Tumt for BPH . How successful if you have undergone this?

I told him that i knew I would have to do a turp but I just couldn't yet as I'm in the midst of an old building remodeling and couldn't be out of commission now, not for a couple of months anyway. he told me that he would actually do a tuvp rather than turp as it's much easier on the patient, quicker recovery and the result would be the same.  But then he said, actually with a third lobe and a 114 mg prostate I really think you need to go see a colleague who specializes in (I forget the name of the procedure) but it is an open incision through the belly into the bladder and opening the prostate, and emptying it out, just leaving the shell of the prostate. He said tuvp or turp would help for a while, for years, but as large as my prostate is i would be back eventually. With the open incision no damage to nerves would result and it should be a 20-30 year fix. I told him at 76 I'm not likely to be around that long but i don't want to be back in ten years either.

So, Monday I'm going to see his colleague to begin to explore the possibility of the open incision method.  We'll see, got to finish my project, maybe in September.

I asked him about self-cathing myself. he said go ahead, lots of his patients do in order to avoid surgery. I believe I could do it at bedtime and sleep eight hours without a problem. 

At this point I'm getting by without any meds except 1/2 of a viagra at bedtime. With no Jalyn the hair on my legs and other parts of my body is growing in again. These damn meds are a real problem, I wish I had never taken them at all.

We'll see I am going to try to self-cath.       

It sounds like your doctor is recommending an open simple prostatectomy. From what I read, it will remove the most tissue, and is faster than the laser or standard turp. The only potential downside I can see vs. the lasers is more blood loss and the possibility of needing a transfusion. (You should stop any blood thinners or aspirin regimen if you are on it prior to surgery).

On the other hand, I got 8 pints of whole blood in December and I'm OK (so far)...  

I think the possibility of retro is the same with the prostatectomy or the laser and probably depends on the surgeon's skill.

Lasers routinely do large prostates now. My doctor used the PVP 180 watt Greenlight XPS Laser. He brought 2 tips (apparently they burn out during the procedure) to the operating room and used them both. My prostate was over 120 g. and he said he removed 70g., leaving 50g. and not doing much with the median lobe.

On the other hand  It seems like your doctor may be correct, that the simple prostatectomy may have the best chance of success. As far as the length of the fix, that doesn't take into account other possible problems that can cause LUTS. I had problems with bladder stones, scar tissue, and my bladder neck needed a resection within 18 months of the GL.

Regarding your PVR, it is quite large. A relative of mine cathed for several years, then had a classic wire turp, then returned to cathing about 4 years after the turp because he had lost elasticity in his bladder, and I suppose the turp only overcame this temporarily. He caths every 6 hours on a schedule. He also lost the ability to tell when his bladder was overfilling. He was told his bladder had overfilled over a long period of time which caused it to stretch out and lose it's elasticity and the sensation of being full.

In your case, you ought to consider how much are you urinating when you feel the need to go? You have to add that amount to your PVR to determine how much your bladder is actually filling. Another poster on another forum developed a diverticulum (a pouch) in his bladder that held 800ml of urine in addition to what his bladder held. He had to have the diverticulum removed surgically.

Ron, best of luck on whatever you decide. Please keep us posted.

Bob

A prostatectomy can be radical (removing the whole gland), or simple (removing part of the prostate). Making an incision in the bladder to allow accessg through the bladder, through the bladder neck into the prostate is called a suprapubic simple prostatectomy. It can be done by hand or laproscopically. I don't thin retro can be addressed surgically. Once part or all of the prostate is removed, the semen has a tendency to go into the bladder rather than out the penis. If you look up diagrams of the prostatic urethra online you will see that the valve that releases semen is towards the top of the prostatic urethra, closer to the bladder neck than the other end which is the urethra leading to the penis. My urologist said he left a little shelf of tissue above that valve so that the semen would ricochet downwards rather than upwards toward the bladder. I never had retro. The nerve sparing part of the simple prostatectomy are, I think, geared toward preserving continence and the ability to have an erection, rather than retro.

Here's a link to a youtube of a suprapubic prostatectomy. I'm not sure if it's radical or simple. If you are squeamish, don't watch it. The doctor does this procedure manually, basically freeing and pulling out the prostate lobes with his finger.

He also leaves a suprapubic and a foley catheter in place, I'm not sure why he does that. Your surgeon may have a different approach, but the video should give you enough info to ask the right questions.

Emis Moderator comment: I have removed the link to youtube as it was to a video from a commercial company selling videos. If any user wants the specific link please use the private message facility.

See http://patient.uservoice.com/knowledgebase/articles/398331-private-messages about messaging.

Bob