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Benign prostatic hyperplasia (BPH) Surgery Options
I had a Urolift procedure last February for my BPH symptoms and it was a total failure. The implants are still in position though. I am looking for a different procedure to alleviate my BPH problem and Rezum seems to be a good alternative. Can it be done considering my prior Urolift procedure. If not, what would be your recommendation.
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@amishboy51
Finasteride is only a TEMPORARY solution and it has side effects. Also I learnt something about taking "medication" to solve BPH. Many, later in life, require cataract surgery. This type of medication will complicate (and introduce risks) to cataract surgery if you should need it later in life. I suffered BPH in silence, for years in my 40,s and refused medication only because I am the type who wouldn't even take a Panadol/ aspirin! I was never on medication until I had to take blood thinners since end of 2018. Yes, even having to take only ONE medication daily, is "annoying"! I tell myself - it's unflavored M&M! The term surgery in ROBOTIC surgery (which refers to all these surgeries to reduce the size of over grown prostate) does not refer to "OPEN SURGERY", i.e. cut through flesh. The surgery is done "robotically". A very thin surgical thread goes into tip of penis, through (where urine flows out of bladder), to the prostate. This surgical carries the laser and camera. The surgeon watches on a TV screen what the teeny weeny camera (now inside the prostate)beams out to TV screen, the "landscape" of the patient's prostate. The patient doesn't see anything because he is on full anasthetic.
BUT a couple of years ago, I had a cystoscopy to find out why I had blood in my urine, everytime after running. A cystoscopy requires only LOCAL anaesthetic so the patient is wide awake and can watch the TV screen - a cystocopy carries only the tiny medical camera, but not the laser (like those required to perform Holep etc). The LIVE view of my prostate, on the TV screen, was not pretty - it showed a dark cave full of blood flushed nodules and lobes (legacy of a prostate regrowing after such a procedure as Greenlight). Now, after Holep, such a view would show a clean hollow cavity of the prostate cavity. Nothing in there to impede passing urine! And sure enough, passing urine now is like the NIAGARA FALLS! GUSH!
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1 ReactionWhether one needs another prostate reduction, further down the road, after a procedure, or any other procedure, depends on how rapidly the prostate grows back. It will always grow back, and create the same "plumbing" blockage. The repeat rate is relatively high. Very few people will never require a repeat prostate reduction - you may be in the lucky minority.
Greenlight v Holep : I consider Greenlight in 2012 when I had it as "gentle"; I left on the same day, without catheter. I spent the next 4 weeks, passing out dead prostate tissue (Greenlight leaves all the lasered off tissue inside bladder). If Greenlight was "gentle", Holep in 2026 is a breeze, a walk in the park. When I woke upfrom Holep, I felt no pain, to indicate I have had a "procedure". Of course the anaesthetic masks the pain. But hours after that, and the day after, it still felt the same - completely pain free.When I left hospital, shortly after catheter removal, the urine was clear and remained clear for the next 4 weeks, and there were no dead prostate tissue being passed out. Holep removes all prostate tissue it lasers off, from the bladder as part of the procedure. That is why Holep recovery is so UNEVENTFUL compared to Greenlight (due to passing out dead tissue over the 4 weeks fater procedure, and the occasional temporary blockages when the dead tissue being passed out is too big.
I also noticed, online, the urologist, who performed my Greenlight in 2012, is now recommending the newer robotic surgeries such as Rezum, etc, but no longer mentions Greenlight. But in 2012, Greenlight, for me, was way more preferable than the old school TURP (very painful, and "bloody"). Definitely glad I had Greenlight, and not TURP, in 2012.
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1 Reaction@mandarin007
Did the urologist confirm you have BPH (enlarged prostate) that is causing blockage to urination? 42 is too young to be suffering BPH, and highly unusual. Bladder blockage and weak stream is not necessarily caused by enlarged prostate. It can be cause by narrowing of the urethra. There is a specific medical prostate to treat this condition - Optilume balloon therapy. Although it was originally aim at constricture of the URETHRA, it has also been modified to treat BPH. So it can be deployed to treat narrowing of the urethra and also enlarged prostate.
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1 Reaction@heath2026
Yes, the urologist confirmed that the enlarged prostate is the issue. It was also confirmed by MRI and cystoscopy. Though, it's uncommon with men of my age to have this condition but they have treated patients my age or younger.
@heath2026 Actually, it’s been reported by the American Academy of Ophthalmology that Finasteride is LESS likely than Tamsulosin to cause complications (“floppy iris syndrome”) during cataract surgery. [also, my surgeon hopes that I’ll be able to stop my Alfuzosin if the Finasteride is successful.]
https://www.aao.org/education/editors-choice/many-factors-can-lead-to-intraoperative-floppy-iri
@heath2026 No guarantees, of course, but at least one prominent study, reported in the New England Journal of Medicine, concluded that Finasteride could have a significant chance of obviating the need for surgery. https://www.nejm.org/doi/full/10.1056/NEJM199802263380901
@heath2026 My surgeon started me on the higher (5 mg) dosage. Per AI, 8.1% of users at this dosage suffer erectile dysfunction, 6.4% suffer decreased sexual drive, and 3.7% suffer decreased ejaculate volume. It’s also reported that, for the vast majority of men who do suffer these side effects, the symptoms improve “over time” (whatever that means).
That said, I’m almost 75, and, frankly, at this point, sexual activity matters a lot less to me than simply being able to pee without difficulty, while also avoiding the need for surgery. But that’s just me.
You may, or may not be aware, the "surgery" (Aquablation, Greenlight, Rezum, Holep etc) is not conventional surgery where there is a cut/ incision in the body. There is no cut in these "robotic surgeries". How it works is this - a super thin metal thread is inserted through the penis tip (where the urine comes out). This "medical thread" houses the CAMERA, and "laser". That miniature camera beams out the view for the surgeon/urologist. The prostate reduction is conducted via the view beamed to the TV screen. It is a minor procedure in medical terms.
When I had Greenlight in 2012, I left the hospital at 2PM that day. No catheter. My "surgery" was at 9;30am that morning. Greenlight although a very pain free procedure is nothing like Holep in 2026 - you would not even notice you had the procedure, even with no aspirin after it. Totally pain free and blood free. That is how much robotic surgery (for BPH) has advanced since 2012. Whatever you decide down the track, stay away from the old school TURP. That is BARBARIC by today's standards!
I was diagnosed with BPH and given Flomax. I’m not a fan of medication and this product does come with side effects. Where I live the only procedure available is Turp. Holep is available if I were to travel several hundreds of miles, that is if my urologist refers me. Any opinions as to what would be the better of the two?