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Turp operation or laser ?or leave alone?

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graham30431
graham30431

Hello there I am 59 years old, I have been diagnosed with bph for several. Years now , psa ok around 2.5 checked every year, symptoms getting worse, peeing several times during the night , also severe retention if leave it too long when need to go .do not leak! (Yet) and would appreciate feedback from others who have had the procedure ( good and bad) The alfuziin 10 mg tablets seem to make little difference, and wondering whether to go ahead or carry on.

6 likes, 975 replies

975 Replies

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  • surfman012
    surfman012 graham30431

    Posted

    Hi there, i have just had the "standard"  turp op! i chose that over the green-light ,based on my local hospital record. My surgeon was now in his 2nd thousand turp ops!! I have to say the British NHS system was fantastic, the op was ok, and 9 weeks later i am back on my bike (ex pro racer,67yrs old) doing 50 -70km`s 2/3 times a week . until the 6th week i still had discomfort after a pee and resorted to occasional  paracetamol al nights!! After initial  10days there was no more discolour or bits in my urine, but discomfort during and after peeing.....so fast forward 8 weeks and all would appear good..  I am gradually recovering to my usuall regime of eating and drinking... No beer , spirits , liquors etc , only occasional red wine! back drinking tea and instant coffee( not real coffee) trying to keep caffeine under control!..I am fairly shure that my original pee symptoms(2/3 times a night) started after my hernia op 10 yrs ago!! brought to a head by a UTI last July! Now once a night at most, so feeling much more like it !  downside is lack of strong ejaculation( but hey less mess!!) if at all! But the feelings are all ok and as before...... I would recommend a visit to Dr asap and start the ball rolling. There are a variety of op`s to research, but they all do the same thing, with the resultant discomfort for a period of time !! hope this helps. regards Syd
    • Jezzaman
      Jezzaman surfman012

      Posted

      Hi

      What was the main thing that put you off Green Light?

      from my research it seems the better option; bloodless, less invasive, quicker recovery period, slightly lower risk of RE.

      I am booked for GL on 6th October,

      regards

      Jeremy

    • kenneth1955
      kenneth1955 Jezzaman

      Posted

      GL is around the same but instead of cutting the prostate they burn it away less blood but same side effects  Good Luck  Ken 
  • gan17488
    gan17488 graham30431

    Posted

    Hello from California.  I am now 65 and have the same conditions that you described since I was 50. I have regular check-ups, have a biopsy to verify it was not prostate cancer, took medication to slow prostate growth, and done a lot of research on prostate surgery including this site. Finally I decided to go with the bipolar turp 3 months ago. Based on the results, I concluded that I should have the turp done 10 years ago...I have wasted 10 years of good life. What I found on sites like this is that there were more postings from people that have issues than those people with good results. I believe that this bias may have prevented me from making the right decision to have or not to have turp years ago. In my opinion, the final decision should based on the 3 following criteria...(1) your health and life style as to whether you want to continue with the current condition or to take a chance on prostate surgery which may improve your life style...there is always a risk in every thing we do; (2) your surgeon's skill as well as how he/she care for your oevrall health...it is just as important to have a doctor who care for your overall health and not just the prostate; and (3) the type of procedure you choose...Holep prostate surgery appears to be the preferred procedure today, but in Southern California, there are only a few surgeons who perform this procedure. Rather than spend exhorbant amount of money in travel (trips to consult various doctors, then perform the surgery, hotel cost, etc.), I opted for the best available procedure and doctor in my area. Now back to my experience on the bipolar turp. According to my surgeon (a female doctor by the way and she was an excellent and caring doctor), about 80 gram was removed. I did not feel any pain from surgery, except for the 4 hours of discomfort due to the catheter. There was bleeding for 10 days, but again no pain. (Take laxatives the day before and for 2 to 3 days after the surgery because you don't want to stress the prostate after surgery). I was able to do my regular daily 4-mile walk at 3 weeks after my surgery.  My IPSS score went from around 25 before the surgery down to around 2 at present. Maybe I luck out...or maybe this is the norm because many patients with successful surgery did not post their experiences.

     

    • surfman012
      surfman012 gan17488

      Posted

      Ye you are crrrect, ther are something like 10% of ops that do not end up successful !! mine was like yours perfectly ok, and now 9 weeks after op am back on bike cycling 70+kma 3x week...... I have overdone it once or twice..and knew about it next day, but, even that is getting less. However these forum site do provide a useful vehicle for successful and unsuccessful  op patients  to form a routine or procedeure for future planning, a pity more  satisfied patients of all types of op procedeures don`t join in these discussions, it wopuld help a lot !!  regards to all, Syd
    • bob120
      bob120 surfman012

      Posted

      10 % sounds like good odds until you realize there have probably been more than a million of these procedures done, leaving more than 100,000 men with complications. If 10% of customers at McDonalds got sick (I'm sure they sell millions of meals) would you eat there hoping to be one of the 90%? And 1 out of 10 is just a little bit better odds than Russian Roulette, and say the gun was aimed at your leg instead of your head to make it fair. Would you play?

      I'm happy for the 90% but having been one of the 10% I would say I wouldn't have a turp type procedure unless I had full retention (which I did) and /or a high PVR above 250ml (which I also did). At that point your only two choices are an operation and cathing yourself every 6 hours. Doing it to reduce your nightly triips by one or two doesn't seem justified to me, even if it works out.

      Bob

    • surfman012
      surfman012 bob120

      Posted

      Hi Bob, what you say  is perfectly fair and sound. I would try and justify the 10% by  saying that not all persons who undergo any prostate op,should have gone that route! for sure there will be surgery procedeure  failing by the  the surgery team( very small amount)  i do feel from some of the forum(s) on prostate procedeure that, not all of the op`s were the correct way to go...Wrong info given, free operations (various contries national health systems ??) there is a desire to keep the number`s up!! peer pressure!! For me 1 in 10 is good odds. I was in Viet-Nam for 2 tours 1967-1970....so those odds on getting back to normal were "no contest"   on the overall scheme of things....! like Gan said operations are not for all and lifestyle etc etc must be taken in to account!! As for McDonalds,would you believe i`ve never eaten there...and you are right,i would be nervous of the ingredients!!!! i hear what you say about the reduction in nightly trips to wc, but i am mighty glad i`m back to 1 a night and  no after effects. I appreciate that to be in the 10% is not good , and, i hope there is some light at the end of the tunnel one way or the other for all sufferers, good wishes to you, regards Syd
    • bob120
      bob120 surfman012

      Posted

      Hi Syd,

      I'm very glad you had good results on your procedure. I'm guessing the vast majority of surgeons are more than competent to perform the procedure. My own theory is that the 10% group of problem outcomes like me is to a large extent due to the peculiararities of their own anatomy. 

      Unfortunately that is basically unknowable in advance so we throw the dice and hope to come up a winner. I've seen lots of posts by people who are very happy with outcomes, some by people who are miserable, and some by those like me who had no choice about having a procedure, and so have improved from where they were, but much less than what was expected or promised. I'm recuperating from my fourth prostate surgery in 3 years, and am glad to be alive. My main problem is hematuria, or a prostate that has periodically bled spontaneously for no reason, starting a year after my inital bph GL turp. That's the only reason I'd be cautious aboout recommending this procedure to anyone who didn't have to have it done. 

      Regards,

      Bob

    • surfman012
      surfman012 bob120

      Posted

      Hi bob, again i agree with you, i am not sure i would recommend the gl turp procedeure to anyone who asked me!! I think i would suggest more rigorous research and questionning into other procedeures? Although i seem to be recovering ok, i would not fancy a return trip in the near future, and like Gan ,lots more info on sites dealing with all procedeures from the people doing them. Not just from us sufferers. I was not offered any other type of op nor was it discussed !!!it was >>well "this is what we`ve got !!" I could only ask the relevant quetions >> how many ops have you done  (500).......... % success(97%)......how do you think i will  react to op >>>>>well you are very fit for age (67)......your recovery will be quick (????!!!) so " should be ok for you"...So off i went...(and it was local to me 9 miles) I really am not sure about any of that now, but am optimistic...BUT there it is?? again best wishes to all. Syd
    • Casper2015
      Casper2015 bob120

      Posted

      Hi Bob, I like your approach - I can highly recommend a solution where you always can return to your starting point. I am thinking of a reversible stent called the Memokath. It is easy to place and if needed easy to remove and the procedure can be donein an outpatient clinic. Memokath's side effect are rare and if thet occur they are not serious side effects and you can always return to your starting point. This should be considered as one of the first treatment methods but the challenge is that the doctors intend to use the surgery "waepon" instead of uising small minimal invasive treatments because they are too simple. But nevertheless more and more doctors are changing their mind-set and start to think of safety-QoL-minimize costs. 
    • Casper2015
      Casper2015 gan17488

      Posted

      Hi Graham, nice you had a successful TURP - The reason why you were not able to have a minimal invasive procedure is due to the fact that some procedures are still not yet approved in US (FDA). Eg. the risk by having a TURP is existing and yes not a huge risk, but if things goes wrong then they really go wrong and then you could have end up by wearing a diaper rest of your life...:-( So I would always go for a minimal procedure EG. Memokath where the risks are minimal in terms of side effects and if this for some reason is not working then I would go for the TURP. But still, happy for you it went well but I am still sad to know that we are talking about millions of men who are now either impotent or incontinence due to a TURP - World Wide
    • kenneth1955
      kenneth1955 Casper2015

      Posted

      That is true. Men now a day need to get as much information they can before they have anything cut, Graham was lucky but who know down the line if anything will happy I just read a post about a guy that had 5 procedure after the the turp because of bleeding. Thats not a good thing. Good luck to all Ken
    • Jezzaman
      Jezzaman bob120

      Posted

      Hi Bob

      I am having GL in 3 weeks so am wondering what went wrong with yours. WHat does your doc think?

      regards

       

    • bob120
      bob120 Jezzaman

      Posted

      Hi Jazzman,

      My uroligist did two GL's on me and a turp. My prostate was probably enormous. Although he said it was about 120g at the start I think it must have been more, maybe 150g. or more. Included was about a 40g. median lobe (larger than a normal prostate) protruding into the bladder. So my problems were probably due in large part to the size of the prostate and median lobe.

      My bph procedures started in 2010 when I experienced complete retention and rushed to the ER. I was put on flomax (actually the generic tamsulosin) for several months but agreed to a TUMT procedure in the spring of 2011 (Trans urethal microwave therapy) where a probe heats your prostate to make it crispy and slough off some tissue, to make a bigger opening. That procedure is out of favor now because it rarely ever worked. Even the tech who administered it told me it probably wouldn't work and I would need a greenlight laser within a year).

      A little more than a year later, in mid 2012, I agreed to a Greenlight laser and my urologist brought two tips and said he used both of them up during a 70 minute procedure to remove 70g. of the prostate, however he never got to the median lobe. 

      By the end of 2012 I had a problem and a cystoscope found a prtion of my prostate had grown over with tissue, which my urologist removed with the cystocope cutting tool. He gave me the choice of anothe GL or self cathing once every 2 to 4 weeks to "keep the channel open". I agreed to the latter. And self cathed about once a month for a full year. Every time I cathed a little bit of blood and a ball of tissue came out, so I gues I was in fact keeping the channel open.

      A year later t the end of 2013 I experienced gross hemturia of fresh, thick, coagulating blood that clotted up my bladder and prostate within minutes. I was admitted to the hospital and was on a 3 way irrigating cath for three days, but the bleeding didn't stop. I passed out on the fourth day due to blodd loss. No one had chgecked my hemoglobin which had dropped from 16 when I was admitted to under 6. I was transfusions of  whole blood (8 pints total before and after surgery) and scheduled for surgery the following day.  My urologist performed a GL laser to cauterize and remove additional tissue, removed bladder stones, and resectioned (widened) the bladder mouth with the laser, and removed a little of the median lobe. My urologist said I had three bleeders on my bladder mouth and prostate and couldn't tell me why they had bled, except that the GL may have weakened some veins that had been sealed during the procedures. 

      All seemed well until 15 months later in the spring of 2015 when the hematuria returned. I was again put on the irrigating cath for 3 days and scheduled for surgery when the bleeding didn't stop. This time my urologist was unable to secure a GL laser machine so he performed the traditional turp. A week after returning home the hematuria returned and I returned to the hospital where I was scheduled for additional surgery to cauterize the bleeding and remove all the clots that filled my bladder. My urologist was out of the country so the house urologist operated on me.

      A week after I returned home I was still urinating a very bloody urine into my foley cath (though not clotting)  and was scheduled for another surgery on Monday with my own urologist, but on Sunday night I stopped bleeding. I had received 6 pints of blood during and after both procedures to bring my hemoglobin count up to 8. It's been 5 months since my procedures in April and so far I am OK.

      Having experienced 2 GL's and a turp I have to say the recovery was better with the turp. Also with the turp I was finally able to get my tissue tested and no malignancy was found. For me the two GL's were followed by a couple of months of peeing blood and eye-popping pain at the end of urination. The aftermath of the turp was much less painful. One strange thing that happened with the turp is that I gained an enormous anount of water (more than 40 lbs in 5 days). I don;t know if it was due to the turp or the fact I was told I was getting 1/2 liter per hour of IV fluids for 3 days. My urologist suspended the IV on the 4th day. When I got home I weighed 246 lbs. A week later I weighed 206.

      After the third surgery, my urologist says I now have a 40g. prostate including a 15g. median lobe that no longer protrudes into the bladder. However I plan to have an ultrasound during the next month or so prior to my 6 month checkup to verify this is the case. 

      One of my biggest fears about the turp was retro (which my urologist took care not to create with the GL's). However, unlike many other posters, I honestly found retro did not impact my sexual enjoyment at all. So that turned out to be a non-issue to me. 

      Based on my own experience I prefer the turp to the GL due to the much easier recovery and the ability to test the tissue.

       

    • lester90053
      lester90053 bob120

      Posted

      I have read many horror stories on these posts and yours is one of the

      worst. After almost a year of recovery from GL. it failed me after 3 and a half years. They now want me to do TURP. Since I am going on age 86, I have decided to stay on a Foley catheter for the rest of my life. My urologist changes it once a month after I remove it 9 hours prior to see if there is any improvement, Each month there seems to be a slight improvement, Has anyone ever experienced this after 6 months of retention?

    • jimjames
      jimjames lester90053

      Posted

      Hi Lester,

      Are you incontinent as well? if not, Instead of a Foley for the rest of your life, you might consider either CIC (Clean Intermittent Catherization) or a suprapubic catheter with a shut off valve. Either one will give you a much better lifestlye without having to have a catheter in your urethra 24/7. My preference would be for CIC, which I have been doing for 25 years now. But either one would allow you to empty your bladder any time you want as well as allowing you to naturally void whenever you want. This combination -- complete bladder emptying via catheterand naturally voiding -- in addition to a better lifestyle can potentially rehabilitate your bladder to some degree. In my case I went from close to a liter of retention down to 100cc or less much of the time. 

      Jim

    • jimjames
      jimjames

      Posted

      Correction -- that should be "2 1/2 years", not 25 years!
    • Jezzaman
      Jezzaman bob120

      Posted

      Hi Bob

      It sounds like hell on earth what you have been through and I really hope you are now stable.

      Interesting that your Uro mamanged to perform a GL and not cause RE.

      Does this mean it can always be done? In which case Id like to find ourt how he did it so he can tell my URO; as I am scheduled for GL in 3 weeks and dont want RE; I may still want to have another kid, and in any case am just not liking the idea of it, 

      regards

      Jeremy

    • bob120
      bob120 lester90053

      Posted

      Well it's been a whirlwind. I certainly expected it to go well, but luckily I at least survived. I don't think being under anesthesia 4 times in 3-1/2 years has been good for me, but at 69 I don't want it to become a regular habit. I told my urologist if I have another unexplained hematuria incident, I just want my prostate removed with a simple prostatectomy.

      When I was in the hospital in 2013 an older fellow in the bed next to me had had a foley for a couple of years and was getting a GL. He was in a lot of pain and couldn't urinate after they removed the foley and said he'd wished he ahad just kept the foley, having become used to it.

      I have an inlaw who is 74 who has been using the CIC (self catheterization) 3 to 4 times a day for several years now. He had a turp, but it only lasted a few years, so he went to CIC.

      I'm not sure I'd want a permanent suprapubic cath, due to possible problems at the stoma site where the tube enters the body.

      Another possibility that some people use is to have the foley cath with a clamp at the end instead of the bag. The clamp is opened to urinate into the bowl whenever desired.

      Another possibility is the new type of stent mentioned in some of the posts above, the reversible Memokath stent. Since it's only an in office procedure without anesthetic to place or remove it, it may be a good option. In my case, I haven't had any retention in the past year and a half. My problem was the unexplained bleeding of the prostate that clotted and closed me up.

      Good luck, whatever you choose. 

      Bob

    • bob120
      bob120 jimjames

      Posted

      Hi Jim,

      When I was self cathing after my first GL and removal of tissue with the cystocope, I could never understand the variations in my PVR (post void residual urine). Sometimes it would be 25cc, sometimes 125cc, amd smetime 250cc. The same before my first GL. Sometimes I would be going great, other times it just an ounce at a time. Whatever caused my prostate to either tighten or relax was a complete mystery. 

      Bob

    • bob120
      bob120 Jezzaman

      Posted

      Hi Jeremy,

      My uro said he left a little shelf of tissue above the point where the ejaculatory duct epties into the prostatic urethra. This is in the portion of the prostatic urethra closer to the bladder. By leavig this shelf of tissue, the ejaculatory liquid is directed downwards towards the penis. Without the bit of tissue the ejaculatory fluid travels up into the bladder, which is what causes retro ejaculation. During the turp, this wasn't an option. But as I've said before, i was lucky in not feeling the absence of fluid during ejaculation.

      Bob

    • jimjames
      jimjames bob120

      Posted

      Hi Bob,

      I can only speculate but PVR and voiding volumes can fluctuate somewhat for different reasons. In your case some of that (especially your 1 ounce void) could have to do with your recent operation with the body still adjusting. 

      Currently my PVR varies from 30cc to 150cc after I naturally void anywhere between 100 and 300cc. My mean void is around 250cc, so rarely am I carrying more than 400cc in my bladder at any one time which is OK, especially since I'm close to emptying completely at least once during the day. 

      Jim

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