Turp and Greenlight laser

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.

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.

This NICE link may get through

https://www.nice.org.uk/news/article/thousands-of-men-with-enlarged-prostates-could-be-helped-by-new-nice-guidance-on-laser-device

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 ?

Hi Tanak - also with Turp you need general anesthesia with the associated risks and you do not need it for PAE/FLA/Resume. Not sure about greenlight maybe someone else can comment.

I agree 100% with Steve. Rezum is the best first line treatment. If that isn't available where you live, Greenlight wins hands down OVER TURP

"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.

Go elsewhere. GL is very precise as is Holep. Does he actually have the equipment to do them ?

Was this a private urologist or NHS ?

Read my NICE link above.