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

      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'm doing very well. My Rezum procedure was done mid-January 2018, so it's been about 19 months.

      I'll provide a quick summary for the benefit of those who haven't seen my previous posts. Around April 2017, I went into retention. Quite a shock for me at 65 years old to be schooled in how to use catheters. But actually, catheter use became easy. I found this website and it really helped me a lot at that time. My urologist at the time recommended a bipolar TURP because that is what he did at the time. (Since then, he's applied to start doing Rezum procedures locally).

      Instead, I did a lot of research, and found that the Rezum procedure sounded like the best first surgical approach. I should mention that I tried all the homeopathic supplements with zero noticeable results. I was also taking 2 X Tamsulosin per day with little to no effect as well. My Rezum procedure was extremely easy for me. My prostate was around 80mg (if I remember correctly) and the enlarged median lobe was pushing up into my bladder.

      I had a twilight anesthesia, and had no pain at all when I woke up. I had already talked to the Rezum urologist (Dr. Kevin McVary) about not getting a Foley catheter, and he agreed. In fact, I self cathed twice within a couple of hours after the procedure, again with no noticeable pain.

      I did have to use catheters for about 3 weeks afterwards (I probably could have stopped at 2 weeks). About 4 weeks after the procedure, I did have to go back to have some tissue removed that was blocking flow, but he said that was very unusual.

      Since then my flow has been just what I expected. It's not the 'race horse' flow that some guys are blessed with, but it's normal for me. If my prostate should grow back and become a problem again, I'll likely choose Rezum again (unless something new comes along between now and then).

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    • Posted

      Just to second what Ken says:

      .

      "Since then my flow has been just what I expected. It's not the 'race horse' flow that some guys are blessed with, but it's normal for me. If my prostate should grow back and become a problem again, I'll likely choose Rezum again (unless something new comes along between now and then)."

      .

      I also tried saw palmetto before and it was worthless. I was on 2 Tamsulosin per day and all it did was make me sleepy and give me blurry vision. My Rezum was successful in clearing the blockage, but due to moderate bladder damage my PVR's are over 100 ml and I am still self-cathing 2 times a day.

      .

      Steve

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    • Posted

      Good Afternoon

      I just found this out over the last few month's

      The Rezum procedure will not destroy the urethra because they are injecting into the prostate tissue not the Prostatic urethra. This is the widest part. That section has your ejaculatory ducts in it. I also found out that the steam that is injection does not travel it only stay's in that area where the needle is put.

      I hope you are have a great day....Ken

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    • Posted

      uncklefester,

      .

      The Rezum will poke holes in the urethra, which I assume will heal over time just like any puncture wound. The steam, is released away from the urethra well within the prostate. Maybe if the injection point is too shallow, the steam might reach the urethra.

      .

      Steve

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    • Posted

      kenneth1955,

      .

      A good urologist that is experienced with Rezum can avoid the ejaculatory ducts by placing the injections away from them. No ED here for me, but as noted in my other posts, PVR's remain over 100 ml due to bladder damage.

      .

      Steve

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    • Posted

      Steven

      Yes that is true they have to stay away from the ducts. Most will do that but I think some do not care and do not feel that we need it if we are not having kids.

      There was a guy on here Ray. His doctor said she saw the ducts and stayed away from them. He had 15 injections and he is doing fine.

      The doctor that did Light1 had told him that out of the hundreds he has done he has only 1% which is great But then you have some doctor that only tell you that it rarely happen.

      The doctor is the key to any procedure.......Take care Ken

      Sorry about your bladder....

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    • Posted

      Ken,

      .

      Yes the doctor you chose is important. I saw 3 urologist until I picked the one who did my Rezum based on a recommendation here. Hopefully, my PVR's will go down over time. Oldbuzzard says that the bladder recovery can take a few years. The graph that I am keeping of my PVR's is showing a slow but steady decline.

      .

      Steve

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