Mini TURP or TUIP after FLA

Posted , 13 users are following.

Hello, 

I had an FLA procedure in February 2017. It worked great for 6-8 months, but has gradually been regressing back towards my pre procedure state, but not nearly that bad. I’m just worried it will continue to get worse, which was always the concern with a new procedure like FLA.  I have been reluctant to post anything, as I didn’t want to jinx myself, and I seem to have good days and bad days, but the bad days are increasing. 

I have been in contact with Dr K, who has followed up with me continually since he was aware things were going downhill. He has been great at following up with me and offering solutions. 

I recently had a second MRI to see what might be going on. I think he said my prostate was reduced by 30% over what it was, but said the areas that were ablated now have a fluid in them, which is causing the blockage. So instead of tissue blocking the urethra, it is now fluid. I’m surprised by this. 

Dr suggested I now have a Mini TURP (TUIP) to cut open the areas of the urethra where the fluid is, and this should dramatically open things up. This is supposedly a much less invasive procedure than traditional TURP, but the thought of this is not exciting, and why I sought out the FLA I. The first place. He has already spoken with my URO about this, and I will see the URO in a weeks time. 

I know the Uro suggested I may need something like a bladder neck incision as well, but I have not heard this first hand.

So I am hoping someone may have gone through this who can chime in with some advice. Dr K thought it might be 3 cuts to open up the urethra, but once they are in there, who knows?

I have looked at videos, and they don’t excite me too much. I’m not prepared for another recovery, unless it is pretty minor. 

I’m hoping to just manage my symptoms for a while, but not so hopeful.

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  • Posted

    Hi,

    Very sorry you have to go through this.  Please consider a second opinion. Did Dr. K describe the fluid and are you the first? Is it possible to remove fluid with a syringe? Is the fluid building up a little at a time causing the blockage symptoms? 

    Katey

    Katey

     

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    • Posted

      He just said fluid tends to fill in voids in the body.

      I am not sure how you would get a syringe up in there, more like the urethra needs to be penetrated to let the fluid out. Apparently, there are large open areas from the ablutions on the other side of the urethra. So it kind of makes sense to open things up, but it’s another procedure.

      He described it as a smaller procedure, but anything with TURP in the name doesn’t sound minor.

      I will be getting a second opinion from the uro when I meet him, but he already told Dr K on the phone, “That’s why they call TURP the gold standard”...

      I was hoping to get a little info on the procedure before I meet with him.

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  • Posted

    Yeah, if it is fluid, why can"t he aspirate?  Also, did he say what caused this?  Also, if it is fluid, instead of gland tissue, why can't fluid go thru the urethra?  

    These docs really suck, never owning up to anything, and blaming our body or the procedure they recommended as the cause of the problem.  NO ACCOUNTABILITY !!

    That is why I have a catheter for the last four years!

    Why have they not have a stent, like the use for the ureter (from kidney) developed yet?

    Just my opiniion and my body.

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    • Posted

      Yes, I fully agree. They have some stents but claim the migrate but that is nonsense they could easily put a suture to hold it or come up with another way but I think they don't want to use them because they can't make enough money for just inserting a stent. To easy of a fix without the big payday. Always about the money and a real shame for all of us going through this nonsense... Riggs

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    • Posted

      I don't think the adverb "easily" should ever be attached to anything regarding the prostate or urethra.

      I've read about stents, which apparently are mostly used for men who are not good candidates for surgery because of age and their overall health.  There have been a number of trials, with some reporting higher levels of success (87%), and others with lower success rates (35%).   Most often, stents are used temporarily, and then removed.  Do a search using [Prostatic stent wikipedia] for a good overview.  It discusses temporary and permanent stents, and says the only FDA approved stent is the Urolume.

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    • Posted

      I'm pretty sure there are stents available but they don't work well.

      I'm assume the fluid is inside the prostate which is on the other side the urethra.

      You would think there would be a way to remove the fluid with a needle. I'm thinking that probably depends on the viscosity of the fluid.

      In the end it's an unforseen side effect of FLA. That's why Dr K. Is doing the half price trial.

      Sorry to hear you're not doing well motoman

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    • Posted

      Uncle,

      You are right, the fluid is in the prostate, where the tissue was ablated, on the opposite side from the urethra. Since the fluid is likely to come back, don't think a needle would provide more than a temporary solution.

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    • Posted

      oldbuzzard,

      I guess if the urethra is cut open from the inside into the cavity, you now have a larger opening, because all the tissue on the other side was ablated already according to Dr K. 

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    • Posted

      Maybe I'm missing something, but if there is ANY opening, fluid should drain. Unless this procedure would leave permanent openings (holes) in the prostate, I don't see how it would help long term any better than having it drained with a needle.

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  • Posted

    TURP is scary - and I don't see why they couldn't just use a needle to remove the fluid. And how do they know it won't happen again? If you're near a major hospital, you might want to find a hot shot urologist who might have an idea that could help with less brute force than a TURP - even a mini one.

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    • Posted

      Yes, TURP is scary. Supposedly, this isn’t as bad, like in and out same day. But the videos are not appealing. The idea is to cut through the urethra to where the larger voids were made by the laser ablation, so the fluid is no longer trapped.

      If a needle was used, the fluid would likely come back, since the cavity created by ablation would be sealed up again.

      I am surprised I am the only one this has happened to, and kinda surprised that fluid on the inner side of the urethra could actually block or impair fluid on the other side of the urethra from going through.

      Too bad there is not a way to attach an image, as it makes it a little easier to understand.

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    • Posted

      I would get a second and third opinion before letting someone cut through my urethra. I would also want to know what this fluid is - I've never heard of a prostate generating fluid. It could easily be a one off that won't repeat. If it was me, I'd rather have a needle extract fluid every 9 months than let someone cut my urethra.

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    • Posted

      Actually, there is a way to attach images.   When you are sending a reply, there are four little icons to the right of your name.  One looks like mountains with a moon over the peaks.  That's the icon for attaching an image.  I'm attaching an image of the stricture my first doctor left me after doing a Greenlight laser procedure plus a Gyrus TURP in March and May of 2016.  This image was taken last July by a specialist I saw in California.  A complex stricture in a terrible location.

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    • Posted

      I did put the photo up, but it is hard to figure it out. I will attach again:

      The white areas are the liquid.

      The large white area in the image without the words written on it is my bladder.

       

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    • Posted

      Hi Motoman,

      Thank you for the images. 

      I've been thinking about this liquid surrounding the urethra.  Never read of this happening on the Ustoo site (focal laser ablation) with over 6000 posts. 

      Is it possible urine is leaking in from the bladder? Have you thought about sending the images to another Fla guy to check out? 

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    • Posted

      I was not aware of another site until today. I will see what I can find out there. 

      I am not aware of any other FLA doctors besides Dr K, and the guy in Florida that do it for BPH. Plus I have been really happy with Dr K up till now. But I am not excited about the advice to go get a TUIP or mini TURP, or the fact that no one who has had it done has chimed in.

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    • Posted

      Dr. Busch is a radiologist in Chattanooga TN. He specializes in reading prostate Mri. He charges $200.00 for review. Im sure he has seen many FLA images and will spend time to explain.

      Focal laser ablation patients is the site on UStoo.

      Fla Doctors

      Dr. Feller in Desert Medical Imaging in California

      Dr. Walser UTMB, Galveston 

      Dr. Sperling New York and Florida

      Dr. Futterer in the Netherlands Radboud University

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