Comments for Physician Update http://physicianupdate.mayoclinic.org News for Medical Professionals from Mayo Clinic Fri, 03 Feb 2012 16:11:41 +0000 hourly 1 http://wordpress.org/?v=3.2.1 Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Miriam Wuensch http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-480 Miriam Wuensch Fri, 03 Feb 2012 16:11:41 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-480 Thank you for your interest in HoLEP procedures at Mayo Clinic. For more information related to your particular situation, please contact Appointments at http://www.mayoclinic.org/patientinfo/appointments.html. Thank you for your interest in HoLEP procedures at Mayo Clinic. For more information related to your particular situation, please contact Appointments at http://www.mayoclinic.org/patientinfo/appointments.html.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Mark http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-463 Mark Fri, 03 Feb 2012 00:06:52 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-463 Scratch my first question. I see from the website that Mayo MN does about 200 procedures a year. Scratch my first question. I see from the website that Mayo MN does about 200 procedures a year.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Mark http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-462 Mark Fri, 03 Feb 2012 00:03:18 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-462 I would appreciate your response to two requests for general info about Mayo's experience with the HoLEP procedure: (1) How many HoLEP procedures are performed annually at Mayo MN? (I've seen on the website that about 150 are performed each year at Mayo AZ.) (2) Can you also reveal which docs have the most experience with this procedure at each location? My sense from what I've read so far is that Dr. Krambeck in MN and Dr. Humphreys in AZ have done the lion's share of the procedures, but I would like confirmation. I would appreciate your response to two requests for general info about Mayo’s experience with the HoLEP procedure:

(1) How many HoLEP procedures are performed annually at Mayo MN? (I’ve seen on the website that about 150 are performed each year at Mayo AZ.)

(2) Can you also reveal which docs have the most experience with this procedure at each location? My sense from what I’ve read so far is that Dr. Krambeck in MN and Dr. Humphreys in AZ have done the lion’s share of the procedures, but I would like confirmation.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Roger Marin http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-365 Roger Marin Thu, 19 Jan 2012 00:16:04 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-365 After having reviewed the information I can access on the Internet concerning HoLep, I am convinced that this procedure is the best one for me. My ability to void naturally is severely compromised by a very enlarged prostate, leaving me with the only option, at this time, of self-catheterization, something I have been doing four times/day since June, 2011. Also, I have been on Finasteride and Tamsulosin since that time but appear to be getting no positive results from these drugs. Logistically AND financially, Dr. Ramsey L. Kuo, who received his training at Methodist Hospital Institute... in Indiana, and now practices at St. Peter's in Albany, NY, is the logical choice for me, despite my wishing it practical that I could go to Mayo. I know that doctors do not like to comment on their peers, so I don't expect a meaningful reply. However, since I have but one body, I have to at least try to seek competent medical advice and comments for it. As an aside and just out of curiosity, why isn't the HoLep procedure available at Mayo in Florida, considering the high number of men over 60 there? It seems Mayo would be encouraging their own doctors to pursue the Holmium route in that state. After having reviewed the information I can access on the Internet concerning HoLep, I am convinced that this procedure is the best one for me. My ability to void naturally is severely compromised by a very enlarged prostate, leaving me with the only option, at this time, of self-catheterization, something I have been doing four times/day since June, 2011. Also, I have been on Finasteride and Tamsulosin since that time but appear to be getting no positive results from these drugs.

Logistically AND financially, Dr. Ramsey L. Kuo, who received his training at Methodist Hospital Institute… in Indiana, and now practices at St. Peter’s in Albany, NY, is the logical choice for me, despite my wishing it practical that I could go to Mayo. I know that doctors do not like to comment on their peers, so I don’t expect a meaningful reply. However, since I have but one body, I have to at least try to seek competent medical advice and comments for it.

As an aside and just out of curiosity, why isn’t the HoLep procedure available at Mayo in Florida, considering the high number of men over 60 there? It seems Mayo would be encouraging their own doctors to pursue the Holmium route in that state.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-322 Amy Krambeck Wed, 23 Nov 2011 22:09:40 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-322 Unfortunately, retrograde ejaculation is a functional problem that cannot be avoided. Any procedure or medication that will correct outflow obstruction with result in retrograde ejaculation. The prostate and bladder neck are continuous. In order to deobstruct the bladder neck the bladder neck function is compromised; thus, it cannot close at time of ejaculation and the semen takes the path of least resistance - into the bladder. If a patient is not ready to accept RE then they should not have any procedure performed on the prostate. Unfortunately, retrograde ejaculation is a functional problem that cannot be avoided. Any procedure or medication that will correct outflow obstruction with result in retrograde ejaculation. The prostate and bladder neck are continuous. In order to deobstruct the bladder neck the bladder neck function is compromised; thus, it cannot close at time of ejaculation and the semen takes the path of least resistance – into the bladder. If a patient is not ready to accept RE then they should not have any procedure performed on the prostate.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-321 Amy Krambeck Wed, 23 Nov 2011 22:03:40 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-321 Although I do not have details of your case to render a second opinion, in general there is no upper or lower size limit to the HoLEP procedure. Thus, in the appropriate patient a median lobe can be removed with the HoLEP procedure. Although I do not have details of your case to render a second opinion, in general there is no upper or lower size limit to the HoLEP procedure. Thus, in the appropriate patient a median lobe can be removed with the HoLEP procedure.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-320 Amy Krambeck Wed, 23 Nov 2011 22:01:24 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-320 Yes in certain cases this is an option. It would need to be reviewed on a case by case basis. Yes in certain cases this is an option. It would need to be reviewed on a case by case basis.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-319 Amy Krambeck Wed, 23 Nov 2011 22:00:28 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-319 HoLEP does not prevent further treatment of prostate cancer. If a low grade, small volume cancer is identified at time of HoLEP then often times active surveilance is recommended. However, if a large volume or aggressive cancer is identified the patient can go on to have a successful radical prostatectomy - open or da Vinci. HoLEP does not prevent further treatment of prostate cancer. If a low grade, small volume cancer is identified at time of HoLEP then often times active surveilance is recommended. However, if a large volume or aggressive cancer is identified the patient can go on to have a successful radical prostatectomy – open or da Vinci.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-318 Amy Krambeck Wed, 23 Nov 2011 21:58:06 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-318 Retrograde ejaculation occurs with any intervention that relieves bladder neck obstruction - thus it can even occur with some of the medications that improve urination. With normal ejaculation the bladder neck closes, preventing back flow of semen into the bladder. A surgical intervention or medication that helps with urination disables the bladder neck muscle. Subsequently, with ejaculation the bladder neck cannot close and the semen takes the path of least resistance - traveling into the bladder. Any procedure that completely relieves prostate obstruction with result in retrograde ejaculation. Retrograde ejaculation occurs with any intervention that relieves bladder neck obstruction – thus it can even occur with some of the medications that improve urination. With normal ejaculation the bladder neck closes, preventing back flow of semen into the bladder. A surgical intervention or medication that helps with urination disables the bladder neck muscle. Subsequently, with ejaculation the bladder neck cannot close and the semen takes the path of least resistance – traveling into the bladder. Any procedure that completely relieves prostate obstruction with result in retrograde ejaculation.

]]> Comment on Advantages and outcomes for holmium laser enucleation of the prostate performed for benign prostatic hyperplasia by Amy Krambeck http://physicianupdate.mayoclinic.org/2010/01/12/advantages-and-outcomes-for-holmium-laser-enucleation-of-the-prostate-performed-for-benign-prostatic-hyperplasia/#comment-317 Amy Krambeck Wed, 23 Nov 2011 21:52:25 +0000 http://physicianupdate.mayoclinic.org/?p=619#comment-317 There is no size limit for HoLEP. A prostate of 130 grams is ideal for the procedure. There is no size limit for HoLEP. A prostate of 130 grams is ideal for the procedure.

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