
Young (38) with confirmed BPH/obstruction — weighing waiting vs operating & HoLEP vs TURP
Looking for advice from anyone who's had HoLEP or TURP, especially younger guys or those with smaller prostates.
My situation:
I'm 38 and have had lower urinary tract symptoms for ~7 years — slow stream, incomplete emptying, occasional straining, weak Qmax of 9 ml/s. Symptoms are bothersome but not debilitating. Just had cystoscopy and TRUS which confirmed:
- BPH with bilobar obstructing hypertrophy and obstructing median lobe
- Moderate intravesical prostatic protrusion (IPP)
- Prostate volume: 32cc (small-ish)
- Mildly to moderately trabeculated bladder wall (early sign the bladder has been under stress)
- No urethral stricture
Why I'm leaning toward acting sooner rather than later:
The trabeculation is what's pushing me toward treatment. I'm 38 and need this bladder for another 60 years. My urologist confirmed that waiting risks bladder decompensation over time.
Dad's history
My father had HoLEP recently and had an excellent outcome. There's a urologist local to me who performed his procedure. I'm seriously considering going back to that same surgeon.
Questions
My prostate is only 32cc —is that a big deal? Saw an article saying its still fine: Efficacy of holmium laser enucleation in patients with a small (less than 30 mL) prostate volume
retrograde ejaculation (done having kids, not a concern). Temporary post-op incontinence I can tolerate if it resolves.
- Any strong reasons to wait?
- Anyone had HoLEP on a smaller prostate (~30cc range)? How were outcomes?
- Anyone who had TURP young and ended up needing retreatment?
- Any questions I should be asking the HoLEP surgeon specifically before committing?