area biopsey positive prostate cancer. Following year negative biopsy. No biopsy following 2 years. Low PSA. 1 month ago blood in urine went to local ER. UTI led to foley catheter, antibiotics, finding kidney stone, . Radiologist said not blocking. 1 month later fever, low blood pressure. Went to Chicago hospital another infection, different radiologist same kidney stone is blocking, bladder wall thickened is 2cm, normal is .5 . prostate 63cm. Neph tube, antibiotics, still have catheter. New urologist wants to break up stone and do HoLEP remove All material in prostate. I want best procedure to resolve issues, preserve bladder function, urination control, and sex function. Least amount of risk. Of course optimum goals most would want. In a few days urologist wants to break up stone (will eliminate all in that kidney); and HoLEP to remove all tissue in prostate. He says alternative procedures fail in a few years and is concerned about bladder getting worse if that happens. 1 and done for enlarged prostate. I am not against retreat at a later date if better results and less negative side effects. He Strongly advises Holep. Another Chicago hospital says they offer all options. Is Aquablation, Optilume, or anothet procedure, research trial procedure better option? Anyone have info. Any Dr with info. Thank you for any help, Truly appreciate You!
Like
Helpful
HugInterested in more discussions like this? Go to the Men's Health Support Group.
Connect
I had aquablation in September 2024. I was completely asymptomatic until my prostate completely shut me down. I lived on a Foley catheter for 4 months, and had two bacterial infections, while I learned and considered options. I'm in Connecticut and Yale has one of the best Holep surgeons in America. He guaranteed me I'd never need surgery again, and that I'd be shooting backwards. I couldn't get comfortable with the idea of a laser burning out most of my prostate. Connecticut has one surgeon at Middlesex hospital who does aquablation. Make a long story short...I'm still peeing normally and have not lost an sexual function. You will bleed more with aquablation...it's a temporary thing. I was 120 grams...now I'm guessing around 60...still large. I'm 66 and in good shape. I eat lots of broccoli and pumpkin seeds. If I ever run into problems again I wouldn't hesitate to do another aquablation. They keep making the equipment better and the surgeon is now capable of making multiple passes. I hope that helps.
@tkohler
I notice you did not mention PAE, which I understand has been growing in popularity. I also had heard urologists don’t recommend it since they don’t get to do the surgery but rather interventional radiologists do most of the work.
@scien123 I have gone through the Rezum therapy. Did not really do much for me, I know I will need something else soon. I too had heard so much about PAE, so I did a MedLine research. The very first article I read described how one patient nearly lost his glans as the artery that fed the prostate also fed that area, whether it be typical or anomalous. That was something that I must say probably soured me on PAE although I realize that the likelihood of this unpleasant event to be minimal.
Good point.
PAE is up and coming however lacks rigorous long term follow up. There is a reason for this - interventional radiologists aren't equipped (flow testing, u/s to check for post void residual) and don't have clinics to monitor long term outcomes (3 month post op checks followed by yearly follow up). The difference in follow up makes it very difficult to know what the true outcomes of the procedures actually are. When we looked at the data about 5 years ago, the AUA recommended PAE to be considered experimental. Since that time, more studies have come out and now PAE is considered to be at the level of MIST treatments (minimally invasive like urolift or rezum which make a trade off of durability for sparing of sexual side effects). Like all BPH treatments it is probably best served in specific clinic circumstances. PAE largely works by shrinking the prostate by choking off the blood supply to the gland - the amount of tissue that goes away is variable, and this really, really varies based on the accuracy and vigilance of getting the key blood vessels going to the prostate - this is not easy by any means. Patients should consider taking dutasteride or finasteride for a year as this mimics the approach without ANY surgical risk (reduces blood supply to prostate and thus shrinks it). In my mind, PAE is promising but not yet proven for the average BPH patient, I have seen several PAE failures for which I had to resect residual tissue. In my mind, the current ideal candidate is someone on blood thinners who cant come off of them with an enormous gland and is pretty sick (risky for anesthesia). We have exceptionally talented IR MDs in Rochester who I have personally seen operate - so if you opt for this approach come to Mayo. Hope this helps.
Dr. Kohler
Professor of Urology
Mayo Clinic Rochester, MN
-
Like -
Helpful -
Hug
1 Reaction@tkohler
Thank you so much for this info. I feel that the data about "Sexual Side Effects" is interesting but also vague. My own surgeon (I had a successful HOLEP procedure two years ago) said that there's basically one question on the questionnaire, "Are you satisfied with your sexual activity after surgery" without diving in a little deeper. I'm fine with RE (and as I've said on this board before, my wife is THRILLED with it) but like a lot of other guys my experience with the quality of orgasm has been weird to say the least. At first, it only felt 90% as powerful as before, but after a few months it improved in ways I'm not sure I can describe yet - "very good, just different, and unsure if satisfied or not." Anyway, I can see why surgeons might not mention this before a procedure, as it could unnecessarily frighten guys off.
Guys hate to break it to you, but surgeon payments are driving some of these procedures. True surgical procedures like Holep and Aquablation don’t pay the surgeon very much, but they’re widely used because they work and have loads of clinical data. On the other hand PAE has barely any data but is being used because the payments to the physician are 10-20x more than a true surgical procedure. Radiologist performs it but the urologists are part of the business so they get a portion of the fee. I didn’t believe it at first but did my own research and now it all makes sense.
@tkohler thank you for this very informative post.
You do have a lot going on. I recently had aquablation and im doing well. But given the condition of your bladder, if I was you I would probably lean toward holep simply to give your bladder the greatest chance at long term recovery since it removes all possible physical obstructions. For good.
But yes, it does cause loss of ejaculation. If you do go holep the experience of the surgeon is critical. You want someone who has done 100s not 10s of procedures. Good luck with whatever you choose.
67 year old in good health and reside in Northern Virginia.
Have had both Artery Embolization and Aquablation to treat an enlarged prostate. The first AE procedure did not work and so did the second aquablation procedure as this was the next least invasive procedure. This procedure worked (solved flow, urgency, and periodicity issues) without impacting sexual function. Important to look at the statistics for all these prostate treatment procedures in terms of side effects - sexual dysfunction, recover time, etc. However, there was a complication factor where stones were developed as part of the healing process and caused bleeding and uncomfortable urination especially after vigorous exercise - running, cycling. So far so good and it has been 4 months since the laser work to break up the bladder and prostate stones.
Hope this helps.