Incontinence after Turp, GL, and HoLEP procedures

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Hi everyone,

I have a question about incontinence after procedures like Turp, GL, and HoLEP.

Which one has a chance free from incontinence , or depend on surgeon's ability and skill, but my brother in law in Paris had TUEVAP done, and he did not have incontinence problem, and in this forum I see people talking about bladder neck sparing, what does this mean ? And how we can avoid incontinence after procedures? please can you guys to advise or share your experiences and successful outcome.

I really appreciate that, and thank you in advance.

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  • Posted

    It could happen with any of them. No two people are the same. There are no guarantees.

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    • Posted

      But to a minority and a small one at that with GL or Holep.

      I've had two laser procedures with quick recoveries and no incontinence or RE. Tamak must remember that happy patients seldom post of their experiences as they are out enjoying life and most of them sleeping better.

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    • Posted

      Good point. If everything goes as planned, and you are satisfied with your results, then you wouldn't have any need to look for further information, nor find yourself on a forum like this one.

      As for us patients that are seeking information prior to surgery, then we can let our BPH brethren know about how it went, good or bad . . .

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  • Posted

    Well Lester is absolutely correct. However, choosing your procedure and Doctor carefully, does appear to improve your odds significantly.

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  • Posted

    I had the urolift procedure 3 weeks ago and my wife is still self cathing me as i can only get drips and a small week stream at times and went into it being able to pee but not fully empty my bladder. My advice would be dont get any of them done unless it is absolutely nessary.

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    • Posted

      Is this a typical result or time frame for the urolift procedure? How much longer before you get things working again? If this in atypical, what did the doctors say about the cause of these adverse results?

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  • Posted

    I had a TURP and totally regained continence in 6 months, but later had the Prostate removed and extra stitching is then required after the TURP. Now 18 months on I have stress incontinence and am awaiting op as sphincter valve not working. If you have Cancer in your Prostate it could be safer to have it removed first rather than the other procedures.

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  • Posted

    I'd like to hear more about the results men are having with the TUEVAP procedure.

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    • Posted

      Transurethral electro-vaporization of the prostate (TUEVAP) is a newer version of the transurethral electro-resection of the prostate (TURP).

      Instead of using an electrical current loop as is done in the TURP procedure, a TUEVAP uses a roller ball to heat the prostate tissue so that it is reduced to vapor. During the process, the small blood vessels in the prostate are sealed off. There is less bleeding during and after this procedure than there is with the TURP. As a result, patients can leave the hospital the same day or next morning.

                      Recovering after Surgery
      

      If you have surgery, you will need to stay in the hospital one to two days.

      Antibiotics to prevent infection may be given prior to or following surgery. Your surgeon will discuss this with you personally and advise you accordingly.

      After surgery, you may notice some blood or clots in your urine as the wound starts to heal. If your bladder is being irrigated (flushed with water), you may notice that your urine becomes red once the irrigation is stopped. Some bleeding is normal. It should clear up before you leave the hospital.

                      What to Be Careful About
      

      Even though you have no visible incision and may have little pain, you are recovering from surgery. Don't try to overdo it getting back into your normal activities. Discuss what to expect during recovering with your doctor. The following guidelines will help you have a smoother recovery:

      Avoid straining, especially when moving your bowel. Eat a balanced, high fiber diet to prevent constipation. If constipation does occur, ask your doctor if you can take a laxative.

      Don't do any heavy lifting.

      Avoid sudden movements.

      Drink plenty of water (up to eight cups a day) to flush the bladder and help prevent infection.

      Don't drive or operate machinery.

      Potential Problems to Watch For

      Due to the nature of the surgery, you may notice changes in your urination or sexual function. Usually these are typical of the surgery and go away over time. Here are a few things you may notice:

      Problems urinating. Although the surgery may make your urine stream stronger almost right away, it may take time before you can urinate completely normally. As you heal, you may have some discomfort or feel a sense of urgency when you urinate. This will slowly disappear. After a couple of months, you should be able to urinate less often and more easily.

      Inability to control urination (incontinence). As you recover, you may have some problems controlling urination. It is rare that this lasts long-term. Usually, the longer you were having problems before surgery, the longer it will take for your bladder and urethra to return to full normal function afterward.

      Bleeding. In the first weeks after TUEVAP surgery, the scab inside the bladder may loosen. Blood may suddenly appear in your urine. Usually, the bleeding stops with some bed rest and drinking fluids. However, if the bleeding is so heavy that it is difficult to see through the urine or if it contains clots or if you feel discomfort, contact your doctor.

      Sexual function. While it may take time for some men to regain full sexual function, most are able to enjoy sex again. Sometimes, concerns about sexual function interfere with sex more than the surgery itself. Talking to your doctor before surgery and understanding what is being done is helpful. Usually, if you could have an erection before surgery, you will after surgery. Prostate surgery usually makes a man unable to father children. This is because the surgery interferes with the function of a muscle. This muscle plays a role in diverting sperm through the penis by blocking the entrance to the bladder. After surgery, sperm goes into the bladder and is then voided out.

      Following up after Surgery

      Since surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problems including prostate cancer or benign prostatic hyperplasia to develop or return.

      After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.

      Usually, surgery for benign prostatic hyperplasia offers relief for about 15 years. Only about one man out of every 10 of have the surgery will need a second operation for an enlarged prostate. Typically, these men were younger when they had the first surgery.

      Sometimes, scar tissue from surgery requires treatment in the year after surgery. Rarely, the opening of the bladder becomes scarred and shrinks, causing obstruction. More often, scar tissue may form in the urethra and cause narrowing.

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  • Posted

    Hi Tanak think your best chance to avoid incontinence is firstly to ensure you really need the procedure and then secondly only work with a doctor who has done the procedure he has proposed for you many many times with little or no incontinence demonstrated in his prior patients... some doctors are uncomfortable talking about this is a watch out.

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  • Posted

    Tanak,

    I had a bipolar TURP in April. No incontinence. In and out of the hospital in 4.5 hours. No pain. Only irritation was from Foley catheter that I had in for 3 days. Never stayed overnight in the hospital. I thought the entire procedure was easy and painless. Only blood noticed after was some in the leg bag when the Foley was in, but once the Foley was out, the leg bad was no longer pink. After a few weeks my stream was at least 50% stronger. My bladder is still recovering my the pre TURP retention. My frequency and urgency is much improved, but still getting up many times per night - might just be a very bad habit. So, if you are having nocturia issues and this goes on for a long time, it may take a long time to get back to a more normal sleep habit. HoLEP is known to be very effective and results last a long time. The surgeons who do this are highly trained. GL is less effective (according to my urologist), but some here have had good results from the procedure. A benefit of both TURP and HoLEP is that the tissue samples are sent to a lab and you get a report a week later letting you know if any cancer was detected. Better than having a 12 core biopsy. Had two of them - not fun.

    It's worth seeking out and interviewing several urologists before moving forward. Try to go with the very best if you can. With radiation treatment for prostate cancer the targeting computer does most of the work, but with any of the BPH procedures the skill and experience of the surgeon is critical. It might even be possible to avoid retro ejaculation with duct sparing techniques. Again, you have to seek out and interview several urologists. This can take some time. Don't know if you have the time.

    Nothing is guaranteed, as we are all different. There is always a possibility of some incontinence, but this can be just minor dribbling - easy to control with padding in your underwear. Gradually this can be improved. If you are on Flomax you can taper off and finally get off this med after your surgery - another positive. The fewer drugs you are on the better.

    Tom

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    • Posted

      Thanks for sharing your experience and for the good advice. Btw, what do you mean when you say that:

      My bladder is still recovering my the pre TURP retention.

      Is it common to have bladder issues when you have BPH? I usually Double Void in order to get it all out, and not have to feel that sensation of having to urinate again so soon, and i'm hoping to avoid getting a UTI or the bladder issue that you are talking about. But i'm not sure if i will be successful . . .

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    • Posted

      When I said that my bladder is still recovering I mean that it is becoming less sensitive so I can last longer between bathroom trips. The frequency/urgency issues are improving, and now, finally, my sleep is beginning to improve as well. Takes time. It will be 6 months post TURP for me next month. It is also getting easier to clear my bladder when I do get up at night and I can get back to sleep faster.

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    • Posted

      Tom,

      You wrote:

      "A benefit of both TURP and HoLEP is that the tissue samples are sent to a lab and you get a report a week later letting you know if any cancer was detected. Better than having a 12 core biopsy. Had two of them - not fun."

      My doctor told me that when samples are sent to pathology for HoLEP, they're only from the central portion of the prostate that surrounds the urethra. HoLEP leaves intact the peripheral zone where 70% of PCa is detected.

      So, a man can have successful HoLEP for BPH but still harbor cancer in the peripheral zone that post-HoLEP pathology will not pick up.

      That was quite a surprise to me when I heard that. My uro is not completely sold on HoLEP, but it has had a lot of clinical trials and has demonstrated good results in the vast majority of men.

      Still, we should be cautious in assuming that a "clean" path report after HoLEP means "all clear" for cancer down the road, because that is not the case (unfortunately).

      After all, HoLEP leaves a lot of prostate tissue. It is not a complete coring out of all the prostate leaving only the prostatic capsule (orange flesh vs. orange peel analogy). The peripheral zone does not impinge of urine flow, and HoLEP does not remove any tissue from that part of the gland. If only it were so.

      Michael

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    • Posted

      Is it common to have bladder issues when you have BPH? I usually Double Void in order to get it all out, and not have to feel that sensation of having to urinate again so soon, and i'm hoping to avoid getting a UTI or the bladder issue that you are talking about.

      If you are considering any kind of prostate surgery, I'm sure the urologist will want to do a cystoscopy to examine both bladder and prostate. If you have experienced BPH for several years, he will be able to see "trabeculation" i.e., thickening in the bladder wall due to having to push the urine out. In my case, it was described as "minor" and I have no trouble emptying my bladder now (post-TURP) and have a PVR of 0. That feeling of having to go 15-30 minutes after voiding is gone!

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    • Posted

      Derek

      You had 80 g removed?

      How big was your prostate before your procedure?

      Are you still peeing ok?

      I'm scheduled for HoLEP soon

      I need relief. Getting up too much at night and my bladder is holding more and more residual.

      Michael

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