Alternatives to TURP

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Looks like I need to get another Urololift clip out, had a cystoscopy today. There is a big glob of calcium on the clip (bladder stone) that will be 3 of the 6. So anyway the Doc is recommending a TURP to just be done with it. I don't want to try urolift again, it was a disaster. I think my funky shaped prostate was a bad candidate for the procedure but the money made it impossible for the Doctor to pass on.

So what are the best alternatives to TURP ? Seems like all of the "minimally evasive" procedures are also minimally effective.

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  • Posted

    benThere,

    .

    I had a successful Rezum in November 2018. I was in AUR and on catheters for 10 months after 2 liters of pee was taken out of me. My Rezum had 10 shots (4 per lateral lobe and 2 median lobe), was done under 1 Percocet and 1 Valium, and the pain was easily tolerated. My IPSS went from 29 to 8 and I have no RE. My recovery followed the standard schedule.

    .

    I was guided through the selection process for both the procedure and the urologist by a family member who was an MD for over 40 years and I have known for over 60 years. We chose Rezum as a 1st try minimally invasive procedure. Urolift was dropped early on because of the known clip problem as you have described in your post.

    .

    I was very careful in selecting the urologist that did my Rezum and found one that had done them for over 2 years from another patient on this forum. Because Rezum is a new procedure, you want to find a urologist that has done them for a few years and not a newbie who has only done a few of them. Finding a urologist experienced with Rezum is critical.

    .

    The family member MD has a negative view of TURP and steered me way from it early on. If you don't mind permanently having RE, then have a TURP or a GLEP. A modern plasma button TURP and GLEP essentially do the same thing but one used a hot plasma stream applied to the button and the other used a hot laser light to remove the prostate tissue.

    .

    Take your time on your decision this time and carefully research what you really want to do and not what the urologist wants to do. Finding a urologist that you can trust is critical.

    .

    Steve

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  • Posted

    I am one week out (just had) the REZUM procedure. Ask me again in 2-3 months after everything has healed.

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  • Posted

    what is the procedure for removal of the Urolift clips?

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    • Posted

      Normally, tissue grows over the clip so it needs to be removed with a TURP like procedure, cut it out but not a complete turp. This one the clip was exposed and covered with the calcium deposit. The doc was able to remove the stone during the cystoscopy and thought she could cut the clip and remove it without surgery but decided against it due to the risk of having a lot of bleeding. She thinks my problems were because the original doc tethered the prostate to the bladder to get it out of the way and that has caused other issues. The reason for recommending a full TURP is that removing the clip will just get me back to the original state before urolift and not fix the reason I had the urolift to begin with. I think my original doc had too much pride to just admit that not all prostates are fixable with clips.

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  • Posted

    Hi Benthere,

    I have been suffering from BPH for decades. I have also been a heart patient for the same amount of time and have been on blood thinners which has complicated treating my prostate which has grown to over 150cc. It took me over a year of researching the procedures available to address a prostate of my size along with my age and other medical conditions. I saw urologist #1 who recommended a TURP, urologist #2 who offered a Rezume and passed on both of them.

    My research led me to discover the Holep procedure which looked like the most appropriate choice for me. I was amazed to learn that it has been in use for 20 years, but is rarely used in comparison to the TURP. Holep appears to be superior to the TURP in terms of efficacy, recoup time and the need to have a repeat procedure. I was also amazed to learn that I could find only ONE urologist that was using the Holep in the entire state of Colorado.

    I had a HoLep 2 weeks ago and it went as well as I could have hoped. After a 4 hour surgery I was sent to a hospital bed where I was infused for 24 hours with bag after bag of saline fluid through a Foley catheter. The flushed fluid was sent to a bag. The mixture was highly tinged red with blood, which I was assured as being a normal event.

    My surgeon removed the Foley catheter 24 hours after surgery and added a drug to induce urination. That drug had an immediate effect of causing me to pee into a plastic urinal while laying in my hospital bed. After an hour or two of this process, I was told I could go home. Just before leaving the hospital, I stood up over a real toilet for the 1st time since the Holep and pee came out of me like a fire hose. The volume and rate of evacuation was alarming but exciting since I had never peed like this before. The pee was highly tinged red but I left the hospital with a feeling that my bladder was as empty as it had been since I can't remember when.

    I came home after spending 1 night in the hospital and slept in my own bed without having a catheter, which was a big concern of mine prior to the surgery. I am getting better every day of the 2 weeks I have been home. I can urinate without pain but am still seeing blood in my urine sometimes and other times I am passing urine with no color in it at all.

    I am told that things should stabilize after 4 to 6 weeks and am feeling very optimistic about the final results from the Holep. Last night I slept through the night for the first time I can remember which is almost worth the entire "cost of admission" in and of itself. I will make a follow up post in a few weeks that will hopefully report my ongoing recovery and improved quality of life.

    So far, I can say that the Holep appears to be working for me and I encourage all that is looking at and weighing having a procedure to take a serious look at the Holep as a way to go.

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    • Posted

      The right guy is absolutely the key element. My understanding is that while the procedure is very well established, it has not been widely used. The two reasons I heard are that the medical equipment is expensive and that the procedure has a steep learning curve.

      The doctor that did my operation had performed about 50 Holeps which didn't sound like a whole lot to me. I read that 30 procedures is the minimum number you should settle on before agreeing to have a doc operate on you.

      A number of studies have been conducted and published that compare the Holep to the TURP. See the link below as an example.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446381/

      The data looks very convincing, but at this point, the proof is in the "p*****g" for me 😃

      I wish you good fortune in finding the right solution for yourself Ben.

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  • Posted

    So what are the best alternatives to TURP ?

    There is no answer to this question. There are alternatives, most of which work for many patients. However if you read enough posts on this forum, you will find both satisfied and dissatisfied recipients or Rezum and PAE, both of which are less invasive than TURP in that they don't involve cutting. You will find advocates for FLA and Holep but you may have difficulty finding a practitioner of those procedures because they are either relatively recent (FLA) and have a long learning curve (Holep.) If you haven't already, read my thread titled "One year post-TURP" and you will read from several happy TURP recipients. Ultimately you will have to make the decision as to what is best for you. Good luck.

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  • Posted

    You need to be scoped and have a urodynamics test to see what will work best. If you have an enlarged median lobe. PAE (and typically Urolift) are not ideal. Rezum works fine for most men, either way and recovery varies a lot, but usually bigger prostates take longer to heal. The advantages of Reaum

    1. No anesthesia
    2. No RE (retro, or dry ejaculations)
    3. Other more invasive procedures can be performed after Rezum if it doesn't work.
    4. Almost no chance of permanent side effects.

    TURP, Holep, Greenlight all get the job done for most men too, but are more invasive, can bring permanent side effects (rare in good hands - but impotence and incontinence can happen) and all but Greenlight (50/50 with Greenlight) almost guarantee RE for life.

    I usually suggest Rezum as a first option and if BPH is the major cause of symptoms, it usually works fine.

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