Turp

There are a lot of options for prostate cancer besides having it removed. For most cancers there are procedures that are as effective with fewer to no side effects

There is a ( maybe new) treatment called focused laser ablation being discussed on this forum. Her is a link:

https://patient.info/forums/discuss/focused-laser-ablation-508907?page=0#2328100

Maybe it is something to look in to 

Re da Vinci prostatectomy. During my cancer scare I researched this op. If you are in the UK the BAUS publishes standard complication rates for audited studies of this op as done by various uro's. A lot of them are sampled. For a benchmark, look up Chris Ogden at the royal Marsden, his stats are particularly good. The "complications" include what you fear. Many men do not get the complications these days with the robotically assisted surgery. If you have radiation therapy or brachytherapy you cannot later have prostatectomy, that option is gone due to tissue damage. I hope your outcome is good, you sound like you have amazing luck so you will be fine !!

Like you I waited a coupe of weeks. I did actually waken with an erection on day one with the catheter still in. A friend was told by his surgeon that it was up to hinself and it was on day 6, Can anyone beat that? His first urination after it was blood vree but a bit cloudy.

That is very rare to have regular ejaculations after TURP.

Had mine june 8th. No problems there. But past couple weeks seems that urination is going back to pre op problem. Cant empty bladder. Weak stream, etc. Have follow up next week. Will be discussing this with doc. Not happy.

 Talked to urologist today 85% chance for RE after surgery

Good luck !! My prayers are with you !!

This is about right. Not happy, but what are you going to do !

I forgot to mention that is with HOLEP surgery. Its a tough decision because RE is permanent. Surgery is scheduled for January unless my symtoms get worse. I'm watching the thread on Focused Laser Ablation. to see if there is any change in that procedure regarding health insurance coverage. I don't think I'm a candidate for urolift because of prostate protruding into bladder. Plus I don't think urolift will with my bleeding prostate.

A guy i know had the laser thing done. Is that the one they just use it to take out some material? I looked that up before said it only worked for minor enlarged and may need to be repeated. I had TURP and have no problems. Only thing is i am getting some pre surgery symptoms back. Poor flow. Have a follow up app with surgen the 27th. Gonna ask him whats up

From the Mayo Clinic :

Some studies have shown that patients who underwent HoLEP actually had improved erectile function after surgery, but almost all had retrograde ejaculation

 

"The laser thing" that you refer to, is two very different possible ops : 1. Greenlight, ablates the core of the prostate, typically removes rather less tissue, you might need it doing again in 5 to 15 years; no intact tissue samples are available for cancer testing (histology).  or, 2. Holmium laser enucleation of the prostate (Holep) or the rarer closely-related Thulium laser version (Thulep; in UK this even less widely available than Holep).  Holep/Thulep is able to removes a lot more tissue (than either greenlight, or TURP) in chunks, which are removed as intact tissue samples are available for cancer testing (histology). 

TURP I think removes a comparable amount of tissue to Greenlight, potentially a little more, but not as much as Holep (or, if you can find it, Thulep) . I chose Holep as it has the best chance of lasting you for life.  I could not find documentation of any advantages of Thulep over Holep, and anyway where I live, it was just a choice of two holep surgeons.  I had already decided on Holep BEFORE making an appointment for any urologist for a first appointment, as obviously if you do indeed need a de-core/re-bore, the uro' will sell you whatever he usually does.  Mine turned out to also offer urolift, but we discussed some drawbacks including my prosate bulging up onto the bladder base - it couldn't have ameliorated that and could even have made it a shade worse - plus obscuration of any future MRIs (metal tabs ....) and the fact I had just had a PSA 16.92 cancer scare, and although biopsy was clear, getting the extra histology on the holep-removed chips would give further confidence that the biopsy hadn't given me a false negative, as that is far from unknown.  He admitted that long-term durability of urolift not yet proven as it hasn't been around as long as holep, which is of course itself a relatively recent (2002, New Zealand?) invention in its refined, with morcellation, form as now practised (c.f. manual removal of prostate slices via multiple in-and-out uses of "grabber basket" on the cystoscope - takes about 3 hours longer than normal and leaves you ultra-sore !!!  - that is how Holep was first practised before some dude came up with the morcellator idea = inflate bladder and turn it into a rough-cut liquidiser once the HOLEP slice-and-dice-with-laser part is done, with bits pushed up in bladder for later morcellation as part of same operation.......)

A few people used to do HOLAP = pure laser ablation (no intact pieces left at all) using Holmium laser, but this is a slow business - if you are going to ablate-only, the greenlight laser is better suited to that. Holep does entail some inadvertant ablation, in my case my uro' says of the 12g he estimated he removed from my 22g little prostate, 6 g came out as chips sent to histology, and 6g was ablated (came out in the 16 litres of sterile water he put through me during the op).  He gave me a 500 MB video of my entire op to watch from the resectoscope, then morcellator, tip, which was cool (I tried to post it here but moderator blocks all URLs).  You could see that near end of lasering, in the tidying-up phase, he was just nuking small bits of loose tissue left sticking out on inside of prostate (some going from white to brown as he did so); in the earlier phase he made deep cuts into prostate tissue in a pattern, you can find an on line video of a lady uro' doing holep and she does the same cuts, and he gradually cuts free bit chunks then stuffs them upwards into bladder.  Urethra has been cut wide open at this stage and is behind the resectoscope, you can't see it.  That cut closes up after removal of 'scope and even more so after removal (OUCH!!!) of catheter through the operation site part of damaged urethra, and you/he hopes that it closes back together in such a way that it heals nice with no scar/stricture risk.  Which is pretty random, and for 2% of men it goes wrong and they do get a stricture due to delayed scar formation (same risk for holep or greenlight, one source indicated slightly less for TURP as TURP needs less length of cut ?).  I think it is the damaged urethra that causes at least some of the ~~fortnight's pee-pain after the op, which I think may be worse for laser ops (both sorts) than it is for TURP.  I guess the cut prostate tissue getting urine on it, also causes pee-pain.  I found drinking water even overnight, stopped it getting much worse overnight, indicating that saltiness of urine was an issue.

NB TURP also removes chunks for testing.  TURP like HOLEP except TURP removes less, TURP has higher complication rates (bleeding etc) other than strictures and longer recovery time for TURP - I think the stricture risk is lower for TURP. 

Greenlight laser is alone in NOT removing intact chunks for cancer testing.  NHS is gradually moving from TURP to Greenlight at more and more locations, as I think the fee charged for the fibre has gone down (most of the greenlight cost is in the fibre .... often a firm lends the greenlight machine to NHS for free, contract says you must buy all fibres from that firm though).  Greenlight and holep would cost more except that the reduced hospital stay and reduced complication rate, mean the NHS wins overall as each night's stay has an effective cost, so "NICE" now supports Greenlight on cost-benefit basis, AS COMPARED TO TURP FROM NHS POINT OF VIEW.  You can ask for an NHS op at the NHS hospital of your choice and in theory choose the method where there are options, but I heard no tell of any NHS hospital offering HOLEP or THULEP so I didn't explore trying to request Holep on NHS.  Even finding private hospitals that do Holep wasn't easy ... some are clear, others just speak on their website of offering "Laser prostatectomy" (as do some private urologists' websites), ring them up to find out if it is holep or greenlight and the receptionist at the hospital doesn't know and says the business development person will ring you back.  Two days later. 

The TURP surgery wasnt bad. The bad part was the MRSA they gave me. 2 days in hospital for TURP. 5 days the following week to get rid of the infection . That was way worse.

Question,

   If you have Prostatitis and youv'e had a TurP. How are you supposed to give a semen sample?     Steve

I had the original GL PVP in 2005 and was very pleased with it. By 2010 it was growing again and I had a Thulium/ Holmium in 2013. No real difference in the recovery from either apart from the hospital being inpatient to be rid of me the second time and sent me home with a catheter in as I was still passing blood on the second day. The surgeon had only wanted it to be in for a week but I was wrongly told to come back in two weeks.

There was always blood coming through the catheter but as soon as it was taken out my urine was crystat clear. 

Several NHS hospitals do Holep they are easily found by Google.

The Freeman in Newcastle went over to it in 2013.

The latest NICE choice though is GL XS.

HOLEP works a well as traditional TURP. HOLEP has shorter recovery and catheter times. My biggest grip is RE. 

Can anybody reiterate my question? What do we do if we have to give semen samples?