Dr suggests bipolar turp

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after 4 years of bhp symptoms I went back to a urologist for a second time. I'm 55 and have typical symptoms. I take flomax 2 times a day. I get up 1 to 2 times a night. I pee about 15 times a day never emptying my bladder. I have urgency when I do have to go. I'm always concerned about a restroom where ever my wife and I go. our sex life is ok i have no problem getting hard but my orgasm has slight pain. so this lead me back to a different urologist last week in livonia michigan. Going in and after a rectal exam he said I needed a urolfit. 15 min later after an ultrasound and going in through my penis he changed quickly and said I needed a bipolar turp and that my bladder showed damage. He said the turp would absolutely fix my problem. He also watched my stream and said I really needed this procedure. I have been following this forum for a couple of years and concluded that nothing is guaranteed. I believe he said I have a very large medium lobe. I left out that most of the time when I urinate I have some pain it varies. He also said my bladder would do some healing after time. Has anyone had success with this. What are your thoughts please. The doctor was quite calm with his first suggestion of urolift. After going in with the camera he seemed very concerned and said I should get the turp done right away that I was damaging my bladder.

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  • Posted

    You mention you have been following this Forum for a couple of years, well it should come as no surprise that a number of people on here will suggest you look at other alternatives and obtain second opinions, preferably from someone with out a vested interest, but I appreciate that isn't how it works in the USA.

    Your Median Lobe issue might preclude PAE but nevertheless a consultation with a Radiologist with a lot of experience of PAE and Median Lobes might be a starting place. The new kid on the block is Aquablation and that doesn't have an issue with ML's and early data suggests better outcomes than TURP. For the latter there are new techniques that are better at preserving prostate function but still relies heavily on the skill of the surgeon. Surgery is a big step so if you have the time then use it wisely to look at all the alternatives on offer, starting with the experiences on here.

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  • Posted

    There is a lot of information on this formum that could help you make your decision. There are many options each with their pros and cons. Bipolar turp is a legitimate one. However, I would try to find someone in your area who has expertise in PAE (prostatic artery embolization) to see if you would be a candidate for that because it is less invasive than bipolar turp. Generally, PAE works best for relatively large prostates. You should ask your urologist how large your prostate is. He probably won't push PAE because it is done by interventional radiologists. Because PAE is relatively non invasive you could always do something else like a Turp afterwards if it doesn't work. Based on my readings here I would consider aquablation (lesser chance of retrograde ejaculation) and Holep before bipolar Turp. A downside of Holep and turp is that they both will likely cause retrograde ejaculation. PAE and aquablation have little chance of causing that. Aquablation is more invasive than PAE.

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  • Posted

    TURP is an effective procedure, but has a higher risk of retrograde ejaculation (RE), urinary incontinence and impotence than some newer procedures that also effectively deal with median lobes. The availability of these procedures varies based on what area of the world you live. These include, in order of my personal preference:

    1. PAE - not always effective for median lobes, but the least invasive with no downside.
    2. Aquablation - the new safer "TURP" like procedure - see Procept website. A robotic saline jet based procedure. Surgeon skill is not a factor with this robotic procedure.
    3. Rezum. Uses steam vapor jets to destroy prostate tissue.

    If your bladder is at risk, you may want to skip trying PAE. Immediately speak with more urologists, but make sure they do one of the procedures you are interested in: Uros sell what they know. Patients, like me, sell what worked for them. MFR websites can tell you where their UROs are so you can make your own decision.

    Time is of essence. TURP is the "gold standard" at present, in that it has been around a long time. A skilled surgeon can help reduce the chances of side effects.

    Ive been where you are. I had my aquablation the beginning of this month. Very successful. Good luck.

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  • Posted

    The have been many satisfied TURP recipients on this forum. Most don't stick around long after the procedure because their BPH problems were taken care of. I had a TURP in February after 5 years or so on an alpha-blocker. I got tired of having to pee every 60-90 minutes with a slow stream and often feeling like my bladder wasn't emptied. I also had a large median lobe. For me, the procedure was a breeze. I stayed over night in the hospital and went home without a catheter. Resumed all normal activities after 3 weeks (I am 70 years old but in good physical condition). I have retrograde ejaculation but I had that from the alpha-blocker and it doesn't really bother me. The best part is that my stream is strong and if I get the urge and am not near a bathroom, I know I can I can hold it until I find one and not have to worry about emptying my bladder with a slow trickle.

    I'm sure there are plenty of good urologists in the Detroit area. If you're not comfortable with the recommendation you've received, by all means, get a 2nd opinion from a bona fide medical expert.

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  • Posted

    sorry to hear this. i had a large median lobe and was told Turp would give me the greatest relief at the greatest risk.

    urolift was recommended but i didnt like it for median lobe. I finally found Rezum on my own and sought a doctor who did this procedure.

    I'm one month out. While the procedure was brutal and the following two weeks really rough, I am 90% better! I peed the other morning for over 90 seconds straight. That hasn't happened in 20 years! I am to the point I can go 3-5 hours between times I go drinking 1/2 to 3/4 of gal of water per day. no urgency, no stop and go. A few times i might go and feel a weak stream but typically I fully empty in 20-30 seconds with a strong stream for me. Thats amazing!

    My first few orgasms were strong but bloody. My last didnt come out much so I'm praying its not Retrograde Ejaculation

    so, I'd have to say the agony was worth it as it has been life changing.

    My gut feel is you need to get a second opinion. This guy doesn't seem like he is giving you all your options. Look up Aquablation On here. Had i heard of that first I'd have tried it.

    Good luck!

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  • Posted

    Not only is nothing guaranteed but prior to any procedure the patient has to sign a waiver of liability against the the facility, doctors and staff which means you cannot claim wrongdoing. It is advisable that you seek a few more opinions. If you are in Michigan, I believe there is a Mayo Clinic nearby. They are good. Contact them.

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  • Posted

    Had a catheter in place for 2 years had my turp procedure 6 months ago on Tamulosin everything ok recommend turp procedure and Tamulosin

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  • Posted

    If you want a "one and done" scenario with a very predictable outcome and quick relief then B-TURP is a good choice. 70+% chance of RE on average though that is dependent on whether the surgeon consciously tries to avoid causing it and to a lesser degree, on the instrument used. Incidence of new ED and incontinence are very low with all of the procedures.

    From the sounds of it I wouldn't mess around with PAE though you might try to find someone who has Rezum in their toolkit. The procedure is simple, quick, inexpensive, and less chance of permanent sexual side effects. On the downside relief may take several months and from what you read here, one of the worst in terms of recovery (in terms of severity, length and having a Foley catheter) without as reliable an outcome as B-TURP.

    Regardless, always a good idea to get a 2nd opinion from someone who does other types of procedures. Good luck!

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  • Posted

    Hey Joe82842,

    Three years ago this past Monday, Dr. Wei did a Holeup on me at the University of Michigan. I would go to him in a heartbeat again if/when something else needs to be done, which is not anticipated at this time. He told me before my surgery that my sexual function would be the same post surgery as it was pre and he was correct. If anything it was better because I did not have to deal with the bph, uti(s) etc after he operated. I had also compromised my bladder, but thankfully that improved after my surgery. Not sure how long it took, but one day probably six months post surgery I noticed that my trips to the bathroom had decreased dramatically, it just happens over time.

    Hope it goes well with you!

    Doug

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  • Posted

    Joe,

    I had a B-TURP in April. No RE. Stream much stronger than before. No overnight stay in hospital, but I did have a Foley catheter in for 3 days after - the only discomfort of the entire experience. PAE might not work if you have a median lobe issue - the TURP will take care of that. There are MANY prostate procedures these days - you can study the alternatives for a very long time. Sounds like you need to do something relatively fast - the longer you wait, the more bladder issues you will have. Talk to your doctor about RE - maybe he can do the TURP and also spare the ducts, that's what happened in my case. With other procedures the issues are: insurance coverage, finding a doctor, travel to another city, time to heal, prostate swelling after and need for self cath etc. Lots to consider.

    Best of luck, Tom

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  • Posted

    This is how I see it: If you can have the same outcomes of an optimal TURP procedure done by the best surgeon in the world without the high risk of RE or incontinence, would you want to do it? If so, you owe it to yourself to investigate the robotic procedure called Aquablation.

    Aquablations are the new TURP. Just as effective, but the recovery is shorter, risk of RE and incontinence is far less, risk of impotence is negligible and surgeon skill is not a factor. Look at the studies. There’s a reason the FDA fast tracked approval of this procedure.

    PROCEPT, the Mfr of the Aquabeam robot, has been very successful in the USA getting insurers to cover Aquablations by doing peer to peer appeals. My appeal took two weeks. The studies demonstrating its superior outcomes are very convincing.

    I agree, you need to make a move quickly, but don’t allow TURP patients or doctors, even if RE is not a big deal to them, distract you from making a few phone calls to see if this is a viable option for you. If it isn’t, you’ll know TURP is your best option. Then get your BP TURP done by the best surgeon you can find and your outcome is likely to be a good one.

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    • Posted

      Marty, while I agree that Aquablation takes the surgeon's hands out of the loop during the cutting part of the procedure and makes that skill a non-issue, the planning part that precedes the cutting is just as important and that is all on the surgeon.

      Like any robot the Aquablation device and software will cut exactly what the surgeon programs it to cut...nothing more, nothing less. In other words, it's only as good (or bad) as the surgeon's programming allows it to be. And that is based on what he/she sees on the TRUS. To me, a sonogram appears to be difficult to read precisely, consistently. They "etch-a-sketch" ablation contours on the visual renderings of the prostate the system provides for planning the procedure via TRUS.

      In addition to the precision of reading the sonogram question, is urologist X one whose plan is to program the machine to core out the prostate all the way out to the capsule, or is he/she one who only wants to shape a modestly-sized channel through the prostate? In the former case it doesn't matter how precise the machine is, that patient will get RE. In the latter case, most likely not if he/she purposely programs it to avoid destroying the inner sphincter at the bladder neck and the musculature and tissue in the apical area of the gland.

      That and the lack of coagulation are the two things that worry me about Aquablation.

      I'm also curious to know if the mechanism that directs the water jet can articulate/control itself adequately to ablate the parts of median lobes that have pushed up into the bladder and do that safely. If you watch the animations and videos of it in action, the only direction the water jet fires in is radially. So what happens when he/she tries to program it to remove some of the bladder neck that has gotten scrunched up into the bladder? I don't think you want that thing firing the water jet out against the bladder walls. All that said, surely they must have devised a way to handle that situation.

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    • Posted

      Russ

      As I can’t understand X-rays and sonograms, I totally understand your concern. I did mention this to the two aquablation doctors I met with and they both had the same response: any urologist, unless he’s a quack, can read an ultrasound with enough precision to do the planning with ease. Furthermore, as far as the overall procedure goes, after a handful of Aquablation patients, he should be through the learning curve.

      Yes, if the Urologist is hell bent on carving out your ejaculatory ducts he can. This is true for any of the BPH procedures. Avoid sadistic urologists.

      The NICE study, I believe, showed about a 7% chance of RE (even lower in some groups). But, face it, statistics vary from study to study, and while the risk of RE and nerve damage with aquablation is the lowest of all the resection procedures, it is not non-existent. I presume that this is because inflammation to nearby areas can impact the ducts.

      I tried PAE (my favorite procedure) without complete success due to median lobe and then researched every resection procedure I could find. I opted to not do Urolift as I cannot get comfortable with the hardware that is left behind - a personal paranoia. I narrowed my choices down to Rezum and Aquablation. I chose the latter due to the absence of heat and the reduced role of surgeon skill.

      I asked my surgeon to do his best to avoid RE as they were wheeling me to the OR. He looked at me like I was nuts to even suggest he would do otherwise. Then I said, “Look, if for some reason there is a choice between race horse like flow and RE, give me less flow.” He responded, “I will try my best, but RE is always a risk.” I am now nicknamed Sea Biscuit.

      I am thrilled with my experience with Aquablation. So far, one month out, no RE, no blood, no incontinence. Flow is great. My bladder is still adjusting, but frequency is way down.

      This procedure is still very new. Last I checked, my doc has only done six of these procedures, all with similar outcomes, except one that was not manageable during setup, so the Aquablation was aborted. That patient then opted for HoLEP. One guy went back to work the day after. I could have done the same, it was just messy when I urinated. By day ten, 95% of bleeding had stopped.

      Six is not sixty. For those outcomes, I look at the studies.

      There are docs out there who were part of early trials who have done a lot more aquablations than my guy. I just didn't see the need to travel far away, given the robot factor.

      A YouTube worth watching:

      Robotic Aquablation: A novel technology to treat prostate enlargement.

      The NICE study is called “Interventional procedure overview of transurethral water jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia”

      I cant answer all of your questions, but I would suggest contacting Procept, the MFR of the Aquabeam robot. They will be happy to give you the answers. I called them several times prior to making my decision.

      Your caution is laudable. Just don’t over think if you are in need of a procedure. You are never going to eliminate risk with what is available at present.

      Marty

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