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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.
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