My Green Light prostatectomy

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.

2 likes, 53 replies