Treatment advice please

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I'm 59 years old and have been aware that I've got an enlarged prostate for a number of years through annual health check-ups. I actually had a scan yesterday and the result was that my prostate shows no abnormalities except for its size (64cc) and some calcification. My main problem with it is that it causes me to make 2 or 3 trips to the bathroom a night, and this is affecting my sleep badly, as I often don't get back to sleep. My doc has prescribed Vesomni after Tamulosin on its own didn't seem to do anything. I've been on the Vesomni for about 3 weeks and it doesn't seem to be working either - still doing a few weak pees most nights despite drinking almost nothing for two hours before bed. What I'm getting to is at what point does one decide that one of the surgical options is the next step? It seems a big decision. But getting only 4 or 5 hours sleep a night is making me feel borderline depressed.

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    Hi Mark, I'm 59 years old as well. The key learning from my TURP surgeries a year ago is that you want to minimize the amount of straining that the bladder has to do in order to force urine out of the body. If the bladder gets stretched and flabby, it impacts your ability to pee after opening up the urine path with surgery or Urolift, etc. It has been noted by others here on this website that the bladder may recover, which I hope is true since I struggled for years before finally having surgery. I hope my bladder will recover over time.

    I've also been told by 2 urologists is that if you are going to do surgery, it's best to get it done when your health is solid and recover is "quick".

    Next step is for the doctor to do a cystoscopy which allows them to see the urinary path and if there are pinch points that prevent you from emptying your bladder properly.

    I used to get up 2-3 times a night or more, then things got really bad if I had a few beers in the evening such that I had to get up 7-8 times a night to pee with a weak stream. Now I don't get up at night at all and it is really nice. 😃

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      The urologist I have been seeing originally suggested Urolift but since my prostate is rather massive, this technology wouldn't work for me. My Urologist seems to be a Urolift/TURP guy....he never suggested anything else. My cousin went to a specialist in Pennsylvania who only does the robotic, laparoscopic approach to removing a lot of prostate tissue which worked well for him. So, it depends on the doctor who is treating you.

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    You should get that cystoscopy, which will tell them where the prostate is blocking your flow.

    At 59, with simple BPH, TURP is probably not the best option. I find it sad and amazing that urologists are still doing them for simple BPH. Look into Rezum, PAE or FLA (Focal laser ablation). All are non invasive, require no anesthesia and have an extremely low side effect profile. At best, TURP will give you the same results, with a much longer recovery, surgical risk and an almost 100% chance of RE (dry ejaculations).

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    • Edited

      Thanks. No definitely not considering Turps. A friend had HoLep laser treatment about 6 years ago and it was completely successful, but as you say, there are more options now.

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      As I understand, Holep is more likely to cause RE than Turp, because a larger amount of prostate tissue is removed. According to the literature the rate of RE in patients is 75%. Holep has other advantages though like less need for repeat procedures, saving of tissue for cancer biopsy, and better urinary improvement than Turp.

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