PAE vs Bipolar TURP: My experiences compared

Posted , 5 users are following.

Had a PAE in Aug of 2017, and a bipolar TURP two months ago (Apr, 2019). Not to promote one over the other, but just wanted to do a side by side first hand comparison.

Cost: both covered by my insurance (Kaiser). Copay $250 for both. Had to drive to another city and stay overnight for the PAE - cost: gas and hotel room.

Time/distance: Had to drive to another city for the PAE but was able to have the TURP done locally. Total time away from home for the PAE - about 24hours, Total time away from home for the TURP was4.5 hours.

Discomfort of the procedure: PAE - was awake but comfortable, very pleasant experience. For the TURP - was totally out. Remember nothing.

Discomfort immediately after the procedure: PAE - was in a hospital bed/recovery area from about 10:30am till 4pm. My back cramped and my bladder filled up with urine because I had to be horizontal until the puncture wound healed (right femoral artery), so asked for a Foley catheter at about 1pm - drained off 660ml, felt better after that. Foley removed before release at 4pm. Was very bored and wanted to stand up or go home. TURP - went home 4.5 hours after first arriving at the hospital (6am to 10:30pm). Foley in, but it was a bigger one than I was used to in the past, so some discomfort.

Discomfort several days post op: PAE - burning sensation peeing, so was able to tolerate this with Tylenol and a second Flomax. TURP: the Foley was a 20fr with double eyelets to drain off any debris, so was somewhat uncomfortable. Irritating but did get used to it by day three. Operation was Friday morning, took the Foley out myself in the shower Monday morning before going to the uro office for a voiding test - passed.

Discomfort out a month: PAE - some discomfort for a couple of weeks, then felt back to normal by end of week two, TURP - once the Foley was out basically no discomfort. There was never any prostate pain from the TURP after the operation or in the days or weeks following.

Energy level at one month post op: PAE - felt basically normal, but took longer after the TURP. TURP is a cutting procedure so there is some blood loss and so I took, and am still taking an iron supplement.

Effectiveness at two months post op: PAE: noticed a minor improvement from pre-op. TURP: noticed a definite improvement with stronger flow and quicker time to empty my bladder. Just had a PVR test and showed zero retention.

Other issues: PAE - slow and minor improvement for about six months, but due to median lobe never did get the results I was hoping for. TURP: still having nocturia issues, but this may be related to radiation from prior operation for prostate cancer.

My perspective: the TURP was faster and easier than the PAE and results at two months are more obvious. The PAE only lasted about a year, and that's why I had to do the TURP. A bipolar TURP is NOT the same as the old style monopolar TURP which requires at least a day stay in a hospital to control bleeding. The bipolar technique uses a plasma button tip to cauterize the bleeding, as does a full plasma button TURP, so one is able to go home the same day (in most cases) and recovery is much faster.

Sexual side effects: due to my radiation for PCa my equipment isn't currently working so can't comment on retro.

Would I do either again? PAE - I really didn't like the hours in the hospital bed after the operation. Other than that, it was a pleasant experience, the recovery during the days after wasn't bad, and I was considering a second PAE to target the median lobe - couldn't wait the two months to get on the schedule. TURP: if necessary I would definitely do this again if needed, but that decision might be many years away. Other than the three days with the Foley catheter, the TURP was relatively easy, recovery was faster, and results better two months post op.

I understand that everyone's experience with any of these procedures will be different. This is just what happened to me.

Tom

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  • Posted

    The doctor could have used a nitinol (nickel-titanium alloy) clip on the artery after PAE so you wouldn't have to stay in recovery so long. Glad everything worked out in the end.

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    • Posted

      Never heard of this. I was told the time that if the artery started bleeding this would be a serious issue and they would have to operate on me right away to stop it. I am not good being horizontal in a hospital bed staring at the ceiling

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  • Posted

    Were you prescribed the iron supplement or decided to take it yourself ? Does Iron not have a constipating effect ? I seldom read of Americans taking stool softeners after prostate procedures to avoid straining .

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    • Posted

      Derek,

      I decided to take the iron supplement myself. I add olive oil to my diet and that keeps me from having any issues with constipation. Last year I had some internal bleeding from my GI tract and my iron and HGB levels fell, so I started taking the iron pills. Once the iron levels were back up I stopped. Then, started taking the pills again after the TURP for same reason.

      Tom

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    • Posted

      "Do you get a blood test to know when to stop the iron tablets ?"

      Yes, CBC plus Ferritin level test quarterly.

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  • Posted

    A major issue for most guys that you didn't have to deal with is the "retro". Makes all the difference to me. PAE is the superior operation for that reason alone. I understand you're in a different situation and appreciate the feedback

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  • Posted

    I can't compare these two procedures but I have been totally happy with my TURP done in February. My uro has a slightly different approach and I stayed overnight in the hospital with continuous bladder irrigation for 17 hours post-op. On the plus side, I went home without a catheter. I experienced only minor discomfort for the first 2 or 3 days from burning, frequency and urgency. Resumed all normal activity after 3 weeks. I have retro but I had it prior due to the meds I was one. Not a big deal for me.

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  • Posted

    How much tissue was removed? That is, how big was your prostate before and after? Was the median lobe completely ablated?

    Thanks for sharing with us. All the best to you.

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    • Posted

      Howard,

      Before my PAE my prostate volume was 56gm measured with a "volume study". I have not had any measurements since. It feels as if all obstructions to the flow have been removed, including the median lobe. My only remaining issue is the nocturia - still getting up 6-7x per night, but I can certainly clear my bladder faster than before, day or night, and during the day I can wait a lot longer between bathroom trips. So far absolutely to incontinence issues. This was a concern prior to the TURP. My uro said that there was a slight chance of this because a radiated prostate isn't the same as a normal one, but, to his credit, or luck, all is still OK. I just stopped my second Flomax - so back to one per day. After another month I may stop the Flomax completely.

      Tom

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    • Posted

      Thanks Tom. I also have Nocturia but I find that if I eat a small bag of salted potato chips a few hours before bed it makes a huge difference. Sometimes I sleep right through! But be sure to monitor your BP.

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  • Posted

    Howard,

    Chips have a lot of carbs and sodium. My BP is slightly high as is my blood sugar so I avoid both sugar and carbs. My nocturia issues haven't improved despite my improving bladder emptying function, so there must be something else going on. I just can't seem to sleep more than 1.5 hours at a stretch no matter what I do or don't do with my diet or fluid intake.

    Tom

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