Treating BPH Comparing HoLEP, Rezum, and UroLift

Scott M. Cheney, MD, reviews the background and practical application of minimally-invasive surgical therapies and definitive therapies for benign prostatic hyperplasia (BPH). He then discusses patient selection for these therapy options based on recommendations, level of evidence, and comparative outcomes.

[@stephenwcarter6919]

The best concise and comprehensive discussion on comparative treatment therapies for BPH

[@John-hq6em]

A major negative of Urolift is it completely precludes the use of MRI to scan for prostate cancer. It also prevents the use of MRI for guiding biopsy of the prostate, putting you back to the sketchy process of random biopsies. The Urolift implants create large blind spots in MRIs of the prostate, eliminating the value of the MRI. This is a huge drawback that no one seems to mention until it’s too late. I know this from personal experience, unfortunately.

[@GeorgeDaymondLush]

An excellent and simple presentation that anyone should be able to absorb

[@jamesreedy1517]

The most complete overview that I have seen on the Internet.

[@jimanderson2518]

Wow that my friends is exactly why the internet is a positive tool Thanks for posting Hope you know how much that helps people . 👍🙏

[@greatgandalf5233]

Excellent presentation with a great review of current procedures!

[@kennyw871]

You need to update this information in consideration of the PAE procedure. Thanks.

[@MrCuddlyable]

@kennyw871 PAE (Prostatic Artery Embolism) gave me a couple of year's relief but clearly did not prevent my prostate continuing to grow so that it is now inoperably large and I am bound to a catheter. However the PAE "intervention by radiologist" was tolerable without anaesthetic and we could chat during the procedure. I was home again the same day. The required skill set and the preparation MRI make this an expensive choice and, I suspect, make it unpopular with established urologists.

[@fredcdobbs823]

No mention of Aquablation in comparison studies. Considered definitive therapy by GRU?

[@ClassicalGuitarist]

Very informative and useful. Thanks.

[@ericrawson2909]

Excellent presentation.

[@valeo6820]

Always ask your urologist whether he/she has financial interest in using particular treatment method/ equipment. Most urologists have financial agreements with companies rewarding them for using their equipment.

[@richardfadle5921]

Great thinking!!!! Or they co own the clinic. Or if just a employee they get bonus if doing one way over another! Even pharmacists get rewards for pushing one drug over another! Human greed: human nature for the almighty because ck rules all!

[@richardfadle5921]

For the almighty buck rules all!! I meant to say!

[@sunilgarg9506]

As if he is going to tell you

[@mgmovassaghi1733]

The operating urologist gets bright from the sales people I experience that while my urologist was doing eurolift on me. He destroyed my livelihood. I used to get up two or three times a night before now I'm getting up 3:00 to 4 times and sometimes five times after the Euroleft. This procedure is a hoax

[@mgmovassaghi1733]

While he was doing procedure on me the salesman was in the room

[@petermontgomery4317]

Very informative and comprehensive. Thanks

[@TheEddiedudley]

Great information and well explained.

[@Agapenutrition]

Very nice presentation, just what I was looking for; however, I didn't see any information on any of the MRI-guided laser ablations such as those offered by Halo Diagnostics, Tulsa-Pro. or Thulium laser. They would appear to offer a very rapid recovery compared to the Rezum treatment. Would appreciate hearing your thoughts on those options.

[@davidanderson8469]

Excellent presentation doctor.

[@silaslongshot941]

Have had UroLift (pul) done twice, failed twice as the prostate just swelled up past the pins, now looking for third and FINAL fix for the issue. So have 10 to 12 pins left in the prostate. How will this complicate the HoLep procedure? And is this more permanent than TURP or greenlight?

[@bobabraham5060]

Would have liked to see robotic prostatectomy included as this is the choice those with

[@Stinsonddog]

Dr Cheney is fantastic. I have seen him in action and if you want a HoLep you should come to Mayo and have him do the surgery.

[@barkingbeanscoffee]

@@user-fm4gv3es3l LOL like you have it done more than once? He was was great.

[@MartinNyberg]

Why not include TURP?

[@Whicheverworks]

Thank you for a good presentation.

[@kimpliny]

A detail and comprehensive comparison among all the options for treating BPH. Wish it also includes TURP, which I just received 3 weeks ago. I am happy about the procedure but having a catheter with me for 9 days in total felt really miserable. Overall, this video has re-confirmed me that I have made the right choice for my BPH.

[@luigi5890]

Some time has passed, do you still feel the same about the TURP?

[@NetoperekMordulec]

Did it involve a total destruction of your urethra??And you call it "the right choice"???Amazing.

[@kimpliny]

@@NetoperekMordulec Yes, I still call it the right choice as of today. I have had no problem urinating since the surgery. I was even surprised that I could have no problem with ejaculation after the surgery, because I was told by my surgeon it won't happen after this surgery. I asked my surgeon about it, and he replied to me that he could do nothing about it, and it was pure luck. Hope this helps.

[@robertpapps3618]

Excellent presentation, thanks much!

[@slava1959]

Urolift worked me for only two years and then urgency returned. I did try to talk to urolift but they refused to talk to me. Any ideas on how to extend the life span of my urolift implant working for me again which is sitting idle inside of me?

[@robertstancliffsr9575]

I only got a year from my Urolift....also, the procedure, once I woke up from having it done, hurt something awful and while I left the hospital on the same day (without a catheter), I had to go to a hospital emergency room that night and get one installed. All of this hurt terrible....and I peed blood and clots for 4 weeks. Now, a year later, something else needs to be done.........

[@piyasaini8578]

CAC Sheet Dhara Syrup is the ayurvedic formulation of Ajwain satv, Peppermint, and Mushak kapoor that balances the vata and pitta dosha. The syrup has coolant properties thus it is very beneficial to cure abdominal pain, discomfort, and improves the metabolism of digestion.

[@xavier05]

I wish these new minimal invasive techniques were available in Brazil

[@peterbrown6867]

Hello. There is minimal invasive procedures in Sao Paulo. The procedure is prostatic artery embolization. Look it up.

[@Rockinrn]

Very few surgeons perform HoLEP due to the steep learning curve.

[@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 !!!!!

[@pearlgarwood8474]

I have a very enlarged prostate ...what is the best treatment option. I am 74 years old and have prostate cancer with Gleason score 3+3

[@mattmilroy3575]

Do the dctors put you out of conciencesness

[@unclefester9113]

Morcellated ? Interesting word. Interesting procedure ( please explain )

[@antoniocalderazzo593]

Excellent its a great help quite comprehensive THANK YOU

[@AZSilverbug]

Great review... any comparison to the good old TURP? Or is the TURP far worse then any of the procedures reviewed?

[@fpftraining]

Very informative.

[@jefferymcleodbeyoursfalway3170]

So what they are doing is removing the tissue inside the prostate turp it's cut out aquablation it steamed too kill it holep is a laser too burn the tissue

[@mickanton7285]

more information is now available which suggest Urolift for patient with enlarged median lobe

[@Falquiboy]

any experiences with the rezum therapy?

[@paradab6543]

i just had rezum about 5 month ago, it does not work for me. i will have holep surgery in the next 4 days. hopefully it will work!

[@Hiker_Mike]

Stricture rate @ 1 year out is 0.5 to 8.1%? What does that mean? Does it mean the risk of getting stricture(s) at 1 year is up to 8.1%? This is the reason I won't get HoLEP or TURP... strictures require additional *potentially serious* medical procedures to correct.

[@Hiker_Mike]

@@SharokD , After researching this for months, I'm going to get TURP. BPH symptoms are destroying my quality of life. I've suffered with BPH for 15 years now, I've had enough. I'm forced to take the risk of potential strictures/etc... I won't take BPH drugs and UroLift has too many unknowns w/r to long term improvement. I'll have TURP done Apr. 22nd, hopefully it works to eliminate the BPH symptoms.

[@SharokD]

@@Hiker_Mike If you are going to take the risk of getting strictures with TURP, why not do HoLEP, which is more like a permeant fix? I've heard people who did TURP ended up going for HoLEP later to clean it for good. Some places where they do HoLEP or TURP might have an option to use a resectoscope with diameter of 21FR (7mm) which reduces the risk of strictures. Usually they use a resectoscope with diameter of 26FR (8.66mm).

[@Hiker_Mike]

@@SharokD , The only option I have with my insurance is UroLift or TURP. I want HoLEP but can't afford the $20k out of pocket to get it. My doc uses the 26 FR diameter continuous flow resectoscope, if that doesn't provide good enough visibility, she moves up to the 28FR. The report I read suggested the 28FR might increase the chance of stricture but the data is not very clear/obvious there's a correlation. I suspect there are so many variables related to causing strictures that they will never pin down the actual cause(s). Same goes with UTI/infection post surgery, I suspect this is highly dependent on the nurses that install the catheters etc. but who knows. If my TURP only lasts 4 years, I'll get a UroLift tuneup using Medicare at 65.

[@SharokD]

@@Hiker_Mike TURP should last more than 4 years. I hope she doesn't need to go to 28FR, but worst case scenario strictures can be fixed later by Endoscopic Urethrotomy, which doesn't seem to be too serious.

[@Hiker_Mike]

@@SharokD , Yes, the TURP should last a long time but it depends on how aggressive the doc is with resection. My doc doesn't like to remove too much of the prostate, lowers risk of incontinence. So, in my case, I hope this TURP lasts 4 years. And yes, many times strictures can be repaired, I hope they don't use the 28FR.

[@sonyjamia3051]

Very well explained.

[@GWAYGWAY1]

In the UKthey have some NHS centres that use it but mostly private clinics. These private hospitals are using a scam with both urolift and rezum. They tell the patients that it must be under full general anaesthetic in a proper theatre . This makes the patient think it is a lot more serious than it is. The costs are therefore a lot higher than could be charged as an outpatient walk in therapy the quotes I got were £6400 or so. Rather than 2200USD

[@cliffdariff74]

are not the procedures already tax paid health in UK?

[@GWAYGWAY1]

@@cliffdariff74 Yes if you use the NHS, but all the NHS hospitals are closed because of the CV19 scam and I am forced to pay for a private clinic to get it done OR wait on a waiting list for at least two years until they might have cleared some off the list, I would have had it Last year otherwise and I cannot live like it with the BPH, tamsulosin kills me with GERD because of the pain of reflux at the slightest lifting or bending.

[@davidscott3292]

@@GWAYGWAY1 Things are getting going again. I've just had a turp at my local NHS hospital in the UK.

[@GWAYGWAY1]

@@davidscott3292 At the moment I am sitting waiting for my op today, having a Rezum ,and costing me £5000 at private hospital in Chichester .The NHS has me on a waiting list of two years time. I could not carry on like that so have blown savings on it. There are it see s 4.8 million waiting for an appointment for seeing an NHS consultant, let alone t hose that haven't seen the GP. It is all a planned agenda.

[@davidscott3292]

I must have been lucky to get a cancellation at short notice. I had acute retention and a catheter in for 15 months, with numerous episodes of severe infection. Sounds like you've got a good, up-to-date procedure with the Rezum, less invasive than the turp. All the best.

[@John-hq6em]

Avoid Urolift like the plague! I should have heeded the huge number of negative reviews. A completely disastrous experience. Intensely painful recovery, and I’m left worse off than before.

[@panostheodoulou1166]

I thought Rezum has risk of non ejaculation, however Urolift does not have that risk

[@Tridhos]

Why nothing about prostate artery embolization PAE which seems to be producing some good results? However good and interesting presentation.

[@robkeast9091]

PAE results are very dependent on practitioner experience. It's a very difficult procedure due to the complicated vascular anatomy in that area. If you go that route, make sure your IR has plenty of experience.

[@azppmd]

Not recommended by the AUA 2018 guidelines.

[@alswearingen323]

I had PAE, but one side was too tortuous to do. so only one side was successful. Improvement was quite noticeable and no side effects. I went from urinating every hour at night to twice a night. However, IPSS went from 21 down to 16. Had both sides been done, I'd have expected even better results. So, I still take Alfuzosin (which other than orthostatic hypotension, has no side effects), along with Tadalafil. Seriously considering Rezum for at the least the side which was not done, to see if I can get off the Alfuzosin, at least.

[@alswearingen323]

@@azppmd Yeah, they probably still hold TURP as the standard of care. Guaranteed to basically ruin your sex life. Maybe if I was 90 years old . . .

[@jaymumford5749]

PAE is done in by a radiologist and not in urology so it actually takes a patient procedure and business away from urology department. I discovered PAE on my own as urology was not forthcoming. Interesting isn't it.

[@dolorespallares2735]

‘Urolift’ comes out, for me, as being the best solution. Price/value seems less high than ‘Rezum’. Very good information. Pity speaking non-stop and quite fast.

[@scottnole8045]

Impressive!

[@westfield90]

Is TURP no longer done or considered?

[@azppmd]

TURPs are still done commonly.

[@alswearingen323]

When you consider what it does to one's sex life, I considered it, for about 2 seconds.

[@johnnyhorizon8368]

@@alswearingen323 have sought another treatment?

[@alswearingen323]

@@johnnyhorizon8368 Hey John. I went for Aquablation. NO side effects.

[@jefferymcleodbeyoursfalway3170]

I have a friend who is a doctor he did not want any of these so he went and had a robotic surgery too remove the prostate he said he did not trust his colleagues in urology

[@hawaiidoves]

Would Holep, be useful with someone with complete retention?

[@USCG.Brennan]

No mention of vitamin supplements. I've been using Saw Palmetto, Lycopene, Tumeric and Stinging Nettle Leaf (health food strores) for several years now and they've been working well for me.....and MUCH less expensive!! Just an idea for those just beginning to have these problems and maybe how to postpone anything invasive for awhile. ;-)

[@Whicheverworks]

Hi Curt, Interesting to hear about your experience with herbs and vitamins. I am having my situation evaluated in some days, and unless there is something more serious going on (cancer) i will also go for the natural treatments as a first choice. All the best.

[@mcanderson3511]

It was mentioned early on in the video.

[@USCG.Brennan]

@@Whicheverworks You betcha, it's working great for me (3 years now).

[@USCG.Brennan]

@@mcanderson3511 Thanks.....I didn't hear that, so I'll listen to this again.

[@Whicheverworks]

@@USCG.Brennan Thanks a lot for your reply ! Two more questions: What do you use for Lycopene (foods og supplement, if so what kind ?) I see there are many producers of Saw Palmetto, to different prices... Do you have any experience to share regarding which to use ? Thanks again Terje

[@roberthowitt1005]

I had a Urolift and it was worthless.

[@LonskiBig]

...Those medication cost figures are way out of whack....A person could get by on generic terazosin 5mg (2 qd) and add atenolol to calm any heart- racing tendencies for about $50 for 3 months...and cheaper if you picked them up in Mexico....

[@billsheehy1]

Very good presentation

[@eugenebdotson7363]

I had rezum and the tissue was not removed, No ejaculation for my manhood !

[@HH-uz9qe]

One of the best of numerous analyses on the subject; audio needs some improvement

[@MarkJohnson-zy4fd]

Regarding Rezum: “Typically four or five treatments…”. From experience, when the moronic doctor performs FIFTEEN treatments, as he did on me, things go poorly. Boston Scientific, IMO, has paid insufficient attention to the dangers of over-treatment.

[@richardfadle5921]

Most doctors do hav a money interest!

[@PODONGI0]

👍

[@eugenebdotson7363]

Be careful for what you wish for you maybe disappointed in the end !

[@sangvong3396]

Urolift last 12 months. No good

[@eugenebdotson7363]

The Elon musk procedure !

[@eugenebdotson7363]

Rezum, you will lose your manhood !

[@edenadam872]

not clear >>>>. u CANNOT TEACH

[@robkeast9091]

I thought it was a great presentation. It was not designed for non-medical listeners, however.

[@Mr406Galaxie]

It was very clear >>>> u CANNOT LEARN

[@alswearingen323]

I think it's pretty clear. This guy specializes in HoLEP.

[@Mr406Galaxie]

@@alswearingen323 Nothing wrong with that. He presented the other options very well in his presentation. Ultimately the decision is up to the patient which procedure he chooses to have done.

[@cliffdariff74]

he is not teaching, dummy.