Post TURP - questions poor urine flow

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Hi all - had a TURP 6 weeks ago for a combination of chronic prostatitis and BPH - it turned out to be a High bladder neck and relatively small prostate - had a BNI and a mini TURP- 6/7 grams removed. Post op spiked a fever was placed on Augmentin - all cultures negative. Day 2 went home after catheter removal - same night has acute retention- ER 600cc urine/ wore a foley for 4 days on double dose tamsulosin - passed trial without catheter- Antibiotics for 4 weeks . A week after stopping antibiotics urine flow again decreased ( had a good not spectacular flow postop) - no retention but stream is very poor. Mild dysuria - back on antibiotics and tamsulosin with marginal improvement

what could be causing the poor flow- uro says the bladder neck should be wide open and that it is likely to be prostatitis

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  • Posted

    There is nothing benign about Benign Prostate Hyperplasia in my opinion. For me, my first procedure for BPH left be with total urinary incontinence because the external sphincter was damaged with complex strictures from the procedures. For one year, I went through 8 to 10 Depends changes per day. I then starting using condom catheters with a bag, which was less odious., for the next year. After a total of 6 procedures, to address the strictures and finally an AUS implant to keep me dry, I regained some degree of normality in my life. A side effect of those two years was impotence, so all of that essentially ended the sex for me and my wife.

    Some, maybe most men have good outcomes, but there are enough poor outcomes that I wonder what the overall statistics are.

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    • Posted

      There really ought to be a medical database tracking outcomes of procedures. Finding good data on the risks of different procedures is tricky at best. At one time I was considering TUMT that my urologist was recommending. I was lucky enough to find some side effect data from Harvard Medical. That data scared me away from any of the transurethral procedures. As I recall, the numbers I found for TURP were >50% RE, ~8% ED, and ~2% incontinence. I also talked in person with quite a few older men. While not enough for statistical valid data, several of them had experienced issues that they had not been warned about. I've had appointments with a few urologists, I've not yet met one that I trust enough for most of the common procedures. But doing nothing is also not a good option, from what I've seen, heard, and read about, that often can lead to worse problems. I finally settled on PAE, as the risk of side effects were lower and I couldn't find anyone complaining of impacts to their sexual health. I'm currently doing well, but I still have some worry about what the future will hold.

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    • Posted

      i had a bipolar turp 3 weeks ago today. i was in the hospital 4 days with a catheter in and a couple of times while flushing. after the fourth day i was sent home and have been peeing ever since with a flow i havent had for at least 6 years that i can remember. its hard to hold back if i wait to long. i have not tried sex yet but have woke up with erections so i dont think ill have a problem. Before the surgery i barely had a stream while taking flowmax. Im extremely happy to be peeing again. My surgeon nearly guaranteed i"d be able to pee like i was a kid when he was done. He took my fears away going in. My prostate was twice the size of a normal one.

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    • Posted

      I apparently hit the trifecta with RE, ED and incontinence. For anyone who has to deal strictures after a transurethral procedure, I was finally able to have that resolved with a successful urethrotomy, the third of three procedures. Shortly afterwards, I had the AUS implant (over two years ago) to deal with the incontinence. wonder whether the fact that the cuff of the AUS is "downstream" of the region of the strictures, which were in the external sphincter, helps keep the strictures from coming back, as that area is always under pressure.. In any event, when I need to open the AUS to empty the bladder, the flow rate is good (about 35 cl per second). So that's better than the 3.5 cl/second I had with the strictures.

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    • Posted

      Hi Jerry,

      I read it, but for me it doesn't make much sense to focus only on flow rates and IPSS. Most urologists don't even ask about side effects impacting sexual health after procedures for BPH. If you don't ask the questions, then you don't collect any potentially negative data that might be analyzed.

      I'm sure that I could get a higher flow rate with a variety of procedures. But I just wanted to have enough flow to lower my PVR, get off the prescriptions, and get my sex life back. I'm not claiming that sex is like when I was in my 20's or 30's or even 40's. But it's better than it had been for 2 or 3 years before my procedure.

      I find it unfortunate that word of mouth and reading hundreds, maybe thousands of personal stories via the internet is the only way to find out about the things that might go wrong with supposed "gold standard" treatments that Dr.'s recommend to patients everyday.

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    • Posted

      I think you're right when you say - "Most urologists don't even ask about side effects impacting sexual health after procedures for BPH. If you don't ask the questions, then you don't collect any potentially negative data that might be analyzed." Most urologists aren't the greatest. When I read the article, I came away with the thinking that HoLEP was superior to most other procedures. I went to a Mayo Clinic urologist for a HoLEP but he said my 40 gm prostate was too small for a HoLEP. So I got a HoLAP which is Ablation (just burn the prostate with a laser) rather than a HoLEP which is Enucleation (chop it up and pull the pieces of prostate out.) I'm doing ok now but still pee a lot at night, but I think that's retained fluid and not so much my prostate.

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  • Posted

    John, I had three turps in 15 years. The last one, was over three years ago. After the last one, I had total retention. Couldn't urinate, at all! I started to do CIC. It's the best thing I did for my prostate and bladder. Now with the catheter, that I have to insert daily, I empty my bladder completely! I don't know what is the problem with your prostate/bladder, but don't despair, you always can resort to CIC, if things don't get better for you. Good luck!!!

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  • Posted

    May I suggest you chat with your urologist about the possibility you have a urethral stricture forming. see https://www.ncbi.nlm.nih.gov/m/pubmed/30267196/ and other references if you Google strictures post TURP.

    My experience after HoLEP mirrors yours after TURP and I am left with this most unfortunate development which frankly leaves me worse off than before the surgery.

    I have no medical knowledge or training just my own journey and I hope and pray for a quick recovery for you.

    take care

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    • Posted

      Had appointment with uro - check of PVR with a bladder scan was 40 ml. Urine was clear for infection- on exam he felt the prostate was soft

      He thinks its prostatitis and suggests more time - sent out a urine PCR after a prostte masaage to identify the culprit bacteria as I have never had positive culltures

      As I dont strain and have a low PVR he thinks stricture is less likely

      will be following up and decide about cystoscopy if it does not improve in a few months

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  • Posted

    Thank you all - will see uro soon

    I had TURP Nov 19 -and the poor flow started a month later - can a stricture happen that quickly

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    • Posted

      I am almost 11 months post-TURP and have noticed no reduction in my flow. My uro mentioned strictures before the procedure and said if one occurs it's a relatively easy fix. Hoping I won't have to find out!

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