Greenlight or TURP for BPH?

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I have BPH, symptoms being urinary retention and recurrent UTIs. My urologist recommends surgery, and has ruled out a Urolift due to my having an enlarged median lobe. That leaves me with a choice between TURP and GreenLight laser, and he’s really pushing TURP. From everything I’m reading however, the Greenlight procedure seems just as effective, and has lower risk of side effects and a much shorter recovery time. Above all, I’m seriously concerned about sexual side effects above all. I’m 57 years old, and I’m not ready to “cash in my chips” just yet. I already have ED issues, and the thought of further sexual diminishment is leaving me quite depressed. Is my doc pushing TURP because he’s more experienced with it?  Are there other options? I’m wondering if a second opinion is advised. Any feedback from guys who have been through this?

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  • Posted

    If your American he might be pushing TURP because he earns out of it. Prostate Artery Embolisation (PAE) is something you should investigate. As this I performed by an Interventional Radiologist Urologists are a little reluctant to refer you. It may still not be right for you but as your fears are well founded this much less invasive procedure could be just what you are looking for.
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  • Posted

    Hi  Chuck ,

    I made really detailed and  long investigation  about treatment  of  similar signs of BPH as you have. My prostate is just  50 ml (grams) ,   but  big median lobe ,which blocks bladder neck. This  causes  nearly  full retention,  sleep shortage,  nocturia, and  in time  the neccessity of CIC-  self cathing.  Pls note  PAE in case  of big median  lobe has small effects.  I passed it last April  . After few months  of symptoms relief,  the problems returned with bigger intensity.  So I lost one year time.   Yes you have some options : TURP,  GL, HOLEP,  open prostatectomy ...new methods as Urolift,  REZUM and FLA.   It seems that for big median  lobe is best  REZUM  and FLA . This is based on my long investigation and consultations with  many patients  and some doctors.  REZUM is  cheaper, probably covered by your insurance  , but still  more random  method in comparision  with FLA.   

    After detailed analyses of my problem  - detailed MRi scannes,  PSA,  PVR, e.t.c.  I decided for FLA.  Living in Europe I'm flying  to USA  early April for FLA procedure.  If you need more details pls PM  to me.  Have a Nice Day, Stan  

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  • Posted

    Hi, I reported extensively on my experience since my problem was the big median lobe as well. I spent several months investigating and looking around. Being in the Houston area I found a great doctor whom I trusted and did GL. Turned out perfect for me with both recovery and results. FLA is a very good option. I would not do TURP which my first doctor wanted to perform. You can always PM me if you can’t find my previous responses. Good luck to you!
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    • Posted

      From my urologist who performs hundreds of TURPs, it works very well. I am worried about the sexual and reproductive fertility app implications. should I be warranted if I want to father a and have a normal sexual relationship in the future?

      I'm 58 and still may want to have children. Especially because in the genetic my family

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  • Posted

    TURP is barbaric given the alternatives i.e. Greenlight and HoLEP.

    HoLEP, in and out in the same day with no catheter.  No experience of GL but would expect the same as HoLEP.

    Minimal incontinence but that may be because I carried out pelvic floor muscle exercises for a month prior to the procedure and after but more gently.  Dribbles had cleared up within a few days. 

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    • Posted

      When you say TURP is barbaric, can it not be done properly if it is a highly experienced urologist surgeon was done hundreds of them successfully? The administrative assistant to the urologist told me most people recover very quickly Kent works like a charm.
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    • Posted

      John there going to tell you anything to get you to have it.  It does work sometimes but it can cause you many problem and can take up to a year to heal and retro ejaculation is a given side effects of a TURP.  Ken 
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    • Posted

      Johnny, I use the term "barbaric" in the sense that it is an outdated form of surgery which has been superseded by other procedures that allow a patient to recover quicker and with far less discomfort during the recovery period.

      The effects of BPH over several years can effectively destroy ones lifestyle and enjoyment of that life and the remedies to regain a lifestyle free of discomfort and inconvenience are now more plentiful than they were 20 or 30 years ago when the TURP procedure was the gold standard.

      The choice is yours and yours alone and no amount of advice from the chaps on this forum should be allowed to affect your decision on what procedure you ultimately choose.

      For me a HoLEP was a procedure I'd been seeking for over two years despite being offered a TURP and I am very pleased with the outcome on all fronts.  OK retrograde ejaculation may be the end of the world for some chaps but a small price to pay for regaining my life and freedom to enjoy it again and loosing a bit of my sexual function was worth it.  I can still "perform" extremely well despite the inability to ejacultate in the normal manner but I and my lady have no regrets in respect of having the procedure.

      Final words on the subject, some people on here throw words such as "sometimes" or "many" around when describing outcomes of procedures, rather than actual statistics. Go do your own research and don't allow yourself to be led by well intentioned people who use glib terms rather than actual statistics that can be verified.

      Good luck with whatever route you choose to follow in your search for a resolution to your BPH and above all keep an open mind.

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  • Posted

    At 57 with some existing ED issues, I would not even consider ANY of the surgeries (TURP, Holep, Greenlight) before trying one of the less invasive ones. Your large median lobe rules out Urolift and PAE, butr Rezum and FLA are both options you should try. If your doc only does TURP and Greenlight he's way behind the times and you should find another doc.

    TURP, Holep and greenlight all can have long recoveries, all can leave you temporarily incontinent and all (much lower chance in a good surgeon's hands but still there) have a somewhere between a high likelihood and guarantee of leaving you with dry ejaculations (RE) for life.

    FLA has shown real promise but isn't as thoroughly vetted as Rezum - both are options and the overwhelming majority of men who pare diagnosed properly and have Rezum are very happy with the results. No anesthesia (although I recommend being twilighted as it can hurt), low incidence of RE (they claim 3%, its probably more like 10, but Greenlight is 50 and HOlep and TURP are close to 100) and almost no chance of permanent devastating side effects like incontinence and impotence. This forum is filled with horror stories after Greenlight and TURP, but only one that I know of regarding Rezum and that was with a 79 year old post stroke patient. The chance of a horror story is low even with the surgeries, but its virtually none with Rezum and FLA and at 57 I wouldn't even consider TURP or Greenlight before trying one or both of them.

    IMO, find a new doc, get a full workup (scope and urodynamics) if you haven't had one and assuming your prostate is most or all of your problem, try REzum and/or FLA with a doc who performs them.

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    • Posted

      This Forum is littered with failures because the people who have problems post and those without need not. We also have the same people posting the same message time after time. I post that GL worked for me in 2004 and Thulium/Holmium similar to Holep did in 2013 but I am practically a voice in the wilderness. I am also sure that procedures done in hospitals in the UK have a much higher success rate than ones in America.

      Did none on the Forum ever subscribe to the NG for BPH. I read it from 1995, it still exists  but is now seldom used. GL was the wonder cure from 2003 and few posters had problems. I have over 13,000 old posts on file. The First ever GL patient posted there and  few days after his procedure flew from America to Japan without any problem. Like Victor Kiam of razor fame he was so impressed he bought shares in the company.

      In my case it was life back to normal on day three.  

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    • Posted

      I'm with you on this Derek.

      I only post to advise people of how it was for me and for only that reason which will hopefully allow them to make the right judgement call for them and not forgetting we are all individuals who react differently to treatments, procedures and the condition itself. There's lots of learned publications online giving all the details, statistics and info on trials of all the procedures and treatments for BPH and I wish people would use these facilities to research the best options for them rather than rely on sometimes quite spurious information that some regular posters persist in rehashing on here.

      The best advice I can ever give is get a second or if need be third opinion if you have any doubts.

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    • Posted

      Most do well with all of the procedures, including TURP and the failure reports here shouldnt be used for statistical purposes, just as a cautionary tale as to what can go wrong - however rarely. Some of the newer, less invasive procedures have almost NO horror stories - meaning worst case scenario is less scary with them. Unless someone's physiology dictates a more invasive surgery, it usually makes sense not to opt for greenlight or Holep first (TURP never IMO) , given what could happen in rare cases (incontinence and/or impotence) or what is likely to happen (retro ejacualtion/longer recovery).

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    • Posted

      TURP never as it is an older procedure.GL, HoLep and other laser procedures do the same thing  much better. Is there any reason now for TURP apart for Uros who do not want to learn or spend money on new equipment. 

      If the options are to shrink it, tuck it away or remove tissue I go for removing it. 

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    • Posted

      I'm not sure about extra opinions as Uro's tend to advise on the procedures they specialise in and have the equipment for. They are unlikely to send you in America particularly to a competitor. In the UK your NHS area heath authority  pays for your NHS treatment in another area but no doubt they are reluctant to pay more than for the cost of their own favoured procedure. It took me eight months from requesting the GL that my area did not do to actually having the procedure. In theory if a procedure is not available in the UK we can ask to be to  referred to a hospital in Europe. A few French and German hospitals are actually touting for business.   

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    • Posted

      I no longer have the first post from Patrick who was the first ever GL PVP patient but this was one of his later updates.

      Just a short note to say the I am now 15 months post-PVP and I feel great. Strong flow, no freq, no urgency, no residual, no retro. After 15 months, my bladder seems to have regained the elasticity lost to years of bladder outlet obstruction caused by BPH. AUA score = 0 Quality of Life Score = Delighted PSA = 1.6 Peak Flow > 50 ml/sec capacity without urgency > 800 ml residual 0 ml I want to mention secondary improvements that I attribute to Laserscope PVP. Prior to PVP, I could not run or bike longer than 20 or 30 minutes because of BPH. I literally timed my runs to be between mens' rooms. Now I am running 5 miles in under 40 minutes (something I haven't done since age 23) and biking over 50 miles without the need to stop. As a result of this, I am in better physical shape now at age 45 than I was at age 25. I attribute this directly to having the PVP done. Seems like many others both on and outside this newsgroup have had excellent results as well. Laserscope tells me that over 5000 PVPs have been done so far this year. This is a significant number given that there are about 150,000 TURPs done per year. I estimate that within 3 years PVP with overtake TURPs inthe United States as the most used and the perferred surgical procedure for the treatment of BPH. I heard that Dr. Te is now running two machines and is fully booked until December. He was inundated with inquiries after the WNBC TV segment that ran in June. It seems like the dialog here has been very positive as well. To those here who are plagued by BPH and are still on the fence. Go have it done. The sooner the better. You will regain freedom over BPH that you don't fully realize how much you have lost. Take care and best wishes for good health, Patrick

       

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