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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!
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@markbph1 I did have a large median lobe...with a much larger prostate at almost 120.
Interesting. Was the median lobe causing the blockage? That was my issue, it was like a trap door, plus I had to make absolutely sure that I could completely void - carrying 500m of urine is no joke to your kidneys - so I chose complete tissue removal long-term over the RE - I hope don't regret it, but it's obviously too late now. Did Kellner try to talk you out of Aquablation? He did to me...
@markbph1 Yes, it took a little getting used too but it does not take away from the pleasure. At times, when I feel a strong orgasm coming it feels like I will erupt, but it's always internal. I get a good amount of pre-ejaculate fluid. HoLEP was a blessing for me and I hope you enjoy the benefits from it.
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2 Reactions@markbph1 Sorry for interjecting, but is a median lobe part of the prostate?
If so, I’m curious how you learned its size; after 7 weeks of voiding trials for what was diagnosed as “post-operative urinary retention,” followed by a cystoscopy, my urologist recommended HoLEP.
But not one word as to prostate size, let alone median lobe. So seeing posts like yours is starting to get me a little concerned about the information he’s providing and NOT providing.
Thanks in advance for any comments, feedback, etc.
@amishboy51 I have had two prostate MRIs. I was able to talk with the nurse practitioner about them and see the images. Later a doctor’s report mentioned a “very large median lobe.” I end up reading online and gather questions to ask the urology department. On many years of my reports the prostate size is mentioned, even the ones that are ultrasound.
Prostate size on my charts is measured in CCs or Grams. I guess they are so close as to be the same. I think asking your doctor about your prostate size is a good question. It may be in your reports. The doctor would give you answers to help you make an informed decision.
Come to think of it, I’ve only had one voiding trial.
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1 Reaction@amishboy51 Hi, so a normal sized prostate is 25 grams and the shape of a walnut with a left and right lobe. Some men can develop a median lobe that grows and can block the urethra, which can act like a trap door. That tissue needs to removed. Or, you can have tissue pinned out of the way i.e. Urolift. I'm not suggesting that by any means. By getting imaging done is the best way to determine, next steps. A Cyscotomy gives the Uro a way to look at it, not necessarily a way to measure it, plus you can also get an infection. Hope that helps.
@oldfiddler Thanks for the confirmation.
I never had a prostate MRI, only the cystoscopy. The doctor recommended HoLEP over aquablation, but without any mention of prostate size. Since one is less effective for larger prostates (> 100, if I remember correctly), I can't figure out how I was supposed to make an informed decision.