Green light PVP vs HoLEP

Posted by raylo32 @raylo32, Jan 28 8:31am

So, 71 YO and I have had BPH LUTS for at least 2 decades, and have been on Alfuzosin for maybe 15 years. It seems to be gradually getting worse but I am getting along and have "adapted" but, still, having to get up between 3 and 6 times a night on average is not fun.

Went back to Uro for a look and the details are 55cc prostate with prominent median lobe. And my bladder is showing the deleterious effects of the struggles, but not yet at the worst case. I'd like to stop that process and get more of my sleep back if possible, hence I once again considering surgery.

My doc does the UroLift and said I was a candidate, but I am not really interested in that for various reasons. He also does green light PVP on an outpatient basis in the same building and he recommends that for me.

I have been reading up on HoLEP and watching the videos it looks like a good process with perhaps less bleeding and no charred tissue like from PVP that may take a little more time to heal. It also seems to me that the way the HoLEP controls bleeding gives the surgeon a much better view of the anatomy and progress, whereas PVP bleeds a good bit and can obscure the view.

In any case, my doc doesn't do HoLEP and the only provider near me is Johns Hopkins about 50 miles away. I am considering going over there for a second opinion consult regarding this choice.

Has anyone here faced this choice and how did it work out for you?

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@elcorbs

Are you saying you don’t have incontinence? What I have read is that everyone has it for a while but most overcome it pretty quickly. I seem to be one that will be 6 months to a year to overcome my incontinence. As far as bleeding I never had any after the first couple of days. I walk 6 to 7 days a week and has never caused any issues or blood. Good luck with your healing and pray all goes well.

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Prior to surgery I started to experience if I was pushing to urinate I d have an “ accident”. And once ( election night’24) I went out for a walk and somebody offered me zero alcohol beer. I liked it and had four bottles. As I waited for the restroom on the long line, I did slightly go on myself. That hadn’t happened before and hasn’t happened since. The only side effect or issue I’m currently having is that slight burning sensation when I go to the bathroom ibuprofen calm that down 600 mg. If I walk too much, I get a numbing feeling in my perennial area. My fluids are still a little orangey in color so I assume that’s still very very light blood.

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I saw Dr. Austen Slade , no regrets. Even if I have lost my ability to do stuff and I haven’t so far I have no regrets. This doctor was probably hands-down the best human being on the planet doing this work.

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@lovethealoha

I saw Dr. Austen Slade , no regrets. Even if I have lost my ability to do stuff and I haven’t so far I have no regrets. This doctor was probably hands-down the best human being on the planet doing this work.

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I thought incontinence was just a drip/squirt every once in a while not continuous dripping like I have had for 9 weeks. This has been very frustrating for me. I wear shorts so that I can rush into a bathroom and change my diaper quickly which I do at least 5 times a day because my diaper gets so full. I have learned to stay dehydrated so that I can go for a few hours without changing my diaper. Kegal exercises are getting so old after 9 weeks when I don’t see any improvement at all. At this time, I am very disappointed with my HOLEP surgery and wonder if I should have opted for Turp instead.

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@elcorbs

I thought incontinence was just a drip/squirt every once in a while not continuous dripping like I have had for 9 weeks. This has been very frustrating for me. I wear shorts so that I can rush into a bathroom and change my diaper quickly which I do at least 5 times a day because my diaper gets so full. I have learned to stay dehydrated so that I can go for a few hours without changing my diaper. Kegal exercises are getting so old after 9 weeks when I don’t see any improvement at all. At this time, I am very disappointed with my HOLEP surgery and wonder if I should have opted for Turp instead.

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I’m no doctor so this is just my personal opinion based on what I’ve been reading and what I’ve been through. How long did you live with this condition and how much damage was done before you got the holep? I’m not ruling out that they could also have been damaged during your procedure, but that’s something that’s hard to prove I suppose and it’s a complete hypothetical statement not to be taken that face value. I’m very sorry you’re going through this. Let’s hope you’re just a slow healer and it’s gonna take you a little more time.

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@lovethealoha

I’m no doctor so this is just my personal opinion based on what I’ve been reading and what I’ve been through. How long did you live with this condition and how much damage was done before you got the holep? I’m not ruling out that they could also have been damaged during your procedure, but that’s something that’s hard to prove I suppose and it’s a complete hypothetical statement not to be taken that face value. I’m very sorry you’re going through this. Let’s hope you’re just a slow healer and it’s gonna take you a little more time.

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I was diagnosed with BPH in 1997. Started medication in 2002. The BPH and not being able to empty my bladder. (Confirmed with void tests) was causing kidney damage. My current urologist said the HOLEP procedure would allow my bladder to drain and allow my kidneys to get back to normal operation. I had kidney and bladder scans done yesterday and will see my urologist on 2/5/2025 for those results and for my first follow up after the 12/3/2024 procedure. I just messaged his office to let them know that my incontinence is not getting any better. My wife is so frustrated because we can’t go golfing where we walk a par 9 course. No way I could do that with no place to change out my depends. I wouldn’t mind a squirt now and then, but a constant drip is not good. Let me get to more kegals.

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I definitely reiterate, my sympathy and I hope that you get better expeditiously. There’s no way to say it, but your wife doesn’t have a right to be frustrated because you can’t go out or she can’t go out. It is what it is and you will get better with time unfortunately it seems to be taking more time. Maybe the answers you seek will be revealed to you at your appointment along with continued advice medication from your doctor to help you achieve the maximum from your surgery.

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@lovethealoha

I definitely reiterate, my sympathy and I hope that you get better expeditiously. There’s no way to say it, but your wife doesn’t have a right to be frustrated because you can’t go out or she can’t go out. It is what it is and you will get better with time unfortunately it seems to be taking more time. Maybe the answers you seek will be revealed to you at your appointment along with continued advice medication from your doctor to help you achieve the maximum from your surgery.

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Thanks for the positive thoughts. Staying as positive as I can under the current situation. Hopefully my doctor can help me with something else next month.

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@elcorbs

Thanks for the positive thoughts. Staying as positive as I can under the current situation. Hopefully my doctor can help me with something else next month.

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Besides knowing living with the on / off pain of a full bladder. Just stay your course even on those days you had enough. I literally called my dr in the morning to see if anyone canceled just to speed things up. Quitting my sugar drinks including coffee and chocolate was hard but I hate admitting the bathroom went smoother. I also spent a fortune on endoscopy treatments 8-10 sessions 3k. In the end it helped my prostate not the lobe.

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@lovethealoha

Besides knowing living with the on / off pain of a full bladder. Just stay your course even on those days you had enough. I literally called my dr in the morning to see if anyone canceled just to speed things up. Quitting my sugar drinks including coffee and chocolate was hard but I hate admitting the bathroom went smoother. I also spent a fortune on endoscopy treatments 8-10 sessions 3k. In the end it helped my prostate not the lobe.

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I too stopped the coffee, chocolates and sweets. My body has never liked sweets. Once the HOLEP procedure was completed I lost nearly 20 pounds over the following week. It was all water. I can see both my ankles now, so I know my kidneys are functioning properly and getting rid of the excess water. Had my best nights sleep last night. I only got up 1 time to pee. That is the first in probably 30 years! I was getting up 3 to 6 times a night to pee before the surgery. So glad your surgery has worked for you and I will keep pushing to get through this incontinence over the next few months.

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@elcorbs

I too stopped the coffee, chocolates and sweets. My body has never liked sweets. Once the HOLEP procedure was completed I lost nearly 20 pounds over the following week. It was all water. I can see both my ankles now, so I know my kidneys are functioning properly and getting rid of the excess water. Had my best nights sleep last night. I only got up 1 time to pee. That is the first in probably 30 years! I was getting up 3 to 6 times a night to pee before the surgery. So glad your surgery has worked for you and I will keep pushing to get through this incontinence over the next few months.

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I’m here with you my braddah 🤙🏽

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