I am 50 and have been living with somewhat severe BPH symptoms for the past
3 - 5 years.  I see an urologist every six months and have been treating
the condition primarily with flomax.  Each visit to the uro I have a flow
test and an ultrasound.  My prostate is about 45 cc according to the ultrasound.
There is a large lobe that protrudes into my bladder that is clearly seen
in the ultrasound and this causes difficulty urinating especially when my
bladder is full.  Over the past six months my symptoms have worsened with
more frequent urgency and slow, sometimes very slow urination and I feel
like I am straining to get the urine out.  My uro recommended a cystoscopy
and we did this recently and he found no strictures in the urethra but confirmed
the prostate is right at the bottom of the bladder and very tight.  He said
the prostate is "longer" than he believed it to be based on the ultrasound.

He hasn't given me his recommendation on our next step of treatment - we
will be meeting later this month to discuss it.  But I have previously mentioned
that based on my reading on the internet, that the PVP laser seemed to be
the preferred approach.  He mentioned that he might recommend TURP combined
with either PVP or a HOLAP laser.  I think he said he might recommend TURP
due to my relatively young age and not wanting me to go through another procedure.
Also he said something about the ability to do a biopsy with TURP that can't
be done if laser is used.  He also gave me a reprint of an article from Urology
Times that compares HOLAP and PVP lasers and concludes HOLAP is better, but
my reading of the article is that they are similar.  He says he doesn't use
PVP that much and I think he might recommend HOLAP over the PVP when we finally
discuss the approach.

I told him that before I proceed with any procedure I would likely want to
get another opinion and he seemed fine with that.  So I am wondering if anyone
has experience with combining two procedures (TURP and a laser).  Or did
I misunderstand him?  (this is entirely possible since our discussion was
after my cystoscopy for which he had given me 10 mg of valium to prepare
for).  And from the Doctor from Madrid, would PVP and HOLAP be about the
same result?

Thanks and warm regards to all