My TURP experience

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Intro

I've learned a lot from the sharing of posters here about their successful and unsuccessful experiences with various BPH treatments. So having had a TURP on July 23rd of 2019, I wanted to share my diary about the good and bad for whatever it might have to offer others.

I'm in my late 50's, and have had escalating BPH symptoms for a decade or so. In fact, I was already getting up every night once or twice to urinate while still in my 30's. Until this week I was on both Alfuzosin and 5 mg. Cialis, which were no longer effective even in combination. I'm one of the guys with a relatively small prostate volume (under 100 g.) but serious obstruction. While my symptoms were no doubt aggravated by my use of caffeine and ADD stimulants, a recent cytoscopy revealed that my prostatic urethra and bladder neck were both badly obstructed. My bladder also showed the riblike appearance that comes from forcing urine out against backpressure. I saw this myself on the video monitor. (During my last cytoscopy 10 years ago, the inside of my bladder looked smooth.)

Why did I choose TURP? If money and insurance coverage were no object, I would probably have had a HoLep. but that was not an option unless I paid for it entirely out of pocket. As a practical matter, my choices were TURP or Urolift, and I wanted a decisive resolution. My uro said, "You qualify for Urolift, because you have a small prostate and no median lobe. But I think you'd be better served by a TURP -- the TURP is one and done. I'd spent enough time on this forum to know that while Urolift recovery is (usually) a lot less difficult, it usually comes with less dramatic results, especially when it comes to retention. Retention has been a major issue for me, with my retention between 400 and 800cc depending on the time of measurement. I didn't want to have to revisit the issue at 70 or 80.

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  • Posted

    The Surgery 7/23/19

    I went in for the surgery this last Tuesday. The plan was that I would spend one night in the hospital and go home the next day, hopefully without a catheter. I awoke in the recovery room experiencing no pain whatsover, except from my urethral opening, which was being stretched by a catheter that felt like it was the size of a garden hose. It's now been 4 days, and I have felt no pelvic pain whatsoever that I could attribute to my bored-out prostate. My urethral opening, however, is going to stay irritated until this catheter comes out.

    The Day After 7/24/19

    The following day the catheter was removed, and I was given several hours to resume urinating successfully. The good news was that when I urinated, it wasn't painful, and I didn't have the bladder spasms which I expected to have due to my musclebound bladder. The bad news was that I could never void more than 50 or 100 cc., eventually retaining almost 800 cc. A Foley catheter was installed, and I left the hospital about 4 PM.

    I went home, ate, emptied the bag, and took a nap. After a couple hours, I awoke to a very empty bag and a very full bladder. During my long history with BPH I had never experienced acute urinary retention, but I was damn sure experiencing it now! I suspected that flushing out the catheter would solve the problem, but I hadn't been given any flushing tips or materials when I was discharged. I went to a neighborhood emergency center affiliated with the hospital where I'd had the surgery, and they were pretty good about attending to me quickly and flushing the catheter, resolving the problem.

    The ER doctor contacted my urologist and was told that something was wrong if I bleeding enough to plug a catheter in 2 hours. My doctor recommended that I come in overnight for evaluation; the following day it might be necessary to go back in and cauterize one or more "bleeders". This seemed logical. But something that went along with it was irksome. I said that I would go home, pack a bag, and get to the hospital promptly. But that was against protocol. The freestanding ER where I went was technically considered the same as hospital's actual ER for administrative purposes, meaning that if I went home and then went downtown to the actual hospital under my own power I would be "leaving against medical advice", meaning that my insurance company might refuse to cover the ER visit or the hospital stay. So I submitted to being wheeled out to an ambulance and driven downtown, without my phone charger, dental appliance, or razor.

    My doctor's recommendation that I come back in was rational enough, but in hindsight I regret that I didn't just go to an Urgent Care center. They would have been more likely to just flush the catheter and give me a flush kit without calling my doctor. As it turned out, that would have dealt with the issue at a fraction of the cost.

    So at 11 PM I was wheeled back into the hospital I had been discharged from at 4 PM.

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    • Posted

      7/25/19

      At 12 or 1 AM a urology resident came in and said, "I'm sorry you had to come back. Your doctor wants to install a larger catheter, but I think if I can thoroughly irrigate this one it'll be fine." He then did some very determined and aggressive flushing and suctioning which weren't particularly comfortable, but which were certainly more comfortable than yanking out the catheter and placing one that was even larger. He pulled out a lot of tissue and clotted blood, and I went home just after lunchtime on the 25th with no cauterization needed.

      7/27/19

      So now it's four days post procedure, and my bloody urine bag is my companion everywhere I go until next Tuesday. I haven't gotten out much, not because I'm weak or in pain but just because my concealed carry leg bag fills up quickly and emptying it in a public men's room seems awkward. Of course, there are guys on here that have worn catheters for months so I guess you can get used to it. Some websites make recovery from a TURP sound like recovery from a gunshot wound, but I don't feel any the worse for wear. If I'd been able to go home without a catheter I'd feel awesome.

      I have confirmed that caffeine is not your friend while recovering from a TURP. I was going to go cold turkey from caffeine while I was off work, but this afternoon I insisted on drinking an energy drink. Shortly my bladder was howling that I needed to urinate and needed to do it NOW. This despite that fact that my catheter is draining nicely and my bladder is emptier than it has been in 6 or 8 years.

      Given the return trip to the hospital, do I regret the TURP? Not yet. Some people have Urolift and have to go to the ER that night because they're retaining. I did suggest to the nursing director on the surgical floor that in the future, TURP patients ought to be taught to flush the catheter and given a flush kit. She said that "We've never had this happen before."

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    • Posted

      I have a question. If you had known how to do self-catheterization (maybe you do) do surgeons allow you to do that instead of a foley following a TURP? Or are things too sensitive to allow that?

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    • Posted

      Phred,

      Sounds like the Foley was being blocked in your bladder by some tissue or clots and needed to be cleared out. My bipolar TURP experience was a bit different. I was in and out of the hospital in 4.5 hours. When I woke up from the operation I was still being flushed out - didn't feel anything. At home the urine in the leg bad was pink so there was some blood but I never had any blockage. Three days later I removed the Foley in the shower by cutting one of the little tubes and it just slipped out of me - slowly, some irritation, but it came out. It was a 20fr with double eyelets so if one got blocked the other would be open.

      Once the Foley was out the urine was less pink, so the Foley was irritating my bladder and causing some internal bleeding. By day 4 my flow was much improved but there was still some prostate swelling, that eventually calmed down after about 6 weeks.

      Don't know if they used a Foley with a single or double eyelet on you. There can be some clots and tissue that can get clogged in a single eyelet Foley so what you went through doesn't surprise me, it's just somewhat uncommon. Sorry you had to go through this.

      All should improve rapidly from this point on.

      My best, Tom

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    • Posted

      Keith,

      After a TURP a Foley is inserted and kept in to flush out prostate tissue and blood clots that are not completely cleared by a flushing process right after the procedure. I had a 20fr double eyelet Foley in for 3 days after my TURP and it never got blocked. I have never heard of self cath being suggested after a TURP - always a Foley for up to 3 days. The urethral tissues are sensitive after the procedure so I am not sure self cath would be the way to go - there is tissue swelling and the passage needs to be kept open and flowing until the tissues settles down and any remaining prostate tissue and blood clots are cleared - takes a while. I only noticed one small piece of tissue and a few minor clots in my leg bag during my three days on the Foley.

      Tom

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    • Posted

      I ended up in the emergency ward of hospital two days after turp because i wasnt voided enough naturally...I am still waiting to find out if anything can be done.

      In answer to your question I self cathed that day.I was extremely worried but the doctor said go carefully and it should be ok. Blood was abundant but that has cleared up now (Im still cathing five weeks later) I do not know why my turp didnt work and am waiting for it to heal before any more potential surgery...it could be an obstruction or a weak bladder. Im on the national health service and it is over burdened at the moment here in UK. So Im not offered more options...

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    • Posted

      Did you contact the urology ward for help as it is your urologists problem. When I had my last prostate procedure I was given an out of hours number to contact as well as the ward if I had any problems or concerns.

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  • Posted

    you got away easy with just a 20 fr foley, my urologist stuffed a 26 fr in me !

    and i had it in for 3 weeks along with a suprapubic catheter which i had for 6 weeks .

    this was hell on earth for me !

    its been a year now and i still have problems although i do have a great flo .

    good luck my friend

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    • Posted

      Kenneth,

      You had a 26fr that was in for 3 weeks in addition to a suprapubic??? I have never heard of anything like this. This was after a TURP, right? What kind of TURP was it? Since your experience was so different than anything else I have read here or anywhere else perhaps you could elaborate - what happened? Good to hear all is much better now.

      Tom

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    • Posted

      Kenneth,

      When you say "standard TURP" do you mean a monopolar TURP? There are three kinds: monopolar, bipolar and plasma button. Anyway, you went through a tough time after and I am sorry to hear about that. My experience was much easier (bipolar TURP). Why did you need both a 26fr AND a suprapubic catheter? Did your urologist tell you why this needed to be done? Was this done in the USA or ??

      Tom

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    • Posted

      yes it was a monopolar TURP .

      the SP was a backup cath according to her, i never used is except once and that was a very painful use, severe bladder spasms happened when i used it.I also had severe UTIs from both caths because they were left in way too long .

      i am currently in litigation against this urologist , and yes this was in the usa , st pete florida to be exact .

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    • Posted

      Kenneth,

      I completely understand now. With all of the advances in surgery I can't imagine anyone still doing the older style monopolar TURP. Your urologist certainly put you through a lot of unnecessary torment. I wish you all the best. Sorry you have to go to litigation over this.

      Tom

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