turp

At one time a TURP involved a four or five night hospital stay. That was one reason why laser day surgery was liked to cut down on hospital stays.

NHS web site still indicates a hospital stay.

http://www.nhs.uk/Conditions/resectionoftheprostate/Pages/Recovery.aspx

  

Hmm… my uro’ told me at the meeting after my holep, when I explained that my first two orgasms (at 7 weeks) had been completely insensate – nothing to feel at all – and since then, only a little better ….. he replied that in all of the turps, greenlights and holeps he had done, he had NEVER had any man mention inferior orgasms.  Now, I like the fellow, but think on this point he may have been dissembling, or maybe patients are coy about this, or maybe it's because post-op meetings are normally at 1 month (= before first sex) - mine was at 2 months.  I did find generalised medical research – one can’t put in a URL here – that there is an effect on average.  First paper : Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial : “Differences between preoperative and postoperative orgasmic domain scores in each group were significant”.  Second paper : Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study : “Also, at 12 months after HoLEP, all IIEF domain scores except for orgasmic function and overall sexual satisfaction recovered to the baseline or showed a marginal but nonsignificant increase compared with baseline. In contrast, both orgasmic function and overall sexual satisfaction domain scores were still slightly decreased at the 12-month follow-up compared with baseline, but this was not statistically significant” (more in a moment)

Hmm… my uro’ told me at the meeting after my holep, when I explained that my first two orgasms (at 7 weeks) had been completely insensate – nothing to feel at all – and since then, only a little better ….. he replied that in all of the turps, greenlights and holeps he had done, he had NEVER had any man mention inferior orgasms.  Now, I like the fellow, but think on this point he may have been dissembling, or maybe patients are coy about this, or maybe it's because post-op meetings are normally at 1 month (= before first sex) - mine was at 2 months.  I did find generalised medical research – one can’t put in a URL here – that there is an effect on average.  First paper : Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial : “Differences between preoperative and postoperative orgasmic domain scores in each group were significant”.  Second paper : Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study : “Also, at 12 months after HoLEP, all IIEF domain scores except for orgasmic function and overall sexual satisfaction recovered to the baseline or showed a marginal but nonsignificant increase compared with baseline. In contrast, both orgasmic function and overall sexual satisfaction domain scores were still slightly decreased at the 12-month follow-up compared with baseline, but this was not statistically significant” (more in a moment)

(....continued) (do at least read final sentence of this post)

In the paper, Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study, look at the orgasm scores before and after the prostate re-bore (I daresay effect is similar regardless of the type of re-bore) in table 2.  I would post a URL but it’s not allowed on this site, so just google for it.  Same paper, says this “the ED seen immediately after BPH surgery may be temporary and due to the neurapraxia induced by thermal injury”.  [not in paper, maybe this heat damage also explains possible effect on orgasm ?].  and, “Another interesting finding was that the orgasmic function or overall sexual satisfaction domain score remained slightly decreased throughout the follow-up period after the HoLEP procedure. In the present study, the scores of "ejaculation frequency," one of two items that compose the orgasmic function domain, were decreased throughout the follow-up period after HoLEP compared with baseline, although not significantly so at 12 months after surgery. Therefore, ejaculatory problems may have an adverse effect on orgasmic function or overall sexual satisfaction after HoLEP. This finding is in accordance with the study by Briganti et al. showing a significant deterioration in the mean IIEF orgasmic function domain score after HoLEP and a recent study by Muntener et al. suggesting that the loss of ejaculatory function after TURP is significant and is associated with considerable bother."

The above pair of papers suggests to me that ON AVERAGE orgasms, for those for whom they are worse after a re-bore (which on average, they are), might recover some way or most of the way to where they used to be after a year.  Table 2 in the above reference suggests continued deterioration ON AVERAGE until 6 months after a re-bore op (HOLEP, TURP, THULEP, Greenlight - not enough reports to distinguish really ... intuition says probably all about same), and then improvement MOST of the way to where you started ("baseline".  I think my experience is of a more marked decline in sensation than most, and I am certainly not psychologically bothered by the retro/very little semen, aspect.  I read a lot of men's posts on boards like this, some bemoaning problems (that might not last?), some saying it feels the same overall if not identical, a few bemoaning problems that have  based on dates cited persisted well beyond a year.  It isn't possible from individual posts to ascertain what percentage are affected.  The two papers I found and cited in the 2 posts above, suggest most are affected but only to a moderate degree ON AVERAGE - within which you have some unaffected and some like me and others posting here, considerably affected, at least initially.  I remain optimistic for a year's time, and think being able to pee well, yet not feeling like wanting to pee far too often, are both pretty useful offsetting outcomes (to this problem). 

I have a theory as to why in some men, a prostate re-bore operation (TURP, HoLEP, ThuLEP, Greenlight) can lead to reduced or even no sensation at orgasm.  The research papers I refer to above, do not speculate as to the REASON.  I see that some men say taking FLOWMAX also slightly reduces the orgasm, at least in cases where it also causes retrograde ejac. 

 

I do not believe it can be the feeling of semen being pumped INSIDE the urethra. When I passed two large clots after HoLEP it felt like a mild electric shock, and certainly not pleasurable.  The urethra is not an erogenous zone, I conclude.

 

Yet …. The prostate has smooth muscle that pumps out semen, normally against some resistance as it has to get it down the urethra. Post re-bore, the semen goes easily up into the bladder, and the reduced pump effort may distort the prostate more and trigger fewer nerves inside, or in the bundles on top of, the prostate.  Might that be it ?  The other theories would be heat damage to nerves – but the Flowmax men don’t have that; or just fewer nerves left as so much chopped out.  But the Flowmax men don’t have that either.  The adverse effect of Flowmax on orgasms appears to be mild, and only to be reported in men who have retro ejac as a result.  I am discounting men who also take 5-ARIs that affect libido and all sorts. 

Final paragraph above, I meant to write, "the reduced pump effort may distort the prostate LESS (not more) and trigger fewer nerves inside".

I think uro's may be told in training/by professional convention among themselves, not to admit that some have reduced-intensity orgasms after a "re-bore".  It would make sense : if they mentioned it before the op, men would ask lots of un-answerable questions using up all of the 15 minute consultation time : will it affect me ? How many of your patients are so affected, compared to others' ?  (nobody, of course, publishes or keeps such stats).  Many men wouldn't go ahead.  So don't mention it, and for those - a few being affected a lot ? or many, but mostly only partly ? - affected, just say no, never heard of that affect before [implication, that's why I didn't warn you].  Simplest and most defensive thing to say.  Some official pre-op data sheets might be HINTING at it : saying orgasm will be similar, but "might feel different for some men".  

Im one of those men who had the TURP and I believed my urologist when he told me that the feeling of sex will be exactly the same after the operation. The only difference would be that I wont ejaculate anymore. I didnt like the idea but I was under the impression that I have no other option and I was under the impression that I could have prostate cancer the way my urologist was going on.Well nobody could gave prepared me for the first time I had a climax after that operation. It is 5 years later and the worst thing is that the only thing I can do is to try and not have sex as I am depressed and so angry at that urologist for lying to me. Of course he told me he never had a patient who had that problem. What is so strange to me is that Ive spoken to 2 other men who had the TURP from him and they agreed fully with me that the orgasm is pathetic to say the least. I got the impression from the urologist that he never heared of anybody with that problem and I also got the impression that he dont know the difference between a climax and an erection. Seams to me that all the research on the subject of sex after prostate operations deliberately dont consentrate on orgasm but just on erection ability. Im sorry but I think that the worst thing I did in my life was to trust that urologist of mine. I thought that the climax is by far the most important part of sex. At least in my case it was.  

Just an update on my previous posts : climax no longer insensate, as it was at first 7 weeks after Holep (literally, there was nothing to feel then, all preceding sensations having been normal) - now at 13 weeks after Holep, I have about 50% of it back, which is a relief.  I theorise (a mere guess) that maybe there was some thermal nerve damage from the laser (the uro' can choose the power setting) that may be repairing itself; otherwise the rapid improvement is hard to explain (my other theory that lack of back-pressure due to retro ejac, meaning that the prostate distorts less triggering fewer nerves, wouldn't be a phenomenon that would alter in a few weeks, so why the improvement, were that the cause ?).  Given the huge advantages of being able to pee fast, lack of after-dribble now after stopping peeing, sleeping through quite a few nights entirely for the first time in 8 years, and not have the feeling of needing to pee again far too soon, I do count my Holep as a significant net positive (I do however have no idea if I could have had these benefits from other treatments without the side effect), even with today's situation of about 50% of sensation at climax "missing" (even if that didn't improve).  I am optimistic that more of it may come back, as one of the (very sparse) studies I cited above in this thread, implied that it takes about a year to work itself out (should be an improvement after a year, but maybe not all the way back to "baseline" i.e. how you were before).  I will post again at some stage over the next 10 months, with a final report on this matter. 

Hello Barry..I read your post and hope your success continues. It would such a pleasure to get a decent nights sleep. Please..where are you located ?

And who's you doctor?

Robbie

Hello Robbie, I am located in West Ky, my surgery was done in Evansville, IN.  My doctor was Dr Gadient, with St Marys Urology.  Very pleased with him, he has lots of experience.  

Barry

hello Barry, 

sorry i haven't replied sooner... how is everything going after your op. ?  any change ..everything ok?   sltill sleeping ?  i'd sure like to know about sexual experience after the op.  not many comments about it.  It's really a scary proposition for all of us !!  

Robbie 

still sleeping good  nothing has changed, can't tell you about the sex yet, but next week,  is when it suppose to happen, lol, can't hardley wait, but following the doctors orders.

Hi Barry, had TURP 7days ago everything went great! But the resuming sex is not mentioned much. WELL? If you don't want to reply ok... BUT would be greatly appreciated.

 

Gary VA53, 

If you want to private message me, I would be glade to answer any questions you want answered.

Barry