HoLEP vs MIST: Patient Selection & Outcomes

madman

Super Moderator

With the abundance of interventional options for benign prostate hyperplasia (BPH), how do you decide on the best treatment for each individual patient? In this episode of BackTable Urology, Dr. Marawan El Tayeb, chief of urology at Baylor Scott and White-Temple, joins host Dr. Jose Silva to discuss the intricacies of decision-making in BPH treatment.




SYNOPSIS

The urologists discuss advantages and disadvantages of various BPH interventions, providing insight on when to use what. The conversation then goes deeper on holmium laser enucleation of the prostate (HoLEP), emphasizing the importance of appropriate patient counseling about retrograde ejaculation and transient urinary incontinence. Dr. El Tayeb shares his experiences in managing BPH both medically and surgically. He details his procedural approach, patient selection criteria, and postoperative care, along with special considerations for patients with prostate cancer on active surveillance. The episode concludes with a detailed look at alternative prostate treatments and insights into upcoming technological advancements in prostate care.




TIMESTAMPS


00:00 - Introduction
02:44 - Evolution of BPH Treatments
09:40 - Weighing BPH Procedures
14:33 - HoLEP Insights
20:59 - Understanding HoLEP Equipment
21:06 - Techniques for Intravesical Lobes
24:10 - Post-Procedure Decisions
30:33 - Special Considerations for Cancer Patients
40:24 - Alternative Treatments and Final Thoughts
 
 

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Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

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Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

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The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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