Post GreenLight Laser Surgery Recovery

Happy patients have no need to post here. I was happy, happy, happy in 2005 and just stick around to try and help others. Life was back to normal for me on day three. My flow was not terrific but the other symptoms were gone after the ten years that I had refused a TURP and waited for a laser system to get approved. OK my prostate regrew over time but they all eventually will. 

As I have posted previously why is it mainly American patients who have problems ?

Perhaps American patients simply complain more often. 

In any case, I thought it was important to post a more positive comment so as not to scare potential candidates away from this surgery. I chose it over TURP because, at least here, TURP patients have a catheter in them for a week following the surgery. My father had TURP years ago and I remember a prety fair amount of blood in his urine while hooked up to the bag.

One other thing: It did seem like many posters here did not realize that one can have both overactive bladder and an enlarged prostate. Neither GZL not TURP cures this addititional problem.

As I said I had greenlight in 2005 when my prostate regrew I had Thulium/Holmium laser. That Uro called GL a commercial procedure not a cure.Certainly the initial use once laser rods used were very expensive but I don't know the cost of the next generation equipment.

I agree with your final paragraph.

How long after your GL in 2005 before you had the Holmium laser?

I think people complain about the GL because it didn't live up to the brochures handed out by the urologists that showed a happy patient playing golf a few days after the procedure, with his nightime voids cured and no worries for 10 to 15 years in the future.

My first GL lasted 18 months. My second one lasted 16 months. My turp was done 18 months ago and I'm hoping it stays good. I started dutasteride a year ago to keep it from re-growing.

These procedures generally work for retention, but nighttime voids is a mixed bag.

Eight years. At GL my prostate was 75 grms. In 2013 it was 135 grms.

Night times only improved slightly after GL and took a long time to improve after the second procedure.Though it is difficult to be precise as for other reasons I sleep badly. 

Hope your holmium lasts a much longer time. My uro said my prostate grows like a weed and was the largest he had ever worked on. I don't know how much was actually removed by the two GL's, but prior to my turp my prostate was 313g., and was 203g. after. That's why I started on the dutasteride.

The best solution I found for the night time urinations was to keep a disposable urinal by my bedside in a plastic basket, and go in the dark, sitting on the edge of my bed. About 85% of the time it just takes a minute or so to pick up the urinal, snap open the lid, go, put the urinal back and go back to sleep. Once in a while I might stay awake for 15 minutes to an hour, but it's once or twice a week at most.

That was some size as is the 203g afterwards. Mine is 55g now with a nodule growing on the median lobe.

The Uro who did my GL did a procedure on a 92 year old with a prostate of around 190g. As he said it is a very gentle procedure for an old person with health problems.

If I don't go during the night (or just once) I can pass 600mls in the morning.

That's great. Your bladder is in great shape. The most I've held is about 400ml. during the night. But I generally wake up at 200ml. to 300ml.

I don't have any retention now and my PSA is 0.74 from 7+ so overall a good result apart from no ejaculation but Tamsulosin had aready started that and it could be age related.

Don't have any retention either but my PSA was 8.7 in Nov. It's been slowly rising for years. Most likely went down from the dutasteride as that will generally cut it in half. I'm 70. The retro only happened after the turp 18 months ago. It changes the path of the ejaculate from going down and out, to going up into the bladder. But the orgasm feels the same.

When I was first told that my prostate was enlarged (35g) my PSA was 5.0. That led to two biopsies as it went up. By the time I had the GL it was 9.8, large prostate = high PSA. It came down to 5.1 after that and went up to about 7.8 as my 'weed' regrew. I was very surprised by the drop to 0.74 after the thulium/holmium procedure.

The holmium part of the procedure saved 37g of tissue for the histologist to test.

It sounds like the holmium procedure did a great job and probably removed a large amount of tissue. My turp also resulted in about 35g. of tissue being sent to the pathology dept. That's a negative of the GL procedure, there's nothing left to test. The PSA can increase due to prostatitis and inflamation. During my turp my urologist said he saw multiple pockets of pus indicating chronic prostatitis that never showed up in testing.

Are you now clear of prostatitis?

I have no bph symptoms since the turp, but I still get up 2-3 times a night. The turp was about 6 weeks of recovery and easier than the GL, except I bled frank blood for about a month. I needed 6 pints of whole blood for the hematuria that necessitated the turp and the recovery. I don't know if the prostatitis is there or not, though I don't have any symptoms if it is. It never showed up on any urine tests.

I am amazed that TURP was an easier recovery than GL. To me GL was easier than going to the dentist..

You are one of the lucky ones then. Both of my GL's were 8-9 weeks of recovery. About a month of frequency and urgency and leaking. About 6 weeks of eye popping pain at the end of urination, and about 8-9 weeks before the bleeding stopped. The turp was less pain and a quicker recovery (about 6 weeks). I think the results were better as well.

Being one of the complainers, I will say that my GreenLight laser procedured did not cause a lot of bleeding afterwards.  If it weren't for being left totally incontinent and having my (our) sex life ended, it would have been great.  I guess there are worse things than living in wet Depends 24x7.

What reason were you given for this terrible outcome?

Did you have grounds for legal action?

I've seen another urologist in another city who will be implanting an artificial sphincter in 3 weeks, so in about 9 weeks from now, I should be dry, or mostly dry.   In my meeting with him where he spent an hour reviewing my history, he was clear that I have a non functioning sphincter, and probably from the Greenlight procedure.  He used to do GL and teach it (he's at a university medical center), but no longer does it or teaches it.

It's occurred to me that I might have a basis for legal action, but I'm just more concerned about regaining some of my quality of life as quickly as possible.  I don't think the first surgeon who did the GL and a second Gyrus TURP procedure to clean up after the GL is incompetent or a bad doctor.  I had read about GL and requested it, and my suspicion is that he did it to be accomodating, but he's not highly experienced with it.  It's a battle that I just don't don't have the energy to flight at this point in my life.  I want to be able totake a plane and vist our children and grandkids again after nearly a year of pretty miserable incontinence and all it entails.

Good luck with the  artificial sphincter. Do you have to pay for it and did you have to pay for the Gyrus proceure? 

I considered Gyrus prior to having the then new GL. Not many UK hospitals were doing Gyrus although one Uro had done 600. I was not concerned that I was my uro's 8th GL procedure. I felt as he had done many TURPs that he would know what he was doing. Years later I met one of the UK's top two Uro's who said that in the begining we thought that GL was a simple procedure but we later found that we had to do them with much more care. By then he was using the second generation GL laser and the hospital who did my GL were about to switch to HoLep that they regarded as marginally better.However GL is now the  preferred procedure by NICE (similar to your FDA) to TURP.

There is an article on Urolift in one of our papers today that I will post and hope that the moderator lets through,

 

I have Medicare coverage and a secondary insurance.  Even so, with charges for many theraphist visits to try to help with the incontinence, and surgery and hospital charges not covered by Medicare and the secondary insurance, I think I have paid $5000 to $6000 out of pocket.  That would include the small mountain of wet diapers and pads that have gone to landfill from our home.  With the upcoming surgery, I am guessing I will be somewhere between $8000 and $10,000 not covered by Medicare and secondary coverage by the end of this.  Then, the artificial sphincters don't last for ever, so there's a good chance of another surgery in the next 5-10 years.  (Look up AMS 800 if you're interested in the device.)

As you are in America where it is easier to take legal action I would seriously think about it. Often the threat is enouugh to get compensation.