Do I need a TURP?

Posted , 12 users are following.

I am 72 years old and, other than BPH, in excellent health. I take tamsulosin (.8mg) daily. My voiding is often, but also highly dependent on my fluid intake throughout the day. I can usually make it through the night with one trip to the bathroom. My urine stream isn't strong, but it's not a dribble either. I have never experienced an inability to void, have no pain when voiding, have no leakage and have never needed a catheter to empty my bladder. A problem I have is that at my regular visits to my urologist I usually show on the ultrasound that I'm retaining a high level of urine, sometimes as much as 75%. For this, my urologist is insisting that I have a TURP. He is concerned about kidney damage. I monitor my voiding and usually void about 27 oz in a six hour period. This is average. I feel that I am managing my BPH fairly well and unwilling at this time to undergo major surgery. I would appreciate hearing someone else's opinion before I get a second opinion from another urologist. Finally, my doctor is not at all keen on any alternative treatments. He says TURP is the only way to go. Thanks.

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  • Posted

    I'm in the same boat as you. My doctor is insisting I get a turp as well. He doesn't do any other types of surgeries and he's probably fairly good at it because he said he's done thousands. He also said that the procedure is better than it was even a few years ago.

    I've been terrified to get it but now I'm feeling I may have to because he said like you I could have kidney damage and my bladder is getting tougher from retention.

    • Posted

      Has your doctor expressed an urgency to have the TURP? I'm trying to get to the end of the summer before having it.

  • Posted

    Hi Jay and Johnny,

    If retrograde ejaculation is something you want to avoid - research Aquablation - 7% risk and much better outcomes than Rezum which has less than a 1% risk of RE.

    Your personal situation will determine which is better for you - you need to find doctor's that due these to have that discussion.

    I have a median lobe obstruction of the prostate - and the Rezum site says it is good for median lobe - but some doctor's agreed, others stated they weren't happy with Rezum results.

    Hope this helps!

    Bob

  • Posted

    In my humble opinion it is damage to your bladder that is or could happen by the walls being stretched and then they become hardened , losing future ability to void sufficiently .

    Things will deteriorate .

    I had TURP three years ago and for 6 months afterwards I was unsure if it was a success but now I feel it was absolutely worth having it done and even though I often void twice in quick succession .

    It feels like my bladder is emptied properly then and after holding up to two litres of urine before my operation then that for me is a success. I had to catheterise five times daily before my operation .

    A bladder needs to be emptied regularly to keep the muscles working well. I believe the muscles of my bladder will never get back to what they were but for me TURP was the only way to go, and I glad I had it done .

    Hopefully your bladder is still relatively undamaged but I think it could get worse over time . it isn`t emptying properly and it is most likely the elasticity of your bladder walls that is forcing urine out when full and over stretched , not the muscles pushing it out naturally .

    Geoff (Uk)

  • Edited

    Hi GInAndPlatnic46,

    In response to your reply: I notice I pee more and longer when I drink more. Does this mean it is likely I have the same issue?

    Meaning my bladder is forcing urine out when full and over stretched? And that is why when I have less I feel the urge but can’t empty very much?

    I guess this is determined by a PVR test?

    Bob

    • Posted

      It makes sense that drinking more would cause you to pee more. That's how it works for me. I don't know, however, if that means you have a prostate or bladder issue. When I go for a check up, they make me pee and then do an ultrasound to see how much urine I have retained.

    • Edited

      One thing I would ask you or your Doctor is when you say 75% remains .

      75% of what ? That is more important actually.

      In answer to your question I would say , yes , if you are feeling the need to pee frequently there is a good chance that your urethra is becoming restricted and so is not allowing your bladder to empty properly and your bladder is being continually over stretched . imho...and it is just an opinion .

      Yes the PVR test explains what is going on more , so you know 75% of what amount is remaining every time you pee.

      I wonder why the doctor couldn`t tell you what was remaining if he/she could tell it was 75% remaining in the first place anyway .

      The peeing more and longer is just a natural progression from drinking more . I tried drinking more water before my operation thinking it might clean things out but I was naive in my thinking and just ended up peeing way more . The overriding problem was the same and stayed so .

      ps just for information I am 67 years of age .

    • Edited

      Hi,

      I think you are mixing up my message with someone else. I never mentioned anything about 75%.

      I have had many PVR's - after my bladder diverticulectomy surgery in 2000, my PVR's for 14 yrs were between 133 and 150, and my surgeon was happy with that. I realize now in retrospect, the blockage that caused the diverticulum still existed.

      My 3 PVR's in late 2021 were 96, 236, and 133.

      Do I understand then, based on your experience, that the amount remaining shown during a PVR is relative to how well your bladder is emptying, which translates to how minor or major one's bladder distension is?

      I am leaning towards Aquablation now, as it's the only one with a low 7% retrograde ejac risk, based on a 5 yr study of just over 150 patients.

      Thanks.

      Bob

    • Edited

      I probably didn't give a very good explanation in my original post. My urologist uses a percentage to give an unscientific lay answer to explain the amount of urine retained in the bladder. Technically, my PVR was 225 two weeks ago and it dropped to 179 last week. It has usually been 129. We are monitoring frequently and I will soon make the decision regarding treatment. I failed to mention that I am located in the US.

  • Posted

    I would worry about the retainer urine. No good can come of that.

    As far as which procedure, I would consider a HoLEP before a TURP, although it results in retrograde ejaculation most likely. Also consider other procedures.

    But if you are retaining lots of urine, it should be fixed.

  • Edited

    Hi. Turp is not only way to go. There are different procedures to reduce size of your prostate gland. If your Urologist is working under NHS guidance then perhaps he is suggesting that to you as it is the most basic and cheapest option. I have heard about Holep procedure which is less invasive and carries less risk.

    He could be right about risk to your kidneys though.

  • Edited

    One thing I would ask you or your Doctor is when you say 75% remains .

    75% of what ? That is more important actually.

    In answer to your question I would say , yes , if you are feeling the need to pee frequently there is a good chance that your urethra is becoming restricted and so is not allowing your bladder to empty properly and your bladder is being continually over stretched . imho...and it is just an opinion .

    Yes the PVR test explains what is going on more , so you know 75% of what amount is remaining every time you pee.

    I wonder why the doctor couldn`t tell you what was remaining if he/she could tell it was 75% remaining in the first place anyway .

    The peeing more and longer is just a natural progression from drinking more . I tried drinking more water before my operation thinking it might clean things out but I was naive in my thinking and just ended up peeing way more . The overriding problem was the same and stayed so .

    ps just for information I am 67 years of age .

  • Edited

    Certain procedures on the prostate can depend on the size and shape of the prostate. Laser surgery studies suggest a quicker recovery but Turp studies suggests better long term outcomes in the sense of needing further surgery or it lasts longer.

    • Posted

      holep is a laser surgery and has a better long term outcome than turp right (at 10 years)?

      aquablation is not laser surgery but also recently posted slightly better 5 year outcomes than turp.

      I agree with you if you are comparing TURP to rezum, urolift/pul or PAE

      FLA for BPH is still up in the air but likely as good as TURP for 3 years.

  • Edited

    I had a TURP 3+ years ago at age 70. Best thing I ever did. Stayed overnight in the hospital, was able to pee the next morning after drinking lots of water and went home without a catheter. Resumed all normal activity in 3 weeks with the doctor's blessing. It also alleviated my bladder spasms and allowed me to eliminate that medication which I'd been on for 15 years. My doctor had done other procedures but said in my case (enlarged median lobe), TURP was the best solution. And he was right. No regrets whatsoever.

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