4 month TURP follow-up
Posted , 9 users are following.
My visit today was two-fold: follow-up on the TURP I had done on 2/20 and a cystoscopy to look at the prostate and check my bladder for tumors. (I had a cancerous tumor removed about 20 months ago and BCG treatments after that. I am still cancer-free but the protocol is quarterly cystoscopies for 2 years after the treatment is finished. This was my 5th post-op cystoscopy. Always slightly uncomfortable but never painful.)
Back to the TURP. My PVR today was 0! I expected that since I no longer feel like I'm not emptying fully. My PSA dropped to 2.2 (the drop was also expected and becomes the new baseline. ) The pathology of the prostate tissue removed showed the least aggressive form of prostate cancer in about 15% of the tissue so we are in the "active surveillance" mode.I would say my TURP was 90% successful in relieving my BPH symptoms. I get up only once at night probably 75-80% of the time. I can hold it if necessary without worrying about my stream being reduced to a dribble because of the median lobe that I had. The volumes of my voids have almost doubled and my frequency has been cut about in half. My stream is stronger than it's been in years. I do have retrograde ejaculation but I had it before due to the medication and for me, it's not a big deal.
I know there are guys that are afraid of a TURP and some bad-mouth it (usually those that haven't had one.) If you look at clinical trial data, which unlike what you get here is real data, the TURP is still as good or better than anything else out there. Most of the guys who have posted here about their successful TURPs do not stick around which is why the overall feeling on this forum seems to be anti-TURP.
So, to paraphrase the title of a Blue Oyster Cult song "Don't fear the TURP."
1 like, 19 replies
rdemyan lee56659
Posted
Hi Lee. Thanks for the update. I'm weighing options myself, and TURP is one of them. I think it's important to note that a lot of bad press on TURP comes from the old monopolar TURP procedures. The new button/bipolar TURP seems to be more successful with fewer problems. Having said that, it is probably just as important that men understand that a bladder damaged over the years from bladder outlet obstruction (BOO) due to an enlarged prostate won't magically be healed by a prostate procedure; but hopefully over time the bladder would improve once the BOO is removed.
lee56659 rdemyan
Posted
That's probably true. I'm not sure how many urologists are doing monopolar TURPs anymore. My guy is 61 years old and he does bi-polar now, starts with a loop electrode and finishes with a plasma button electrode. Not sure how long he's been doing it this way but several years I think. Although I am 70, my prostate was relatively small (50g estimated from the DRE) and I am in excellent physical condition with no real health issues. I'm sure that helped speed my recovery.
gene97713 lee56659
Posted
Both of you are right to some extent. The percentage of complications is still around 25%. II.strongly depends on age and prostate size. The bigger the prostate>80 g and older the patient >65 yo, the worse the outcome is. Too many Uri surgeons disregard these limitations or use older monopolar procedure. complications with GL or HoLEP are roughly at the same level. Recovery is much linger than with less invasive procedures. Remind you that the first 74,year old PAE patient in Portugal already had TURP and suprapubuc surgeries 8 and 4 ears before his PAE.
lee56659 gene97713
Posted
Not sure where you got that figure from. An article in the November 2018 "Urology Times" reported a study of almost 32,000 TURPs from 2006 to 2016. The overall complication rate was 9%. The article did say that complication rates were linked to the length of the procedure which would indicate that larger prostates could result in more complications.
uncklefester gene97713
Posted
Didn't know complications from HOLE
p were that high. Everything I've read says its better than ""Gold Standard" Turp
gene97713 lee56659
Posted
Both of you are right to some extent. The percentage of complications is still around 25%. II.strongly depends on age and prostate size. The bigger the prostate>80 g and older the patient >65 yo, the worse the outcome is. Too many Uri surgeons disregard these limitations or use older monopolar procedure. complications with GL or HoLEP are roughly at the same level. Recovery is much linger than with less invasive procedures. Remind you that the first 74,year old PAE patient in Portugal already had TURP and suprapubuc surgeries 8 and 4 ears before his PAE.
jim1494 lee56659
Posted
Congratulations, Lee, on the good TURP outcome. I had my TURP about two and a half years ago and also had an excellent outcome. I chose TURP over the other options because it was reported to have durable lasting results. Thus far, that's been the case. It completely changed my life and I now wish I'd had it done ten years earlier. In addition to resolving the urgency feeling and trickle flow issues, I did not have retrograde ejaculation after the procedure. I wasn't really concerned about that anyway. I just wanted good urination. I agree TURP is often maligned, but like you, I suspect those with a good outcome rarely report it.
tom86211 lee56659
Posted
I am now 3 months post bipolar TURP. My flow has increased from about 100ml in 20 seconds to around 150ml, and I can completely empty my bladder, but it takes a couple of additional squirts after the initial flow. Overall, the TURP was more effective and easier than my PAE.
PAE: in hospital 7am to 4:30pm, TURP: 6am to 10:30pm.
PAE: in recovery room for hours, needed Foley catheter. TURP: recovery at home, Foley in for 3 days.
PAE: some pain and irritation for about a week to two weeks. TURP no pain or irritation once Foley removed.
PAE: 10-20% improvement in flow after a few months, TURP: 50% improvement in flow after about a month.
TURP: tissue samples sent to lab to check for prostate cancer - so this is an added benefit not available with other BPH treatments. Sure is easier than another 12 core biopsy - if you've ever had one of these you know what I'm talking about. My tissue report came back negative.
IPSS score - no improvement after either procedure. Turns out I have radiation cystitis from prostate cancer treatment in 2014. So, no improvement from either my PAE or TURP in my frequency/urgency/nocturia, because my bladder is constantly irritated and keeps me getting up at night.
I have posted this elsewhere, but now that I know that I have bladder issues from the radiation, I would have elected to have my prostate removed in 2014, rather than the radiation. That way, no BPH issues ever again, no radiation issues, no PAE, no TURP. The only downside to a RRP is that it can take a year to regain full continence. Knowing what I know now, I should have just had the RRP, but, there might have been complications after that operation that I might have experienced.
I am happy I decided to have the TURP. A bipolar or plasma button TURP is NOT the same as the older mono polar TURP because the newer techniques use a plasma button tip to cauterize the bleeding so recovery is much faster. I would be happy do another TURP again if necessary. I don't think I would do another PAE again due to concerns about the radiation. I don't know if the radiation from the PAE added to the radiation from my prostate cancer treatment increased my bladder issues - no way to know, but I wouldn't take the chance now. For someone who has never had radiation for prostate cancer the minor amounts of radiation from a PAE are likely to be benign.
rdemyan tom86211
Posted
Hi Tom:
Nice comparison of your experience with both PAE and bipolar TURP. I'm wondering if there is a possibility that the PAE embolized blood vessels/capillaries that supply the bladder and if so, whether or not, that might have contributed to or even caused your bladder issues.
tom86211 rdemyan
Posted
It's possible that the bladder irritation issues (I call this hyper sensitivity) were aggravated by the PAE but just going over my notes from my Aug 2017 operation I was only sleeping in 1-2hr segments before the PAE, so my sleep disturbance and bladder issues were happening before. I had my radiation in 2014 and the bladder issues seemed to get worse about three years later. In a report I just read it said that radiation cystitis can start about 32 months after the radiation treatment, which would be about the time I went in for my PAE. So, really, I don't know if the PAE had any effects on my bladder or not. It's possible that since I have been having severely disturbed sleep due to prostate and bladder issues for a couple of years, that my brain is just not used to sleeping in long segments - a very bad habit that I can't seem to break. I really don't know if my bladder wakes me up to pee or if I wake up THEN feel the need to pee. So, I say to anyone who is only getting up 2-3x per night, be thankful, it can get a lot worse!
rdemyan tom86211
Posted
Tom:
I've noticed that when I take ibuprofen at bedtime, I tend to sleep longer before the fullness in my bladder wakes me up. The ibuprofen seems to make my bladder less sensitive. Do you take any medications/supplements to help you sleep? Have you tried any medications to make your bladder less sensitive like Myrbetriq? There are some posters here who have quite a bit of experience with the overactive bladder medications and maybe they'll chime in.
Maybe taking something like Myrbetriq could help your issue and possibly with some time you could start to wean yourself from the Myrbetriq in order to break the habit you mentioned. Have you discussed this at all with a uro?
rdemyan
Posted
I just found a recent trial where Myrbetriq was used in combination with tamsulosin on men who have BPH. It looks like there is a potential side effect of urinary retention in a small percentage of men who have significant bladder outlet obstruction (BOO). Since you had a TURP you shouldn't have much if any BOO - but of course you would need to discuss this with your uro - I am only speculating.
Moderators won't let me add a link. The study lead researcher appears to be Steven A. Kaplan at Icahn School of Medicine at Mount Sinai. Results were reported in May or so of this year.
tom86211 rdemyan
Posted
I have taken Tylenol but don't react well to Ibuprofen. Recently I have started taking a bit of Benadryl and a tiny amount of melatonin - if I take too much I feel really spaced out - drugged up. It helps a little bit. Next I'm going to try some valerian.
I do take trospium - similar to the Myrbetrig. Problem with Myrbetrig is that it's not generic and it is very expensive, at least 10-20x more expensive than my trospium. I might stop the trospium for a while because one of the side effects is insomnia. Maybe the Flomax is disturbing my sleep - haven't heard about this before, but I am taking 2 Flomax per day. Maybe I will cut back to 1. Then, if my flow is OK, cut it out entirely.
rdemyan tom86211
Posted
Tom:
Although I wasn't able to read the complete study, I believe it is the Myrbetrig and not flomax that could potentially cause urinary retention. Myrbetrig works to allow the bladder to fill up more. I think the flomax for the study was probably because they had difficulty finding men with BPH who weren't taking one of the drugs or were considering surgery. So they just decided to take men who were already using flomax. Also, it is probably more realistic that men with BPH would be taking flomax or another alpha blocker.
Now that you've had the TURP, it might be worth your while to see if you can reduce and potentially get off of the Flomax. If the channel through the prostate is much bigger as it should be after TURP (i.e. prostate urethra has been cored out), I frankly don't understand what the Flomax would do for you. Unless, Flomax also affects the bladder neck.
What's your blood pressure after taking two flomax?
You say you feel spacy from too much melatonin. So, I assume you mean you feel spacy but still have trouble sleeping. If, on the other hand, you are able to sleep but feel spacy upon waking up, that might still be a good option. You could take something like ginseng or other natural stimulant to get your body moving.
tom86211 rdemyan
Posted
I have been taking Flomax and trospium and it's possible one or the other might be contributing to my insomnia. Yes, I will start cutting back on the Flomax. My urologist is switching me from trospium to detrol, very similar to Myrbetrig. Maybe that will help. I just want the constant irritation in my bladder to calm down so I can get some sleep. It's been going on like this for more than two years and I'm getting worn down psychologically.
My blood pressure is just fine on the Flomax. I just took it the other day (usually take 10-15 readings one after the other, and then use the average). It was 119/75, and even lower a few weeks before that, so no issues with BP. I don't take any BP meds, and the Flomax isn't supposed to do much for BP. I have Alfuzosin, never taken it, and it known to lower BP more.
The Benadryl and melatonin make me feel drugged and spaced out during the night and do help a bit. I can usually sleep for 1.5 hour stretches and once in a while a little longer. But closer to morning as the drugs wear off I am up more often - sleep less than an hour at a time, so it's like being a yoyo. And I can't just pee once and get back to bed, I have to pee, then try a few times more to finally get that empty feeling, so maybe the TURP didn't do enough and I am still having some flow issues. I just sent for some Valerian capsules, and will give that a try in a few days. I don't mind experimenting on myself to find out what works.
lee56659 rdemyan
Posted
I was on OAB meds for 20 years before my TURP. The last 10 years on oxybutinen, first the patch, the 5mg pills twice daily. My uro said the TURP might allow me to eliminate the oxybutinen and he was right. I stopped it at abouy 3 months after. I still get spasms occasionally but if I ignore them, they usually pass. That was not the case pre-TURP and I literally used to panic if I got the urge and a restroom was not available, e.g., in a car in traffic.