My Green Light prostatectomy

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Background: 64 years old, good health overall, have had urinary issues since my 20s.  Also suffer from IBS and Interstitial Cystitis.  In the mid 90s was diagnosed with chronic prostatitis and with BPH.  Was put on doxazosin (Cardura 4mg), and have been taking it to this day.  Have tried some other alpha blockers (Flomax, Rapaflo, Alfuzosin) but nothing worked better for me than doxazosin.  I’m REALLY tired of the side effects, though.  As I’ve gotten older the side effects seem to bother me more.

I’ve had 3 TUMTs, in 2009, 2011 and 2015.  The only one that really did any good was in 2011.  The last one I had in 2015 did nothing.  Note for those that are considering TUMT ...if during the procedure you do not feel some decent ‘heating” in your prostate, it’s not doing any good.  In 2011 I felt practically nothing and the results were nothing.  In 2011 things got really warm ... so warm they had to put an ice pack on me during the procedure.  For 3-4 days after the procedure I couldn’t hardly sit ... but it did make a difference in my flow and I was able to cut back to taking just 2mg per day of doxazosin, which reduced the side effects.  Symptoms started returning in 2015.  I had my last TUMT in July of that year.  My urologist said to me they just received a software update for the machine (he uses the Urologix Cooled ThermoTherapy machine). The update was supposed to make the procedure easier to tolerate while maintaining effectiveness.  Well, it was easier but it did nothing.  I felt about 2 minutes of good heat (during a 45 minute procedure) and that was it.  No soreness afterward.  Total waste of time.  So if you don’t feel the heat, it’s not doing you any good.

Since the TUMT didn’t work I began considering other alternatives, including Green Light Laser.  I talked it over with my urologist and he went over the procedure and the risks and benefits.  At the time I was having some cardiac issues that I had to have resolved, so I put off the surgery for about 2 months.  When I went back to my Urologist he announced that he was very high on a new procedure called “Urolift”, and that it was what he would choose for himself.  Unfortunately, my Obamacare plan in California (Anthem) refused to ok the Urolift, considering it “investigational”.  Even after I appealed they refused.  Didn’t matter that both Medicare and Medical approve it.  So at this point my only other choice seemed to be Green Light.

My Urologist booked my surgery for May 19th in a local hospital.  I did the normal pre-op blood, EKG and chest X-ray, along with a urine culture.  My Urologist uses the Green Light XPS 180W 532nm system.  His policy is to do the surgery and put a catheter in place for 7 days.  Not thrilled with that.  However, since I also have Interstitial Cystitis he gave me a break and said the catheter would be removed on the 4th day.  Prior to the surgery I was urinating ok with the help of Cardura.  I have continued to take Cardura since the surgery.

After surgery wasn’t very pleasant because of the after effects of the anaesthesia and the catheter.  Had quite a bit of post-operative pain.  They gave me a Percoset before I was discharged.  The pain quieted down after I got home.  So for the next 4 days I shuffled around the house, toting my urine bag wherever I went.  Urine very pink first 24 hours, then mostly clear the rest of the time.  My bottom was so sore from the laser and the damn catheter that I couldn’t really sit anywhere without pain.  I’m a pretty skinny guy and I don’t have much padding on my bottom end.  In addition, where the catheter enters the penis it gets very raw and irritated.  I used Neosporin ointment, but that didn’t help all that much.  The end of my penis was really raw after 4 days of the catheter.  And what’s up with the size of the catheter!  Sucker was as big as my finger.  I didn’t think something that large would fit up there.  Another reason why I was so damn uncomfortable.

Catheter was removed on the 4th day.  They filled my bladder with 250cc of saline before removing it.  I had heard that pulling out the catheter was very painful, but it really wasn’t that bad.  Then they wanted me to see if I could pee out the 250cc.  I could, but it was like peeing through a piece of spaghetti.  But I did push everything out, so they sent me home.  I have read stories of what it would be like to urinate after the laser surgery and I was expecting to have a big improvement in flow, but stinging and some pain.  I have experienced the exact opposite.  I continue to have a very slow stream, but no pain or stinging.  I am now 13 days out from my surgery and my flow is still very slow, although improving somewhat.  It’s really tough during the night time hours.  I will wake up with a full bladder and it will take forever to dribble it out.  I don’t understand why my flow is so slow.  I am urinating much more slowing than pre-surgery.   I’m hoping it’s just due to the trauma of surgery.   But at this point I am VERY DISAPPOINTED in my results.  I sure hope it gets better.

I have urinated a little debris, mostly during the first 3 or 4 days.  Also saw a few very small blood clots, but nothing in the last 3-4 days.  I’m assuming the lack of debris and blood clots is partially due to the 180w laser that was used.

At 12 days post surgery things appeared to be getting a bit better, at least during the daytime hours.  I did a urine flow test at my Urologist’s office and it was actually pretty good.  Just a little better than my pre-surgery flow.  However, I continue to have issues urinating at night.  I don’t mind the urges, but it is just so difficult to urinate.

At 14 days post surgery I had to take my wife to the VA Emergency (about 40 miles away) because of ongoing issues with a condition she has called Medullary Sponge Kidney.  Apparently she had been passing 2 or 3 stones over a period of the last 3 weeks and it gave her a kidney infection and lots of pain.  She had to stay in the hospital overnight.  While at the hospital I tried to stay hydrated but it’s difficult to do because of what was going on, worry, etc.  However, I was not having any problems urinating while at the hospital.  I returned home and had the typical slowdown during the night, but not quite as bad.  The next morning when I first got up I tried to urinate and it was difficult, but all of a sudden something let go and the flow markedly increased.  But now I had a sensation of pain near the tip of my penis.  Not major pain, but it hurt.  About 45 minutes later I went to urinate again and out popped a fairly good size scab.  Pain at tip of penis was gone.  Well, that was good I thought to myself.  So I went about my day, returned to the VA to pick up my wife and tried to drink fluids, especially after I returned home.

The next day (day 16 post surgery) after I got up I started to experience REAL difficulty urinating.  I just felt like there was something blocking the path.  I could really feel a strain on my bladder.  This was a Sunday, so no calling the doctor.  I toughed it out most of the day, but each time I attempted to urinate it only dribbled and it hurt my bladder to push.  So I went to the local emergency room, where they diagnosed me with a UTI and wanted to send me home with a prescription for Cipro. I had to insist they insert a foley catheter in me because I could not urinate (never thought I would actually ask someone to stick a catheter in me.  They finally relented and put a French 16 Foley in me, although they wanted to take it out as soon as I was drained.  The damn visit to the ER cost me $325 (thanks Obamacare) I didn’t want to have to come back to have them do it again.

After I informed my doctor’s office on Monday as to what happened, they told me to come in on Wednesday, when I had a regular post surgery check up scheduled.

I met with my doctor on Wednesday (19 days post surgery) and he expressed sympathy for the problem I was having and that how the post op was going was exactly why he wanted to try Urolift before doing the Greenlight.  However, he is still confident I will be able to push through the issues I am currently having and end up with good long term results.  He wanted to have me continue with the catheter for another two weeks, although I talked him into just one week.  So I will go in on post op day 25 (9 days with current catheter) and have it removed and see what my flow looks like.  One thing I have to say is that the current catheter I am using is a lot more tolerable than the one I received after the Greenlight surgery.  My Urologist told me they use a French 32 size after surgery (he called it a garden hose, with a smirk) and the one I have now is a French 16, about half the diameter.  Makes a BIG difference in comfort.  I understand the reason for the large catheter after surgery (pass blood clots easier), so I am thankful the smaller size is working for me at the moment.

On day 25 I had the catheter removed at the doctors office, and again I could urinate, although still slowly.  One surprise is that when I did the post foley urination at the doctors office I peed out two rather large stones.  The nurse asked me if I had a history of kidney stones, which I don’t.  Upon subsequent examination of the stones they were determined to be PROSTATE stones, 4-5mm in size.  They were probably uncovered by the vaporization of the prostate tissue.  Was able to urinate ok all day, but around 9pm everything stopped again.  Back to the emergency room to have another foley inserted (another $325 visit).  So my doctor said to keep the foley in for another week.  I had it removed on day 32 at the doctors office.  However I asked my doctor to allow me to self-cath in case I stopped up again, since I did not want to have to go back to the emergency room.  He agreed and his nurse taught me how.  Sure enough, after being able to urinate at a reasonable rate for around 12 hours I started slowing down to a dribble.  At 3am I could not go at all.  So I did a self-cath, and after that was able to sleep 2 ½ hours, and was able to urinate ok (although still slow) once I woke up.  The next day I was able to urinate ok until around 10pm, and I had to do another self-cath at around 11pm.  I got up several times that night and was able to urinate normally, and it continued when I got up the next morning.  Since that time my flow rate has INCREASED for the first time since the surgery, and I did not have to a self-cath that night.

So on day 28 I finally have some positive results.  I am hopeful my flow continues to improve and that I am over the worst of it.  I should say that, during all this I have not had any buring at all when I urinate, as others have complained of.  Just a very slow flow, and I have passed some debris.  I’ll have to say having the option to self cath really decreased my anxiety and might have helped my flow in the long run (I’m kind of a nervous person).  One thing that does occur to me now is that I am actually HAPPY the insurance company denied my request for the Urolift procedure.  Given I had some rather large stones in my prostate I don’t see how the Urolift procedure would have helped me.  While it might have opened up the prostate a bit, I think it would have aggravated the rather large prostate stones that were present and probably INCREASED my pain.  By the way, I had an abdominal CT done back in 2011 and at that time only a “tiny” stone was seen by the Radiologist.  Don’t know what they consider “tiny”, but those 5mm stones I saw were really large and very nasty looking, with real sharp edges.  It’s no wonder I complained of not just urgency and slow flow, but PAIN.  Urologist passed the pain off as bladder pain.  I am hopeful that by passing those stones that I won’t have that pain any more.

   

 

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  • Posted

    Thanks, toby52, for posting this. I sympathise with your experience as, although I haven't had any surgical interventions yet, I've had a few scares, UTIs and retention episodes myself. I just wanted to say that I've also found learning to insert and remove a Foley (indwelling) catheter has been useful for me rather than rely on appointments with doctors or nurses for this. I've also done the intermittent self-cathing bit on occasions. I know there are infection risks, but I've only used self-cathing of either type with great care when appropriate advice / help has been available. It's given me some welcome nights of recovery sleeps !

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  • Posted

    I had a clot get stuck. Did same thing. Doc cathed me to check for obstructions and said he felt no resistance. But I passed a big clot and flow was awesome after. Blood clots, scabs and scar tissue can cause flow rate to be bad. Swelling from the trauma of having all the equipment put in a place that's not designed to have things put into it can cause issues. The trauma and stretching from that garden hose doesn't help either. Hopefully you will continue to get better. Good luck.

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  • Posted

    Thanks for documenting your experience.  Given the fact that a prostate stone was found in 2011, did your urologist look for prostate stones before the greenlight procedure?  If he had seen some, would that have changed what he would have done?  In light of your experience, would you advise others to make sure that prostate stones are looked for before any procedure?

    Again, thanks for telling us your story.  I hope you continue to heal.

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    • Posted

      Mark02906, in checking my notes the CT was actually done in 8/2012 and the reason for it was they were checking me for a possible hernia.  It's funny, they didn't find evidence of a hernia, but I did actually have one on my left side, which was repaired surgically shortly after that (I've had both sides done).  This is what the radiologist said about my urinary track:  "The distal ureters, uninary bladder and seminal vesicles are unremarkable.  The prostate size is normal, with multiple small incidental calcifications.  There are multiple phleboliths in the pelvis bilaterally".

      My Urologist read the report and did not think there was anything significant about it, at least from a Urological point of view.  In the research I did regarding prostate calcifications it would seem they are seen in almost all men as we age and are not condidered significant by most Urologists.

      In my case, I can tell you that over the years in addition to the slower flow and urgency issues I had developed "sharp" pains emanating from that area.  My doctor felt these pains were being caused by my bladder, and after doing tests (such as cystoscopy under anesthesia to distend the bladder) he diagnosed me with interstitial cystitis.  However, given the stones I have passed after surgery I am of the opinion the pain I was feeling was caused by the stones rather than the bladder.  I do not feel that same pain anymore.  Time will tell if that is true.

      I am not sure my Urologist would have done anything different unless he had been able to definitely see the larger stones.  I had an Ultrasound of the Kidneys and Bladder done in June of 2016 and no stones in the prostate were seen.  In fact, my prostate was listed as measuring 3.7 x 2.9 x 4.5 cm, with a volume of 25.1 ml.  Certainly not very large at all, but I am not a large person.  I am 5' 6" and weight 137 lbs.

      As I said previously,  given the fact I had some large stones in my prostate it appears the Greenlight procedure was the correct one to have, rather than Urolift.  I think that pinning back the prostate tissue would have only aggravated my condition.  Perhaps this is why some men who have had the Urolift procedure end up worse off than they were prior to the implants.

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    • Posted

      All who look and post on this site are trying to improve their understanding of the prostate and their treatment alternatives.  A few, like yourself, have taken a very proactive approach and serve as a good example.  As I remember, the old boy scout motto is "be prepared".  Thanks for reminding me.

       

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  • Posted

    Thanks Toby for sharing your experience. BTW, If you expand this post a little, you could probably turn it into a book. smile Question: What are the side effects of doxazosin that are so bad to you ? I am also taking 4mg doxazosin and also experiencing some side effects, but nothing really bad. Due to chronic retention, I am also self cathing, usu once before bed, once around 3-4AM, and sometimes once in the afternoon, so I am able to postpone surgeries, for now. Hank
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    • Posted

      Hank1953, thanks for your comments ... yes, prior to going with Greenlight I spent a lot of time reading posts on this forum and other web sites.  After I had my procedure I felt it was only right I give something back by chronicling my experience in the hopes it will help others.

      I have been on Doxazosin since 1997.  Over the years I have tried most of the other alpha blockers but none have been as effective on my symptoms than doxazosin.  However, it really sucks the life out of you.  Because it's basically a muscle relaxer it makes me feel weak and tired, and it affects my endurance.  As I have gotton older and my muscle mass has decreased the effects have gotton even worse.  In addition, I have never had high blood pressure and in the last year taking doxazosin has driven my blood pressure down to 90/40 at times.  That's why I tried moving to other alpha blockers, such as Floxmax, Rapiflo, etc.  None of them worked as well as doxazosin, perhaps because of my unique situation of having prostate stones.

      In any case, since the surgery I have cut my daily dose from 4mg to 2mg and will try to eliminate it entirely in about 30 days, assuming my flow rate continues to improve.

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    • Posted

      Your storied experiences can be used as a primer in medical schools. My green light laser took 8 months to recover. Then 2 years later I was in an auto accident and retention recurred for another 8 months. Now a year later retention is starting again. Fortunately I have a good supply of CIC catheters on hand as I always thought it would happen again.
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    • Posted

      Hi toby,

      I experienced low BP just like you do, down to 80s/50s at times, usually after a long walk after breakfast. I adjust by adding extra sodium to my BF. Have you look into Finasteride ? I read an article that after taking Finas for 6 months, you can quit doxazosin altogether. Some kind souls on this forum tried to warn me about it but I just started taking it, at least trying it out for a while. Hank

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    • Posted

      Hank, Finasteride is a 5a-reductase inhibitor.  This enzyme converts testosterone to dihydrotestosterone (DHT).  DHT is thought to encourage the growth of the prostate.  At this point I don't think I need a DHT inhibitor, since my prostate was just reduced by the Green Light surgery.  Granted, the prostate may (and probably will) continue to grow, but I am very reluctant to take a drug that may or may not inhibit the growth of my prostate, plus all the side affects that come with it.  Besides, as a benefit of the Green Light surgery I hope to discontinue doxazosin very soon.

      And one other thing ... I am not totally convinced that DHT is the root cause of prostate enlargement.  When a man is young we have much higher levels of testosterone in our bodies, and a good portion of that is being converted to DHT.  So if lots of DHT stimulates the prostate to grow, why don't young men have huge prostates then?

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  • Posted

    Today I was reading about your experience after greenlight surgery and would like you to know that, after 72 days of my PAE, TODAY I felt difficult to pass urine when something with 1,5cm2 passed by my urethra with no pain. It was a triangular shape soft "thing" that didn´t seems to be a clot. I really don´t know what this really was, but yesterday I felt something that stopped my urine flow and it was a VERY uncomfortable sensation. After the "thing" gone I experienced burning in my urethra just like ater my PAE. The urine flow improved a little bit and I don´t know if I have other "things" like that in my bladder.

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  • Posted

    Thanks toby for the excellent description of your history...Its hard to believe that with alll the modern technology they have a hard time finding whats blocking....but they do. Please keep experimenting and allow the curing process to continue.

    God Bless

     

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  • Posted

    Ok. This was a GREAT post.  The only thing I would ask is that you follow it up periodically because, while it may be unbeknownst to you, you've probably helped a lot of guys on this site.  Your post is honest. 

    Now allow me to be honest.  My friend, sounds like you've taken an excursion tour through hell with your recovery.  That said, I read your post objectively, and what follows are my objective conclusions. 

    First of all, you are just over one month post-op.  Granted, your recovery was difficult, but I've read horror stories about Green Light recoveries on this forum, and it took some of my brothers-in-suffering months and months to be where you are in just a few weeks.

    Second, I would encourage you to look at your own words:

    "I am now 13 days out from my surgery and my flow is still very slow, although improving somewhat."

    A slow recovery is the central theme of your post.  That said, you are recovering.  And while most guys do recover, a minuscule few do not.

    "I am urinating much more slowing than pre-surgery.   I’m hoping it’s just due to the trauma of surgery."

    The "trauma of surgery" makes a great deal of sense, as to why you're urinating slowly.  Come on!  Think about what they did to your organ!

    While I'm in no position to ask for anything at all, I'd like to know - admittedly for selfish reasons - how Green Light has affected your sex life.  Like I said, you've already helped a lot of guys on here - myself included.  Whatever additional data you supply may be beneficial for ALL of us.

    Finally, you post those occasional follow ups.  We'll continue to be most appreciative.

     

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    • Posted

      One additional datum I forgot to mention, toby52.  You said, "I’m a pretty skinny guy."  It's simply a gut instinct I have, but I do believe that - FOR THE MOST PART - the bigger the man, the bigger the prostate.  I'm simply convinced.  Obesity serves us no useful purpose whatsoever.  Believe me, I, myself, could stand to lose a few lbs., and I've noticed that when I do, my own prostate issues seem to abate, at least somewhat.  Take the comment for what it's worth.

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    • Posted

      Actually, what I SHOULD have said was that I have a small frame (although I am pretty skinny).  confused  Many of the men who have posted here have MUCH larger prostates than what mine was.  Even so, mine was definately enlarged for my body type and causing the typical BPH symptoms. 
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    • Posted

      I haven't spoken much about sex yet, mostly because I have had a foley catheter inside me for a good portion of the time since my surgery.  confused

      Before surgery I did not have any problems sex wise, aside from how BPH normally affects a person because of the near constant urge to urinate.  Doxazosin never gave me retrograde ejaculation, even at the normal dose of 4mg/day.   When I tried to get off Doxazosin and take other alpha blockers I did experience retrograde ejaculation, particularly with Rapiflo, although Floxmax did it to me, too.  Rapiflo also greatly diminished my orgasm.  Didn't like that at all.

      In any case, now that I am free of the foley catheter and peeing relatively well I will give it a test drive and post back here.  I will say that, even when I had a catheter in me I still was able to have erections just fine.  In fact, nightime erections became a real pain (literally).  Having an erection with a foley catheter in you is really no fun at all.

      If I end up with retrograde ejaculation I won't be real upset as long as the orgasm is still intense.  Don't really need to father any children at 64.  And my output of semen has diminished over the years anyway.  Anyway, I'll make a date with the wife and report back.  cheesygrin

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