Turp and Greenlight laser

Posted , 14 users are following.

Hello all,

I have had BPH issue since 2 years, and I plan to have a surgery, but I hesitate between Turp and Greenlight surgey .

Please I need help, and advise which one is better.

I will appreciate that.

Thank You

0 likes, 27 replies

Report / Delete

27 Replies

Next
  • Posted

    There is no comparison GL wins hands down. It seals the blood vessels as it goes and there is very little later bleeding.

    Report / Delete Reply
    • Posted

      My urology department performs two prostate procedures - bipolar TURP and GL. They don't do many GLs anymore because I was told they weren't very effective. My urologist is a top surgeon and performs many RRP prostate surgeries and I trust his judgment in these matters. When you say "there is no comparison GL winds hands down" this is exactly the opposite of what my urologist told me.

      Report / Delete Reply
    • Posted

      I can only speak from my experience of GL that I have repeated here many times over the years. I have also posted the GL experience of two friends who had it a different UK hospitalswith different sized prostates and different pre op problems.

      This leading UK NHS hospital that did my GL continued with it for about seven years before going over to HoLep on what they said was on a split decision.

      Does your Uro have the latest third generation GL equipment ? It is expensive compared to the simple TURP equipment.

      What I posted after my procedure on the then prostate News Group.

      My

      BPH symptoms were first diagnosed in 1995 (I am now 70) when my prostate

      was 35g. Flow and residual tests at that time showed that I had retained 400

      mls. and I was

      advised to have a TURP as a matter of urgency. After researching TURP I turned

      the offer down to wait for something better to come along. TUNA and TUMP did

      not really catch on with British urologists and were not readily available. My

      symptoms did not change all that much over the years but my prostate continued

      to grow to 72g . My PSA was 5.2 in 1995 and latterly swung between 6.5 and 9.0

      and during this time I had three negative biopsies.

      My test results in September 2003 showed my first void as 339 mls with a

      QMAX flow of 11.7 mls/sec and a residual of 411 mls. I was asked to void again

      30 minutes later and passed 309 mls this time at QMAX flow of 11.7 and now a residual

      of 371 mls. I had been using Saw Palmetto all this time and had only briefly

      tried Flowmax and Proscar which caused tachycardia and headaches.

      I read of PVP on its first mention on this NG and it seemed to be what I

      had been waiting for but it was only about a year ago that it arrived in the UK

      at Kings College Hospital. The NHS waiting list soon became quite long there

      and last year the UK representative for Laserscope Mike Degun

      told me that the Freeman Hospital in Newcastle (North East England) had started

      doing the procedure. Newcastle is only about 110 miles away from Edinburgh

      where I live. I contacted them last October to find how long it would take to

      get an appointment and how long the waiting list was for the procedure. I was

      told that it was about three months for the initial appointment with the

      urologist and probably a further three months to get it done if accepted as a

      suitable patient. I liked the Newcastle way of doing things as they take the

      patient in on a Thursday for tests, do the procedure on the Friday and let them

      out on the Saturday. This seems much less stressful than being done at break of

      dawn and out on the street by lunchtime as Kings College and America do it.

      The urologist in Edinburgh agreed to refer me to Newcastle as an NHS patient

      and I had my outpatient appointment there with the Staff Urologist John Davies

      on January 9th. Mr Davies was very thorough doing all the tests himself rather

      than getting a urology nurse to do them. He was already very enthusiastic and committed

      to PVP. We spent about 25 minutes discussing its merits and the benefits of it

      over TURP. He said that only 25 procedures had so far been carried out at the

      hospital as they were only doing them on Fridays if an operating theatre was

      available. He had performed six by that time under supervision and would do

      mine. The rest had been done by the consultants Phil Powell and Mr Thorpe.I

      reckoned that by the time my procedure was done they would all be pretty good

      at it and Mike Degun had said that they were a 'Red hot team' It was confirmed

      that the waiting time was still three months but I might lose out a bit as the

      NHS area accountants have to agree to pay for their patients to be done in

      another Health Authority area. In early June I got June 30th as the magic

      admission day with the usual NHS proviso that you have to phone on the day to

      confirm that a bed is available. I phoned at 10 am and was told that Matron was

      still allocating beds and that they would call me back within two hours. I

      explained that I was coming from a distance by train and that I would need to

      get the 11 am train. They called back within five nail biting minutes to

      confirm that a bed was available and I arrived at the hospital by 1.30. A

      doctor was soon on the scene to examine me, take my medical history, do blood

      tests and send me to get an ECG (aka EKG). Soon John Davies was round to see me

      followed by the anaesthetist who did his own medical exam. I have hypertension

      and am Glucose Intolerant. He was concerned about my heart murmur and some

      conflicting information on the health summary my GP had supplied so I had to go

      for and Echo Cardiogram. He was happy with both sets of results and he

      discussed the anaesthetic options. I told him that this part was my only fear

      as an uncle with angina had arrested and died ( cardiac arrest ) when

      undergoing an anaesthetic for a fairly routine operation and my mother

      previously a very sharp minded 82 year old had suffered cognitive dysfunctions

      after major surgery. We discussed epidural as an option but I was not too keen

      on that as I have twice had vaso-vagal syncope, once before an angiogram and

      the other time when having a tumour removed from my ear. Where my body is

      concerned I am one of the great world cowards:-)

      I went down to theatre the next day at 1.30 by now convinced that the excellent

      anaesthetist would not kill me! I came round about 4.00PM feeling a slight pain

      in my penis and what felt like the need to urinate, however that feeling was

      probably due to the catheter being in. John Davies came

      round to see me pleased with how the procedure had gone. He said that they

      started lasing at 1.53 and finished at 2.50. He said that the Median Lobe was

      not bad and that the Lateral Lobes had been my problem. He described them as

      looking like a floppy saggy bottom pressing against each side my bladder. He

      said that no bladder neck resection was needed and that Mr Powell tries to

      avoid that as it is the cause of retrograde ejaculation. John did the procedure

      and said that Phil had been there at the start when they had planned what to do

      and that Phil had popped in a couple of times from the next theatre to see how

      things were going and again before John had started on the Lateral Lobes. I had

      been give shots of two types of broad band penicillin during the procedure and

      a shot of morphine. I had every confidence in John who is a lovely guy, very

      enthusiastic in what he does and very caring. Soon I was drinking a cup of tea

      and waiting for dinner. I had no pain during the night and did not need any painkillers.

      I kept on drinking and watching the catheter bag fill up with a nice Red Wine,

      it

      needed to be emptied three times before the catheter was removed the next

      morning at seven.

      Now for the moment of truth by peeing on my own. I was drinking plenty

      (the nurse said too much) but it was not until 11.45 that I passed a red 100ml.

      John came in to see me and said that he would come back in the afternoon and

      that if I was voiding properly could go home. He suggested that I might be

      dehydrated but I did not think so from the volumes passed in the night. My wife

      had already checked out of her hotel as we had assumed that things would be OK.

      1PM 250 ml pink. 2.30 150 ml pink and a scan showed a residue of 193 ml.

      2.50PM 190 ml and much lighter but the scan showed 329 ml retained. John

      came back in and said that as I had a long journey he would be happier if

      stayed overnight. My wife went off to find another hotel as the Best Western

      had no vacancies for that night.

      5.10PM 220 ml rosy but only due to the few drops of blood at the start.

      8.05PM 150 ml retained 290 ml. 11.00PM 300 ml quickly followed by another

      100 ml before bed. Woke up at 2.00 AM and passed 500 ml with a decent flow and

      another 300 ml at 3.45 AM. 7.00AM 300 ml followed by 100 ml at 7.30. but back

      to my usual slow rate ending in a weak dribble. Drinking a lot but no more

      until 10.30 200 ml. Passed another 250 ml at 11.30 but the scan showed 416 ml

      retained. We went

      for a walk to get some fresh air and missed John's visit (He had said that he

      would just phone the ward to check on me) He said that I could go and that when

      drinking normally at home things should settle down. He also gave me a three

      day course of Trimethoprim.

      I was restless the first night at home and kept on going and passed 1700 ml in

      small amounts all crystal clear. During the morning I passed a total of 1000 ml

      in five visits to the toilet. I felt 100% well and set off for a day at

      the local racecourse. Just like any normal day dodging around from the

      paddock to the bookies and climbing up the grandstand to get a good view.

      With G8 riots going on in Edinburgh we had to take an indirect route. Our

      journey took 90 minutes using busses rather than the usual 40. Normally I get

      off the bus and go straight to the toilet but not yesterday. Everyone was

      amazed to see me saying I thought you were having an operation on Friday was it

      cancelled ?

      I

      had two large mugs of coffee and was getting worried that I had not needed yet

      and tried about 4.45 and probably passed only 200ml. I seem to get a period

      like that every day but the rest of the time my prostate symptoms are still the

      same, slow flow that goes down to a trickle and only about 200 ml.

      Last night was better waking up at 2.50 and 5.30 passing a total of 800 ml. I

      have not been drinking so much today to see what that does and results have

      been on the low slow side and I have been forgetting to record the volumes.

      Not worried yet, I am sure that things will gradually adjust. John Davies

      did say that my sense of urgency might remain, did he mean forever I forgot to

      ask!

      Later

      to a friend who had GL just before me as a private patient in London.

      My caring Uro phoned me today. I said, You just caught me in time, I was about

      to lock the door. He said that he was glad that I felt like going out. I told

      him where I had been on Monday and other days. On day four I had a dermatology

      appointment at a hospital over two miles away and we had a bus strike that day

      and walking there and back had been no problem. I told the nurse about my

      procedure and she said that her father a

      retired teacher had also had GL recently and was delighted with its success and

      the new freedom it had given him.

      He is delighted with my progress and

      I proudly said that I had slept till 6.15 this morning when I passed 450 ml

      followed by 300 at 8.20. He suggests that I should take a urine sample to my

      doctor for testing to make sure that it is protein and infection free and to

      get a scan to see how much retention I now have. He warns that week’s two and

      three are when bleeding can be expected as scabs detach. Drink plenty of water

      to keep well flushed out as any weak spot can let germs in. I asked if it is a

      series of scabs or one big one. He said that the whole lased area is a scab

      and it all has to eventually come off to leave a new surface.

      I asked what he had meant when

      saying that my urgency would remain. He said that it might remain but could

      improve. He suggests that various factors including my Hypertension or Glucose

      Intolerance could cause me to pass more urine at night than during the day. I

      said that running taps and sometimes standing up can create an urge. He

      sometimes prescribes Alpha Blockers to relax the bladder.

      I mentioned the discomfort in my

      pelvic area and he said it often seems to happen to people who have taken Saw

      Palmetto for a long time but that there is no proof of the connection. I had

      taken Saw Palmetto for ten years. He commented!!! that I had done well in that

      time in avoiding bladder and kidney damage and that I could probably have continued

      in the same way for a long time. I replied that on first hearing of PVP I was

      ready for it and that the urology nurse at the Edinburgh hospital had put the

      frighteners on me by saying that I should start using a catheter at nights to

      drain my bladder in order to get a good night’s sleep.

      Part of reply from friend who had GL just before in a

      reply to one of my E-mails

      I was very interested to read that John Davies prefers

      PVP to TURP for large prostates. It seems only sensible that the least stressful

      and invasive method must be best and I wonder why the Americans are loathe to

      PVP bigger ones. Do you think that there

      is a danger that Newcastle is being a bit too premature in doing things which

      are not the norm in the US, considering their relative lack of experience

      ** John said that PVP is very gentle and that they do not

      like to laser continually during the procedure. They must stop for a Kit Kat

      and coffee.

      Report / Delete Reply
  • Posted

    Speaking from my experience i would recommend TURP my procedure was a success i had a catheter in place for 21 months sure the procedure is intrusive you recover in hospital for two days then in my case 3 months at home i have a appointment with my urologist today 2nd Septmber having had a discussion with my GP i am returning to work at the end of the month i am on Tamulosin with procedure now a distant memory my life is slowly returning back to normal good luck john

    Report / Delete Reply
    • Posted

      Was the catheter for 21 months prior to your TURP ? Three months at home and on Tamsulosin after it can hardly be regarded as a success. You would be back to work after heart surgery in that time. And why are you on Tamsulosin ?

      Report / Delete Reply
  • Posted

    TURP is more aggressive and more effective than Greenlight. My urologist told me his department doesn't do Greenlight anymore. Make sure, if you are considering a TURP, that you understand what kind - the older style if monopolar, and the newer versions are bipolar and plasma button. The older monopolar caused a lot more issues. My TURP was bipolar and I was in and out of the hospital in 4.5 hours. Had a catheter for 3 days after, which was the only irritation. Procedure was easy and painless. My flow had increased at least 50% and now, 5 months later, my bladder is calming down and my frequency/urgency issues are better. I am happy I had the operation and would do it again if necessary.

    Report / Delete Reply
  • Posted

    Hi Tanak1693,

    .

    I had a Rezum. While I waited for my bladder to recover, I worked closely with a family member that I have known for over 60 years who has been an MD for over 40 years. I am a retired scientist so researching is something that I do well and the family-member-MD knows surgery well. The family-member-MD had a highly negative view of TURP.

    .

    The old monopolar TURP was at the absolute bottom of our list. It has the highest morbidity, highest complications (10% ED, over 90% RE), longest hospital stay, and longest recovery time. In 2019, there is absolutely no reason to do a TURP when there are more modern procedures available. That is unless you don't do your research before choosing a procedure and a urologist.

    .

    Green Light Laser Enucleation of the Prostate (GLEP) was our 2nd choice after Rezum. I would encourage you to research Rezum. It is a new procedure, having been approved by the US FDA at the end of 2015. It is a minimally invasive outpatient procedure with minimal morbidity and complications. Because it is so new, a lot of guys don't know about it.

    .

    Another new procedure is the button/plasma TURP which works similar to a GLEP, but instead of using the heat from a laser to enucleate (vaporize) the prostate tissue, it uses heat from a hot plasma stream applied to a button-shaped surface, which then vaporizes the tissue. Both GLEP and button/plasma TURP seal the wound as they remove tissue so they have a lower morbidity.

    .

    Absolutely don't do an old monopolar TURP in 2019. Would you buy a car with a carburetor and not EFI in 2019? I am not bringing up electric cars here...

    .

    Steve

    Report / Delete Reply
  • Posted

    Hi Tanak,

    You might also consider the possibility of a PAE or an FLA.

    PAE is the least intrusive in my opinion, quick procedure, little to no bleeding, no catheter and very rare for any complications ie ED, RE, incontinence etc. If you have a large prostate and NO median lobe, and a blood vessel architecture that allows them to do both sides it would be my first choice. It is often covered by insurance.

    If the prostate is large and regardless if you have a median lobe you could opt for an FLA. It is less invasive than a turp or greenlight in my opinion, with much less bleeding. You do get a catheter for about a week. Results come quickly and it appears that in most cases there is almost no evidence of ED and very little (ie 15% or less) with RE or incontinence. Bear in mind turp has perhaps a 90% chance of RE. The jury is out on how long the benefits last with FLA as it is newer. Also insurance may not cover it.

    Note - I had a PAE which helped for about 20 months then relapsed... and had a FLA in June with so far great results. Strong flow and everything works. Time will tell how long it lasts...

    My father had the "newer" button plasma turp and had severe bleeding. It helped but after 2 years he had to do it again and also had severe bleeding. The Uro told him he might have to come back for a third time! Each one was 4-5 months to recover.

    I also explored Resume but was concerned after reading post operative reports on this forum. However more recently there seem to be some positive reports so may be worth looking into.

    I would suggest that the younger you are the better off you will be if you can do PAE/FLA or Resume. If you have to go for a greenlight and if no choice go for a turp.

    Keep in mind many Urologists will only talk about procedures they can do ie greenlight, turp or resume. You may have to look farther to get the best answer for you.

    Also would suggest that you have a flow test and get a 3T MRI image of your prostate. The 3T will help you see if you are a candidate for either FLA or PAE by an interventional radiologist. It will also show if you have a large median lobe. It can also see many (but not all) potential cancer spots.

    Keep reading and educate yourself many people here will try to help.

    Report / Delete Reply
    • Posted

      "My father had the "newer" button plasma turp and had severe bleeding. It helped but after 2 years he had to do it again and also had severe bleeding. The Uro told him he might have to come back for a third time! Each one was 4-5 months to recover."

      Sorry to hear about this. Very unusual. A plasma buttom TURP cauterizes the bleeding so there is usually very little post op bleeding. I had a bipolar TURP and was out of the hospital in 4.5 hours. I had a catheter in for 3 days with the urine pink and a minor amount of bleeding. After the catheter came out, no bleeding. Recovery was fast. I began to exercise gradually after a week and after several weeks was back to where I was before the operation. I just can't imagine why it took 4-5 months to recover. This is completely different than my experience.

      Report / Delete Reply
  • Posted

    My Uro (in the UK) told me that GL laser is like a scattergun and that Holep is much better because it is targeted. He also recommended I have a TURP rather than Holep as he doesn't need to take much off and reckoned he could do it better with the hot TURP loop than with Holep; he said something like it was difficult to get the plains using Holep on a small prostate.

    Report / Delete Reply

Join this discussion or start a new one?

New discussion Reply

Report or request deletion

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up