Surgery That Destroys Prostate Urethra and Subsequent Prostate Removal

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I have a general question about BPH surgeries such as TURP, Holium Laser, Greenlight, etc. that destroy the urethra passing through the prostate.  If I understand correctly, these surgeries rely on the remaining prostate to act as a substitute urethra for the section of the urethra that was removed.  The remaining prostate contains the urine as it flows out of the bladder and keeps it from spilling into the body.

However, what happens if, after one of these surgeries, the prostate needs to be removed say because of prostate cancer?  Do the surgeons have to "sew in" a new replacement urethra for the section that was removed by the earlier BPH surgery? 

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  • Posted

    I had a friend who had his prostate gland removed due to cancer.  The surgeon simply cut his urethra on each side of the prostate, removed the gland, then stretched the urethra and reconnected it.

    I assume the same could/would be done in the instance that you describe. 

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  • Posted

    My friend   These surgery do not destroy urethra they will remove the prostate tissue.  If you remove the the whole prostate ( Radical Prostatectomy ) then the urethra is attached to the bladder neck.  Before you do any surgery please get a second opinion.  Please read Turp with Prostatitis.  It will open your eyes  Good luck  Ken  
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  • Posted

    The urethra is not destroyed. The parts of the prostate pressing on, or squeezing the urethra are destroyed. This relieves the pressure on the urethra and allows the urine to flow more freely.  This destruction of the over-large prostate is more, or less, targeted and accurate depending on the technology used in the operation.  I would guess Helium, green light and FLA would argue they are more focused and accurate than TURP. However, none of these operations destroys the urethra. I hope this is clear.
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    • Posted

      If the prostate surrounds the urethra and the the cutting instrument is inserted through the urethra it is difficult to see how the urethra is not destroyed in that area.
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    • Posted

      Thanks for the reply, Peter, but I believe the section of the urethra running through the prostate IS destroyed for the procedures I mentioned (TURP, Holium laser, Greenlight).  It is not destroyed with Rezum or Urolift and I'm pretty sure not with FLA or PAE either.  Not sure about aqua ablation.

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    • Posted

      Peter,

            For the majority of the old school BPH surgeries, such as laser and TURP, the urethra is definitely removed, and the prostate becomes the conduit for urine. My understanding is that the prostate cells that carry the urine change and basically rebuild the urethra. Or at least a lining for the prostate.

      The only BPH procedures that I'm aware of that don't remove part of the urethra are PAE, Urolift, FLA and Rezum.  Interestingly, all of those procedures also leave sexual function intact as well.

      When it came time for me to have a procedure a few months ago, Rezum was my choice. Part of my reasoning was because the urethra itself was left intact. The tiny holes that he needle made in the urethra to inject steam into the prostate were the only damage done to the urethra itself, and those holes healed up within days after the procedure. 

       

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    • Posted

      Ken + Peter,

      Good question and very good answer. I asked my uro this question via email last year and he never responded. Thanks guys. Hank

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    • Posted

      BPH surgeries divide into two types: resective techniques and non-resective techniques. the former have better functional outcomes such as Qmax and PVR (and thus more durable) but often come with the disadvantage that ejaculaton reverses its direction whereas for the latter, they do not have as good functional outcomes but ejaculation is normal.

      aqubaltion is a resective technique but is designed in such a way try to persevere ejaculation with about 90% success rate.

      to understand the pros and cons of various technologies, I suggest to start with a technology then use it as a base to compare with other  technologies.

      steadyhealth.com has an interesting thread of HoLEP with more than a thousand posts. If u are interested, just google steadyhealth HoLEP experience.

       

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    • Posted

      I am ready to stand corrected. I flew to USA 18 months ago and had FLA specifically to avoid TURP. I have never looked back. BPH issues are no longer part of my life.

      Pete

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    • Posted

      Ken  The only procedure that they do anything to the urethra is when they remove the whole prostate.  It then has to be attached to the bladder neck.  If you look at the surgery videos.  They are only removing the prostate tissue on each side of the urethra What is left of the prostate is still attached to the bladder neck.  Then they put in the catheter.  It said nothing of bringing the urethra.  I may be wrong but that is what I understand by reading and looking at the videos  The other Ken  
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    • Posted

      Thomas, My prostate was something like 86 grams. I think doctor K said it was the largest he had operated on at the time. The worst thing for me was that it was a bleeder. Driving for a few hours, any kind of sexual activity would cause bleeding for days on end, and of course, I was up 9 times per night peeing.  I researched on this site and discovered FLA which was just gaining popularity.  I contacted Dr K and flew to Houston for the op. It takes a couple of months for you to see the results but it really does the job and does not do any of the damage associated with TURP. (At least that was the case for me and many others - I know some here have reported unsuccessful operations.)

      You will have heard many here talk about what a great guy Dr K is and I would recommend him to anyone. 

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    • Posted

      I asked my first urologist what happened to the urethra that is obliterated by either Greenlight laser or a cold knife TURP procedure.  He assured me that the urethra surface grew back, typically within two weeks.

      Glenn

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  • Posted

    I had my Prostate removed in May and a TURP 18 months before, resulting in extra stitching being done and have been advised I will be incontinent for a year, which is longer than after a normal Prostate removal.

    David

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    • Posted

      Thanks for the reply tractorman.  Was the extra stitching due to the surgeons stitching in a urethral replacement for the section that was removed during the TURP.  If so, was it tissue from your body or an artificial urethra?
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    • Posted

      rdemyan,  I will be honest and say I never enquired but was told that if anyone has had a TURP previously then additional stitching is required. I will try to find out when I see Prof on Thursday.

      David

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