After my cystoscopy, He said he will perform a two-for-one operation. TURB & TURP

TURP according to this 2017 article is still the most widely performed procedure for BPH.

Enlarged prostate (BPH) surgery is the most effective and longest lasting treatment of all of the options available for BPH (benign prostatic hyperplasia). 

One of the most common symptoms men face when they reach their sixties and seventies (sometimes even earlier), is BPH, which may sound unfamiliar until called by its more common name, enlarged prostate. 

The prostate is located just below the bladder, and it connects to the urethra, which a tube that carries urine from the bladder outside of your body when you urinate.

When a prostate is enlarged, there is excess cell growth in the prostate. The prostate may press too tightly around the urethra, interfering with its normal flow. If your symptoms are extremely severe, you may be unable to urinate at all, which is an emergency that you should tell your urologist about right away. 

With BPH surgery, symptoms can be improved for as long as 10 years. However, of all of the options, surgery is the one most likely to leave you with erectile dysfunction. If you are bothered a lot by BPH symptoms, you should weigh the pros and cons of this treatment option before choosing it. ****************** TURP - The Most Common Enlarged Prostate Surgery*********** 

A transurethral resection of the prostate (TURP) is the most common surgery performed for BPH. It is considered the gold standard treatment for BPH because it has been around the longest. It is the treatment that newer treatments are often compared to.The surgery involves inserting a very small tubular camera or endoscope that is passed through the tip of the penis up through the urethra and into the bladder and removing excess tissue from the prostate. 

During the first part of this procedure, the urologist checks for problems in the bladder itself, such as bladder tumors or stones.

Assuming that the urologist finds no unexpected problems, an electrical loop is then placed up through the urethra and close to the area where prostate tissue is pressing up against the urethra. The loop removes excess tissue in the prostate. The electrical loop is also used to control bleeding where the surgery was performed. 

The tissue that is removed is analyzed at a laboratory to ensure that no prostate cancer is present. A catheter is placed up through the urethra and bladder to collect your urine until you heal.

The procedure is usually done in the hospital under spinal anesthesia. Hospital stays are short, sometimes as short as one day under managed care. At discharge, you should be sure that your urologist gives you instructions on how to take care of yourself and a sense of potential complications. 

Recovery After TURP for Enlarged Prostate 

You should expect to have a urinary catheter in several hours to a few days. If you go home with a catheter, you will be seen by your urologist within a day or two of the procedure to have the catheter removed. 

After returning home, men commonly see blood in the urine. Though alarming at first, this is often just a flushing out of scab material from the wound around surgery.

However, if your urine is an intense red, contact your doctor immediately. 

Be sure that you rest in bed right after surgery and that you drink plenty of fluids. This will wash out any blood deposits and prevent a clot, which could lead to a blockage in your urinary tract.

Avoid driving and heavy lifting.

Do not strain when you are moving your bowels.

If you are constipated, ask your doctor

 

This article is wrong on many levels. TURP is no longer the "gold standard". Repeating that, whether a doctor or journalist does is just fiction. Bleeding with leaches has been around longer than gamma knife and they used to do it on people with brain tumors, but that doesn't make it the gold standard.

There is almost no reason, particularly on a first treatment to EVER do a TURP. Its much more dangerous, involved, with a way longer recovery than anything else, has a greater incidence of permanent devastating side effects than all other procedures and at best, leaves a long, messy recovery for pretty much the same result as most men get with far less invasive and dangerous procedures. TURP may actually offer a slightly better flow than something like REzum, but for most men what they get from Rezu,/Urolift/FLA, ect. is sufficient to lead a normal life without worrying about BPH. 

I just read a post from someone who had a successful TURP. He wore a diaper for two months and was completely incontinent that entire time - and he still as some urgency over a year later. I had Rezum done, took longer to pee than anyone they'd done at that point (I self cathed for about 3 weeks...way better than diaper) and was functioning better at 6 weeks than before the procedure. And most men are OK within 10 days. Why would any ethical doc do a TURP before trying something less dangerous and invasive first? 

I'm not advocating TURP and ran a mile from it to wait for something better . However like it or not it is still the most widely performed surgery for BPH and all that many people can get

 

Good afternoon guys.  We on here have all had our own problem with that little walnut ( prostate )  We picked the procedure that we felt was right for us.  And it worked for us.  Holep, Urolift, PAE, Rezum and Turp has work for some but It is a last resort procedure. Not all treatment will work for everyone.  Protocol from any doctor in the US and in the UK is start with med's first and then move on to less evasive.  Then if that does not work you move on to the other more intense surgery.  Now Turp is a last resort because of the damage to a man body.  No man should have to deal with that just to pee better.  Do many things can go wrong and there are to many side effects.  My doctor told me about a friend of his.  He pick to have the Rezum procedure.  My doctor does not do them.  His friend with in a month had a lot of problems.  The Rezum caused him a lot of scare tissue that blocked him more then before.  In order to fix the problem he had to have a TURP which he was trying not to have.  My doctors partner did it.  My urologist said that he could not do it on his friend.  They have a very good practice.  They both have only done 3 Turps in the last year.  So Turp in in a free fall.  The only doctor that do TURP's are the one that do not want to learn new procedures.  It's 2018 and it time for a new beginning.  Take care all.  Things are looking up  Good Health to all  Ken      

Hi Derek, a question for you is if you had your prostate growing upwards pushing into or hard up against your bladder(called a median lobe) and blocking off your urine flow and knowing turp in that case would require cutting away much of your bladder neck valve and damaging permanently the upper prostate sphincter valve leaving you permanently incontinent unless your lower prostate valve could be guaranteed to hold urine which no urologist surgeon can guarantee in each individual, and leave you with permanent retro ejaculation (your sperm then goes into your bladder not out the usual way) and removes or what surgeons call shell out half your prostate including your prostate urethra running the risk of urine infection through the remaining prostate tissue as urine is now permanently in the remaining tissue 24/7, and risk penis urethra scar tissue and go through a lot of pain,and be willing to recommend this to someone just so that they can pee!!! FLA on the other hand does not operate through the penis but uses a tiny tiny very very small laser through the anus under live mri and very precisely removes unimportant over growth prostate tissue which was causing the urine blockage but without damage to anything at all so there is NO damage to ANYTHING!!!, what would you recommend???

I'd still say Holep or GL. My median lobe was not too bad when I had GL and the team doing it always tried to avoid the bladder neck. My lateral lobes were the problem. They were described as being like two floppy bottoms and remember my life was back to normal in three days. 

Most people will never get FLA as it will always be an expensive procedure due to MRI equipment being needed. Do you know that perhaps the majority of NHS hospitals cannot afford their own MRI machines. They give space to private companies to set theirs up in hospitals and the NHS pay for their patients to be scanned and the companies do their own private patients. One company here in South East England  have their scanners in 34 hospitals when I last checked. They also bring in mobile scanner trucks  when very busy. Our local hospital has a CT scanner but that was funded as much other equipment by 'The Friends of the Hospital ' who are now raising money for a second. Also the private ones did not for many years have a protocol to cover patients with MRI compatible pacemakers at any of their units. I had to travel to get my last full spine and pelvis MRI done and they most certainly did not follow the makers protocol.

Seems from another post that fluid can collect in the prostate after FLA. Laser takes tissue away but it seems that FLA can leave holes within the prostate. Is that because it was designed to treat tumors in the prostate? Anyway at the moment you evidently need to be a world traveler to get FLA.

Hi Dereck, thanks, can you please tell me with GL or holep with regard to a median lobe growth as mentioned in my previous note to you, how with these two options exactly what they do to prevent retro ejac,risk of upper sphincter valve damage, risk of urine in prosate 24/7infection, risk of prostate urethra damage, risk of penis urethra damage, assuming both options cause no damage or removal of tissue to the bladder neck please, thank you.

No. You need to ask a urologist all that. How can urine get into the prostate ? I have never heard of anyone with 24/7 infection after it, why should they?  In my case I did not get prostate infections/prostatitis again after the surgery. They don't cut the urethra during GL or Holep  nor laser it. The instruments pass through it on the way to the prostate. Have you not looked at procedures on Youtube ? There are hundreds of them.

Tissue is lasered away and the inside of the prostate is left enlarged and smooth and not like a Swiss Cheese. Some early Uro's were no so careful and left the inside like tattered curtains.

The urethra suffers trauma from the Instruments being passed through and absorbs blood from the procedure as it is spongy that is the main cause of post operative bleeding but that does not last long.

I have a prostate encylopedia that I downloaded I'll see if I can find the link to send to you. The Guy who did my last laser procedure demonstrates it around the world and they are also on Youtube. Once I had freedom of movement again after my GL I travelled around New Zealand for a month on your busses without toilets.

Hi Derek, what I mean is after the prostate has been shelled out urine remains in that cavity 24/7 and hopefully it remains water proof to prevent infection,and there are many cases where penis urethra has been damaged and many urologist surgeons purposely cut up the penis urethra to fit in the laser as they conclude this is safer than risking damage to the urethra even though the blood reduces friction like a lubricant, so clearly there are some good results and some bad, what I am pointing out is why not choose a less invasive operation with less risks as I have said previously I was warned loud and clear if I had turp with a median lobe I would be left incontinent and have retro ejac, I am happy your outcome was good I feel very sorry for those who trust your comments and live to regret it.

Please don't as me technical questions than I'm not qualified to answer :-) This is where that Guy from Jersey Urology would come in handy. My friendly GL Uro from 2004 has evidently moved on as his name no longer appears on the hospitals staff listing. 

Certainly in my case there is no urine held in my prostate nor was my urethra sliced open. Surely it is the job of the upper sphincter to keep it in the bladder. Any scans for retention for retention or MRI's for other reasons would presumably show that

He Derek, I am happy for you and wish you well, kind regards Brian.

It does not give modern treatments but if you Google 'an atlas of prostatic diseases' you can download it. The edition I downloaded years ago was the 2004 one that may have been updated by now. It is well illustrated and the book can be purchased online.

Brian, remember that I am one of the vast majority of successful patients. I don't need to be here, I just stick around to try to be a voice of reason in an ocean of pessimism. Quite frankly FLA is the procedure that I least think suitable of the new ones. It was developed for prostate cancer and should be kept for that. The laser options are simpler and in the right hand are simple day surgery with a rapid recovery. I just don't understand the tales of people wearing diapers and bleeding for weeks. The laser seals of all the blood vessels and that is it's advantage over TURP and it's newer variations.  

Many, perhaps most have real urgency issues for a month or so after greenlight. My urologist said that not everyone needs to, but to people prepared to wear a diaper for a month. FWIW, that's why I opted to pass on Greenlight and wait for something less invasive. At the time I traveled a lot for work/attended a lot of conferences, so a diaper for a month didn't really work for me.

With Greenlight there is close to a 50% chance of RE. In the right hands long term issues are rare, but with Greenlight, life ruining, permanent complications are possible. With several of the others they are almost unheard of. For that reason, in most cases it's advisable to try one of them first IMO.

I had a HoLep using a very experienced New Zealand surgeon in Cambridge. RE is inevitable, but all of the other complications you mention I don't believe are usual. I'm 100% satisfied with my operation 3 years later. No leaks at all, no pain, full sexual capability etc. I had a very large median lobe and a 140cc prostate for which HoLEP is well matched. So I can only speak for myself but HoLEP is at least one procedure worth considering but you MUST use an experienced urologist

Not in my experience and not with people I know and have met over the past 14 years. On the old BPH newsgroup few reported any problems and I still read the few posts that appear there. I just don't know where you get your figures from. 

As I said to Brian I was soon travelling around N.Z. for a month on busses without toilets.

The median lobe probably made RE inevitable. How well and how quickly did the rest of your recovery go?

Derek,

I'm only continuing this conversation so that someone doesn't act on what you said. 1) I said that some people don't experience it. 2) My info comes from my Doctor - one of the top urologists at one of the largest and most highly regarded US hospitals - world renowned actually. When I asked about greenlight recovery he mentioned urgency often severe enough to require a diaper. When I asked how likely, he said "depend on it". When I asked how long it would last he said probably about a month.

If I were trying to estimate recovery issues from a procedure and could either believe some guy on a forum and people he knows, or one of the top urologists in the country who has performed the procedure thousands of time...well I know where I would lean where their opinions diverge.

I can only say that from UK figures you have been very misinformed. I think that you did read the NICE links from the UK that I posted and I think sent to you as well. You must have some f'ing bad Uro's in America.  

Why are top London and UK hospitals like Guys, St.Thoma’s and The Freeman in Newcastle doing HoLep or GL as their preferred treatment. Don’t you think that there would be a national outcry if patient had long term problems.  GL has been around for about 16 years and its use is increasing and Holep is catching up. 

Google success rates for BPH laser treatments and other options.

I forgot to ask what procedure this renowned expert used on his patients and had like others reason for his bias 

You appear to be on your own lane and not reading anything I said. I stand by it and have way more faith in one of the top uros in the US than some Googled links. The UK is typically behind the US with new treatments. Look for Urolfit and Rezum to start being done more and more in the UK over the next few years. I won't bother repeating myself yet again.

This renowned expert does them all, including but not limited to greenlight. He was part of the Rezum trials, does urolift, greenlight, TURP and Holep. We was honest about the pros and cons of all of them and suggested Greenlight in 2013. I was hesitant about it due to a 50/50 chance of RE and decided against it when he said that urgency for the first month could be a real problem. He told me about Rezum, offered to get me into the clinical trials. I declined that too, preferring to wait until it was FDA approved and perfected, preferring to keep catheters handy in I ever went into retention.

I Had Rezum done 2 years ago, am happy with the results and I never had to wear a diaper or deal with urgency that was more than annoying. And I had no risk of anything catastrophic, even if it failed. Such is not true with greenlight. Read Glenn77's posts if you doubt that.

Good evening.  Glad you waited but did you end up with retro The last 4 men that I have talked to had it done 2 it work and 2 it didn't and all 4 ended up with retro.  The one guy 52 is very mist off because his doctor talk him into it.  Bug him for 6 month's  Ken

I have read thousands  of posts over the years from different sources. Glenn was obviously very unfortunate with GL but you can't cite him as a typical outcome.

Using your usual doubting type of thoughts was this Guy persuading you to come on his trial as he was short of Guinea Pigs ???  Rezum statistics are still in the early days and some reports say that it is not known beyond two years how long benefits will last. All the 'usual' after problems are listed against Rezum during the recovery process. I'm sure that he also told you that all prostates will continue to grow.

My GL was part of a UK trial by a very good team of five Uro's .  I was my Uro's eighth patient from about forty they had done. At that time Laserscope (the original makers of the equipment) had an observer at the procedures. I'm sure being part of a trial we each got the chance as our prostates were very suitable for our particular procedures. They sure ain't going to pick ones that are difficult or likely to spoil their sponsors trial figures. 

 To get success you need to specialise and your  Guy like so many other American Uro's seems to want to cover the field.

This Forum is no more than Googled links either. We should only post ones that should reflect our own experiences. I not talking just of feedback from individual but of reports from learned bodies from around the world.

As we both say some things work for certain patients and not for others.

Did you read of Rezum in clinical trials in the US library of medicine headed

Safety and Efficacy Study for the Treatment of BPH (Enlarged Prostate) (REZUM

Again, I only post so someone doesn't think you're saying something truthful. I said, "In the right hands long term issues are rare, but with Greenlight, life ruining, permanent complications are possible." You said, "Glenn was obviously very unfortunate with GL but you can't cite him as a typical outcome."

I said long term issues are rare (but possible by definition) so I'm not sure what your point is. I cant post a link, but google the term "troll"

He offered to put me in the trial because I was very uncomfortable, had an IPSS score in the 30s and it was at the end of trial, so he was pretty confident that it would work. I had read all of the clinical trial reports, which as it turns out from my experience, conversations with my uro and the anecdotal posts here, were not fully representative.

As for long term effect, nothing other than prostate removal stops prostates from growing. And given a choice, I'd rather have Rezum every 5 years than something with more risk once. Not a high risk, but a risk and IMO, no risk is better than low risk.

I happily repeated laser surgery after 9 nine years. It is no big deal in my book. 

I have already suggest that some here are Trolls:-)

As you say long term issues are rare so you should not use them to put people off what benefits most.

For some reason you believe your Top Man but not Johnny's high ranking one. Can you logically explain that ?

The catheter was removed the day after surgery and I pee'd with no problem. Most bleeding stopped after 2 days but there was slight staining for 5 weeks. I was able to just use standard pain killers after a few days. I had post op tests after 1 month and they showed no urine retention etc. So, after about 1 week I was almost back to normal but with a powerful stream. My NZ uro was trained by the NZ guys who 'invented' HoLEP. He does several HoLEps each week and did another two on the same day as mine. I get the feeling that the UK and USA have followed slightly different approaches to prostate surgery i.e. up-to-date but with different solutions and hence the leading uros may use different approaches?

That was a good result for you and a reasonably quick recovery. UK tends to be governed to a great extent  by what the NHS are prepared to pay and America seems to have variations depending on your type of insurance.

I think that the UK Uro's are under closer observation working in hospitals as opposed to American's working out of their offices. 

Did you end up with RE?