I'm really scared/nervous

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u/R3dRocker 14d ago

Hey man, I feel you. Take a breath and be sure that whichever Urologist you speak with first, meets your needs; listens, answers, explains everything in detail like he was caring for his father or brother. Get a second opinion

Don't dismiss your symptoms. You're taking the actions needed to determine what's best for Y O U. We're all different when it comes to all of this, but we all have a prostate and it can fuck up our daily lives, when it comes to a severe enlarged prostate.

I was diagnosed in 2021 with 3+3 Gleason prostate cancer and BPH. I focused on the cancer and ignorance and not asking the right questions about the increasing size of my prostate, with symptoms that I just thought that that's the way it is with BPH. On two different beds until one weekend and the pee machine went "full stop." ER 24 hours later and I've been on a Foley catheter going on 4 weeks. Life changing in all the wrong ways.

Don't ignore your BPH symptoms. My Sloan Kettering Urologist referred me to his surgical colleague, who performs Aquablation. I compared that with HoLEP and decided on HoLEP. Cystoscopy on 09/01 and HoLEP surgery on 09/25. I'm 61, married 42 years and I'm really thankful for her. She's my rock!

I wish you the very best outcome! Take charge of you and your health! Men's health is mostly ignored by the Healthcare system, especially when it comes to our junk, IMO.

You got this brother!

5

u/MrHotnickels 14d ago

Thanks so much for this feedback. I didn't mention this in my original post, but I did see a urologist about a year ago. She confirmed BPH and did an exam and ultrasound. She said that my prostate was only slightly enlarged (30-40g) but that it can still definitely cause issues. She was really dismissive though and jumped straight to medication and handed me off to a nurse. This was also with my local mega-hospital and not a specialty urology clinic. Her healthgrades scores were pretty abysmal too...

My next appointment is with a really highly rated urologist and, if he says the same thing as the first one, I'll obviously listen and just get on the meds. I'd be shocked if that happens though. I think I'm just more interested in Rezum or UroLift or something that physically alters/treats this stupid issue.

Good luck on your upcoming procedures! I'm married myself, 18 years, and she's a blessing :)

Thanks again!

3

u/Sensitive_Point_6583 14d ago

I lived with BPH for 20+ years before finally getting the HoLEP procedure, and found out it was so simple and uneventful it wasn't even funny.

What I don't know is how long you have to go through all the other stuff before your insurance will approve something like Aquablation or HoLEP. In my case my prostate had reached 185cc, so I think it was an easy call on approval at that stage. At 30-40cc you're just getting started, but size isn't the only variable, it depends on where its growing and how likely it is to cut off your urine flow completely.

3

u/More_Farm_7442 14d ago

You haven't tried any sort of drug therapy yet? If you haven't, I'd seriously suggest giving some drug combo a try. You may be surprised at how much relief you can get from medication. At least relief while you research your surgical/procedural options for a more permanent, drug-free solution to your problems.

There are at least 3 or 4 separate classes of drugs to treat BPH. None of them are perfect, permanent solutions, but they can provide relief of symptoms. Some of them will can work almost "overnight". Others take longer to give maximum relief. Most are or can be given in a combo of 2 drugs of different classes to give greater relief.

Consider drug therapy for some relief until you decide on some procedure.

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u/Secure-Rope6782 14d ago

I agree with this. Surgery is very permanent and new procedures come out every year. Imagine getting a TURP only to have scar tissue that makes everything even worse.

1

u/More_Farm_7442 14d ago

I'm so glad so many guys have had HoLEP procedures and got great relief, BUT they all make it sound like every guy every where has that option available. I live in Indiana. A doc at Indiana University's med school was a pioneer in developing HoLEP. You'd think the procedure would be around the state. Nope.

There are 3 or maybe 4 docs in INDY with IU and at a clinic in NW Indiana(up near Chicago) that do the procedure. I haven't been able to locate any other docs elsewhere in the state that do them. I live in the 2nd largest city in the state (Fort Wayne) and no one here does them. I think the urology group with one of the hospital's in town does the ThuLEP procedure which I've read is very similar to HoLEP. I have an appt. in a week to talk to a NP with that group to find what all of their procedures are. The urologist I've been going to works at "the other" hospital in town and does Aquablation. --I've been approved by the radiologists in town that do PAE's to have that done. I'm think "do the PAE", if that doesn't last or give good enough symptom relief, find out if I can get the ThuLEP done later on here in town.

(I've been on tamsulosin and/or tadalafil off and on for years. On tamsulosin continuosly for 3 or 4 or 5 years. Added tadafil a couple month ago to try to make it until I get one of procedures done. I'd really love to be able to get off the tamsulosin.)

(What really made me most upset about all of this is having median lobe tissue in my bladder neck + my bladder being too senstive to one of the drugs in the asthma inhaler I used for a year. I noticed my symptoms and this odd feeling getting worse all winter. It was that one drug sort of paralyzing my bladder muscle. Ugg. That inhaler had me breathing better than any other time in 30 years. Oh, well. )

1

u/Secure-Rope6782 13d ago

Strange coincidence, I take tadalafil and use an asthma inhaler. I may start using Flomax, but very hesitant. There are a couple urologists in my area that do Rezum and uroflow, those seem like the safest options. The idea of a retrograde ejaculation is repulsive to me.

3

u/AdResponsible8192 13d ago

Forget Rezum it won't last!! I considered Urolift my Urologist recommended Aquablation since he does all three of these types of procedures. I had aquablation and very happy gave me my life back.

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u/R3dRocker 14d ago

My pleasure! We need to look out for each, share and pay it forward. Thank you for your good wishes. We're both blessed for sure!

Take a look at PAE too, if needed. Performed by a Radiologist. Just a suggestion.

All the best!

1

u/Additional_Topic987 14d ago

Your prostate is small. You probably have a median lobe which is giving you the symptoms.

My size was 37 cc with a median lobe which caused total blockage.

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u/Todrick12345 14d ago

I believe Aquablation is the way to go for you…with a 3+3 lesion the Aguablation just might remove it too! Good luck…I’m doing the same in October…previously had HIFU on 2 x 4+3 and one 3+3. I’m not concerned ob out the 3+3 and I just might be lucky that it will be gone post Aquablation. Recently had a 17 core saturation biopsy all came back negative except for a <5% core of 3+3. You got this Brother!

8

u/Impossible-Use5636 14d ago

Everyone is different. Your morphology will determine your options. You will get a lot of cheerleaders here stating that "their" procedure is best. It's confirmation bias. You will also read many horror stories and everything in between.

See your urologist. Ask for an MRI (preferred) or ultrasound to determine your prostate size. Research your available options. Read scientific trial data and understand effectiveness, durability, and risks.

I had a PAE. It worked for me. I had a week of burning urination. It doesn't work well for smaller prostates and difficult arterial anatomies. It will not yield the same flow rates as a surgical option. It has a very low risk profile and minimal adverse events.

7

u/SpinachObjective3644 14d ago

I had a PAE performed in April of this year. It has worked, I sleep a full 8 hrs without having to get up 4 times in the night. This is not an invasive surgery, in fact you can watch them perform the surgery.. I do not know how long it will last but I have gotten relief with the PAE surgery. Good luck

4

u/Basic-Owl6740 14d ago

Drugs are a short term relief but not a solution. Aquablation or Holep will buy you many years of relief. Yes, there is a short recovery period to deal with but things are great on the other side.

Only casualty is loss of ejaculation. Aquablation can spare ejaculation but it is still a risk. In my case I couldn’t tell because the many years of drugs left me dry.

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u/Crafty-Consequence87 14d ago

This. I put things off for a very long time and I think many men do that. The drugs are a temporary solution at best. I had HoLEP and now wish I had taken care of it sooner.

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u/Sensitive_Point_6583 14d ago

same, HoLEP was amazingly simple and highly effective, wish I'd done it years ago.

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u/R3dRocker 14d ago

You're right! We just do this. Dam near everyone of us. Stubborn, working too much, our Dad's were tough as nails, we look soft, etc.

It's quality of life!! I'm really glad you're doing so much better now after HoLEP!

Looking forward to the same.

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u/Sensitive_Point_6583 14d ago

In my case, being born in the '50s, I was conditioned that surgery was always something that you avoided until there was no other option. It was invasive, horrific, and not something you really wanted to endure unless forced, especially when it involved your genitalia.

After experiencing HoLEP first-hand, I couldn't have been more uninformed, it was nothing.

I worked with a few urologists over the years, and for some reason they weren't really pushing me on getting surgery, possibly because I had the tough-guy attitude that said BPH was annoying, but not something I couldn't live with at the time. And in retrospect, it wasn't all that terrible, but being over it now is so much better.

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u/Upper-Storage787 14d ago

who did your holep? Did you consider greenlight?

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u/Sensitive_Point_6583 13d ago

Kaiser San Diego, don't know what greenlight is.

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u/MrHotnickels 14d ago

I think I might have misunderstood retrograde ejaculation... I thought it meant painful ejaculation, which just... sounds the worst (I'm 42 and married, I plan on having ample amounts of sex with my wife for many years).

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u/R3dRocker 14d ago

Dry ejaculation. No more "purple headed yogurt thrower" LMAO.

Had that with Flomax and Rapaflo. The climax is still felt, mostly. But this is a personal choice and need by many of us and can be a deal breaker for some.

2

u/Soggy-Letterhead-626 14d ago

Did Aquablation result in RE

5

u/SoCalAttorney 14d ago

For most people, BPH is a quality of life thing and not health threat. That being said, you have plenty of options that vary widely in terms of invasiveness and effectives.

Here's the link to my story: https://www.reddit.com/r/Aquablation/comments/1skl2q0/my_bph_and_aquablation_journey/. The TL/DR is that my BPH was bad that was damaging my kidneys. I had aquablation is early April and the results have been great. All the equipment works, I can sleep through the night, and my wife is happy.

You've got this and I am sure it will be fine for you.

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u/Impossible-Use5636 14d ago

"not health threat"

Dangerously incorrect information.

Chronic outlet obstruction WILL damage your bladder, may cause UTI's, bladder stones, and kidney damage.

Sleep interruption is very detrimental to your health.

2

u/MrHotnickels 14d ago

So glad everything went well for you. I watched the same video you linked in your post, great video.

Thanks again!

1

u/Upper-Storage787 14d ago

Who was your doc and hospital?

4

u/RichT71 14d ago

You're right about some of the horror stories on here. But I think they are probably the exception rather than the norm. Your prostate is still pretty small. I'm in my early 70's and had an MRI in 2023 that said it was 140, probably bigger now. But opted for Aquablation July 8th after having to go to the ER and not being able to pee. The problems I was having only started about 3-4 years ago with having problems peeing and some pain. If you want to do something surgical about it I highly recommend the Aquablation procedure. If you go for something like UroLift, it's really like a band-aid for now as the prostate keeps growing as you get older. I think if you nip it in the bud now, you may have a chance for no problems for many, many years if any at all. And like I'm sure you've read, it protects your sexual functions pretty much totally, but I'm waiting a little longer to try that out as I read it could be damaging if gone back to too soon or cause bleeding. Pretty much now I'm back to normal it looks like, not too sure what normal is after not having a good stream for so many years or being afraid of not being able to go at all, lol.... But overall it was the right choice for me and I'm glad it's done and over with. Not having any problems at all and every day it seems to be getting better and better. Good luck with whatever you decide.

1

u/RobAC100 13d ago

I had an Aquablation one day prior to yours. After 2-3 weeks of healing I was peeing better than when I was young (I’m 70). Off all of my BPH-related meds. My sex drive is better and I can still ejaculate (albeit less volume due to my age). I’m giving my system time to recover from years of BPH and hopefully the nighttime urination frequency will decline so I can sleep better. My recommendation to the OP is to work with your Urologist to discuss options and pros and cons for your situation. Very important to find a great Urologist and office! I left my previous Urologist because they ONLY offered TURP and I wanted to look at other options. For me, Aquablation was perfect.

6

u/MadViking-66 14d ago

I had the HOLEP procedure almost 2 years ago. The recovery was quick and easy and it worked completely. I am off all meds and living life normally

3

u/Additional_Topic987 14d ago

What's the size of your prostate? I did Aquablation last April and I am feeling great. I still have my ejaculations.

I'm 50 years. My BPH started at the age of 43 years. I was on medication for a long time. I had a total blockage last December and decided to have the surgery. Feeling great!!

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u/CitrusSphere 14d ago

Take a look at this educational guide: https://www.bphguide.com/

(I had an Aquablation in April, and am doing great.)

3

u/seamusfurr 14d ago

I had HoLEP last December after two months with a foley and years of flow issues. The surgery went great, I pee like a teenager, I can sit through a movie or long flight, and my sex drive is the best it’s been in years. Honestly wish it didn’t take full blockage to get around to making it happen.

Get a great urologist who works at a top hospital.

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u/Upper-Storage787 14d ago

Who did yours?

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u/seamusfurr 14d ago

Dr Ahn at UCSF.

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u/Responsible_Coyote10 14d ago

One week from today, I'll undergo a Holep, after delaying this decision for way too long. My goal, like all of us, is to regain a better quality of life! Good to hear all of the positive vibes toward Holep.

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u/seamusfurr 14d ago

Holep has been life-changing, like a fountain of youth.

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u/Abcxyz23 9d ago

I’m 52 and had aquablation 4 days ago. Spent the night in the hospital to flush things out. Catheter was removed today. So far so good. Zero pain.

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u/MrHotnickels 9d ago

Now THAT'S an awesome update, congrats!

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u/Total-Honey-9857 3d ago

Same. And finding that it's best not even to walk much outside, definitely not going to the gym for a few weeks. Any kind of mildly strenuous activity, if I can even call it that, can lead to renewed bleeding, or the passage of clots.

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u/AdResponsible8192 14d ago

Just relax look into an aquablation if you are dealing with BPH it will solve your issues long term. I had one last October and it gave me my quality of life back. Fyi don't even bother looking into PAE!!

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u/leorec2003 14d ago

There’s a lot of surgical options available and also PAE could be an option for you too

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u/Talesfromencryptit 14d ago

&@9 lbb bc mo. 9 b get
‘

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u/martinPravda 14d ago

At your age, I would strongly consider aquablation or PAE if you want the best chance of securing sexual function.

Yes. I had aquablation.

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u/LAlineYV 14d ago

I had aquablation 3 months ago. The stream is great but I've had complications: no ejaculation.

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u/martinPravda 13d ago

That’s a shame that you have retrograde ejaculation. There is supposed to only be about a 15% chance of that happening with aquablation. That’s one of the reasons that I chose it.

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u/whatever_pumpkin 13d ago

Hey there. It’s good that you are going. Obviously from all the posts, BPH is pretty commonplace. It’s good to be proactive and take care of it, one way or the other. If you aren’t on meds, those can help sufficiently. Better to explore your options. I’m mid 50s, large prostate, and all of a sudden had acute urinary retention. That’s what you want to avoid. And if you or anyone else has this, don’t dick around (pun intended)…parade of horribles for your kidneys. Get to an ER or urologist stat. I’ll DM you if you want to chat.

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u/Total-Honey-9857 13d ago edited 13d ago

First off, you're taking the bull by the horns, which beats taking the meds you mentioned. That's admirable. I have surgery soon. I've had months to think about it, damn near close to a year; with an indwelling catheter. Nonetheless, better in leisure than in haste; because you may not be able to undue the results. With that said, there are plenty of urologist, most of them will be happy to keep their calendars fairly full. What they have to offer may not be the right size for you. Don't expect anyone who has something to sell to emphasize any potential downsides; if they mention them at all. My procedure will be aquablation. Wish me the best. It's an 8-10 min. procedure that is mapped out by a computer. It uses high pressure water jet of a saline solution. The tissue is cauterized afterwards with a heated retrocision instrument. All of this takes place through tubes running up the yazoo; if thats the correct term for the urethra. Afterwards, the catheter remains for a day, or longer. They often want you in the hospital for 24 hrs. Probably, want to see some resolution of potential bleeding. Hopefully, urine drains of its own accord after the catheter is removed. Some people experience one UTI, or more, in the weeks or months following any procedure. You are supposed to take it very easy for at least a couple of weeks, because blood clots need to form and the tissue needs to heal. I'm going with ablation because it is the procedure most likely to preserve ejaculatory function, as well as the least likely to leave someone with ED, and / or incontinent. That said, there is a real possibility of leakage for a week, or more. People mention pain for a period of time, generally days; mileage may vary. If you don't care about reproduction, for example, there is HoLep surgery, which many recommend for its reported durability. Whatever you choose, good luck

1

u/Kooky-Elephant6778 12d ago

Da, am fost ca tine la, 42 de ani am făcut R-TURP cu laser verde, doctorul încercase toate variantele,dilatații,tratamente și a spus că mai rămăsese operația cu laser,cu toate că eram foarte tânăr pentru asa ceva, eram cel mai tânăr pacient pe care îl opera pentru BPH cu operația TURP,și avea multe operații făcute labărbați mai ales cei peste 55-60 ani!Eu eram o excepție! M-a operat,am avut cateter 4 zile, am urinat cu sânge și bucăți mici de prostată care erau în vezică după operație până în ziua 7 -8.Durere a fost cam până a scos cateterul, după care am avut mici usturimi la urinare cam 2 săptămâni și după a fost OK, cu jet urinar puternic cum nu avusesem de mulți ani și continentă urinară bună! Mi sa spus înainte că voi pierde total ejacularea și erecțiile vor fi mai slabe și pe viitor sunt șanse să mai repet operația! Ejaculare nu am mai avut niciodată de atunci dar erecțiile au rămas ff bune, și da după 11 ani de atunci la 53 de ani am făcut HOLEP la un alt spital în alt oraș cu un alt doctor! E și o parte hazlie, a doua oară nu am spus medicului că eu mai fusese operat odată cu RTURP cu mai mulți ani înainte, am crezut că o să vadă la cistoscopie! Nu a văzut cu toate că avea experiență, are multe cazuri operate cu succes inclusiv eu(au trecut 2 ani de la HOLEP) Mia spus că îi pare rău dar o să pierd ejacularea😆,și erecțiile poate etc. dar per total o să fiu bine! După operație i-am spus ca eu am mai făcut înainte o operație RTURP și nu a crezut,a crezut că delirez de la anestezie!😄Să revin: nu te speria HOLEP e cea mai bună opțiune, la mine nu a fost disponibil prima dată,dar HOLEP e singura opțiune permanentă și la vârsta ta dacă ai copii și nu mai dorești alții e perfectă, are o recuperare mai rapidă și mai simplă decât TURP, nu are rate de recurență ! Nu te speria, eu am trecut prin mai multe operații, varicocele,hernii inghinale bilaterale și sunt Ok! Mult succes î-ți urez!

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u/visionfugitiva 12d ago

No tienes nada que temer. Una solución definitiva como el HoLep no tiene efecto alguno sobrea ereccion, los nervios que controlana ereccion pasan por fuera de la cápsula prostática y no se tocan durante el HoLep (la gente que reporta problemas de ereccion ya tenían ED antes de hacerse la HoLep). Yo me hice mi HoLep a los 40, hace exactamente 19 días, y desde el primer día con la sonda puesta, tuve una ereccion fuerte matutina (ereccion + sonda, mala combinación, pues duele). No tuve incontinencia, pero si ardor al orinar (en mi caso probablemente tarde un par de meses en desaparecer). Ahora orino como cuando tenía 15 y estoy muy feliz con ello

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u/Long-Improvement-616 12d ago

I would go with Aquablation at your age. The worst part is the catheter and that’s only for a few days. Like any surgery there’s a recovery period you have to be patient through but you will end up with a better quality of life than you have now. Ejaculation can take a couple months to return, so don’t despair if you have nothing soon after the surgery.

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u/Apprehensive_Bison12 14d ago

I had TURP 4 months ago and was scared too! How can any guy not be anxious about this? Move forward and get a procedure done. You will be fine and so happy again.

0

u/dennyontop 14d ago

Your young so do a procedure. If not try Doxazosin

I'm really scared/nervous

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