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PAE to TURP , please help me decide/ alleviate fears

Posted , 6 users are following.

farmerste
farmerste

Hello,

I had PAE in 2018 in Aintree University Hospital in the UK. I was happy with the outcome as it reduced my prostrate from 103cc to 68 cc, and urinary flow was good afterwards. In summer this year I had a UTI for which a 5 day course of bactrim antibiotics cleared up quickly ( I was away on holiday at time ).

So i decided to ask to be referred to my local hospital urologist, and after flow tests, camera inspection, and an MRI scam my doctor told me that because my large median lobe is pushing up into bladder again ( my prostate is currently 88cc by estimation) that other treatments like REZUM would not be suitable as it makes the area around the steam injection go hard, so therefore as PAE only lasted 5 years the best treatment for me would be TURP .

I wonder if anyone could answer some or any of the the questions below,

1, with the TURP using a hot wire i presume when the large median lobe has been cut away, does this make it more likely that i will experience heavy bleeding, or incontinence after surgery ?

2, when they are cutting away are they really close to nerves that control continence/sexual function? and how do they avoid this if they are?

  1. if I were to develop prostate cancer in the future would having a TURP make it more likely to spread?

4, Does having a large median lobe cut out and TURP make UTI more prevalent?

5, Does the prostate make fluid all the time after a TURP?

6, Does having a TURP affect any travel insurance as I love to go to see family in New Zealand.

I apologise in advance if these questions seem stupid, but I would greatly appreciate any answers or advice forum members may have.

I am quite concerned about TURP, but I have seen/heard lots of positive outcomes from it but I am unsure how good this is with a large median lobe.

thank you in advance

0 likes, 16 replies

16 Replies

  • bill24813
    bill24813 farmerste

    Edited

    I'm in a similar situation . I have a large median lobe. I also have a smaller prostate than you. my options are a little bit wider variety, as to where you will be limited to a TURP, HoLep (my choice),or Aquablation.

    I was told, due to vascular tissue being left behind with the TURP and Aquablation, there would be a good chance of a second surgery later on in my life. The prostate never stops growing. The procedure I chose doesn't leave much behind, so it is considered a one and done. No future surgeries due to BPH.

    The surgeries all have an end result of retrograde ejaculation with the exception of aquablation, which is mixed

    Any other side effects with your choice of procedures are rare or temporary.

    • farmerste
      farmerste bill24813

      Posted

      ok thankyou for the reply, i thought holep was more to remove all the prostate as a result of cancer been found within it somewhere, I can't seem to find info on how good it is for large median lobe. I think I might be able to join a waiting list for it to be done under the NHS but my urologist said 18 month plus waiting.

      Do you think I would be better having this done, do youu think it is safer regarding incontinence and ED afterwards and better recovery time

    • bill24813
      bill24813 farmerste

      Edited

      HoLep is the same as a TURP. The difference is the method used to remove the prostate tissue. Holep removes the prostate tissue as one piece using a laser in 3 dimensions as opposed to TURP which uses cutting Loop or button in 2 dimensions, taking the tissue out 1 strip at a time, like cutting a butter stick lengthwise starting from the top of the butter stick using a butter knife and working your way down until the stick is gone. Both methods removes tissue within the prostate capsule, leaving the capsule place. YouTube has plenty of videos on the 2 methods as well as aquablation.

  • andrew57992
    andrew57992 farmerste

    Edited

    I had to decide whether to have TURP or another procedure. After much research, I decided turp was too invasive and could leave undesirable after effects. I went for Aquablation which is approved by NICE. I had tp travel almot 300 miles to a Qualified Urologist at Reading. Had my op on 9th October. No pain after op and only a taint of blood in water for less than 48 hours. Did have problem with TWOC, mainly because had been cathetertised for 2 months before op. Urologist at post op appointment stated my bladder had become lazy and to be patient. He was right TWOC eventually worked and am voiding naturally without problem. The Uro at Reading is 1st Class.

    Hope this helps

    • farmerste
      farmerste andrew57992

      Posted

      thankyou for the reply, I don't think I can get that procedure done any closer to myself, ( yorkshire ), but i will look into it

      thankyou

    • andrew57992
      andrew57992 farmerste

      Edited

      Have a look at BAUS British Association Of Urological Surgeons, Their website lists many Urologists and their various expertise. Incidentally the op ( Aquablation) is available on NHS. I could not wait 6 or 8 months so went private

  • michael31017
    michael31017 farmerste

    Edited

    1, with the TURP using a hot wire i presume when the large median lobe has been cut away, does this make it more likely that i will experience heavy bleeding, or incontinence after surgery ?

    For my 3 TURPs and a "massive" prostate, my urologist removed just enough of the large median lobe to restore urine flow. This, done 3 years ago, didn't last long as now I have scar tissue (strictures) that are limiting flow once again. With 102g of tissue removed from the median lobe, I bled significantly during surgery and to a lesser amount during recover, and was anemic for a few months. I had no issues with incontinence.

    Does having a large median lobe cut out and TURP make UTI more prevalent?

    I haven't any any UTIs after my 3 TURPs.

    • farmerste
      farmerste michael31017

      Posted

      thanks for the reply, I am also trying to find out if Holep can also be bad for a large median lobe, my prostate is about 88ml/cc but median lobe sticks up into bladder. Have you found any indications that Holep is any better?

      thanks

    • bill24813
      bill24813 farmerste

      Edited

      HoLep, TURP, and Aquablasion, are the preferred methods for addressing the median lobe. As far as I know, no other procedures address/remove the median lobe tissue due to BPH. You could try Rezume, but it will not last long and from what I hear its a brutal recovery.

      My prostate is 55ml/cc. My lobe is large enough, blocking all urine flow, doc notes from Cystoscopy. For me, the median lobe is the real issue and needs to be removed. I am on anticoagulants (coumadin) for an mechanical heart valve. I can only be off of the meds for 3 consecutive days. Since the HoLep procedure cauterizes blood vessels better than TURP, removes more tissue, plus, one and done, this ended up being the better choice me.

    • michael31017
      michael31017 bill24813

      Posted

      Next week I'm going to have a "Robotic Partial Prostatectomy" using laparoscopic techniques. The plan is to remove a lot (if not all, I'm not sure) of my median lobe which sounds like the right approach to solve the issue. I assume this approach is mainly for large median lobes and would be overkill for smaller prostates.

    • Richard14755
      Richard14755 bill24813

      Posted

      I had a median lobe protruding into my bladder, and as advised that Urolift was an option that would pin back the lobe to improve the urine flow. This was developed after it was first introduced when it was just used on lateral lobes. From my experience (it didn't help at all) and from what I have seen I think it is no more than a punt and would not recommend. It also rules out HOLEP in the future according to the surgeons I have spoken to.

      I was previously advised to consider Rezum - just didn't fancy it, including the recovery (takes weeks before any improvement, long period with a catheter in, generally spraying steam at a prostate doesn't seem like a great idea..), and have no regrets about not doing so.

      Following the Urolift I had Greenlight laser, which removed the median lobe but was not otherwise a success, and finally had a TURP, which I am still recovering from.

    • bill24813
      bill24813 Richard14755

      Posted

      I have had an unsuccessful lateral lobe Urolift. In regards to Holep and Urolift, the real issue is the emulsifying attachment used in the Holep procedure. The urolift clips will destroy the emulsifying attachment. That's the real reason they don't want to do the Holep and choose a TU R P.

    • farmerste
      farmerste Richard14755

      Posted

      hiya,

      so how long is it since you hard your turp?, hope things are going well and improving?

    • Richard14755
      Richard14755 farmerste

      Edited

      Thank you. I had the Turp in mid-November. For the first six weeks there was small in improvement in my urine flow but a lot of discomfort and sometimes pain (although not as bad as before the operation). Since then the symptoms have improved, there is less discomfort and my flow is stronger. I hope this continues but for now feel it it too early to reach a conclusion on what the eventual outcome will be.

    • Richard14755
      Richard14755

      Posted

      Looking at the rest of this thread, and to add my thoughts on the different options (for what they are worth), given the choice I would have gone for HOLEP over TURP. I bled for some hours after the operation, requiring multiple saline solution clear outs of my bladder and "traction" and understand that bleeding is less of an issue with HOLEP. Unfortunately it is not possible after a Urolift so TURP was the only alternative (although I didn't look into Aquablation and wasn't offered it).

    • andrew57992
      andrew57992 Richard14755

      Posted

      Likewise, I was not offered Aquablation, just TURP. Had to do a lot of research, as not happy with TURP as previously reported. I found Aquablation and when mentioned to several Uro's I had consulted, they were not aware, which truly amazed me.

      The Uro I found who does Aquablation was/is first class.

      Anyone contemplating the op, read the BAUS site there is heaps of information including practicioners.

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