Bipolar TURP - 6 month update

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On April 4 of this year (2019) I had a bipolar TURP operation. I actually had it scheduled for the prior December, but canceled, in part due to negative comments here. As it turns out, canceling was a mistake. I spent four months becoming increasingly uncomfortable with my retention, getting up frequently at night, difficulty going back to sleep, and fighting frequency and urgency issues.

During the week before the operation I was instructed to stop taking all vitamins and supplements, and the night before did a complete body wash with antiseptic pads - all of this part of the pre op instructions.

I got up at 5am, and my wife drove me to the hospital, then checked in a 6am. I was asked to urinate and was barely able to get anything out. I could not wait for the operation. Pre op I was visited by two anesthesiologists, several nurses who asked me many questions about my health, exercise, vitamins, and any other issues that seemed important. I was offered a general or spinal, and was told that with a spinal It I might be unsteady on my feet for a while after the operation. I have had this before, but went for the general.

I was wheeled into the operating room and next thing I knew the whole thing was over - in the blink of an eye from my point of view. My wife and urologist were in the room checking on me. I had a Foley catheter in me and was being irrigated - didn't feel anything at all.

I got home 4.5 hours after I checked in and the only discomfort that day was from the Foley. I found I could not sit on a toilet seat - too much pain from the catheter, so when I had to go to the bathroom I learned to do it standing up. No big deal.

The operation was on Friday morning and I was instructed to take the Foley out on Monday morning. I did this in the shower. I have taken Foleys out before, but this one was big (20fr with double eyelets), so it was a bit painful briefly. A few hours later I went to the urology office for a "voiding test". I barely passed, but was able to void. If I had failed the test I was concerned that another Foley would be put in, and my urethral lining was very tender - was not looking forward to that. But, I was sent home with no Foley.

While the Foley was in the urine in my leg bag was pink and there were a few small blood clots and debris particles in the bag, but once the Foley was out, the urine returned to its normal color. Only a couple of minor blood clots came out after that.

Except for the Foley, there was no pain whatsoever associated with the operation and the post op weeks that followed. I waited for about a week and slowly began to resume my normal exercise program. After about a month I was back to my usual routine, working out three times per week on an elliptical trainer and doing some free weights. So issues, no pain, no bleeding.

Pre op my flow was very restricted, even on 2 Flomax per day. But, after the TURP my flow was stronger. The best I could do before the procedure was 5ml/second measured by peeing in a plastic beaker. After the TURP my flow had increased to 7ml/second. Gradually over the next couple of months I cut back to 1 Flomax per day, and now am taking 1 every other day. My flow is still good.

I have learned that just because the prostate is now much smaller doesn't mean that the bladder is immediately back to normal. After years of retention it takes the bladder time to "calm down", and I find my bladder is calming down. However, my urologist says that because of radiation for prostate cancer in 2014, I have "radiation cystitis", meaning that the cells in my bladder are more sensitive than normal. So, I have minor symptoms of overactive bladder. My frequency/urgency issues are much improved, but I am still getting up frequently at night. But, even this issue is better. I am now able to sleep in longer stretches, but the big difference is that before the operation when I got up at night, it took me at least 10 minutes and sometimes 20 minutes and many attempts to clear my bladder enough to get back to sleep. Now, I can clear the bladder in as little as a few minutes to usually no more than 10 minutes. This means I can get back to sleep much faster - a big improvement in the quality of my sleep.

Now, six months post op, I am happy I decided to go for the procedure. You may ask about retro - but that is not an issue for me since the radiation for my prostate cancer has generally wiped out my sex life. And, I am now rethinking my decision to have the radiation. If I had to do it all over again, I would have gone for the RRP, prostate removal. This would have saved me from five years of BPH torment. I had a PAE in 2017, and now this TURP, so if my prostate had been removed no PAE, no TURP, and no radiation cystitis. However, I might have had issues with incontinence. At least the radiation took care of the cancer - now 100% gone from all indications. My PSA is 0.2 and the tissue samples taken from the TURP showed no cancer.

Now, no incontinence issues during the day. I was having some dribbling at night, easily taken care of by padding my underwear with toilet tissue, but when I cut back on the Flomax, most of this issue went away.

I am still surprised by how many on this forum still don't understand that there are three types of TURP - monopolar, bipolar and plasma button. But it does seem that most here are now understanding the difference. This all helps to make a rational decision about treatment.

I never recommend any procedure, but in my case the TURP worked out well. My only issue remains the frequency of trips to the bathroom at night, but that situation is improving. My bladder is feeling better and this is encouraging.

In retrospect would I do this again? Absolutely, yes.

2 likes, 16 replies

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16 Replies

  • Posted

    Thanks for sharing, Tom. Good choice.

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  • Posted

    Hi Tom,

    So was PAE useless, or it was OK at first?

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    • Posted

      Alex,

      My PAE improved urine flow about 20%, and I was able to get off Flomax, but only lasted about a year. Then, back on Flomax again. Based on comments by two urologists and the IR who did the PAE I did have a median lobe issue - not a big issue but enough to make the PAE only partially effective.

      Tom

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  • Posted

    HI TOM. Your story is very interesting. Mine is different then yours. I have seen a new URO. He is a head of the the dept urology at Russ Univercity. At my age 90 ,he does not recommend surgery. This could bring on a lot of problems. First, i had C-diff ,could bring this back, as antibiotics are used,overnight hospital stay,maybe 2 nights ,possible infections, could catch other problems, he does not recommend Holep or Turp Bipolar. He said at my age i should keep doing CIC. Started me on finesteride,if i keep bleeding he would do a green light laser or a small turp bipolar to stop the bleeding problem. I am still totally confused, and i will see a doctor who does Holep for his opinion. Feels great to have foley out,however now ,very concerned about bleeding again? I did a urine culture today as i thought i was getting UTI? Hope not?

    frank,

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    • Posted

      Don't blame you for being confused. Seems like each uro has a different idea. It's always good to get more opinions but when the docs are saying different things it can lead to confusion and inaction. I totally understand. The finasteride might shrink your prostate and this could solve your issues, but will take months to know if it works.

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    • Posted

      Hi TOm. Have you heard of a Limted Turp Bipolar,my Uro said he would do this to stop the bleeding he would do this find the problem. He aslo says PVP laser is another option,less invasive then Holep ,and the Turp Bipolar?He also said the finesteride ,he hopes would stop the bleeding and the clots that stop urine from coming out.I remember what you said .having to go to the ER with crushing pain because of retention,thats the same pain i went through last Sunday ,they took out 600ml

      I sure wish i can get an answer.

      frank,

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  • Posted

    I am 8 months post-TURP and also glad I did it. My flow is quite strong (not 20 year old strong but probably 40 year old strong) and my daytime and nighttime frequency have been reduced. I used to get up 2 or 3 times/night and now it's once about 1/2 the time. I no longer have the feeling of not having emptied my bladder and no longer have to go 30-60 minutes later. Traveling is much less stressful since I know I can hold it if a bathroom isn't nearby. I had zero post-op complications and only minor burning during urination for the first 2 or 3 days. I resumed all normal activity in 3 weeks. My IPSS is now 3, before it was 21. I have retro but had it from medication before and it doesn't bother me.

    I can understand why some don't want a "roto-rooter" procedure (I was apprehensive about it too). If medication works for you, stick with it. If you think Rezum or PAE or FLA is a better alternative, that's your call. All I can say with certainly is that the TURP worked for me.

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    • Posted

      Lee,

      My IPSS score was 29-30 before the operation, now it is 21 - so better, but some of this may be because of the bladder sensitivity from the radiation. Your score of 3 is excellent!!. I obviously have a long way to go.

      Thanks for your comment,

      Tom

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  • Posted

    Thanks for the detailed description of your experience Tom. Your point about there being different types of TURP is spot on. You could also say GLL is a form of TURP too since it also aims to remove tissue working from the urethra out though it does it by vaporization instead of cutting....just a different device to do the removal. One finer point I'd add is that it may be even more descriptive to list the three types as monopolar loop, bipolar loop and bipolar plasma button. The first term describes the path the electrical current takes while the second describes the shape of the electrode(s). I've also seen videos of a sort of roller ball electrode being used after a loop TURP to smooth out the surface and cauterize any bleeders.

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    • Posted

      One finer point I'd add is that it may be even more descriptive to list the three types as monopolar loop, bipolar loop and bipolar plasma button. The first term describes the path the electrical current takes while the second describes the shape of the electrode(s).

      The other difference between monopolar and bipolar is the latter allows the use of saline instead of glycine as the irrigation medium. Saline is not absorbed into the blood stream and thus does not cause TUR syndrome which can be a complication of the monopolar approach.

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    • Posted

      Hi Russ,

      I think that you are spot on regarding the three types and I could be wrong but I believe that the roller ball electrode is the plasma button, right? I saw my urologist yesterday as I was scheduled for a TURP on 11/1 but it has been postponed until after the first of the year because I am dealing with another (non prostate) medical issue. I asked her what tool (loop or button) she would be using on me and she said that she would probably use the button for the whole thing. My prostate is pretty small (30 grams) but I have a median lobe that is causing a problem. She said that for guys with really big prostates tho she generally starts with the loop and finishes with the plasma button. She also told me that nobody she knows does a monopolar loop anymore.

      Rob

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    • Posted

      Hi Rob, I don't know who your urologist is but her info and approach is very similar to what other uros have told me and what I've read.

      There are videos on you tube of both plasma buttons and what I described as a roller ball being used during a TURP procedure. They are two different types of electrodes but I'm not sure what the performance differences are.

      Good luck with both of your medical issues.

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    • Posted

      That's the single biggest difference and why bipolar is safer. There is also a nerve that can be inadvertently stimulated and cause problems during monopolar TURP because the electrical current flows through your body to the other electrode which is a large patch attached to your skin. Certainly nothing that I would subject myself to unless that was all that was available.

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    • Posted

      There are videos on you tube of both plasma buttons and what I described as a roller ball being used during a TURP procedure. They are two different types of electrodes but I'm not sure what the performance differences are.

      There are different shapes to the plasma "button." I think originally it was spherical and still is from some suppliers. Olympus now has an "ovalbutton" which appears to have a larger contact area and thus is faster than than the spherical shape. In either case, it does offer some advantages over the loop and it's interesting to note that Rob's urologist is another one who uses the combination of loop first, button second when the prostate size or geometry dictates it.

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