Benign prostatic hyperplasia (BPH) Surgery Options

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

@rfherald Good luck on your continued recovery. I like you have been undecided but leaning towards AquaAblation. I found a urologist in the area that has done about 20 of them, being a relatively new procedure. I have spoken to someone who had Rezum and he was happy he had it done but it took about 6 months for it work as hoped, he's good to go now. I have been OK with the condition for now, in fact the last question on the IPSS (someone had a sense of humor when naming this), where it asks how you would feel if you spent the rest of your life at the current stage of BPH and I was fine for the most part, so I do have some time, but a procedure is definitely in my future.
Rf, if you could keep us updated on your progress that would be very appreciated and thank you for the video and links, very helpful.
Bill

I go back and forth on procedure versus status quo. I am 80 years of age. Tamsulosin works (morning and evening plus 2 ibuprofen at night).

Thank you. I am 80 also. On Tamsulosin for a few years now. Considering REZUM for a while. Was ready to go last year but Urologist lost access to the equipment? Now I am seeing another Urologist in NYC. Got sidetracked when my PSA came up at 5....That is a whole other story. Still considering REZUM.
I have considered Laser in past but concerned about post procedure and confused about what is actually removed.
The medical system is confusing to navigate to come to quality decision.

I am 76 and am scheduled for Prostate Artery Embolization on Nov 23. You can click on my screen name above to see my previous discussions about and reasons for trying this least invasive procedure first. I will give you all a full report of the results for me.

Hello Cent66! We’re cheering for you as you go through Green Light Laser Treatment, hoping that you are completely satisfied in the end! I did not have “green light” but I did have Holmium Laser Enucleation of Prostate (HOLEP). Upon completion of the procedure, I did wear the Foley for the first night and it was removed the following morning. The Mayo Urologist that performed the procedure told me to stop taking Tamsulosin and Finasteride after the surgery….I’ve been off the medication ever since! Good luck friend on your procedure…..please let us know how it all goes for you!

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.