Treating BPH: Comparing HoLEP, Rezūm, UroLift, and Aquablation

Mitchell R. Humphreys, MD, reviews the current society recommendations addressing when to intervene with surgical management in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). He provides an overview of new minimally-invasive surgical therapy technologies for these patients.
Read more here: grandroundsinurology.com/trea...

[@journeyon1983]

This is one of the most informative and educational videos I've seen so far. Thank you.

[@yaneznayu9997]

I had aquablation this week on my 108 gram prostate. Easy-peasy, I'm now blasting paint off the walls at home.

[@honeyboy3rd]

The most informative, in depth, and communicative video... thanx and God Bless

[@mostguitarswins]

There is a wealth of information here. It's being presented to other clinicians and so it's not easy for the layperson to take in, but outcomes are easy enough to understand. Aquablation looks like a good way to go - so does Urolife - if you meet the criteria. One big takeaway is that having a skilled doctor is more important than the particular technique in determining the outcome.

[@witzed1]

Dr Humpheys did my holep with good long term results. No antegrade ejaculation but at 63, I considered that a feature. I peed red fire for a week but this was the expectation. No nerve damage or ed. Like he told me many times, you will "pee like you did when you were 17". At 17, it wasn't something that I remember but I frequently sleep through the night.

[@gerardodesola7906]

Dr Moss great presentation, i am insulin dependent 69 years old. Your video make me feel better informed about the aftermath simptoms

[@brianb336]

so informative. well thought out options that I did not know were available

[@slhgrow7683]

Though I'm not a medical practitioner, This provided very good points to cover with my doctor... I'm glad that are putting so much heart into this level of medicine. May other fields follow this enthusiasm and commitment.

[@ADAM-fy8ht]

Thank you 🙏 the greatest video to decide what to proceed with .

[@sayeedc]

This is very helpful as I try to select the right option for myself.

[@drzenkobilas7770]

IPSS is International Prostate Symptom Score; PACU is Post Anesthesia Care Unit; HoLEP is Holmium Laser Enucleation.

[@nabuk3]

Thank you. Would it killed the speaker to mention this the first time each term came up?

[@rodedc]

Excellent speaker, beautifully explained

[@berg6964]

Very informative, thank you

[@alexwonner7469]

very useful infos and so well presented. Thank you

[@spumemonk11]

I had the Urolift procedure done on my median lobe and thankfully it worked wonderers for me. However, it only fully lasted about 2 years but it's still much better than it was before.

[@johnjbuffojr6789]

Liked the the whole presentation, some a little confusing but I got most of it. I live in Chandler AZ and need to see a new urologist that can perform any of these procedure's. Maybe ill call Mr Humphreys.

[@johnhembree9740]

Just had my HoLEP done by Dr. Humphreys. I'm grateful that we live so close to Mayo in Phoenix.

[@haimkohan9241]

Hi John, I think to come to the US to have HoLEP, could you please tell me how much approximately it costs? Thank you.

[@jron20r51]

I was blown away about the data. I live in CT, and it is a backwater for this stuff. I think they worry more about their bottom line than the patient.

[@whiteyobanion1104]

Urologists are the laziest doctors on the planet. Surgeons at least do the job.

[@eleveneleven6638]

Urolift completely and permanently destroyed my life !!!! Now I am faced with my new urologist wanting to do another surgery (greenlight) to correct to the botched UROLIFT procedure. I am told I would have to self catheterize everyday possible for the rest of my life. My symptoms now are WORSE than before Urolift. Please be advised and don't say I didn't warn you if you get this procedure !!!!!

[@x6011]

It's a great video, very helpful for my decision making. Quick question for you: Under 48 mth comparison date, the Qmax of PUL and Rezum is ~ 4.2, is this number a post-opteration one? it looks very low, it suppose to be 10+ by the internet explanation. My Qmax is 7 which is low enough. I might be wrong. thank you!

[@MH55YT]

thanks for the video

[@josephfili8003]

My urologist is recommending Rezum. I am doing research and this presentation was very helpful. As a layperson I had to pause quite a bit to look up some of the terms that were used but definitely a learning experience for me.

[@shuckyducky5212]

Did you have this done? It sounds so simple and quick and with great benefits but the more I research the more complications and less favourable results I find in different forums, support groups, etc.

[@IAmTheEggMan111]

@@shuckyducky5212 interesting. Which forums have you found to be the most helpful?

[@johnnyhorizon8368]

@@IAmTheEggMan111 also considering Rezum...any further comments?

[@gilbronc1]

@@shuckyducky5212 Friend underwent the procedure, some pain after the procedure, affected the ejaculation

[@shuckyducky5212]

@@gilbronc1 oh no! Every doctor I've consulted here in Spain keeps saying that the safest option. I recently found another doctor who suggest iTIND, so I'm exploring that route now. Thanks for the info

[@valeo6820]

Always ask you urologist whether he/she has a financial interest in using particular treatment method/ equipment. Most urologists get financially rewarded on regular basis by the companies for choosing their equipment / treatment method.

[@nagausha5]

with the new Federal laws, any reimbursement or back payment is against the law. as a Urologist, I have never been approached by the company about back payments in my whole career.

[@bobbender5858]

@@nagausha5 ..That is very good to know. !!!

[@aubrey1008]

@@nagausha5 Well, maybe the Urologist has a separate corporation so he doesn't have to disclose. I don't know what is legal or illegal.

[@LucasTakikawa]

thanks

[@DB-xp9px]

anyone else notice how different urologists speak about the various procedures when they're talking to their peers vs us patients in the office or the message the industry gives u? i would've never learned of the downsides to each had i only consumed what my local docs and the industry marketing presented. after watching a # of these kinds of videos, seems aquablation is a good compromise to all the competing variables. too bad it hasn't been around for very long so we have a larger sampling of data.

[@paulhemingway6442]

I am 72 yrs old. I had high PSA levels 4.0 to 12 for the last 16 years. I had 5 biopsy's (all negative) Was given testosterone injections, patches, then gel (4 pumps) for the last 15 yrs. Urination problems, PSA levels, & prostate size increased. I found out 2 wks ago, that the testosterone could have contributed to this. I also was given Avodart & Flowmax first, but stopped after 2 months. I then had a PAE done. No long term relief. I then had an Urolift done by Dr. Gange. (even though he said my prostate was the biggest he's seen). I was awake during the entire hour long torture session. Afterwards, only had slight relief, as I had to keep using Flomax, then later Uroxatrol & Cialis 5mg daily. Last month I was interested in Rezum, but when having a MRI, my prostate size was 214 cc, So I decided to do the ToLEP by the only Dr, in my area that does them (Dr Gross). I was released after 2 overnights, and came home 2 evenings ago. My surgery took 6 hrs, and the biggest pain today is R shoulder and my upper butt cheeks (probably caused by being in the same position for 6 hrs on the operating table. My hope now is that my life gets much better in the bathroom and the bedroom with no more medicine or treatments ever again. Thanks for posting the video. I wish I had seen it years ago.

[@grantpassman2318]

I hope you've found some relief after your last procedure, Paul.

[@richardfadle5921]

Finding a doctor; especially a urologist that s not a huge asshole is very very hard!!!! You are brave sir!!! Good Luck! 🍀 I hope this works good for you!! I had the P.A.E. And it shunk my prostate a little but not enough to do any good at all!!! I had the urolift. It worked! So far! But doctors say it will stop working good in a few years. Hoping for the best. Some doctors lie by omission and don’t tell you it’s only good for short term! About two to three years. I’m hoping to ladt much longer than this because the pae shunk my prostate some. Hang in there man.

[@robpage7125]

Beware of the administration of Testosterone, gang ! Lots of disagreements between so-called "medical experts" ! The latest unbiased treatments tests suggests..

[@robpage7125]

...that Anti-androgenen treatments (hormone drug therapy) reduce the PSA levels..Like Lupron and Xtandi... Apparently, Prostate Cancer cells actually "feed" and grow from the presence of Testosterone....My friends, all over 70, have had a variety of treatments...Of course, every human will have different reactions, and no what doctors and the Pharmaceutical Salespeople promote, our time on this planet is unfairly short...So choose carefully by doing your OWN research ! Be not intimidated by "Dr. All- wisdom" types...All of us patients have the right to read the same journals and KZbin presentations "they" do ...Break out your medical dictionaries and de-code exactly what the hodgepodge of medical terms mean, and at LEAST ask questions ! At least 6 doctors myself and relatives have encountered have given advice that was HEAVILY influenced by INSURANCE restrictions and overly zealous use of medicines which have dangerous side effects ! Just saying...😮

[@MrJOHNMICHAELVEGA]

He doesn’t talk about Prostatic Artery Embolization which is a very simple procedure to slow the blood flow of the prostate producing some shrinkage of the prostate. This procedure has been around for many years but was used for other interventions and not the prostate per se. Now since 10years it is used in different hospitals and clinics. This procedure is done by a radiologist and takes 3/4hours depending on the efficacy of the facility. It has 90% success rate with few minor side effects the first five days of performing the Prostatic Artery Embolization (PAE)for short. Check this out! From my heart to yours, Michael ❤️🎶🙏

[@paulhemingway6442]

I tried PAE first. Unfortunately my prostate continued to grow and symptoms got worse.

[@johnM-Jr]

@@paulhemingway6442 i had pae, didnt help if at all.

[@samkitty5894]

This procedure take ALL day not 3/4 of an hour. And it is very delicate...no room for error.

[@richardfadle5921]

It really strongly seems that for any of these treatments for a to big prostate without cancer; that the quality of the doctor ( surgeon ) is what matters most!!!! More than which type of prostate treatment you choose! And this means someone who has done many of them before you come along!!!!!

[@JN-gi6bf]

A lot of information. A conclusion summarry and recommentation at the end of the video would be helpful

[@serinodiaz4140]

Which would you have done and by whom? How many have you done ?

[@RobertSpiller]

Question...I live in the Metro Detroit area, and I'm looking at either the aquablation procedure or the Holep...do you know of any Urologist in Michigan who does this? I thought that U of Michigan was an advanced institution keeping up with the latest technologies but to my surprise they don't and I am highly disappointed.

[@haimkohan9241]

Dear Robert, I leave in a country that does not do aquablation nor Holep. My sister lives in Metro Detroit area, and I was thinking of going to Detroit and looking there for someone who does aquablation procedure or the Holep. Did you find anyone who does these procedures in Metro Detroit area? Please let me know. Thank you.

[@teddyboehm9252]

Great information

[@williamevans6522]

QUESTION :What about ThULEP(Thulium laser instead of Holmium)? What are the advantages?

[@edoc431]

what about greenlight? so what surgery is best

[@mrsub500]

My thoughts on Urolift, there are other factors to consider long term... restrictions or to be careful with future MRI scans given the metal implants, longevity of the implants?, will they dislodge in the future?, can they safely be removed if necessary?

[@paulhemingway6442]

I had Urolift. Helped only slightly for a couple of months. Now a few yrs later, I've had HoLEP. During the procedure all Urolift straps came out

[@tomsantella5538]

Had urolift been in testicle pain for two years have to remove clips painful urination urolift is no good

[@alswearingen323]

VERY useful video! Thanks much! HoLEP or TURP or RASP? I think I'd choose none of the above. If my situation were that dire, I guess I'd choose the Aqua Ablation. The nerve damage from RASP cauterization was news to me. For now, I'm going for the Rezūm to augment the effects of my single-sided PAE.

[@marianoyogore3249]

PAE in the US is a bilateral procedure. What is the rationale for a single sided PAE? Was the other side inaccessible by catheterization? BPH is always bilateral.

[@alswearingen323]

@@marianoyogore3249 One side was too tortuous to traverse. Unfortunately.

[@marianoyogore3249]

@@alswearingen323 That means another procedure is needed for the other side. Good luck!

[@alswearingen323]

@@marianoyogore3249 Actually, Mariano, my symptoms had become so unbearable that I opted for the Aquablation procedure in December. The results are amazing. Passing urine has become a pleasure rather than a trial. All the advantages of a TURP with none of the side effects. No incontinence, no impact on ejaculatory (volume was slightly reduced) or erectile functions. Now, I'll grant you, the procedure itself (including hospital stay and catherization) was not pleasant, but the results speak for themselves. No man should ever have to endure a TURP.

[@gilbronc1]

@@alswearingen323 friend and would you know what the cost of the aquabeam is

[@lunacallie6858]

Aquablation sounds very promising 👍👍👍👍👍

[@samkitty5894]

My urologist told me to pee sitting down. He ordered me not to lift anything heavy...

[@hamiltheo]

Does anyone know of a physician in South Carolina who does Aquablation? I can't find a single one.

[@OutRAjious]

Who is on the same level as this wise man in the UK … please …)

[@alswearingen323]

I had a failed PAE, could only treat one side. Good relief for several years, but eventually as bad as before. Does the previous necrosis of some of the prostatic tissues cause any issue with any of the methods which were discussed?

[@leonlevental6471]

I had PAE last year and it lasted only 2 months. What a shame!

[@johnM-Jr]

@@leonlevental6471 i had pae too. Very little if any benefit

[@habibbolourchi5998]

Excellent video and very educational. I had PAE 4 years ago with great success but now the symptoms are back. My prostate size was 100cc and now is the same. I am 75 years old. What procedure should I have ? HoLEP vs Aquablation. Thank you,

[@garycortesi8406]

I’m 70 and had Aquablation two days ago. Had PAE about a year and a half ago. Worked for about 6 months. Hope things go as advertised.

[@lunacallie6858]

Im seriously looking at Aquablation👍👍👍

[@lonewolf7803]

HoLEP. Its a one and done deal. Not knowing whre you live, you might have to travel far to find a competent surgeon.

[@suecarlson7311]

can you do these procedures if you have slow growing cancer in the prostate

[@eugenebdotson7363]

I went to a urologist well I think he was ! When I mention a different approach rather than pills he wasn't helpful on a alternative approach and this is the word of the patient gets frustrated and pissed off and these jackasses call themselves specialists ! Should be no office fee for a shitty consultation !

[@whiteyobanion1104]

Sounds like HoLEP is the best to me.

[@alcoury332]

Could you do that video in laypersons language please?

[@witzed1]

Just get a holep, performed by Dr Humphreys if possible. It will cure you BPH.

[@marianoyogore3249]

After looking at all of these, I also found Prostatic Artery Embolization. It's a procedure done by interventional Radiology, not Urologists. Basically, they thread catheters into your prostatic arteries, and then block them. Kills off the prostate selectively. I had it done a week ago at Northwestern Hospital in Chicago. We will see how it does. Consider it. Newer technology.

[@TheTruthSeeker756]

Let us know how it goes please!!

[@paulawood4802]

Help! How are you doing? I’m an RN researching for my husband who has heart issues.. He had a TURP 14 years ago but now obstructed. He has had a catheter for a month while the cardiologist and urologist now are looking at Rezume and we are looking at another opinion. How are you doing? Going to check this out. Looking at Vanderbilt urologist. Daughter lives in Chicago so this may be option.

[@alan30189]

Did you have this procedure done? If so, how are you doing? Do you still recommend it?

[@marianoyogore3249]

@@alan30189 Yes. Definitely recommend it. Now off the alpha blocker, no difficulty in urination, no ED, no incontinence. Back to normal. Consider this procedure before the rotorooter procedure. I am a retired MD and am so thankful I had access to this new technology. This should be the preferred treatment for large 85cc to 125cc enlarged prostates with BPH.

[@InfusionFotoMpls]

@@marianoyogore3249 what was the cost?? I want to get this done.

[@hombo88]

What is the safest procedure for 80+ year patient?

[@paulhemingway6442]

Either Rezum or HoLEP, depending on your prostate size & other conditions. Talk to your Men's Health Urologist.

[@paulhemingway6442]

Depends on the size of your prostate. Rezum if not too large, and Holep if very large. A pelvic MRI will determine your exact size.

[@hombo88]

Thank you sir

[@samkitty5894]

Happy ending at the local massage parlor...

[@jaimemarun2841]

What about embolization?

[@tmthanhable]

Almost no effect

[@lindaguida4074]

My husband had Urolift….was rushed to ER, pain, blood clots! Very painful! DON’t do this procedure!!!!!

[@greggallant8663]

I had the same problem with my UroLift. I developed a blood clot that would not let me pee. My wife took me to the ER at 1:30 AM and they had to put in a catheter. The overall results were great for the first year, but slowly got worse and I'm now obstructed again and up four times a night to pee. Not sure what to do next.

[@zahidhossain8410]

What about Semen production. Wl it sustain???

[@paulhemingway6442]

It will still be produced, but after procedures (except for Urolift) most have retrograde ejaculation.

[@stephenerickson4649]

NO mention of PAE??

[@johnbyrley3925]

not from a urologist...that’s a radiology procedure

[@TJnDB99]

Read my reply in the thread above

[@paulhemingway6442]

PAE didn't do a thing for me.

[@petercollins1032]

I had it UroLift done failed after a month or so.

[@randolphkoch2267]

How did it fail?

[@paulhemingway6442]

Me too, by the Dr that did the first ones (& the most) in North America. It was extremely painful hour procedure, and it only helped a little for about 2 months. Just found out a couple of weeks ago that he probably should not have done the procedure on me because my prostate size was too large. I just had the HoLEP done 4 days ago,

[@StevenBanks123]

aquablation 11:30

[@draganzurovac5741]

Ja sam operisao agablezia pte dva mesrca.protok urina ispocetka bio dobar.kasnije oslabio ali zadovoljan.sve funkcije sacuvane.ali oporavak i posle dva meseca nijevnajbolji.osecam pećenje i bol prilikom uriniranja i kao pre operacije nocu ustajem isto kao pre.1h.4h.7.30

[@nabuk3]

Lots of good info but apparently given mainly to fellow urologists, since he fails to explain many medical terms and acronyms, which makes it hard to follow. What for example is IPSS, which he mentions several times. Why not define it (and other terms) when first mentioned? This would make it far more useful for laymen and potential patients of these procedures. Or, why not make a video just for us, where all these terms were explained as you go along?

[@richardfadle5921]

Yes!!!!

[@tysonstallingsiii3005]

My Real Is Tyson Stallings III

[@waltertomlinson4932]

I thank you for the information. I have a 150 gram prostate. Using catheters daily. Like to have info for best treatment to eliminate catheter use. Thanks again

[@antoniettagalati2530]

Look in to LDDH. This has been performed in Germany with much success.

[@paulhemingway6442]

I would say HoLEP. But talk to your Men's Health Urologist.

[@marianoyogore3249]

@@paulhemingway6442Urologists are not trained to do PAE. That is done by Interventional Radiologists. PAE actually takes patients from Urologists, so they do not know or recommend the procedure, even at Northwestern University in Chicago. I had to do all research by myself.

[@paulhemingway6442]

@@marianoyogore3249 - I had my PAE done by Dr. Michael Webb, Jr who is a Vascular & Interventional Radiology Specialist. It did nothing for me.

[@marianoyogore3249]

@@paulhemingway6442 Wait. Your prostate should start shrinking within a week. Takes at least a month for full effect.

[@PODONGI0]

👍

[@AshotPiramzyan]

Aquablation :)

[@kirdref9431]

A friend is getting Aquablation. Interesting video. PS: enucleation should be pronounced e-nu-cle-a-ti-on. Not e-nu-cu-la-ti-on. Sheesh. As bad as Pres. Bush2 saying nu-ku-lar when it should be nu-cle-ar.

[@randolphkoch2267]

It really doesn't matter.

[@jackburkhart873]

6weeks into a resume procedure, big mistake! Had I known then what I know now, I’d have uro/lift!

[@ADAM-fy8ht]

Please help me out decide what to proceed with , I have REZUM in mind verses TURP , I am 56 now and would like to have a baby child .

[@paulhemingway6442]

I had Urolift done by the first Dr in North America to do it (he has done the most). It was a terribly painful experience for about a year. It only helped a little for about a month (& prostate continued to grow & BPH symptoms became worse). Fortunately, 3 yrs later (in Sept 2022) I had a specialized MRI on the only machine that could do it to determine the prostate size). Found out that Mine was too large for Resum, so had the HoLEP in Nov. I've been singing the Beatles song "Getting Better" ever since. Plus the good thing is that during the HoLEP, all the metal Urolift straps came out.

[@lonewolf7803]

@@ADAM-fy8ht get pregnant if you can before going through any procedure.

[@zahidhossain8410]

Hv to give a patience hearing. Otherwise difficult to catch the accent.

[@tracyfredy450]

I am actually a believer in natural treatment. My father suffered from BPH and had several surgeries unfortunately, no cure. It was all expensive procedures which exposed his health to risk at 68 years of age…. *Read reply to know how he found help*….

[@lynnattwood6689]

What did your dad find that helped

[@nabuk3]

Why don't you tell us what he did? You say to "Read reply" for that but there is no reply explaining it.

[@justgivemethetruth]

@@nabuk3 It probably got deleted because he was trying to scam people.

[@tomsantella5538]

Urolift should be outlawed

[@mgmovassaghi1733]

I did do eurolift and it made my situation worse. I think they are doing that to make money

[@alexisengland1972]

I didn't even realize it, but suddenly it hit me, I was actually letting it flow after the movies, it all started after I go'ogled Beck Reznark's guide and felt something changed since, couldn't even remember the last time that happened lol

[@jamescalifornia2964]

Take a Thailand vacation to have the damn prostate removed. Problems over 😊👍

[@gohrt9139]

Aquablstion 😁

[@luigi5890]

DON'T DO THE REZUM PROCEDURE. You will be sorry.

[@nabuk3]

Please explain why you say that? Pain? Long recovery? Symptoms not relieved? Or what?

[@luigi5890]

@@nabuk3 If you get this procedure, make sure you can urinate when they take out the cath (The first time) Make sure you know where the nearest open hospital emergency room is and how long it takes to get there. Make sure your car is in operation condition for a possible midnight run to the hospital. After about three or four years, you might consider your next procedure for BPH. Good Luck.

[@justgivemethetruth]

that is not a cool thing to say in an unqualified way. a lot of accusations. did you have this procedure or is something paying you to post?

[@luigi5890]

@@justgivemethetruth GO GET THAT PROCEDURE AND SEE FOR YOUSELF. GOOD LUCK.

[@paulhemingway6442]

My prostate was too large to do Rezum. But I'm interested in why you say that.

[@handiman5]

Blah, blah blah. Typical medical Mumbo jumbo. Educated beyond his intelligence.

[@marianoyogore3249]

You don’t know anything, troll.

[@nataliepapolis]

😅😅😅😅😅😅😅😅