Getting ready to choose HoLEP vs Aquablation

You sound like me 5 years ago. I lived with a very large prostate that was 200 when I had my HOLEP. I took Flowmax and dutasteride for years, high PSA, chronic Prostatitis, holding to much urine in bladder, stomach tender to touch, etc. For the last 3 months before my HOLEP I had to self catheter. I also had Biopsies and MRI'S and all came back negative. The Doctor took out about 90% of my Prostate and as you may know it is sent to the lab for Cancer review. Fortunately for me all was clear.
I reviewed the various procedures and based on my prostate size and outcomes of most patients I felt HOLEP was my best choice. My surgery lasted 2.5 hours and I spent the night in the hospital. The next say the catheter was taken out and I was able to pee like college. Went home, was in diapers for 2 weeks where there was blood and some leakage. After 3 weeks all seemed to clear up and other than retro (which I had with Flowmax)
I have had no problems. Quality of life far better.

You are doing the correct review as YOU need to select the procedure that you feel is best for you. There are many procedures as there are cars and for the most part the Doctor will sell what they know.

Wish you the best and hope this is of some help.

I believe I have read here that getting up to the necessary HoLEP skill level requires 100-200 procedures; whereas the Aquablation has more of a computer technical component reducing the art and number of procedures to 50. Most of the posts emphasize the procedure differences. The equal or more important component is the skill of the applicator. I suggest listening to Condoleezza Rice's modified advice. "Distrust and verify" even at the most prestigious institutions. July 1st is when new residents begin their training [Earn while you learn"] Medicare pays for the learning and allows beneficiaries to decline resident surgeon's care.

@skipz Thanks for your reply.

After reading many of the posts on here, I get to wondering if I am deciding too early. My symptoms don’t seem to be as bad as many of the guy’s. I have had a few times that I could not start to urinate, or the stream was only a dribble where I was wishing to insert a catheter to relieve the pressure.

I get the feeling like I am spending too much time every day doing research. How much is too much? I am spending time researching when I should be doing other things.

I’ve mentioned to two urologists that if I am about to start to pee before I have the toilet lid up, or otherwise not ready, I should not squeeze my penis with my thumb and fingers to physically delay the flow. If I do I feel a ripping or burning in the area of my prostate and blood comes out with the urine. This has been going on for maybe 10 years. The bleeding lasts for about two days. Neither seemed to be concerned enough to want to find out where the bleeding was coming from. I’d like to hear if other guys have experienced this.

The nurse practitioner I talked with said the doctor has performed many HoLEP procedures. I asked if it was more than 1000 and she said no. After a few more questions she said about 4 per week and his complications after surgery is within the normal rate.

I guess the material removed by HOLEP is sent to pathology to look for cancer cells. I haven’t read that this is usual for Aquablation. I guess that the material removed with Aquablation would make it difficult to tell where the cancer cells came from.

@thmssllvn Thank you for the numbers. Those are good to know. I'll have to ask the doctors how many they have performed and what their complication rates are. I also must ask if the doctor is going to do the actual procedure. If not, are they going to be right there guiding the intern? If not, why am I talking with them?

You can not spend too much time researching! You didn't mention your age and how important normal ejaculation is to you. Best chance of that is with Aquablation. If thats what you choose, be aware of the post op issues and only go to a Urologist/Center that does lots of these. If you choose HoLEP you will have retrograde ejaculation, it does allow for a pathology exam of the "chips" and will remove >80% of the prostate. Your PSA will fall below 1.0. If you go with HoLEP - I can not stress this enough - you must have a highly skilled surgeon! If you don't your risk of incontinence and other issue is very real. I had HoLEP with Dr Austin Slade in Boise, ID. Look him up, he has a good website and is on YouTube. Extraordinary surgeon, I'm very happy

@soor Thank you. I didn't think of adding my age, even in the notes I took to help remind me of things to include on here. I'm 67.

I have spent more than 4 hours per day doing research online and taking notes. Some days a lot more. I am still undecided between the two procedures, but leaning a little more toward Aquablation.

I am not too concerned about ejaculation because it was just a little dribble by the time I first went to a urologist in 2019. After taking Flomax there was either no ejaculate or just a dribble like before. I don't know if I have retrograde ejaculation or not. I don't see anything in my urine. It may be that the semen quantity is so low that I would not notice anyway. It would be nice to be able to squirt like 20 or so years ago, but I don't think it is very important.

My PSA has been above 4 since the second time I got tested. I don't remember the date, but I was in the 1990's. Maybe the doctor's paper records I have would have that data. He closed practice sometime before 2000. Just realizing it was 30 years ago is pretty crazy. My first PSA test showed 3.75.

The Aquablation urologist I am going to consult is Dr. Comiter at Stanford. I believe he also does HoLEP. I have yet to meet him. The medifind website lists Dr. Comiter as "advanced in aquablation." Their levels are elite, distinguished, advanced, and experienced. I haven't found one near me in the elite or distinguished categories, but I haven't looked too hard.

I am glad you have good results. I would like that to be my outcome.

@oldfiddler

Yes the material will be sent to Pathology where I think it was about 10% had cancer. As to when ready. I waited a long time and put up with more than I should, relating to the quality of my life. In the end I had no choice as my Prostatitis was getting very bad and I was having to self catheter.

Skip

I was just looking through the write up from my October MRI and saw "Trabeculated" when referencing the bladder. A quick search shows that the bladder walls have become thickened and stiff resulting in difficulty o empty the bladder. Does anyone here have any information about this for me? Will it make battling incontinence after surgery more difficult?

I'm having a whopper of a migraine today. Most of the time I have a migraine with aura without pain, or very little pain. The kind with rainbow crystals in my vision. I started thinking about when I first experienced a migraine with aura. I was just after I started taking tamsulosin. Headaches and migraines are no stranger to me. I've had them since I was 10 or younger. Most of the time it would be triggered by strawberries. When I was in my 30's I stopped eating strawberry anything. The headaches stopped after a few days. I waited two weeks and had strawberry jam on a sandwich. I got itchy and a migraine. Never had I experienced a migraine that is only in my vision until late 2019 or early 2020. I read today that one side effect of tamsulosin is headache. Now I am wondering if tamsulosin is a cause of the visual migraines. I get them a couple times a month, or three days in a row. Does anyone else experience headaches from taking tamsulosin? Maybe it is all in my head and not the drug.