A transurethral laser treatment at Mount Sinai rescues patient from kidney failure caused by enlarged prostate.
One crucial lesson Andrew Charles Jordan, 61, learned about his health was to never ignore any symptoms. In late 2021, the retired commercial real estate broker found himself in the emergency room due to immense pain and was subsequently admitted to the ICU when doctors realized he was in kidney failure. The diagnosis revealed a swollen bladder and an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).
“I was ignoring the signs,” he admits. “It was during COVID [when the symptoms began], so it was a bad time to deal with it. Then I realized it was getting out of control.”
Years of untreated urination strain (a consequence of BPH) had led Andrew to a serious problem. Fortunately, Dr. Nicholas Smith, a urologist at Mount Sinai Medical Center’s Columbia University Division of Urology, offered a solution.
During his training at UCLA and the University of Miami, Dr. Smith specialized in holmium laser enucleation of the prostate (HoLEP)—a minimally invasive procedure that utilizes laser pulses to remove tissues or blockages from the inside of an enlarged prostate, facilitating the flow of urination. Dr. Smith is currently one of only two physicians in Miami-Dade County fully trained in this treatment and boasts the highest volume of completed procedures.
Because of this procedure, Andrew, who is happily married with a recent addition to the family, thanks Mount Sinai for the opportunity to freeze his sperm pre-HoLEP, enabling him and his wife to have a baby through in vitro fertilization (IVF). The advantage of HoLEP lies in its remarkably low risk of recurrence post-operation, estimated at 1-2% per lifetime, in contrast to other BPH procedures with recurrence rates ranging between 20-30% after ten years. HoLEP is also the most versatile BPH procedure available, approved by the American Urological Association for prostates of all shapes and sizes and a leading option for most men.
Dr. Smith’s patients, typically in their mid-60s but ranging from 50 to 95 years old, are often referrals from other urologists. The procedure duration varies between one to three hours, with most patients recovering overnight, and the catheter is usually removed the next morning—a faster recovery compared to alternative procedures. Dr. Smith notes that patients are often back to normal activities within a few days, although strenuous activities should be avoided for at least a month.
“Many of the men are having significant difficulty with urination or cannot urinate at all and some have a catheter in place,” Dr. Smith explains. “They are either on medication or have had other procedures that were not effective, so they come to me or get referred to me. This newer option can remove more problematic prostate tissue than any other procedure aside from an open prostatectomy.”
Mastering the procedure is a time-consuming undertaking, typically requiring a fellowship for surgeons to learn it. Utilizing a MOSES 2.0 laser from biotech company Boston Scientific, Dr. Smith now performs approximately six HoLEP procedures weekly. With two and a half years at Mount Sinai, he has completed more than 225 HoLEP procedures, including Andrew’s.
“He is such a kind and gentle guy with a sense of humor and was able put me at ease and completely make me comfortable with this procedure,” Andrew says. “The whole team there is wonderful. When I was in recovery, the whole team of urologists came in and watched me pee on my own and all clapped when I was able to do it. It was actually so awesome!”
While the procedure comes with temporary side effects like burning and bleeding during urination, which is considered part of the estimated three-month healing process post-surgery, almost all HoLEP operations yield positive outcomes.
“Catheterized for all that time, and this procedure changed this man’s life,” Dr. Smith says about Andrew. “He no longer needs medication for his condition.”
Andrew now encourages men not to ignore symptoms that could be indicators of BPH and to listen to their bodies. Thankfully, his pre- and post-HoLEP journey brought his body back to normal and restored his ability to become a father.
“My body was telling me,” he adds. “My bladder was so full and the thought of a procedure was horrifying, and I didn’t act quick enough. But the procedure is quick and the recovery too.”
