Thursday, October 23, 2014
Wednesday, May 04, 2011 mike, Community Member, asks

Q: why do so few urologists use holmium (HOLAP) for prostate surgery and so many use greenlight, which looks far more dangerous? My theory is that greenlight is cheaper (surgery is quicker).

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Answers (4)
Jay Motola, Health Pro
6/ 1/11 10:13pm

At many centers both lasers are available, however most urologists prefer greenlight. Time to perform the procedures are similar, however most Urologistsfeel that the results with green light are superior.

rockman, Community Member
9/11/11 9:14am

Went to Mayo Jax. Friday. Their GURU  (their statement) is a Dr. HUMPHREYS from Scottdale AZ. Mayo. He is their HOLEP expert. will be here next week to train others. Would I be interested in having him do me. So far Yes. Any one have  fast imfo on him would be helpful. I saw 2 doctors while their. Both do Greenlight told Turp is still #1 procedure they do. HOLEP is good but has a LONG and HARD Learning curve. That must be used Frequently to stay good at it. Greenlight is a low maintance Chevy. Holep is the high Maintance Jag. DOES do better job on larger Prostates. 

mike, Community Member
9/11/11 11:52am

There is a blog on the web (you'd have to look for it, I haven't seen it in months), patients discuss the results of their surgery, HOLEP, TURP and greenlight. The worst results are from greenlight. Surgeons use it is because is quickest, meaning cheapest, and requires least training time and inexperienced surgeons botch the operation all the time and the damage cannot be repaired.


TURP is the most invasive but appears to be most effective with best long-term results. My surgeon is chief of urology at Kaiser, an HMO in San FRancisco, and he will not do anything else.


There is another technique which stimulates the prostate with an electric current, but that has problems too.


If the Mayo surgeon is doing the HOLEP on you for free, maybe it's worth a try. But if he tells you that the most common procedure at Mayo is TURP, you have to ask yourself why.




rockman, Community Member
9/12/11 9:51am

Going back to mayo Tues for pre surgery testing will see the uro's again and will ask more questions. Surg set for Thurs. will try and maintaine log for others to go by in the future. Thanks

rockman, Community Member
9/14/11 10:43am

I went back to Mayo Jacksonville Tues 9/13/2011. After faxing a request based on the advice and questions from the various chatrooms. Who was to be doing the hands on? The Expert from Ariz. Mayo or the other Doctor.

It was was in fact the other Doctor. Who they stated. After futher questioning only had done 10-15 Holep's and None as big as mine.

He will be closely supervised and the expert will assist. How long does it take to miss by less than a 1/4 of a mm  and cut a crutial nerve that puts you on a urine bag or depends for life?

The learning curve is stated all over the web as 50 to start. About 100 for the large glans. Mine is over 100g.

I know many people out their LOVE the Mayo Clinic.  and they have done much good work.

However my experience has been one of miss statements? On my 1st phone call I was told that Dr. A*****.  was well past the learning curve on HOLEP. This  by his nurse on the phone. When I dove the 120 miles to meet him. I was imformed by a different Dr. he had in Reallity done  No Holeps to his knowledge. 

They then attempted to present Turp or greenlight as the way I should choose. as this did not work. I was left waiting in a room till Dr. A***** showed up.

He then imformed me of the Visit by their HOLEP GURU from Az. and would I be interested in having it done next week by him? I agreed and they ran me thru Ultrasound of the prostate and 2 DRE'S. They then  made a pre surgery test appointment for tues and surgery by two Drs. Thursday.  Their Dr. was listed 1st RED Flag. thanks again to the boards. Tuesday morning I asked the right questions before going any futher.

I have canceled it all.

Had I not been Misled from the start. I would of NEVER made an Appointment. in the first place. Saved 2 round trips. 240 miles each and days of getting reddy packing for motel ect

It is a shame. Have we gotten this far. That you need a Lawyer present to decifer between what is said and what is meant when talking to Doctors and their staffs.

Please be AWARE out their. Trust YES! But most importanly take time to think and VERIFY everything.  Rockman

EJ, Community Member
10/ 3/11 8:18pm

Thanks for your post. My Uro seems to be pushing surgery ever since I started with him 3yrs ago.  Have been dealing with BPH for about 3 yrs...using Uroxatral ...and lately included Avodart. May try Jaylin.  My problem is getting up at night couple times...however, not too bad during the day. Play golf etc. with little or no problem with frequent urinating.   I'm reluctant to go with surgery (TURP or green light laser), mainly because of possible side effects.  I seem to be getting by with some meds. Urine retention seems to be the issue with the Uro.  Have gone through several tests with him which have been normal, such as bladder test and kidney ultrsound.  Would appreciate any comments for folks on this board about decision making process.  

rockman, Community Member
10/ 4/11 2:31pm

I Read the best article I ever had Yesterday. Univ of Tenn hospital in Knowville. At their site. Look up uro then bph. It's a long article. But tells you things I HAVE NEVER HERD OF BEFORE.  Size is not all their is. Some small have bad bph and need surgery. Others large Do Not need it. It's WHERE and HOW it grows not size that matters. Up the bladder neck  or far and wide. Or small and tight around the urine passage. That is the determining factor. Retension bladder is like a ballon it streches. How much is, to much for you? Could be fine in someone else.

Told when I hit 120 ret. you'll have bad kidney failure etc. We  need to Operate NOW.

That was 8/10.  Now at 235 ret 8/11 No infections ect. I use flomax .04. I also did do avodart till side effects stoped that.

Do you drink? if so It makes it worse 1-2 drinks early evening  up 1-2 x.   3 drinks 3x. 4 drinks 4x depends on how late you drink. If I do not drink or  say not after 5pm. 1or2 on the boat in the afternoon. I'll Get up 1 or maybe 2x.

Looking for a Dr. now but Imfo is like pulling teeth with a door knob.

Numbers DO NOT exist. A lot, Many, all the time, regular. quite a few.

Time frame also does not exist. Don't know but a long time. Since I came here 3-6 mo. For years I think? Classic, We count all turps, Open Prostecs. Lasers, Micro wave ect the same. So we do not know.

Where are you located I am in central Fl. east coast.

Be carefull out their You are the one who will suffer after a mistake.  

EJ, Community Member
10/12/11 10:00am

Thanks for the feedback and advice.  I suspect that I may be out of the 'norm' somewhat in that I've always had a bit of reten issue for over 30 yrs (small bladder possibility).  I'm 74 and slight build (125 lbs), play a fair about of golf with little urinary problems...etc.  health is excellent....PSA had been very low (under 1) over past 6 yrs.  Blood work is excellent. Have altered fluid intake after 9pm which has helped.  I have feeling that I may be a good candidate (health wise) for the surgeon to get another notch is his belt! 


The Uroxatol has helped since I noticed less need to urinate on long auto trips (and other events)....I drive to Fla each winter for couple months from Phila Pa area.

mike, Community Member
9/14/11 11:36am

Sorry to hear about all that wasted time.


I can mention again that although greenlight and TURP are the most common surgeries, my urology chief at Kaiser in San Francisco will only do TURP and in 20 years he has done many hundreds, He will not do greenlight. Doctors do greenlight because it is cheaper for the hospital. Quicker procedure, quicker learning curve.


The way TURP is done at this Kaiser, a catheter is fastened immediately after the operation and the patient goes home with it the same day. There is no hospital stay. But it stays on for 8 days. I have been putting it off and self-catheterizing, which is a lot easier than it sounds --- you slip in a tube and urinate stnading up over ther toilet just as though you were peeing. But eventually I will get around to doing it.


Why don't you talk to the chief urologist at a big local hospital and ask him about TURP and greenlight. TURP is more invasive but has been the standard for many years.

rockman, Community Member
9/14/11 4:53pm

Mike. I live on the east coast of mid central Fl. We have 4 Hospitals the one in my town pop,about 20,000 has had various owners. A Fl State rating of worse/more than expected in almost every negative cat. US news has no rating on it. I have been their several times in 32 yrs. Any one who is good leaves Quickly. It is a fine place if you want to Die. The rest are almost as bad many staff persons are rented from an agency so they to a large extent are the same.

I got an infection. Punchured rear of Aorta. plus 4mo of C. Diff. 3 yrs ago at what was the best of the bunch. For a simple heart Cath.  I have since had 3 friends get C. Dif in the same place. They called the Priest for 2. One later died due to the delay in treatment of his admission problem,  due to it. Problem simple colon check top and bottom.

When I do go to an Hospital. I and many many others leave. Some I know Go Up North or at least to Orlando for a fighting chance of living. Brother in law went to the Bahamas for surgey as due many others with prostate cancer.

Florida's Medical Laws are easy on bad doctors. You collect nothing for No permanent damage. No matter how long you suffer.  No dependents under 18 or LegaL DISABLED WITH YOUR SOLE SUPPORT. Dependent wife forget it.

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By mike, Community Member— Last Modified: 11/05/13, First Published: 05/04/11