My Bipolar TURP Experience

I had B-TURP, bipolar resection of the prostate, on August 26, 2016, at the age of 59 years and 8 months.

I had researched alternatives to TURP, which remains the “gold standard” according to most of the medical literature, with HOLEP (aka HOLAP) a strong contender, especially for very large prostates, and other emerging therapies being introduced in far-flung locales which seek to minimize the pain and side effects TURP and, in particular, avoid retrograde ejaculation, which is a feature of both TURP and HOLEP.

After my head-spinning, perhaps-too-thorough research of all the treatments, including steam ablation (four doctors in Texas offering that) and a study at a local hospital of prostate artery embolization, in the end I came back to B-TURP, which is the tried-and-true surgery my urologist in Plantation, Florida, recommends and performs.  (To quote the conclusion of one of many articles on the subject, “Bipolar TURP is safer than monopolar TURP because of lower risk for TUR syndrome [not something you want to happen to you], less intraoperative bleeding, and lower incidence of postoperative complications.”  

BACKGROUND: As I slid from my 40s into my early 50s, I began having symptoms of BPH, benign prostatic hyperplasia, with the need to urinate more frequently and a progressively weaker and erratic urine stream.  Eventually, symptoms of urgency to urinate became a problem as well, which is especially inconvenient when you’re out and about and, for me, even at my place of employment, which in my BPH-filtered opinion has too few bathrooms for the size of the staff.  Reluctantly, because I was concerned with side effects including fainting, I began taking tamsulosin around the age of 56, which was prescribed by my primary care physician (PCP).  Tamsulosin made ejaculation difficult, somewhat less pleasurable, but not impossible.  (And I never fainted.) But in the last year before my surgery, the benefits of tamsulosin petered out (pun intended).  I tried switching briefly to Rapaflow, a non-generic cousin of tamsulosin that my PCP said some patients had more success with, but it did nothing for me.  I took the next step of seeing a urologist this past March.  We talked about surgical options, but he recommended I first try tamsulosin in combination with AvoDart, which had recently become available as the generic dutasteride.  I was concerned about the side effects but he told me very few patients experienced the most alarming of these, such as breast enlargement (and a high-pitched squeaky voice—just kidding).  And I resolved myself to retrograde ejaculation, which, while definitely not as pleasurable as normal ejaculation, is something that can be improved upon with practice.

The dutasteride began working well within a month, and I forgot about surgery. However, after four months, when my doctor said I should expect the full benefits of the wonder drug, I was already reverting to my previous symptoms, minus the urgency.  I would have intermittently strong urine streams followed by weaker ones, and although the frequency of urination had halved itself at night (from about six pees to three or four), the doctor and I ruefully agreed that this was still too much to have a decent night’s sleep. Further, the ultrasounds that I had at each appointment with my urologist showed I was retaining urine in my bladder, which was responsible for the frequency because my bladder didn’t empty completely.  The urologist said that if this progressed further the stale urine held in the bladder can lead to kidney damage.  Whoa… that was enough to get me back on the surgery bandwagon. As I said previously, after much research and discussing the options thoroughly with my urologist, who candidly told me that every urologist will tell you that their preferred procedure is “the best,” I decided on his beloved B-TURP.  (And the guy is only about 40, so he doesn’t do TURP because of some nostalgia for the good old days.)

PRE-SURGICAL TESTING:, My urologist ordered a cystoscopy, to look into my prostate and bladder.  The nurse numbed my penis with lidocaine and the procedure was not particularly painful but it was an odd sensation of pressure when the scope went into my bladder.  After the test, which lasted about 2 minutes and 15 minutes of prep, the urologist said I had a large prostate (ha!) and no tumors in my bladder (good news and I’m glad I hadn’t considered that possibility before he mentioned it). He also said there might be blood in my urine the next day (not so) and pain on urination (yes, for a day, and bearable).

The next procedure the following week was urodynamics, to test the health and functioning of the bladder. By now I had resigned myself to the embarrassment of having strangers stick things into my pee-hole and, in this case, also a small catheter in the rectum, to help measure “pressure.”  This test was not done with anesthesia but was not exactly painful, just very awkward. I also had a couple of electrodes (EKG-style) stuck on my body, and then let the games begin!  The technician filled my bladder slowly with a sterile water, and instructed me to let her know when I had an urgency to urinate along the lines of “Okay, you’re at the mall and you have to find a bathroom.”  When I felt this way, she noted it on her computer which was purring and clicking while she told me my bladder was doing all the right things. Next, she told me to tell her when I absolutely had to—must—pee.  At that point, she instructed me to urinate into a collection device that was part of the chair I was in. Mind you, the small catheter in my penis was still inserted and I had to pee “past” it.  The urine stream was much weaker than I had hoped based my sensation of having a full bladder.  When I thought I was done, she turned off the program but I told her I had more urine to surrender to the container.  “Oh, she said, a double void. Okay. Well, just go ahead. Because I’ve already stopped the test, I may have to ‘cath” you again to see now much urine is still in there after you finish.” At that moment, I hated her, but when I finished my second void she said she thought she could get by with an ultrasound.  She had the urologist’s excellent nurse come in and they concluded I had 200 cc left in my bladder.  (300 cc if usually considered enough to warrant concern.)  However, I had previously had less than that on my two previous ultrasounds and I didn’t think much of it, considering the unique awkwardness of the procedure.  And on the plus side, she said that my bladder was perfectly healthy, and that the urine retention was probably cause by pressure from the large prostate, meaning surgery should effectively reduce the amount of retention. Hooray. (This test was followed by another day of painful yet bearable urination, which I believe is par for the course when things go into the penis in the wrong direction).

Next up, I scheduled the surgery four weeks out with the staff’s surgical coordinator, who told me I needed to consult with my primary care physician to get cleared for surgery, which included blood work, an EKG, and a chest X-ray, all of which had to be done no earlier than 30 days from surgery.  The tests came back and I was good to go.

SURGERY DAY: I arrived at my hospital at 10:00 am to check in for surgery scheduled at noon. Technically, I was in the outpatient surgical department of the hospital and would be kept for “23 hours” for observation, meaning I’d spend the night in a hospital room but wasn’t formally “admitted.” This is apparently a legal distinction which can make your stay more or less expensive depending on your insurance plan. For me, it was less expensive.  I was checked in by a pre-surgical nurse and then interviewed by the anesthesiologist, who told me I’d be having general anesthesia.  The nurse put me on a bed and fitted me with an IV line, which would stay in until my departure from the hospital. Later, my two surgical nurses stopped by to introduce themselves.  Then the pre-surgical nurse gave me an anti-nausea, anti-vomiting drug through my IV, prescribed by the anesthesiologist, and we all waited for my urologist, who arrived about an hour late with a perfunctory apology.  The pre-surgical nurse then gave me what she called an “margarita” through my IV.  It must have been Valium or something similar, because as they wheeled me off to surgery I didn’t have a care in the world.  I vaguely remember seeing the operating room and the hustle and bustle of numerous people in there before I was out for good.  I woke up in recovery where I stayed for about an hour or perhaps longer.  I believe I had been in surgery for just about an hour.  In the recovery room, I was quite out of it from the anesthesia but at some point did feel some discomfort in the area of my penis, which had been fitted with a Foley catheter after the surgery.  The nurse immediately deposited some morphine into my IV, which may have been overkill but I didn’t object.  I was wheeled up to my hospital room around 4:00 pm and told I would be on a clear liquid diet.  I wasn’t happy about that but understood the reason.  For the next 18 hours, I lay in the hospital bed with large bags of sterile water being pumped into and out of my bladder through the catheter.  The liquid coming out was initially dark pink and over the hours changed to lighter shades of pink indicating less blood (the prostate is a very vascular organ and bleeding is normal but must be carefully monitored).  I slept on and off until early the next morning without pain.

THE DAY AFTER SURGERY: , In the morning, I had enough energy that I wished I wasn’t in a hospital bed chained to an IV and catheter.  Fortunately, my urologist called the hospital fairly early, around 8:00 am, and told the nurse I could switch to a normal diet, which meant coffee with cream, not to mention eggs and sausage.  The doctor arrived himself around 10:00 am and said that I was going home today, either with or without the catheter.  He said that in 20 percent of patients, the bladder isn’t ready to urinate on its own when the catheter is removed. If you aren’t able to pee on your own, the catheter is reinserted and the patient is given a “leg bag” to take home (which apparently will fit under jeans).  Then the catheter is removed a few days later at the doctor’s office.  The nurse came in and removed the catheter from my raw and inflamed urethra, which was two seconds of hell (but: two seconds).  Still, I couldn’t imagine it going back in, so I quickly gulped down two cups of water and waited for the urge to go.  The nurse helped me to the bathroom and waited outside.  I immediately and joyfully urinated in a strong but thin stream of “pink lemonade” which felt like peeing razor blades.  No matter. I knew I wasn’t going to have to have that catheter reinserted and I figured the pain of urination was a small price to pay for my freedom.  Within an hour, I was discharged from the hospital and went home with two prescriptions, one for post-surgical antibiotics to help prevent infection, and the second for pain (Percocet).  At home, I found myself having the urge to urinate frequently, and I must say for the next six hours or so, each 15 seconds or so of urinating was very painful. (I decided to forgo the Percocet and just take acetaminophen.)  But remarkably, by midnight the pain subsided to a milder stinging sensation, and by morning I was alternately urinating pinkish to clear liquid with little to no pain.  I was still a bit wiped out the anesthesia but delighted with the quick progress I’d made. 

THE DAY AFTER THAT.  The next day I actually felt well enough to be driven down to South Beach by my spouse and have a long lunch in our favorite Sardinian restaurant. I was still urinating frequently, but no more so than before the surgery, and my urine stream was becoming so strong it felt like a firehose. That evening, I happily dumped my tamsulosin and dutasteride into the trash.  No more prostate medications required. I urinated about four or five times that night, with very little discomfort.  It seemed that the only thing that hadn’t improved was the frequency of urination. But my urologist had assured me that this would get better over time.  And now I had the entire week off.  Although I felt more or less fine, rest is recommended for a week after surgery to allow the prostate to heal and prevent any hemorrhaging from exertion.  The doctor did tell me I’d be able to work out and play tennis within two weeks.  After all the fears I had reading so many horror stories about this procedure, I was so happy and relieved that things went so well for me, and relatively painless other than a few brief hours.

FIRST WEEK AFTER SURGERY.  Surgery was one week ago today, and I’m feeling no pain. Literally. Until yesterday, I had some mild stinging/burning when urinating that lessened each day until, nada!  There is still blood in the urine, but unlike the “pink lemonade” urine of the first day after surgery it is now a few drops of blood just at the beginning or end of urinating. I also believe some destroyed prostate tissue is in there from time to time, which can lead to a mild tingling sensation at the tip of the urethra but not really pain.  I also experienced a few urgency symptoms that were not like any I previously had with BPH.  In these cases, I wouldn’t feel an overwhelming sense of urgency other than that I had to go, but as I got close to the urinal or toilet, I could barely contain the flow of urine.  Although I don’t think I had any accidents, I did buy some underwear liners that sop up drips.  (Even a couple of drops of blood on underwear is unsightly, and this helps with that.  I also have had to urinate very frequently, but no more so than before surgery. I have been urinating three or four times at night until last night, when I got up only twice (could be a fluke; time will tell). Otherwise, my urine stream is very strong, much better than I achieved taking both tamsulosin and dutasteride.  Despite the discomfort in the hospital and the first eight hours after removal of the catheter when I urinated, I’ve very glad I had the procedure.

SECOND WEEK AFTER SURGERY.  On the eleventh day after surgery, I began bleeding more, usually at the very beginning of urination, and sometimes also a little at the end.  Bright red blood, but no pain. I was initially alarmed but found some post-TURP guidelines online that said to expect this between 10 to 14 days after surgery and had to do with the prostate healing and scabbing.  So bleeding, as long as it’s not excessive (which would indicate a hemorrhage and would require medical attention) is par for the course for several weeks.  I have read that in some rare cases, the blood clots/scabbing can prevent block the flow of urine entirely, in which case you have to go to the emergency room and be catheterized.  I have also read a lot of reports of bladder spasms, which sound awful but so far haven’t afflicted me.  I still urinate three to four times a night, as I did before surgery.  I’m not sure if that will change over time, but I’m used to it regardless.  Meanwhile, the urine stream remains very strong, and the occasional urgency I had in the first week post-TURP has lessened.  I also had ejaculated for the first time since surgery, and it was more pleasurable than it had been when I was on tamsulosin and dutasteride.

ONE MONTH AFTER SURGERY. It’s been a month and this is my last entry. I still have some blood in my urine about 75 percent of the time but it’s not enough to worry about.  The urgency to urinate is gone, the frequency of urination is much less than when I began taking medications for BPH, and the urine stream is that of a 30-year old. Also, with the help of a 5 milligram tablet melatonin before bed, I am now sleeping up to four hours a night without having to go to the bathroom.  I have heard that this will only get better.  I’m already a satisfied customer, and I’d do it again if I had to.  Although I know from reading about it that some suffer from complications of one sort or another, the percentage is by all accounts small and I urge you to explore B-TURP or another option to relieve your BPH if it’s interfering with your quality of life.  

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