My Bipolar TURP Experience 4/5/19 - updated 4 weeks post op
Posted , 6 users are following.
Exactly four weeks ago I had my bipolar TURP and during the first week after I posted regular updates. I have been asked to update my progress by several forum members so I will do so here.
A brief recap: before my TURP my BPH symptoms were getting severe and I was concerned that I would go into total retention. My frequency/urgency/nocturia situation was at crisis levels. I was up 6-8 times per night and spending 10-30 minutes in the bathroom each time trying to empty my bladder. A few times this extended to an hour.
After researching all of the possible treatments I decided on a bipolar TURP. I got to the hospital at 6am and was home at 10:30am - only gone 4 1/2 hours. General anesthetic so no pain or discomfort. At home I had a BIG catheter for three days - 20fr with double eyelets. This was somewhat uncomfortable, but I had Foley catheters before so was able to deal with it. I removed it myself the following Monday, and several hours later went in for a PVR test. My pre-op PVR was 200, and the new one was 93.
Once the Foley was out my urine color went from pink to yellow, and since then I have not seen any blood in my urine, although I have been using urine dip sticks and there is still some blood in the urine. A recent CBS showed my iron levels down a bit so I am taking an iron supplement.
My prostate swelling continues to go down, but this is a slow process. I am still getting up frequently at night (6-7x) but clearing my bladder is getting a bit easier. So, my sleep is improved, but only a bit.
The rate of flow is still about 5ml/second, not any different than before. It is getting easier for me to wait to go to the bathroom during the day, so this is an improvement. The frequent ups and downs at night may be a bad habit that, hopefully, will improve over time.
The lab analysis of the removed prostate tissue showed no cancer, so that was a big relief (I had radiation for prostate cancer in 2014).
I have been gradually increasing my workouts and am now back to where I was before the operation, but I am definitely working out at a lower intensity - so trying to "take it easy". Most people wouldn't be concerned with this because they aren't regular exercisers, but I am.
I would say that my quality of life is better now than it was before the operation, but it's going to take more time before I know how much the TURP helped me. My hope is that my rate of flow will gradually increase as the prostate swelling goes down (after my radiation in 2014 it took 5-6 weeks for the swelling to resolve). I am also hoping that I will be able to sleep in longer stretches, and when I do get up, will be able to clear my bladder faster, so I am not standing at the toilet for 20 minutes or more.
I am definitely happy I went through with this. I would just like to experience more progress but I am a bit impatient. I do understand that it might take up to 8 weeks for the healing process to complete.
If there is no further progress, then at least I will know that my issues are no longer being caused by my prostate and might be bladder related.
In 2017 I had a PAE and this did help me, but only slightly - I said at the time 10-20% improvement. But, that only lasted for a year.
I am still on tamsulosin and trospium and am hoping to eventually go off both, but it's still too early to chance any of my meds.
So, bottom line, better but still have a long road ahead.
0 likes, 20 replies
rdemyan tom86211
Posted
Tom:
Any comments on retrograde ejaculation, incontinence, erectile dysfunction that you care to share? Thanks.
tom86211 rdemyan
Posted
I had minor incontinence before the TURP but that is greatly improved. I believe the median lobe of my prostate was pressing against the bladder outlet in such a way before that it was causing some issues, but as soon as that tissue was gone, there was and is no more dribbling.
As for ED and retro, my BPH issues and prior radiation for prostate cancer have pretty much knocked me out of that activity - at least for now. It's difficult to think about having sex if you feel like you have to run to the bathroom every five minutes. So, once the TURP swelling settles down I will think about trying to have some intimacy again. Even without the radiation, the frequency/urgency/nocturia issues have taken any thoughts of sex out of my mind - I just want to get a good night's sleep, which hasn't happened in a very long time. Sleep is a requirement, sex is optional.
rdemyan tom86211
Posted
Tom: If almost every time you get up at night you are peeing a lot (> 250 mL), then that suggests that your body is processing a lot of fluid. Maybe your bladder is compromised from years of BPH and can't hold as much as it might otherwise (hopefully, that will improve with time), but is it unrealistic to say that a reasonably full bladder wants to relieve itself. Maybe you should consider ways to reduce how much fluid is being processed at nighttime. I'm not very familiar with it, but a number here have tried and are perhaps still trying the nighttime potato chip protocol (i.e. eating something salty before bedtime - you could probably substitute healthier alternatives like nuts). The other thing I'd like to recommend, is trying compression socks during the daytime. They will help to keep liquid from pooling in your legs during the daytime, which then gets processed by the kidneys at night while you are lying horizontal. You might also discuss desmopressin with your uro. These suggestions are made under the assumption that you are processing a lot of urine at night and not just small amounts each time you go.
tom86211 rdemyan
Posted
I am peeing a total of about 1300ml for the entire night. I never pee more than 250ml at a time - it's usually much less than that.
I am beginning to think that getting up frequently is a habit, and that my bladder just isn't used to holding much urine before it wakes me up.
Last night was a bit better - I had a couple of slightly longer sleep segments, so perhaps I am better able to empty my bladder and am gradually retraining myself to stay in bed longer. Time will tell.
There is something else that is going on that I haven't mentioned previously, and I think it's related to the Flomax. I take a Flomax just before bed and I believe it not only relaxes the muscles around the prostate and bladder, but also the muscles that keep food in my stomach. So, if I eat anything before I go to sleep, I burp it up and it gets into my lungs and I have to cough this up for an hour - very scary. So, forget the potato chips. I am going to start taking the Flomax earlier in the evening and hope this helps.
rdemyan tom86211
Posted
Didn't realize that you are taking Flomax. Have you tried alfuzosin? It's a newer drug. Far less likelihood of floppy iris syndrome than Flomax (but if you have taken Flomax for years, then it might already be irreversible). Many will attest to fewer side effects. Also, there is a chart that graphs when alfuzosin has it's maximum effect, which is typically 8 hours after you take it while eating something (the effect stays pretty close to the maximum through 10 hours). I try to take alfuzosin around 5 to 6 PM with a snack (we eat dinner after 8:00 PM typically).
rdemyan tom86211
Posted
Do you know what the ratio of the nighttime urination is to the total urinated over 24 hours? If it's greater than 0.33 to 0.35, you have nocturnal polyuria. If you haven't really considered this too much, I strongly suggest you do. You might get some relief and be able to reduce the number of times you get up if you take some measures to counter it.
https://patient.info/doctor/nocturia
TKM tom86211
Posted
Tom
I have not heard of flomax relaxing the stomach sphincters. That is a question for a doctor, or research on the internet.
Stomach acid blockers like Zantac or Pepcid might help. Tums just before bed may help. Sodium bicarbonate may help also and help with retaining water at night, thus peeing less. You can also elevate the head of your bed to reduce food and acid coming up.
Thomas
tom86211 rdemyan
Posted
Have been taking Flomax for years. After my PAE in 2017 I was off of it for a year, then had to go back to 1 per day, then 2 per day. Still on 2 until my flow opens up, then will discontinue (I hope). I will take it earlier so I don't burp up anything.
tom86211 TKM
Posted
Before bed I take 1 Flomax and 1 trospium. If I eat anything before going to bed then fall asleep I will burp up and breathe it into my lungs, then go on a coughing marathon for an hour. This never happens during the day. It is worse if I have some yogurt in the hour before going to bed. So, I am just going to have to take my meds at least two hours before bed and not have any yogurt. I can't eat anything granular before bed or the little particles go in my lungs and it's a big issue. As for stomach acid, I do take some omeprazole every other day. It calms down my stomach acid. I am hoping to get off both the Flomax and trospium as my recovery from the TURP continues.
rdemyan tom86211
Posted
Tom: I think someone mentioned this earlier, but have you tried a bed wedge. I got one because of congestion problems and I absolutely love it. My wife uses one as well and we swear by them. When we cruise we make a special request for wedges. I think ours provide an incline of about 7" in vertical height. Mfr of ours is Intevision purchased from Amazon.
TKM rdemyan
Posted
Rdemyan,
Is the Wedge the full length of the bed or half the length of the bed ?
Thomas
tom86211 rdemyan
Posted
Never heard of this but will check it out.
rdemyan TKM
Posted
The one we have is 32 inches long by 25 inches wide by 7 inches high at the highest end. A lot of people with acid reflux use bed wedges. If you want the exact one that we use, PM me.
lee56659 tom86211
Posted
I'm not sure about your theory on prostate "swelling" after surgery. A good portion of your prostate was removed so I can't imagine any swelling would be enough to make up for the material that was removed. I also can't imagine any swelling lasting for weeks. As you know, I went home w/o a catheter about 24 hrs after my TURP and discontinued my alpha-blocker immediately. Voiding was uncomfortable for a few days but I had noticeable symptom relief within 4-5 days. By 4 weeks, I was voiding better than I had in years and the improvement after the 4-5 week point was minor (my uro said it would take 3 months to heal completely but I saw no scabs or visible blood after the 4 week point.) My nighttime bathroom visits have gone from 2 or 3 100% of the time to 1 50% of the time.
I'm not qualified to give medical advice but based on your lack of improvement (based on my experience and others on this forum), I've got to believe there's something else going on. I hope your doctor can figure it out.
tom86211 lee56659
Posted
Lee,
The swelling is not my theory but I was told by my urologist that this is happening. My urine dip stick results showed some leukocytes and my uro said this was from the swelling. Anyway, it is getting a bit easier to empty my bladder but the rate of flow is still only 5ml/second - not any better than before. Also, there has been no improvement in my number of nightly trips to the bathroom so I suspect this may be a bad habit that has been going on for so long that I can't break it.
The only other procedure that I can think of that would help my flow rate would be a bladder neck incision (BNI). It's performed in a similar way to a TURP but it's a much easier operation. I really don't want to go into surgery again, but I have to get this sleep issue resolved. The fact that you only get up once per night now is a huge positive. This tells me that your bladder can hold a lot of urine before telling you to wake up.
During my next scheduled uro appointment they will do another PVR. It feels like this is has improved but hasn't translated into better sleep.
Tom
rdemyan tom86211
Posted
Tom:
Be sure not to mixup average flowrate with maximum flowrate. The maximum flowrate is what the uros are usually interested in. It sounds like your 5 mL/sec is the average flowrate. I already mentioned a simple inexpensive device for getting a good estimate on the maximum flowrate. You can purchase it on Amazon. Search for "Uflow Meter, Monitor Male Urine Flow at Home" in the Amazon website.
Maximum flowrates can easily be twice or more the average flowrate.
tom86211 rdemyan
Posted
I just pee into my beaker and count the seconds. With 1 Flomax it used to be 3ml/second. With 2 Flomax per day it went up to 5ml/second. Now, it's about 5.5. I start counting when the first drops enter the beaker and stop when there is nothing left. This is usually about 125ml and 20-25 seconds.
rdemyan tom86211
Posted
The beginning and end effects can really be variable and substantially affect the time measured. That's why the maximum flowrate is preferred. Spend the $10 for the device I measured and start guaging your progress using that device. 15 mL/sec is considered to be adequate. Most young guys do significantly better than that. I used it a couple of days ago after a long layoff and I just went over the 15 mL/sec mark.
TKM rdemyan
Posted
Rdemyan,
I looked up the "Uflow Meter" on Amazon. Can you explain how it works ?
Thomas
rdemyan TKM
Posted
I posted a lengthy post on the device about 8 or so months ago, but I can't find it now on this website.
To explain how it works, I'll use the following terms. The top part that is a wide oval shape, I'll call "reservoir". You urinate into the reservoir and then the urine flows by gravity into the "pipe" section. However, the pipe section is comprised of three chambers. If you look at the picture, you'll see that from the top to bottom of the device in the pipe section, each chamber is narrower than the one above it. At the very bottom or end of the last chamber there is a calibrated orifice through which the urine flows into the measuring cup or toilet. The orifice restricts the flow out of the device. So, as you urinate, the urine begins to fill the chambers (just like water in a sink if you restrict its ability to flow out the drain). While urinating you must watch the urine as it fills the chambers and note the chamber in which the highest level is obtained. That highest level corresponds to the maximum flowrate. So the urine level increases as you urinate until you hit the maximum flowrate and then some small amount of time after that it begins to decrease as the urine flow slows down and then the device eventually empties when you stop urinating.
If the highest level occurs in the lowest chamber, then the maximum flowrate is between 0 and 10 mL/sec. In the middle chamber, the flowrate is between 10 and 15 mL/sec. If the maximum urine level is in the top chamber of the pipe section, the flowrate is greater than 15 mL/sec. If the urine level actually makes it to the reservoir, then you are probably a young person.
It is a crude device, but imo, better than just trying to measure the average flowrate. If the level is in the bottom two chambers of the pipe, you should be able to roughly interpolate what the likely maximum flowrate is; i.e. betwee 0 an 10 in the very bottom chamber and 10 to 15 mL/sec in the middle chamber.
I find that when I am urinating into the device it is easiest for me to discern the level by looking at the device from the side and not straight down at the top of the device. Also, you need to have a decent void in order to get a good level reading. If one were to void only 40 mL total, for example, it would be hard to get a reading. My guess is that the total void of continuously flowing urine needs to be > 120 mL to see a maximum level that remains constant for a few seconds. For me, the longer I continuously void, the longer the level stays at the maximum level, so it is easier for me to note that level.