TURP Surgery - Yes or NO?.......

Randy....I’ve been following this blog for about 7 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  Some procedures seem to work for some but not all.  Worse yet, many have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

The real answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it out.

Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

Randy, your urologist is reccomending all he knows which is TURP. There are much better proceedures out there. 

I had all the usual BPH symptoms,....getting up 6 times a night, urgency, slow flow etc. 

I too was reccomended to have a TURP ,, a Holep, and open surgery by three different urologists and was booked in to have a Holep. I cancelled three days before I was due to have it.,

Why? I became increasingly uncomfortable with each of these three proceedures,.Open surgery was out of the question. TURP had the possibility of permanent incontinrce and or impotence and Holep was only marginally better than TURP. 

I found out about PAE...Prostate Artery Embolisation which is carried out by Interventional Radiologists not urologists. 

I had mine 15 months ago and couldn't be happier. I only get up once now. Strong flow and sex life is great....no incontinence.

I strongly reccomend you cancel or at least postpone TURP until you have researched PAE. There is a TON of stuff on PAE on this site. 

Best Wishes. 

don't be rushed to any invasive procedure, try first any common drugs for BPH like Alfuzosin or Flomax, if your uro don't agree go to somebody else

First of all did you tell your doctor that you would have the surgery.  Why did  he schedule it.  Tell him no you done't want it.  If it is your bladder then work with the bladder.  He does not even know if it will work.    Tell him you want to try a Uro-lift a PAE or a rezum treatment first.  Don't let him cut out you prostate that will cause you more problem  Alot more.  PLease tell him  NO NO NO NO He should do what you want not what he what to do...  He ever told you it hope it will help.  The problem is not your prostate it your bladder....PLEASE  Call and cancel  Don't be force into having something that is the last restort and will cause you more problems  Ken.    

Hi Randy,

Like caringbah I too have had PAE (Nov 15), very simple, relatively discomfort free and succesful. I am not a Doctor nor of course do I know your particular circumstances but I would urge you to look at irreversible interventional surgery as a step too far at this stage. Even if PAE or even a Urolift doesn't work they don't preclude further surgery, PAE least of all. Interventional research around the prostate is advancing at considerable pace, anything that buys you some time without commiting you should be considered first, even drugs but you won't find many on here that advocate for those. A Urologist will by definition offer what they know and be sceptical about what another discipline (Radiologist and PAE), particularly with a relatively new procedure, may have to offer and if you are in the USA one that they are going to earn from.

There are so many horror stories concerning TURP on here and even with the caveat successful ones don't have the lucky patient coming on here to brag about it. I would urge you to look into PAE whilst you still have the option to cancel. Whatever you choose I wish you well and hope you have the right outcome.

Everybody's anecdotal experience can help guide you, but do keep in mind that everybody's anatomy is slightly different, and there's no one solution.  On top of that, there's some variability in outcome, no matter what procedure you're discussing.  With all those caveats, I'll agree with the advice I'm seeing from others--TURP used to be the standard, but it's becoming more of a last resort with other technologies like PAE and Urolift providing better results with fewer complications.  I had very good luck with a urolift on June 8th.  Now at the end of July I'm happy to be back to pretty normal functioning.  Kegel exercises did seem to help as I got accustomed to the stronger stream and better voiding.  Good luck!