My TURP, part 1
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I had a TURP on 2/20/2019. Here's is some background data: 70 years old, BMI 21.6, BPH symptoms for 7 or 8 years and bladder spasms for almost 20 years. On doxazosin for 5 or 6 years (gave me retro-no big deal). Prostate not large (urologist est. 50g from the DRE) but with a large median lobe protruding into my bladder. Flow was poor and PVR was 60ml. I generally get up twice per night unless I drank a lot after dinner. Daytime frequency was my biggest complaint which made traveling sometimes inconvenient. I rarely passed up a chance to use the restroom! I had two prior transurethral surgeries to remove bladder tumors (one cancerous, one not). In the last 18 months, I have had a prostate biopsy (negative) and 4 cystoscopies and none caused me any undue discomfort. Despite this, I consider myself to be in pretty good health!
After doing a considerable amount of research, I decided I was more comfortable sticking with my regular urologist (30 years experience) than traveling to someone who does a different procedure that may or may not produce better results. My doctor uses what I believe is the currently popular version of the TURP, i.e., bipolar (in saline), loop electrode to start and then a plasma button to smooth out the surface and cauterize any bleeders. The surgery was scheduled for 1:45 pm.
Day 0 (Wednesday)
Awoke at 5:15 am so I could eat breakfast before the 8 hour pre-surgery fast. Checked into the hospital at 11:45 and by 12:15 or so I was in a gown in the pre-op room with an IV in my right hand. Since I had a slight cold the anesthesiologist wanted a white blood cell reading so I got stuck in the left arm. WBC and temp were normal. They gave me 2 Tylenols, not sure why. At 2:00 the surgical nurse came to get me. She said she would inject some Versed into my line to relax me. That's the last thing I remember until I woke up in recovery at 3:30. CBI (continuous bladder irrigation) was underway via a 3-way catheter and they drained 1000-1300 ml of cranberry juice-colored fluid every hour or so. The doctor told me everything went well. I was wheeled into my room for the overnight stay about 4:45. They checked my vitals (BP, pulse, temperature) every hour when they emptied the catheter bag. I had occasional bladder spasms but they never last more than a minute or two. After my wife left, I ate dinner and watched TV. At 11, they did the last hourly check of the vitals and said they would go to 4 hour intervals. At 11:45, I turned off the TV and the lights for the night. Still awake at 12:15 am, I asked for sleeping pill and that worked. No pain whatsoever.
Day 1 (Thursday)
They woke me a 4:00 a.m. to check my vitals but I was able to fall back asleep until about 7. Had some breakfast and watched TV. At 8:30, the nurse clamped the catheter outflow, instilled 300ml into my bladder, let the water out of the balloon and pulled out the catheter. It stung but only lasted a second or two. I started drinking lots of water. About 10, I voided about 25ml into a measurement container. It stung quite a bit and felt like I was squeezing the cranberry-colored urine through a small opening. Over the next few hours, I voided several times, never more than 60ml. The doctor came by around 1 pm, said everything was normal and I would experience frequency, urgency and red or pink urine for a couple weeks. He recommended Azo for the burning. He discharged me and said he would see me in 2 weeks. Called my wife to pick me up and finally exited the hospital at about 2:30. Got a warm hug from the attractive 50-something day nurse that made a nice end to my stay.
Day 2 (Friday)
I got up 8 times during the night but voided only a little each time. The bladder spasms woke me up. I have been on oxybutinen for 15+ years for bladder spasms but these are too strong for the medicine to suppress. Still feels like I'm having to pee through a small orifice. I'm sure everything is still a little swollen. The Azo is working and the burning is greatly reduced. Turns the pee a very bright yellow. I get a little reddish-yellow ooze out the urethra after I finish so I'm wrapping some toilet paper around the tip to keep my underwear (relatively) clean. Drinking more than usual and therefore voiding more than usual.
Day 3 (Saturday)
Got up 3 times last night which is just once more than usual. Bladder spasms have subsided a lot. If I wait too long to void, the spasms get very strong and I run to the bathroom. Flow still slow and pee bright yellow (from the Azo). Went to a concert Saturday night and was 1 hour 45 minutes between bathroom visits. That resulted in the first visible blood in about 24 hours.
This is the end of part 1. I will start part 2 in a couple days when I have more to report.
0 likes, 22 replies
kenneth1955 lee56659
Posted
Hello Lee
Thank you for your story.
Looking forward to the second part. I hope all works out for you
All that matters is that you are happy with you decision
Best of luck....Ken
hank1953 lee56659
Posted
Thanks for sharing Lee. Bipolar Turp is a very good choice, knowing that you don't care about RE. Good decision!
lester90053 lee56659
Posted
What is your secret to remembering every little detail including the exact time for each one?
lee56659 lester90053
Posted
I started writing things down as soon as I got to my room! Otherwise, I would have forgotten half the details.
kenneth1955 lee56659
Posted
Lee
The only thing I do not understand is.
Why did your doctor do 2 different Turp procedures on you. A regular Turp is done with a wire loop and the plasma button Turp is done with a device with a button tip which is easier to handle.
Did you talk with any of his patients that had it done by him
I hope you get better you just will have to give it time.....Ken
lee56659 kenneth1955
Posted
I have read online that some urologists are now using both types of electrodes in a single procedure. The loop can apparently remove material quicker than the button so they start with that and when the bulk of the material is removed, they use the plasma button to smooth out the surface since it does a better job than the loop. Only the electrode tip has to be changed, the rest of the tool is the same.
I did not talk to any of his patients. He could not give me names without violated HIPAA laws. He told me that most of this patients leave the hospital after one night and without a catheter. That was my case also.
Six days out I am feeling great. The challenge will be to try not to do too much too soon. As I noted in my summary, I was never in any pain and never had to take any kind of pain medication. I still feel a little tingling when I pee but it's the same feeling I had after the two prior trans-urethral surgeries.
kenneth1955 lee56659
Posted
Well I do hope you heal well. I never heard of them using 2 kind. It must be something they just started to speed things up. I know with the button they have to take there time. With the other they just go in and cut everything in sight. Was not a pretty video and nothing I would do..
But that is your choice. You did what you felt was good for you.
I wish you well and good luck.....Ken
lee56659 kenneth1955
Posted
Here are a couple quotes from a paper from 2016 titled "How I do it: Same day discharge for transurethral resection of prostate using Olympus PlasmaButton and PlasmaLoop"
Quote 1: "First, the bipolar loop is used to resect the bladder neck in a circumferential manner and then any median lobe."
Quote 2: "The goal of the resection is to remove the majority of the prostatic tissue as in a standard M-TURP." (M-TURP is mono-polar, i.e., the old way.)
Quote 3: "Once all chips have been removed from the bladder, the bipolar loop is then removed and the PlasmaButton is then engaged into the working element of
the scope and further vaporization of the prostate is then carried out over the resection sites. The advantage of the vaporization is two-fold. First, it allows for
smoothing of the resection bed through vaporization and then aids in better hemostasis than the bipolar loop."
If you Google the exact title, the first hit should be a link to this paper. I have also seen at least one YouTube video of a TURP in which the doctor uses the same technique. So I don't think it's an uncommon procedure.
kenneth1955 lee56659
Posted
Thank you Lee.
It is nothing I would do. I hope it works out for you. I have seen a few of the Turp procedure and it is the worst thing I ever watch. They cut this mans prostate up so bad that when they took out the pieces and put them on the table it looks like a bunch of brains.
Good Luck...Ken
tom86211 kenneth1955
Posted
Ken,
I watched the same YouTube videos and they didn't bother me at all. I have been reading about all of the bipolar TURP experiences here and the post op side effects seem a lot less painful than for many who have had Rezum or Urolift - I am talking about pain, bleeding, catheters, retention, trips to the ER etc. Lee seems to have a relatively benign week after his procedure.
Tom
kenneth1955 tom86211
Posted
Hey Tom
Yes there was one on You Tube that I watched which was bad enough but I watch some other and it is not right. I don't know how another man can do that to another man in the name of helping him.
I do agree Lee seam to be okay. I hope all works out for him. Just like I hope it will for you also. What pain are you taking about with the Urolift. I had it done 4 years ago and I did have a catheter. I ask for one. Only had it for 3 days. Was good to go in a week. I would have it again.
The button turp is a much better procedure and if you have a good doctor all can be good. They can get rid of the tissue that they need to. But doing both seam like they are trying to hide something. We will do a regular Turp and they will smooth everything over to make it look nice.
Men have a right to have whatever they want. I hope the procedure works for both of you.
Best of Luck....Ken
tom86211 kenneth1955
Posted
Ken,
"What pain are you talking about with the Urolift." That procedure is painful unless you are under anesthetic. Then, from what I have read here, there can be weeks of issues. You were lucky, but some here have not been so fortunate - same with Rezum, FLA, aquablation, Greenlight etc. Any procedure that heats or attacks the prostate will result in some swelling, pain, and bleeding. My PAE was fairly benign and the discomfort I experienced during the week or two after was minor. Unfortunately, it was only about 20% successful due to my median lobe.
Prostate swelling is the big one for me - I had that and don't want to go through it again. I can barely pee now, so any additional swelling and I would be in total retention. Not going to do that.
Due to my median lobe a normal Urolift is not an option. Medlift is not available to me.
So, I continue to get through with two Tamsulosin per day, and at some point will make a decision to either go with a second PAE or the bipolar TURP. I want to hear from more men who have had the TURP, like Lee.
Tom
lee56659 tom86211
Posted
You are correct Tom. Six days post-procedure I am feeling great. Stream seems to be getting stronger and not currently seeing any red or pink in my pee. I think I pee'd my first clot or scab yesterday. Saw a small reddish brown flake in the bowl. Nowhere else it could have come from. I expect to see more in the coming days.
kenneth1955 tom86211
Posted
Tom I must have wrote it the wrong way. I did not have any pain. I had it done in a surgery center and I was out when I had it. I went home a hour after I woke up with a catheter. That I asked for. . Most of the time your good to go in 4 weeks. I was good in 2 weeks. I new that the prostate was going to get swelling that is why I ask for a catheter.
A lot of men that have the Urolift done are doing it in the office and doctors are not using catheters.Which I think they should. That was the first time I had one. It helped with the bleeding and the clogs. And I drove with it until I had it out. I just was careful. It was only 3 days.
Tom are they sure that it is your prostate. What about your bladder or even the sphincters. I'm still wide open but a year ago I stopped having the feeling to go to the bathroom. At the time I was in the hospital for something else. I went through 7 very painful tried to get a catheter in. I even had a nurse crying because of the pain they put me through. They gave me morphine.
I had a inflamed bladder but it was caused by a tight external sphincter. I'm on Vasicare 10 mg. It help's me. I can tell I did not have them for a month. Glad I got them now. It will relax the prostate and the bladder. Ask your doctor for some samples and try it. It is worth a try.
Take care Ken
tom86211 kenneth1955
Posted
Ken,
Vesicare is for OAB - I already take trospium - it's similar. My uro and I have gone through every possible cause of my retention and frequent bathroom trips and the conclusion is that it's the size and shape of my prostate that is restricting urine flow. On two Flomax per day I can only pee at 5ml per second. On one Flomax it's 3ml/sec. So, I am really being squeezed.
Tom
kenneth1955 tom86211
Posted
Tom
I'm sorry to hear that. I'm glad you are working with you doctor to do the best for you. I was on Flomax and Rapaflo. Did not care for the side effects that is why I had the Urolift was off all pills for 3 years.
I can tell the difference when I don't have them I was still peeing but it was much slower. And with me taking the pill It seam like I pee better.
Tom you have to do what is right for you. But it has to be your decision not the doctors.I don't think I have a over active bladder. I only go 2 or 3 time a day. It all depends on how much I drink.
Have a good day,,,,,,,Ken
tom86211 kenneth1955
Posted
Ken,
How I move forward will be completely my decision. That's why I am on this forum - to learn from the experiences of others.
I have to go to the bathroom about every hour to hour and a half day and night. Once in a while at night I can last a bit longer. During the day there is always a bathroom nearby. When I go at night it can take me 10 or more minutes to clear enough of my bladder so that I can get back to sleep. Occasionally, it takes 20 minutes. I have to pee three or four times. I pee the first time, then wait a few minutes, then pee a bit more, then do this a third or fourth time. This is very disruptive of my sleep.
The idea of undergoing a procedure that will cause my prostate to swell up for weeks isn't anything I would want to do at this point. I want to get rid of the obstructing prostate tissue and clear a path for the flow, not make things worse and go back to a Foley for weeks on end. That's why I am seriously considering the bipolar TURP.
My prostate has caused me unending stress for almost 10 years - first it was the prostate cancer, then the radiation, then the BPH symptoms. I am holding up fairly well psychologically, but life was so much better before all of this happened.
I know that most of the men on this forum are in a similar situation, each with his own story.
Tom
hank1953 tom86211
Posted
Tom, you are on the right track. Bipolar Turp is your best shot. Your symptoms are probably too severe for Urolift. Make sure it's bipolar, not the old regular mono Turp. Urolift has the least chance of retro but it's not very effective.
hank1953 tom86211
Posted
Tom, how bad is your retention? You might consider self cathing. It might solve all your problems.
kenneth1955 tom86211
Posted
Tom
I'm sorry for what you are going through. You do what is best for you.
That is all that matters. Like Hank said stay away from the regular Turp. The bipolar would do the job for you.
All the best......Ken
tom86211 hank1953
Posted
Hank,
Latest PVR ultrasound was 200ml, so my bladder is always about 1/3 to 1/2 full at best. That's why I have to pee several times to clear it to the point where I can get some sleep. My wife sleeps through most of the night, then goes to the bathroom and in just a matter of seconds empties her bladder - swoosh! Wow - the good old days! I don't mind getting up a few times during the night - I am used to it, but it just takes a long time to get the bladder empty enough so that I can fall asleep again. I am always a bit tired during the day.
Before I go to bed I have been taking trospium (for OAB) and recently a small amount of melatonin and now 1/2 tablet of Tylenol PM. This is helping me a bit during the early part of the night. I also take two Flomax per day, one in the morning and one in the evening, that that helps as well. It would sure be nice not to have to take a pile of pills just get some sleep. I am, however, willing to keep doing this pill regimen until I am sure of what I want to do next. There are certainly a lot of options, and each one has it's good and bad points.
I have done CIC and it's not something I want to do except in an emergency situation. I have some hydrophilic catheters on hand in case I go into total retention, but I haven't had to use them in several years.
Tom
hank1953 tom86211
Posted
Tom, your story is similar to mine. PVR is about the same. I am taking Doxazosin instead of Flomax. I used to have the same problems you are having. Not anymore! Because I am now self cathing. I always cath before bedtime, to have few extra hours of continuous sleep. The result is I can usually sleep through the night. The rest of the day, I will cath extra as needed, if I am sedentary, or if I feel a bloated bladder. Otherwise, I can function very much normally. Also, cathing gives me extra kidney protection.
I've looked into procedures and pretty much concluded that my best choices are HoLep, bipolar TURP, or GL if my situation worsened.