Benign prostatic hyperplasia (BPH) Surgery Options

Will do @rfherald. We all need each other in navigating this difficult condition. I know we will be successful because we are doing all the research footwork and will make an educated decision.

I am 69 yrs old and have been dealing with BPH for at least 15 years. Symptoms finally bad enough that I am ready to have surgery in hopes of some relief. Had a cystoscopy and TRUS recently. Prostate at 90ml. Cystoscopy showed narrowed passage through the prostate and also a median lobe blocking the bladder outlet. That doctor only does traditional mechanical TURP surgery. I had read online about HoLEP, PVP and Rezum. Had a video conference with a Mayo Clinic doctor to get a second opinion. Mayo Clinic doc recommends 1. HoLEP 2. BiPolar Enucleation and 3. Robotic Simple Prostatectomy. Wondering if anyone has had a procedure done for an obstructing median lobe in addition to standard BPH, what procedure(s) were used and what was your outcome? Thanks.

Hello,

I Had HoLEP done yesterday at the Mayo site in Mankato, MN.

I've had to urinate several times a night for years. Started taking tamsulosin in 2019, which helped a little. Then In June 2021 I had several episodes of acute urinary blockage. My local urologist did not offer to be available to me for several months. And he doesn't do either Rezum or HoLEP, which sounded to me like promising types of surgery, if I needed surgery. I secured an appointment at Mayo Rochester within a week of requesting one. A practioneer and I talked about options for more than an hour. I did a lot of research and got back to him to propose meds (dutasteride) for five months and if my bathroom trips were not then significantly reduced, seek another Mayo visit to see if I was a candidate for Rezum. But soon after starting dutasteride I began have very painful urination about 2x/hour, 24 hours/day. To gain some control over that, I consulted my local PCP in person several times and also the practioneer at Mayo Rochester via many emails. He was very available and helpful. He prescribed some meds that seemed to help. Next I secured a second Mayo visit with (one of?) the Mayo surgeon who does Rezum; I got this appointment about two weeks after I asked for it. Tests then showed conclusively I was not a candidate for Rezum—prostate too large (135 cc) and symptoms too advanced (multiple urinary blocages, etc.) Next I sought and received a Mayo visit with the Mayo surgeon who does HoLEP. I got one in a month. There are only two surgeons in Minnesota who do this procedure and Mayo Mankato has one. At the end of that visit I had an appointment for HoLEP surgery on November 12. Mayo prepared me for that visit very satisfactorily.

In my extensive research about treatments I learned (something) about quite a number of types of surgeries. I asked the Mayo people I met with on the above mentioned occasions about those other options. In the end I decided to trust Mayo's judgment on which surgery suited me rather than my own amateur views on the subject.

Yesterday morning I had HoLEP surgery. Very impresssive process. I was discharged to go home that afternoon, wearing a Foley catheter. I am to return for some tests in two days, with the probability that the catheter can be removed. I believe it's more common for Mayo HoLEP patients to come back the next day for catheter removal. My surgeon wanted to give something a little more time to heal before removing my catheter.

I feel normal to nearly normal. No pain to speak of. The surgeon prescribed some meds to help me through any short-term pain in urination and to avoid the common bladder spasms, which I've experience before with a Foley catheter.

The HoLEP procedure is a definitive solution, it is said, whereas Rezum is not.

Mayo Rochester and Mayo Mankato are a 4 hour drive from my home. But I do not count that against them. I have found suitable lodging in Rochester and Mankato when my Mayo visits required it. I am extremely satisfied with Mayo.

I cannot, of course, say what my experience will in fact be after recovery, but so far the process has worked very well for me.

I am 80 years old.

Bruce

Bill and @rfherald, I noticed that you both are looking into aquablation. I hadn't heard of it before and wanted to find articles that are not written by the company itself for an objective viewpoint. Looks promising. See these articles:
- Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results https://www.sciencedirect.com/science/article/pii/S0090429519304194
- Aquablation of the prostate: a review and update https://pubmed.ncbi.nlm.nih.gov/31481145/

At the time of 2019, researchers concluded:
"Aquablation is a safe and effective option for treating LUTS secondary to BPH. Aquablation is a new surgical option that shows very promising short term results, in particular, due to its short resection time regardless of gland size and low rate of sexual side effects. This technology still requires further investigation to confirm durability and efficacy over time."

Here's some additional information in plain language from Mayo Clinic
- Mayo Clinic Q and A: New steam treatment for benign prostatic hyperplasia https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-new-steam-treatment-for-benign-prostatic-hyperplasia/

@jetjock , I have never heard of "median lobe blocking the bladder outlet" so I looked on mayoclinic.com and found:
>>
Possible causes of bladder outlet obstruction might include:

o Enlarged prostate, also known as benign prostatic hyperplasia (BPH) — this is the most common cause of bladder outlet obstruction in men
o Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery
o Use of certain medications, including antihistamines, decongestants or drugs to treat overactive bladder
o Prostate cancer
>>

Has the doctor defined the blocking to be other than BPH?

@colleenyoung Colleen, Thank you for searching! I appreciate the objectivity. And there is much reading to do here, but it sounds like Aquablation is another good candidate, comparable to Rezum.

Thank you Colleen for taking the time to assist us. Some good reading here. I also had a discussion with my new Uro who has done numerous aquablations with prostates of all sizes with good results.

Now I owe you 2 months of weekly car washes.

I had the Rezum procedure January 2021 and very satisfied as of November 2021. Only issue I had was the doctor did not use enough pain medication for the procedure.

Hi @sirref, Welcome to Connect. It's good to hear that the Rezūm Water Vapor treatment helped. I've been taking medication for quite a few years for BPH and was wondering about asking my doctor if it would help me. Was the procedure itself painful due to not enough pain medication or was it after the procedure you felt the pain during the healing process?

Great question John. 
To be honest with the Rezum procedure and my Urologist. I have had a sensitivity to pain all my life and various so-called drugs as Valium do little to keep the pain at a minimum. During the procedure, it was a Horrid torture for me. Pain is one of the triggers that kick me back into AFIB and I missed my 5 year AFIB free anniversary. 

Only minor pain and discomfort after the procedure. Regarding urination, took me 6 weeks until I began to notice a  positive flow. Eleven months later and this guy has no regrets from the Rezum procedure.  If I did it again, it would not be in a physician office. There is nothing as sweet as being in Normal Sinus Rhythm.

Back to the pain subject.  Ask your doctor damn hard questions regarding pain management and not the script used by the Rezum talk. Need to point out, I went against my own advice I share with others.  Pick out large volume hospitals and a Center of Excellence Physician. Rezum site has a Physician finder. After the procedure I did tell my Doctor I was not a happy guy with him and his pain management and for him to tell me the reactions from other patients. His reply was the large majority of the patients seemed to tolerate the pain and experience little discomfort and then the other side of the patients as myself  is another story.
Hope the above is not too confusing.

Ferris Watson