Turp operation or laser ?or leave alone?

HI Andy.......I'm sure others will pipe in too, especially SDPORTER who I've been communicating with and has been very helpful. I had my TURP on April 10th, exactly a month ago today. I had my catheter in for 4 days after the procedure, and after it was removed I was able to urinate with no problem except for some discomfort. I was in the hospital overnight. I continue to have painful bladder spasms towards the end of emptying along with some shooting sharp pains in the uretha. I am on percoset for pain and an anti-spasmatic to reduce the  bladder spasms. I also developed a bacteria infection from the catheter most likely and was on a strong antibiotic for another week. I had blood in my urine for about 10 days but haven't seen anything since. What I'm reading is for many of us, it's going to take 8-12 weeks before you'll really turn the corner and notice some real improvement. Some poeple are back to normal quickly, and others it take a lot longer. Much of this depends on your surgeons skill and the size of the prostate (and how much was removed). By the way, I'm 58 and in good health generally. Lastly, I've been taking a laxitive (Natural fiber) and it helps alot with bowel movements.........

Hi Bart (and a lot of other BPH sufferers who will read this). I've bared my soul on BPH threads for the last three weeks or so, hoping to stimulate enough replies about the Urolift procedure to encourage me to go ahead with it. I've now heard from three patients who have had Urolift in the last month or so. All reports are very positive, BPH symptoms are mostly over in a week or so and they are very glad to be pioneering a new procedure that has great promise to replace TURP and Green Light Laser except in unusual circumstances. I have decided to go ahead with the procedure as soon as possible maybe this month, or June for sure. I've found a Dr who has performed Urolift about twelve times and that should be plenty of experience considering that it is a simple routine of just compressing and stitching the prostate lobes back out of the way via a newly developed little device inserted thru the urethra along with a scope to see the way. This provides a free flow of urine. All these devices in my urethra is not a pleasant thought but it is supposed to be over in 15 minutes, probably no catheter, little blood and you go home at the latest the next morning. Possibly the same day.  I'm scheduled for the cystoscope exam tomorrow to determine if my prostate is small enough (less than 80 or 100?) grams and has only two lobes, as a third one (rare) would just fill in the urethra and block flow. Either of these conditions will eliminate Urolift as a possibility and I'm back to square one with TURP the only real option.

My concentration now, since I have decided to go ahead with Urolift, is to see how to pay for it. It is supposedly covered by Medicare but I haven't been able to find a Dr who accepts Medicare for the procedure. There's some question as to whether Medicare is covering the procedure yet but I have been assured that it is. May have to pay out of pocket then ask for reimbursement by Medicare later.  I'm hoping for the best outcome and expecting that as well as my urologist is well-recognized as a leader in the field and a pioneer in Urolift.

By the way, I'm 75, in excellent health which I have pursued strenuously with proper diet, good habits, hard exercise in the gym, weight control etc. My heart rate, blood pressure, chlolesterol level, blood suger, body mass index, you name it are better than the average 40 year old American and that's sad but true. But I've had BPH for 35 years or so with increasing difficulty. and I'm getting to the point where meds don't solve the problem and I've had them all. It's time to take a more serious step. I've avoided TURP like the plague and I am wonderfully relieved to discover Urolift a month or so ago. I will report here as to whether I am a candidate as to be determined tomorrow. Then I'll report the results of the actual procedure when it has been performed. Hopefully, other Urolift patients will chime in. I hope and anticipate that my information here will be helpful to thousands (millions?) of BPH sufferers worldwide. 80% of American males will eventually have BPH. Fortunately, medical innovation in the US still leads the world. Maybe this will continue. I try to be optimistic

I will advise, thanks for all of your input. Growing to an age usually considered "old" is not for the weak of heart but it can be managed to some extent. I feel strongly that information disseminated on the intenet via forums like this can be a tremendous aid to all of us and i intend to do my part!     

Ron, just for comparison, I thought I'd list the cost and out-of-pockets expenses for my recent turp surgery........I have decent Blue Cross/Blue Shield HMO insurance in the U.S.

Anesthesioloists (2 of them)  Insurance Billed $2,000  My cost:  $80

Surgeon                                Insurance Billed $2,500  My cost   $40

Hospital    (1 night)                Insurance Billed $3,900  My cost   $150

  

I would say that's pretty good private insurance. My wife and I pay about $500 per month total for our Medicare and supplement.and it normally covers every penny of standard costs. I recently had cataract surgery on both eyes and 100% covered, same with wife last year. I had a sinoplasty last year and 100% covered. Wife is currently undergoing varicose vein procedures and everything is covered until it becomes just cosmetics. I'm sure Medicare would cover 100% of TURP as well. And I am sure that Urolift will eventually be covered as well at 100%.  The only quote I have received is a flat $2500 for the urolift procedure including anesthesiologists with no hospital stay necessary. That's what I will pay out of pocket and hope to get Medicare and my supp provider to reimburse me. The Doctor's office will pursue it for me.  Your example tells me that I should be reimbursed completely and that's good to know. I'll find out tomorrow if I'm doing Urolift or TURP, one is $2500 and the other free. I'll gladly pay the $2500 even if I am not reimbursed. 

I'm curious, had you not heard of the Urolift procedure? It has been approved by the FDA since last September but private insurance companies are just now getting on board and some Urologists are unaware of it.

It's funny, my urologist initially was talking about a "laser" procedure for me, but not sure exactly which one. His decision, I think, may have had to do with the size of my prostate, which was large, if I'm not mistaken. I like my urologist, and trust him as I've ben seeing him for 13+ years (he's in his 40's). I've done a lot of research but know little about the Urolift procedure. TURP remains to be the "gold" standard of prostate surgery, and the one all other are compared to. It's been shown to have the fewest long term effects down the road I believe. I know my surgeon used to do many of these each month (like 25+) until med's like Uroxatrol were developed. Now he does 1-2 a month. The two biggest problems I see with the Urolift is 1) surgeon hasn't done a lot of the procedures (12 is not a lot at all) and 2) since it's newer, you don't have a history of the long term issues with it.

True, TURP is the "gold Standard" and has been for some time. I've read that some Dr's use Green Light laser instead and the Doc on Fox News touted the laser as the best procedure. I think the method of both procedures have the same results they just use a different cutting tool to cut a path thru the prostate in order to allow urine flow. Both methods cauterize the cut-away area to minimize blood loss, enhance healing  and keep a clear work area so the surgeon can do his job. The procedure is effective usually  for at least ten years and in most cases complete recovery takes no more than 60-90 days and upon recovery the patient is very glad that he had the surgery done.

My problem with TURP or Laser is that very serious and permanent side-effects can and do sometimes occur and I won't go into them all here as that information is available everywhere but suffice it to say that permanent ED and other sexual effects are known possible side effects as well as dry ejaculation and continuation of the BPH symptoms as well, with continued use of medications that we intended to eliminate by having the procedure done.

There's no doubt that I will do the TURP if I have no choice. For 15 years or so my choice has been medications which are not without side effects of their own. I have fought a daily battle to maintain some sort of normal life while submitting to the abuses of the meds for about 15 years and I've come to the end of it.

Currently I am taking Jalyn nightly which is a combination of two BPH drugs that attack the symptoms differently. I also take two Motrin PM, a sleep aid,  every night to make me sleep deeper and avoid the little urges to urinate that tell you to get up and get it done several times at night. With Jalyn and the sleep aid i typically get up only once and sleep like a baby.for 7-8 hours. All of this is not without trade-offs. Both portions of Jalyn work to destroy your libido and sexual ability. To counter that I take Cialis and give myself testosterone shots to try to maintain normalcy.  Cialis for daily use has been discovered to help with BPH symptoms. I just cut my pills in half and take one daily. It does help.u

As for urolift, it has been proven to be effective for two years with the results as good at the end of an extensive two-year study as at the beginning. Certainly indicating that it will be beneficial for much more than two years. Time will tell. As far as experienced surgeons, I don't know of any that have done more than maybe 25. On the other hand, I have corresponded with patients who were the 2nd and 4th with their docs and the results are excellent. My long-term urologist offered to do it for me with no experience at all. I considered it seriously but decided that a surgeon must have some experience. I was probably wrong when you consider how many hundreds of times he has peered at a prostate thru a cystoscope performing TURP, a procedure that must require much more skill and knowledge than Urolift.  I know that most of the skill in TURP is not in opening up a path for urine. That's the easy part. Where the skill lies is in doing this without destroying nerves and structures that one must have in operation to live a normal life.

As far as side-effects with urolift, mostly there aren't any. The nerves affecting erections, bladder and sphincter are not touched. There is no incidence of dry ejaculation at all. There will be minor pain and minimal bleeding, some swelling slowing the urine flow, all of which go away in an average of nine days.

At any rate I will know tomorrow if I'm a candidate for Urolift and if so, I will have it done as soon as I possibly can. I would like to get back to a normal life. Actually, I want to get back to a better life than almost a 76 year old has a right to expect. 

Wow.....it's obvious you've done your homework. It does appear that the Urolift procedure has numerous benefits. Please let us know what you decide and keep us posted.

I did forget to mention 2 things: 1) My wife and I had intercourse a few days ago. We didn't mean for it to happen but we just got carried away. I got my normal erection and had a "dry" orgasm, which felt mostly normal. EXCEPT for the pain afterwards. It took 10-15 minutes for my prostate to calm down and the next few days I was more irratated then normal. I'm going to wait another month before attempting again (it happened 26 days after the surgery) and 2) I'm finding motrin/advil is much more effective in controlling my pain and discomfort than the Percosets. After a day or two taking 4 of them every 6 hours, I'm peeing without the pain and spasms (almost). Taking both would probably make your day happy!

This might be helpful for others who aren't getting the relief they hoped for.

Sounds like you are tracking right along on schedule. Meds have given me the dry orgasm for the last couple of years. You learn to live with it. I don't know for sure if I'll return to wet ones after urolift but I'm hoping. You know what they say, use it or lose it.

I've taken a lot of Motrin for sacroiliac pain and I'm usually able to take 16 or so daily for maybe three days then I get heartburn which tells me to slack off. By then the sacro attack is about over so all is well. 

 I take two regular motrin every night and two motrin pm at the same time. I'm pretty much dependent on the pm now and once I've licked the BPH problem I'll have to get non-addicted to the pm. 

I'll predict that you will continue to improve as TURP patients usually do and a month or so from now you'll be a new man. Wishing the best for you. I'll reply after the scoping tomorrow. 

Well, the news is not good, I'm not a candidate for urolift at all. My prostate is too large and I have the dreaded third lobe of the prostate as well. Either condition would eliminate urolift as an option.  I have them both - wonderful. Turns out that the "rare" third lobe is just unusual not rare. 

So, if I am to have a procedure of some sort it will have to be TURP or green light laser. Very depressing, indeed. I'm probably the most knowledgeable former urolift prospect in the country. A prostate with a third lobe or larger than 85-90 grams, depending on the surgeon will probably eliminate you as it did me. But have the ultrasound to determine size and a cystoscope procedure to look for a third lobe or possibly other problems that only a surgeon can tell. I had them both today, both were a bit painful but not too bad. If you qualify for urolift I say go for it. I would in a heartbeat if I could. 

My problem is probably because I had prostate difficulty for at least 35 years and it has been growing all that time.  

Well, now I'll do the same study with TURP and green light laser , I suppose, trying to decide if the danger is worth it.

Oh well, if anyone wants to know about urolift my posts contain a lot of valuable info and I will be glad to help. I know an excellent urolift urologist, the one I saw today, that I will recommend without qualification. I also know anothe urologist who has not done the urolift procedure but is an excellent urologist never the less. If I can help in some way let me know.  

I'm going to get back on these forums looking for help in determining if  there is anything I need to know about these more invasive procedures that I should know.

But as for now, I'm too depressed about this turnabout in expectations and planning that I'm not going to think about it for awhile. I'm just really down right now.      

Hi Ron,

As I told my wife today, you never know whether something is good or bad until after the fact. Sometimes something that looks like a bad thing can turn out for the best and vice versa. I've been mired in this prostate drama for more than 3 years. Had several procedures and have read thousands of posts. Can say that I learned that not everyone who gets a procedure gets the outcome they hoped for, though most wind up better than when they started. Most procedures look good in the short term, few last for more than a few years. I can say that what I wound up with was an improvement over where I started which was very painful incidents of full retention, but after all that medical science could do for me, still have to urinate every 2 to 3 hours around the clock. When I read of peope whose only complaint is getting up twice a night I wish that was me.

Well, sorry to hear the news- I'm sure you're disappointed, but you'll do what needs to be done, and be better off in the long run. 

And for Bob120 below........peeing every 2-3 hours isn't that bad really. As you age, your bladder loses it's elasticity anyway, and you pee more because of it. If my stream is strong and I'm able to empty better and I'm not up peeing 4X a night- peeing every few hours sounds fine.

Bart,

4x a night is the norm for me lately. I find a disposable bedside urinal lets me void in the dark and get right back to sleep. 

Thanks, I appreciate your replies. I've never had full retention. I can only imagine how bad that must be. My sympathy goes out to you. Maybe I need to quit complaining. I'm just so afraid of losing sexual ability. (I know - younger people including medical professionals wonder why you're worried about sex anyway at my age). I don't care what they think, I'm going to live as normal a life as I always have as long as I can.   

Well, I'm going to sit down with my urologist ASAP, he's done hundreds of Turps, and we're going to to talk about the odds of coming out worse than at present. What are the chances that I wear a bag for the rest of my life or can't get an erection, etc? 

At best I know I'll have months to recover. We go Jeeping with the kids and Grandkids in Colorado every summer. Those trails are brutal, How long before I can take the jostling? Can I drive 1100 miles to get there? We also take the trails around Ouray on foot for miles. Can I do that after a month ot two months or three? I could wait until fall but last year it was becoming embarrassing how often I had to get behind a tree.

I'll see what my Doc says next month. He's a good one, I think he'll steer me right. 

   

Hey! look at the bright side, there may be a silver lining in every cloud, including prostate surgery ....... It's covered by Medicare without question. So, I'll just have to think about where I'm going to spend that $2500. Maybe I'll buy 115 American Silver Eagles. That would make me feel a lot better. 

Hey Bob......so, just to make sure I'm understanding you- what surgeries have you had exactly and how long ago????? And you're still up 4x a night to pee? 

Hi Bart.   Did you bleed after sex?   I had a similar situation where I 'tried the system' almost one month after the procedure. And fresh bleeding in my urine happened.   It is now almost a week after it and the I still have fresh bleeding.  I felt sore after it but it is only happened for a while.  Doctor told me not to worry. But it is quite concerning.  Your thoughts please.  

Hi Bart,

Three years ago I started off with the microwave treatment known as a TUMT. Was supposed to last 5 years. Prior to the TUMT i was peeing just an ounce at a time, burning like crazy, then went into full retention a couple of times. The TUMT lasted 12 Months before I started going into full retention, even taken 2 flomax a day. Two years ago I had the XPS 180 watt greenlight laser. Was supposed to last 10 to 15 years. My uro used two laser tips and removed 70g. of tissue in 70 minutes. Told me I had had a 120g. prostate (the biggest he'd seen) and chronic prostatitis with impacted pockets of pus in the tissue he removed. (I had always tested negative for any sort of bacterial prostatitis.) Recovery was 8 weeks, a lot of urgency, frequency, bleeding, leaking and pain. Had a median lobe protruding into the bladder which he was not able to address with the laser, but it wasn't blocking the bladder mouth. Had 6 good months. 8 months after the GL laser, symptoms of restricted flow returned. Cystoscope found a 1-1/2cm membrane blocking my urethra near the start of the prostate which he removed. Suggested I self cath once a month to "keep the channel open", which I did for the next 8 months. When cathing I noted anywhere from 200ml to 50ml of post void residual, but the uro did not think that was an issue. 5 months ago I started bleeding sporadically for a couple of days. The night before my scheduled appointment with the uro I started hemmoraging thick blood that clotted almost immediately. Spent 7 days in hospital. The first 4 days I was put on a three way cath with a continual water flow to flush clots from my bladder. I must have been bleeding the whole time so my Hemoglobin dropped from 15 to 6 and I passed out. I was given 8 pints of whole blood and scheduled for surgery. My uro cauterized bleeders on my urethra, prostate and bladder neck, resectioned the bladder neck, and found and removed a bunch of bladder stones the size of bb's. After 7 days in hospital I was released with a foley cath for a week.  I presently take flomax just two days a week to keep things flowing, and to flush any stones that might be forming. Stream is decent but not a gusher like it was for a couple of months after the GL and after the bladder neck resection. I go every 2 -3 hours during the day. Being in bed at night seems to wake up my bladder so I go about 4 times a night. Usually after the first and second hour of sleep, then at the 5th and 7th hour. I sleep 8 hours a night. Using a disposable bedside 1 liter urinal at night by the bedside, I am used to waking up, standing next to the bed and voiding in the dark, resealing the cap, checking the urinal volume against the light of the led time display that the urinal isn't close to full, and going back to sleep all within a couple of minutes. On occasions where I need to empty the urinal it takes about 5 minutes more to get back to sleep. I am better off than I was, but I don't know for how long. Stopped looking for a cure when I got back from the last surgery and just learned to take it a day at a time and cope with it the best I can. There's people with lots worse issues. I tell myself I'm more than just a urine stream.

   

Hey Prost..........no, I had no bleeding BUT I was really sore for about 20 minutes after and felt the days after having sex i went backwards instead of forward. How long has it been before that had you seen any blood before that? I hadn't seen anything for over 2 weeks and knew it had basically healed enough. Some people, I've read, bleed for up to 3 weeks which I think is still pretty normal. Of course we're not talking ALOT of blood as the amounts (and clots) should taper off with time. I've read there at circumstances, when bleeding continues for too long, they have to go back in to cauterize an area again that didn't heal properly. Remember, bleeding is made worse by straining when going to the bathroom, lifting heavy stuff, coughing, etc......maybe you're doing too much too soon?

Also, my urologist happened to call me today as he was returning from a vacation and he felt I should continue with the Advil, as it's an anti-inflamitory, and it's really made a big difference with the spasms and discomfort I was feeling. Off the Percosets for good now....they weren't very effective. If you are still bleeding, DO NOT TAKE ADVIL, ASPIRIN, ETC AS THEY ARE BLOOD THINNERS AND will make things worse.

Wow.......you've been thru a lot. How many urologists have you seen during this time? If it was me, at this point, I'd be searching for the BEST urologist in the country. I'm curious......do you sleep on your stomach, side or back? I find when I sleep on my stomach, it puts pressure on the bladder and forces me up more at night. I've re-learned to sleep on my back instead lately. My urologist told me 95% of people improve with these surgeries while 5% just continue to have issues for one reason or another............ sometimes it's mental i.e. stress or anxiety, other have a lot of inflamation in their bodies, etc., etc.

It's almost 4 weeks now and I am still bleeding.  Urine is bloody still at the beginning of the urination.  It is starting to get less.  But I guess it is mostly because I resumed my normal oversease travel as well as sitting long hours in my office.  I also tend to strain during defication (particularly that I got severe constipation after the procedure).    

On another note, retrograde ejaculation felt VERY weird!!   Orgasm was flat and less intense. Probably the distension of the urethra with semen during ejaculation plays a role?   I guess I have to get used to it.  Any advice and hopefully reassurance is highly appreciated.   

Retrograde ejaculation reminds me of an old limerick from high school - a loong time ago ---

There was a young man from Kent,  

Whose dick was so long that it it bent,

To save all the trouble he put it in double

And instead of coming he went!! 

Jeez, you've really been thru the mill. I'm going to quit complaining. This is from your post "When cathing I noted anywhere from 200ml to 50ml of post void residual". How can you tell that? I've never used a cath, may be looking at it before long.   

Hi Bart,

I just have used the one urologist. I like him. He was able to keep me from getting retrograde ejaculation by leaving a small flap of tissue above the ejaculatory duct which basically directs the semen down instead of letting it go upward into the bladder. He has a good reputation and will work with me instead of dictating to me. He also accepts Medicare.  It's true that the majority of people are successful with any of the turp type procedures. But I read recently that several million peoplein the world, men and women, have varying degrees of urinary tract issues known collectively as LUTS, (frequency, urgency, trouble urinating, burning, bladder/pelvic/genital pain, etc.) with no identifiable cause and no successful treatment options. They just have to learn to live with it and have strategies (like my bedside urinal) to live as normal a life as possible.

I sleep on my side and generally switch sides several times a night. I tried many paths to improve my situation and the bottom line for me is I need to accept and adapt to whatever comes. There's many worse conditions than this and if this is as good as it gets I'll be quite satisfied, because it's been much worse. 

Hi Ron,

The one liter disposable bedside urinals I use at night have milimeter markings on the side. When I used to cath, I would double void before cathing and then cath into the urinal to capture and measure the amount that remained in my bladder after urinating (PVR or post void residual). When the PVR exceeds 300ml., most urologists will say it poses a danger of backflow of urine into the kidneys which can cause kidney damage. For me, the conditions that caused me to go ahead with the GL were retention and PVR. A by product was going small amounts very often.  I considered everything else to be annoying but not medically serious. As it turns out, these were the two things that were addressed by the GL  and the second surgery to resection the bladder neck and remove stones (the retention and the PVR). I think the odds that the GL will solve frequency issues in the absence of a significant PVR is questionable.

It doesn't work for everyone but I found that 2 or 3 tablespoons of cold pressed flax seed oil and a glass of water when I get up in the morning will help with constipation. I don't use it all the time, just a couple of days in a row when needed. Also I've taken to eating cereals like raisin bran for breakfast which also seems to keep things flowing.

Well, that's an excellent attitude. You clearly have learned everything you can about your condition in order to help your Doc manage your treatment.

That little flap is really going an extra step. If I have to do TURP and I suppose I will soon, I'll be sure to mention it to my Doc as well as  the 300ml rention causing kidney problems.  They've told me that I'm retaining but never how much. I'll ask next time. It's amazing what you learn in these forums. Speaking of catheters, the cystoscope routine yesterday must have bruised my urethra as it's still painful to go. I'm sure it's temporary but do you get the same thing from the cath?

Hi Ron,

Every time I had the cystoscope I wound up with a UTI. If you start urinating very often and it starts to burn, that's what it feels like. The caths I used where the one use hydrophillic caths that are packed in a sterile water foil pack and are self lubricating.I used the  "Coloplast Speedicath Male Straight Intermittent Catheter" which have a little handle on the end you can grab onto and thread the cath into the urethra. They didn't need any extra lube.  I didn't hurt from cathing but always got a drop or two of blood and a little tissue in the cath. It's quite tricky the first time but there are videos online of how to do it. The cath hits two points of resistence that you have to gently pressure through, the start of the prostate (the internal sphincter) and the end of the prostate/bladder mouth (the external sphincter). I found I needed the more rigid caths (size 14 Fr or higher) because the thinner 12FR would just double up inside me and not push through the points of resistence. I was quite surprised that the 14" cath went in nearly all the way to the hilt before urine came out. There's an incredible amount of plumbing in there.

There is an excellent product on the market called Konsyl, which is basically a high dose of fiber. I take it with a glass of water/juice each day. It keeps me very regular and it adds enough bulk to the movement that straining is rarely necessary. And, it great because it absorbs fat in your system too lowering cholesterol. 

Years ago the Dr. wanted me to learn to self cath to stop my midnight trips to the emergency room to empty. It was getting ridiculous there for a while. But what I thought was a prostate issue was really a bladder issue and certain foods (italian/citrus/soda/onions/peppers/spicey) were irrating my bladder so much that, with the enlarged prostate, urinating became impossible. I always thought cathing was painful and irrating, and infections were never far away.....

It can be a tricky combination of things. The first path urologists take is to work on the enlarged prostate with drugs and then surgery. But while it's a contributor it sometimes isn't the whole problem. Bladder elascticity, bladder capacity, the extrnal sphincter (bladder mouth), prostatitis, stones, can all contribute. In my case all of them did and do.

Hi Ron,

I just had a URP  weeks ago.  I investigaed the Uroift and would hve one tht but I wa not a andidate as my medium lobe was causing the problem and the urolift doesn't correct that...or something like that.. me it seems like he perfect answer to BPH problems...I will tell you my surgery went very well..In the hospital one night..by day 3 I felt very good and went out for awile...drove after 4 days..found outlater tht I wasn't supposed to but I felt vey good...pee in urine and some leakage for about 9 days..went to a party 2 weeks post op...I did push it...wouldn't recommend that...peemuh better..up 2-3 times at night vs--5-8 times...I also lifted over 10 pounds (40)  which i did fe for a few days...all in all after 3 1/2 weeks I am very satisfied..hope things stay this way and get better..

That may be the best report I have heard. I'll bet you're right that the Dr has a lot to do with it. Looks like the third lobe  prostate is fairly common. The urolift procedure is perfect for those who qualify and I hope everyone checks it out. I'm beginning to feel a lot more confident hearing of TURP results like yours. Glad to hear of your recovery!!

I had the TURP 3 years ago and I dont understand the fact that so many websites and urologists are telling us that the Climax should be perfectly the same as I had the same experience as you. I just dont have a climax at all and after 3 years Im quite depressed. All the people who I know who had thie TURP are hating the dry climax yet urologists dont seem to know anything about anybody who is unhappy about it.  

RonTexan,

Just to give you some perspective and some hope, I'm 55 and have had BPH issues for a year (came on suddenly, literally overnight!) and have done a ton of research on UrolIft vs. button TURP (BVP) vs. Prostate Artery Embolization (PAE). I'm on Alfuzosin now and it works fairly well (would be better without caffeine) but I don't like the side-effects and really want to do something fairly permanent while my bladder is still in good shape. 

UroLift sounds good on paper but the effectiveness is not very good. Do some research on Qmax, IPSS and PVR among all three procedures. BVP is far superior than UroLift and PAE in all 3 categories. Also, the retreatment rate on UroLift is about 10X higher than BVP and it's only been around 2-3 years! It's for these reasons that I am just about ready to pull the trigger on BVP. I guess I'd rather have RE and be able to pee like a kid than have to do through this all over again in a few years when the UroLift "wears off".

Urolift:

Qmax: 8 mL/s (before), 12-13 mL/s (after)

IPSS: 26 (before), 16 (after)

BVP:

Qmax: 8 mL/s (before), 24 mL/s (after)

IPSS: 25 (before),  4-5 (after)

I guess this is why BVP is the new "gold standard". Every case is different but I'm hoping and praying that my normal-sized prostate, attending to this early, being in great shape (low fat vegan for 35 years, exercise 7 day/wk, very low lipids, BP, etc) and having a great surgeon will all help to make the surgery a success. My point with this post thouygh was to hopefully make you feel better about your own situation!

- Dave

Ron

I had the Urolift operation just over a year ago, I use to be up at least six times a night peeing some times going to sleep when on the toilet and ending up in a heap on the floor, I was very lucky as I was due to have the Turp operation but it was decided that as I was quite young they decided that I could have the urolift and if this failed I could go back and have the Turp.

the operation was conducted whilst I was awake it tool about 25 mins but the urine retention stopped staright away within a day I was back peeing like a sixteen year old again, I did have to have a catheter in for a day

after the operation I had to go in to my hospital to fill in loads of forms all questions about the operation and how I felt and how much it had inproved by life these were done after two weeks, one month, six months and a year.

One thing that did go wrong and I had to have surgery to correct was the one of the alluminum tyre wraps that pull the prostrate up against the wall of the bladder had punched through the bladder wall, and for some reason when I use to get dehydrared I would have issues with Haematuria "blood in my urine" I have got to go back in hospital shortly to get this corrected, but the operation was fantastic, and I would suggest to anyone who is concidering getting the operation dome in place of the Turp is a definete yes

Hello Ron--I am a fellow Texan and hoping your TURP was successful and without complication.  I feel I am on a similar journey in trying to avoid TURP...I have been researching less invasive procedures and, like you, was very excited to hear of the Urolift alternative. I have recently been "ORDERED" by my urologist that I must have the TURP--do these docs really think patients are going to be lead like lamps to the slaughter simply because they don't keep up on cutting edge medicine or simply don't

want to deal with informed patients who are actually interested in being

a partner in their healthcare?  Come on medical professionals---this is not the old days where docs were considered GODS and thier word sacrocanct...I am appalled by the treatment (or lack thereof) and total lack of compassion I have experienced with not only this a**hole doc, but the previous urologist as well who simply shoved cathaters at me and explained NOTHING!  My purpose here is not to bitch but to hopefully

take you up on your offer (of some months ago) to share your posts with info pertaining to the Urolift procedure and ESPECIALLY to get your recommendation of a urolift urologist.  I have been researching, but would always welcome more information and perspective.  Since the Urolift is still considered a new procedure, the only specialist in urolift that I have found within a reasonable distance from where I live in the panhandle is a doc in San Antonio at a clinic called the Urology and Prostate Institute....I have requested add'l information and pricing but have yet to hear back from them (though it's only been a few days).  Reading many of your posts was like deja-vu...I was so disappointed that you ended up not being a candidate for Urolift, and I truly hope your experience with TURP has been not too dreadful and that you have fully recovered without complication. I would love to hear that all went well and that my concerns about the TURP surgery are exaggerated.  I have had the cyctoscopy but

to date I have not been given the information about the size of my prostate or if I have the dreaded "third lobe"....I have simply been TOLD I will have the TURP....which is NOT going to happen with this guy, even if I find I have to end up with the TURP.  Anyway, I would appreciate your sharing the information you found about Urolift and the recommendations of urologists that have served you well...it's a sorry situation when one can't trust their medical providers to DO THIER JOB!!!! 

Many thanks and hope to hear you are a-ok!  best regards-Tim 

Hi Tim. Glad to hear from a fellow Texan. Actually, I have managed to avoid TURP or any other procedure so far. Jalyn is keeping me open enough to avoid too much retention but I have trouble holding my urine very long when I get the urge. This precludes any long driving or airline trips and I've just missed a trip to Colorado because I just can't be away from a bathroom very long.

The downside of Jalyn and all the other Meds is that it destroys your Testosterone production and eventually causes ED. That's where I am and at my age, 76, it may not come back, ever. And of course all of the meds have a period in which they are effective and when it ends there are no alternatives short of urolift, turp, laser or simply self-catheter about four times per day. Or wear a catheter with a bag on your leg. 

I heard about urolife early this year, studied everything available and concluded that it was for me. I saw my long-time Urologist about it and he had never heard of it. So, I found the closest one who has done this procedure and saw him a few months ago.

Google Dr. Naveen Kella

He is an American born of Indian heritage and I thoroughly enjoyed my meeting with him and his staff. Ultrasound and cystoscopy in his office determined that my prostate was too large for urolift (114 gms) and had the dreaded third lobe besides. So, he sent me back to my regular urologist, who advised me that my prostate was too large for TURP as well and sent me to another surgeon in his group for a more invasive procedure. That urologist recommended supra-pubic simple prostatectomy that is done by a large incision from the navel to just above the penis, and from there into the bladder and then through the bladder neck to core out the prostate from the inside. Really sounds simple!!

He stated that the bladder neck would be stretched out somewhat and I would have to wear a catheter (or two) until exercises can restore the strength of the bladder sphincter.  (In my opinion incontinence would surely result as I have a problem there already).  

Nope, not doing that if there is any alternative. So, in desperation I consulted again with Dr Kella. If you can believe it this Doctor answers inquiries by email!  He suggested that the third lobe could be removed by Turp or laser. He thought that would work and hopefully the absence of meds would allow my sex life to be restored in a few months. No guarantees of course. He also stated that if a problem with flow continues then a urolift procedure could be done as the third lobe is no longer a problem!

Let me tell you that the dreaded TURP or laser looks really minimal compared to the "simple" prostatectomy and I have lost all misgivings about doing it.

You have got to know several things; is there any cancer present, the size of your prostate, whether or not it has the third lobe, how much retention of urine or you maintaining. Too much can cause kidney damage but the amount varies widely by person. Does your bladder have any damage from too much retention. The Dr and his staff will determine these things painlessly while you watch on a screen and then will make his recommendation. Dr Kella is one or the foremost urologists in the robotic method and a pioneer in the urolift procedure. At the time I saw him a few months ago Medicare and insurance programs had not caught up with urolift and reimbusement for the cost was questionable. Turp of course is covered by any plan. 

You know, looking with lots of hindsight, my regular uro has been recommending turp or laser for at least seven or eight years but I had a dread I could not overcome. I took the meds instead, all of them without a proper investigation of their effect on your sex life. If I could push the reset button and go back ten years or so I would do the turp routine and never take the first BPH med as the loss of a vital part of my life has become very disappointing.

Again, with what I know now I would never take a single damn one of the BPH meds, period.  

I'll keep you posted, Tim. Our experiences related here can help thousands of BPH surrers who have few unbiased sources. One thing I have discovered about these forums is that there are many, many successes that are not related here. We tend to hear of the unsucessful outcomes.       

Emis Moderator comment: I have replaced the link with a suggested Google search rather than a specific website that is unsuitable for inclusion.

From my own experience, having had the Urolift back in January of this year, it is not a cure but an alleviation of symptoms to the point where you don't worry any more about BPH. At least for me, the flow is not what I had when I was sixteen like some of the TURP patients report, but strong enough to empty the bladder and give you the feeling of emptying which for me was absent for almost 15 years. For me the Urolift has relegated BPH to an after thought and has become basically a non-issue which is a dramatic change from my previous 15 years battling it. There were no side effects unlike those experienced by TURP patients. No catheter, no hospital stay, instant painless recovery, which is different than a lot of reports here. If you want a pain free recovery, no side effects and the physcological relief that comes from an alleviation of BPH symptoms then the Urolift is your best bet, IMHO.

Hi Ron,

I wonder if you know why a large median lobe is a diqualification for the Urolift?

I had a very large prostate (over 120G.). The last cat scan said it was 9cm x 8cm x10cm which would make it the size of a regualtion baseball. I also had a 2cm x3cm x4cm median lobe, probably thumb size protruding into my bladder and taking up about 20% of my lower bladder. My uro does not want to address the median lobe because he fears damaging my bladder in the process. As of yet, the lobe doesn't block the bladder opening. My uro used up 2 tips for the 180 watt GL XPS laser and removed 70 g. (more than half) of the tissue, probably leaving me about a 50-60g prostate, and pretty much left the median lobe alone. So my prostate size now qualifies but the median lobe doesn't. I just wondered if you knew why the median lobe precludes the urolift. It didn't prevent me from getting relief from the GL laser.  The only advantage I can see from the simple prostatectomy is that it wouldn't need repeating. My experience with the TUMT and GL is that in less than a year I needed additional procedures. I get the feeling my prostate is a leaky radiator being held together with duct tape and the life expectancy of the tape isn't very good.

Hope you get the relief you need .

Bob

P.S., I've had ED for 15 years and low T all that time (hovers in the 200-250 range).  I've found the cialis was only working about 25% of the time for intercourse. Finally decided to give up the frustration, anxiety and disappointment and just use other means of stimulation and satisfaction for myself and my wife. As long as we both "get there" sex is just as satisfying as it was when we were teenagers.

I had a TURP at the age of 49 and I had the best sex life before the operation and absolutely no enjoyable sex life after the TURP.I think that is much worse than  you who are now at the age of 76 and who at least sound as if you have a kind of a sex life. I have the worst and empty climax that you can get and for me there is just no sence to have sex without a climax..

As explained to me by the Uro who has done numerous urolift procedures, if the urethra is opened up by Turp or Gl or one of the roro-rooter procedures  the third lobe will simply drop down and fill the channel created. I believe this is the reason why he would remove the third lobe and see if that was a sufficient fix in itself.  If not he could then do a urolift to pull the remaining two lobes apart.  I'm arranging now to have this done. and I will advise.  

Here's the way I now see the turp, turn, tuvp, laser routines compared to the BPH meds. These procedures may create ED, low libido, continued problems with sexual function  or may not. The BPH meds will eventually shut your libido down, produce poor erections, etc etc. Take the meds long enough and you might as well be castrated.  That is the difference to me. It may be reversable depending on the individual patient. Looking back, I should have had turp or laser or whatever ten years or longer ago. It's a crap shoot, pure and simple and probably depends on the surgeons experience and skill more than anything.   

Wally, I would convince my uro that I need testosterone shots (1ml every two weeks in the thighs). I gave them to myself for a year or so and there is a real effect in libido increase.  I'm not doing it anymore for several different reasons but I may take it up again in the future. It's a minimal dosage and my testosterone level was in the lower normal range anyway but I got a sexual boost that I feel you may need more than I. See your Doc and demand it. A guy your age with a low sex drive is not normal. You have to do your part, though, you can't expect the testosterone to work if you are out of shape, general poor condition, diabetic, poor diet, not enough sleep, abusing alcohol or drugs, etc. Not implying that you are doing any of these but if you are then get your health together and the test will make a dramatic difference. You can be screwing yourself silly if you want to bad enough.

Best of luck, Wally. Report here with your progress. Whatever your problem may be there are thousands more like you and you may hear from some of them. That's the value of these forums.    

Thanks, Moderator. 

Ron, Thanks for the info. I'm going for a sonogram in a couple of weeks. My uro never said anything about the median lobe dropping down, but now I will look for it on the sonogram. In my case it might be a plus for it to disengage from the bladder wall. My uro is loathe to do any more surgery on me. So far in just three and a half years I've had a TUMT, a GL laser, a cold wire removal of scar tissue, the removal of bladder stones and resection of the bladder neck. Recently I am experiencing a decreased flow during the day and a slow start to urinating when I get up in the morning if I have been sleeping on my right side. For now I am upping my tamsulosin from 2x a week to 3x to see if it gets my flow back. After my hematurias in Dec. I have no desire to use a cath again. Not sure what will happen, but I guess I'll figure it out when I have to.

You say you are arranging to have the median lobe removed. Have you decided upon what type of procedure you will have to do that?

Good luck,

Bob 

RonTexan, I am a fellow Texan like you and live in The Woodlands, north of Houston. Have you considered a Button TURP? (Button Plasma Vaporization of the Prostate or BPVP). As Dave93021 said here, it is now considered the gold standard, as good on tissue removal as a conventional TURP, but with far less complications. See my earlier post regarding the details of my own surgery in August. The procedure was a piece of cake with great results and minimal issues. I had a large prostate also with a third lobe that had grown into the bladder. The Uro, Dr. Steven Sukin, removed essentially all of the third lobe and about 80-90% of the lateral lobes (the removable part, not the capsule of course). I also would not have an open surgery.  A BPVP will remove the third lobe. With your concerns about Jaylin why not consider this option?

Hi CS123, I haven't seen a Post by a person from The Woodlands. I'm in Burnet in the Highland Lakes of Central Texas. I know how Button Turp works and that it is the most-prevalent method nowadays and both uros I have seen this year recommend it. I just believe that it is the best for the Dr, not necessarily for the patient from all sources I have read.  I would like to hear your experience with the procedure. My prostate has been measured at 114 mg and I'm not sure that this includes the third lobe. Can you go back to your post, copy it and repost it here? I'd like to hear the experience of a fellow Texan.   

Hi Ron, I have several post on this page discussin my surgery. Rather than repost them again (which may run afoul of the moderator) I suggest the following. If you are using Internet Exploret as your browser just hit Ctrl F. A drop down will appear showing the word Find. Enter cs123 and all of my posts will be highlighted. You can then scroll through them by hitting Next. Please look at my replies to "SD1959" and "samdelhi" which contain details about my surgery. If the above does not work then reply to this and I will cut and paste regardless of the moderator.

After you have read them I'll be glad to answer any questions and help a fellow Texan, especially one from the Highland Lakes. My case is probably different than yours (I suspect I had a smaller prostate) but nonetheless the third lobe is gone and I urinate like a 20 year old (I wish sex was like that also). The frequency is rapidly improving (about every 2-3 hours during the day with one time at night) and it is getting better. I had no complications, no incontinence, minimal bleeding and pain, no issues. I just started having sex again and too early to fully know about RE but I believe I have some (partial retrograde, some out, some in). In my case the surgery was a big success and a piece of cake compared wiht the other surgeries I have had.

Well, I'm using chrome which is a pain for several reasons. Supposed to be faster so I use it. There should be a way to search for all of the posts by a single person but I haven't found it.

But let me say this; I delayed at least ten years having any procedure at all out of fear that I would be one of the many who wind up worse off than before the procedure. There were many examples of that back then as there are now. I actually have gotten by pretty well as long as the Jaylin works and I don't care about the sexual side effects. (but I do care) Even now I'm getting up only once at night and go about every hour or so during the day. It's been tolerable as long as I can find a bathroom within a couple of minutes. I delayed too long last evening, had to go in a plastic cup and was surprised at the dark color and strong smell. That tells me that I'm retaining too long and too much and risking infections and kidney damage. So, I'm resigned to surgery, I just want the least-invasive, most likely-successful procedure for my circumstances.  With my vital signs, genealogy and life-style I have another twenty years or so above ground.  I have a failing wife to care for, a business to run and I am very suspicious of most surgeries suggested.  I know damn well that Turp and simple prostatectomy are a lot easier on the Uro than the patient in all  cases and I'm not doing it.

 After six months of study almost every day I'm sure that Holeb that will be most likely the best bet mainly because the size and shape of the prostate doen't matter. I'll have it done by the most-experienced surgeon in the US for that procedure (over 3000 times).. There's some problems with that; he's 1000 miles away and I'm not about to get on an airplane with my problem. So my wife and I will drive up and back during the Xmas holidays in mid-winter. We'll be driving a 4x4 with snow tires so we'll be prepared for most anything. Going to take a week to get there and a week back if necessary.

If I had done the turp thing fifteen years ago maybe I could stayed off the meds but my prostate would have grown back by now and I would be doing it again.  I'm expecting a one-time lifetime fix and I'm doing everything I can possible do to make that happen. We'll see if it works. 

Ron, here are my two cents for whatever they are worth.  In the end you are the only person who can decide what is best for you but if I were you I would seriously consider having a Button TURP (BPVP for Button Plasma Vaporization of the Prostate).  You can have it done a lot closer to home - here in The Woodlands for instance or also in the Houston Medical Center.

I am 68 years old.  Just like you I had been on Avodart and Flomax (Jaylin is a combination of the two).  The meds worked for a while.  Also like you I was having problems with travel.  While I could still get on a plane, the time between boarding and being able to go to the bathroom was painful.  I like classical music concerts and most of the time before intermission I was dying to go (same at a movie, had to get up in the middle).  These issues, more than any others, prompted me to get something done.  Urinating every hour or so was no longer acceptable.

The gold standard for surgery has been the conventional TURP as you know.  It has many associated risks (bleeding, pain, incontinence, etc.).  I would never have an open prostatectomy if I could avoid it.  The TURP gold standard is quickly being replaced by the Plasma Button TURP.  I scored 21 on the IPSS, and had what was initially described by my Urologist and two PCPs as a moderately enlarged prostate (PSA was 0.9).  This turned out not be the case as my prostate was very large (I don’t have a size figure).  My prostate had grown inwards into the bladder as a third lobe.  I had been on Avodart and Flomax (discontinued the latter because of the headaches alpha-blockers cause for some people).  Drugs had run their course and on August 21 I had the Button TURP here at St. Luke’s in The Woodland.  The doctor was Dr. Steven Sukin.  It has been a big success with no complications or issues.  My IPSS is now at 6 and I expect it to be at about 5 in a couple of months after the frequency improves further.  It has improved a lot already.   If you are familiar with the IPSS score, prior to surgery I was at 2-5-5-3-4-0-2 for a total of 21.  Now I am at 0-2-1-1-1-0-1 for a total of 6.  I am going on vacation in 2 weeks and I now have no fear of travelling.  The Uro (and reading the web) warned me that it takes about 3 to 4 months post-surgery for the bladder to adjust and retrain and that frequency is the last issue to improve but I have already improved a lot.   Like others have said, the real key and this cannot be overemphasized, is the ability of the Uro.  A good Uro with lots of experience is extremely important and is the main factor for good results.  My father had a regular TURP when he was about 75 and he was partially incontinent for about a month and a half (it resolved after that).  I asked my Uro about this and he told me that incontinence is the result of the Uro damaging the sphincter muscles by going too far in or too far out with the scope (regardless of it being a Button, a regular TURP or Laser HoLep for that matter).  He told me that in all the years of doing surgery he has never caused anyone to be incontinent and that it would not happen to me (he said so categorically and with assurance) and it did not happen to me indeed - no incontinence whatsoever even on day one.

I would not do a Urolift even if I could as it will not last as long as a TURP (why go through a second procedure later).  Urolift just compresses the side lobes.  What determines the lifespan of any procedure is how much of the prostate (the removable portion) is actually removed.  The button TURP has been reported to be equally as good on tissue removal as a regular TURP but with far less side effects (bleeding, pain, recuperation time, etc.).  The HoLep is reputed to remove even more tissue, claimed to remove as much as 100% (but nothing really removes 100% no matter what they say).  However it has potential complications of its own.  With Button the tissue is vaporized, nothing to extract as it just flushes out with irrigation.  With HoLep the tissue is cut and driven into the bladder.  The tissue then has to be mechanically removed by the Uro during the procedure and sometimes pieces are left behind causing blocking or other issues.  HoLep has been around for a long time, with very good results at times and not very good at others.  HoLep has one advantage over Button, the removed tissue can be analyzed by a pathologist for cancer.  With Button there is nothing to analyze.

My button TURP was a piece of cake.  I had rotator cuff surgery on my shoulder in 2010 and I was concerned that a TURP would be very painful also.  My apprehension was way overblown.  Yes I had pain, 7-8 out of 10 the first night.  The shoulder was a 10 out of 10 for about a month and 8 or so for 2 additional months, even on heavy doses of Norco.  With the Button I spent one night in the hospital on morphine so no big deal - by the next morning pain was down to 3-4 without morphine.  Had a catheter overnight in the hospital, removed the next morning and waited to test urination.  After passing some blood clots I could urinate ok and was sent home.  The Uro gave me Norco for pain (5 days’ worth) and I took it two nights only to sleep better.  Urination burned for 2-3 weeks (took pyridium).  Blood disappeared after 3 days.  No incontinence whatsoever.  A little discharge for the about 5 days (small drops of blood and other oozing – wore feminine pads with my underwear, diapers at night - for 1 week only).  My only regret is that I did not have the surgery sooner.  As it turned out I had a large prostate after all.  The prostate can grow laterally on the side lobes and this is detectable by the usual rectal exam.  However it can grow into the bladder as a third lobe and this was my case.  The growth into the bladder is not detectable by rectal examination, only by cysto or ultrasound.  The Uro told me that he removed essentially all of the third lobe and 80-90 % of the lateral lobes (of the portion that can be removed - they never touch the outer capsule which does not grow anyway).  I got off Avodart 1 month ago, will take about 3 months to flush it out of my system but I can tell already that my libido is better.  My libido will never come back like when I was 40.  I had to stay off sex for 6 weeks and I now have some RE (not enough data yet).  Some ejaculate has been noted but not as much as before.  Most people with any kind of prostate-tissue-removal-surgery will get some degree of RE and I expect to have it.  Sex is still fun but not as intense on the climax (just like when I was on Flomax which gave me RE anyway).

I think those of us who have a successful and easy procedure tend to not post on these websites, they are happy with the results and go about their way.  So take all comments including mine with a grain of salt and form your own opinions.  Hope this helps…

I do not know about button TURP, but I had TURP and I was having severe prostate problems within 18 months. So you have to wonder why. I had HoLEP 2 1/2 years ago and things have gone great since day 1. I think the reasons TURP didn't work for me was either 1) not enough was taken out, or 2) my prostate was growing very quickly, or both. 

so if you are influenced by others saying do button TURP, and for all I know that might be a great option, I would make sure your prostate is not too large for it, or growing too quickly, and make sure the doctor tells you what size it is before (grams) and what it will be after the procedure.

Thanks CS123,   Your posts are quite informative.   After reading your posts it seems like  Button TURP is something like PVP where the tissue is vaporized. 

  

Can you get into surgery while you are on Jaylin. 

Generally what is the cost of these sugeries in US. I am searching around to find  a procedure and a doctor who can avoid RE.  My  preference is to retain it even if means travel and some expense. 

Thanks samdelhi.  A Button TURP is somewhat analogous to a PVP but much better.  A “Button” uses plasma ionization to vaporize the prostate tissue whereas a PVP just like a HoLep uses a laser.  A Button TURP is much longer lasting than a PVP as it is able to remove far more tissue than a GL PVP.

You can certainly have it done while on Jaylin, in fact it will help but check with a doctor.  The Tamsulosin (Flomax) part of Jaylin will help you urinate better while you are swollen after the surgery and the Dutasteride (Avodart) part will minimize bleeding.  My Uro asked me to stay on Avodart for a month after the surgery to minimize bleeding although this may have been overkill as I only bled a little for about 5 days.  I am now off Avodart completely and my libido is definitively improving.

Unfortunately I have some bad news.  Any type of prostate resection, be it a regular TURP, a Button or a PVP, will potentially or likely give you RE.  The process of removing excess tissue results in a wide open channel (that is the desired goal of the surgery) and this wide open channel allows the sperm/prostate fluid to go backwards into the bladder.  I had this issue with Flomax anyway and I have some of it now although too early to tell you for sure as I could not have sex for 6 weeks on the advice of the doctor.  Since the 6 weeks have passed, I now have some anecdotal evidence that some of the ejaculate is going out and some of it is going in.  If you have any kind of prostate resection you need to be prepared that RE is likely to occur.  Then again it may not happen to you but be forewarned.

Costs unfortunately are high in the US for those with no insurance.  In fact some in the US go to India to have surgery as it is cheaper.  I am on Medicare and what the doctor/hospital bill and what Medicare pays are way far apart.  I have been billed so far $18,592 (I have a spreadsheet) of which $12.6K was for the Hospital (with one night stay) and the rest mostly to the Surgeon and Anesthesiologist.  Medicare has yet to sort out the Anesthesiologist but it is looking like this:  Medicare will pay a total of about $4,200 and I will pay $1,100, the rest is written off.  My supplementary does not kick in until I spend $2.5K out of pocket.

The Houston Medical Center is world renowned and we get many international patients (usually for more elaborate treatments like heart transplants or cancer).  The reason I mention this is that it is well known that they “negotiate” rates for international patients who have no US insurance.  This is an option I would check into if you do decide to come here.  Best….

My two cents worth to the posters above and anyone considering surgery for BPH…

RonTexan had already reported the size of his prostate on this webpage as 114 grams, large indeed but treatable for sure - there are larger ones with successful surgery outcomes every day.

Unless one has a radical prostatectomy the capsule is not touched during surgery and therefore the size of the prostate appears about the same from the outside (the inside is hollowed out).  While a doctor can estimate how much he might be able to remove (emphasis on the word “might”) his estimate is nothing more than his best guess.  The Uro may or may not be able to remove as much tissue as he wants and they are usually optimistic for a reason - nobody wants a pessimist for a surgeon.

Prostate growth rates are impossible to predict like many other things in medicine such as cataracts.  For some the prostatic tissue will grow slowly and for others it will grow fast.  The goal of any prostate surgery is to remove as much tissue as possible and the expertise of the doctor is key regardless of the method.  I think expertise is by far the largest factor contributing to a good outcome.

A TURP and a Button TURP are two very different procedures.  TURP has been around for a century.  It is still considered the gold standard by many however it often results in substantial bleeding and long recuperation times among other issues.  The Uro doing the TURP is also limited as to how much time he can work on the prostate.  The reason is that a regular TURP uses fresh (non-conductive) water as the irrigation fluid, not saline water.  In a regular TURP saline irrigation would short out the electrical loop that is used to cauterize the blood vessels.  Non-saline fluids tend to build up in the blood stream and if too much time is spent during a TURP, water intoxication by way of the blood stream will develop.  This can be very serious and limits the operating time.  The reason for these comments is that there could be a large number of reasons why a TURP was not successful - maybe the doctor was not experienced enough or maybe he had reached the maximum time allowed to avoid water intoxication thus resulting in inadequate tissue removal.  Or maybe he had a long day still ahead with lot procedures to perform.  -

A Button TURP is totally different.  It uses a plasma ionization “Button” to vaporize the prostate tissue.   It also uses saline irrigation and therefore is not limited as to the time spent removing tissue (same for HoLep).  It results in far less bleeding and complications - and also quicker recovery times while removing as much or more tissue as a regular TURP.  There are studies after studies comparing the Button to a regular TURP and a Button is now the preferred option (some exceptions still exist).  In my case the Uro removed essentially all of my third lobe and 80 to 90% of the side tissue.  A successful regular TURP would not have done any better.  HoLep is often touted as removing all of the prostate (not the capsule) but as we know nothing runs perfect in the OR - unlikely that all of the tissue will be removed, maybe most or nearly all but some is likely to remain.  HoLep has a serious potential complication - large sections of the prostate are irrigated into the bladder and this tissue needs to be removed during the surgery- not always successfully done.  The lifespan of any given procedure depends how much tissue is removed and how fast will the remaining tissue regrow.  The first one is very dependent on the skill of the doctor - the later one is unpredictable.

The statements that follow in quotes were cut and pasted from a web summary:  “Conventional TURP removes tissue with a wire loop that has electrical current flowing in one direction (monopolar) through the resectoscope to cut the tissue. The surgical site is irrigated with nonconducting fluid. The fluid prevents the electrical current from disturbing surrounding tissues, but it can damage surrounding tissue after prolonged exposure, resulting in TUR syndrome. This limits surgery time.  A newer technique, Bipolar TURP uses bipolar current to remove the tissue. Because it allows for saline irrigation (instead of nonconducting glycine as in monopolar TURP) it reduces complications such as TUR syndrome. This allows for longer procedure time and better resection.  Button resection uses ionized vapor that heats up (by low voltage electricity) a semi-spherical button to vaporize the prostate tissue from inside.  It also uses saline irrigation.  This is considered to be the least intrusive of all current techniques and has as good or better tissue removal as a TURP.  It also features far fewer post-op complications and shorter healing time.”  End of quote.

There are “horror” stories about any medical procedure and the web is full of them, be it for prostate surgery or cataract surgery or shoulder surgery or what have you.  I can certainly find people complaining about a Button TURP as well as a HoLep and a conventional TURP.  I can also find many who are happy with any of these.  If I had listened to the horror stories on the web I would not have had cataract surgery in 2007 and I would likely be blind or close to it today.  Instead I now see better than I did when I was 40 and do not wear glasses at all.  If I had listened to the horror stories about rotator cuff surgery I would not have had shoulder surgery in 2010 and my right arm would be dangling like a rope (and in pain).  Instead I have full use of my arm, can swim, paddle a kayak, and enjoy life.  If I had listened to the horror stories about any kind of TURP I would not have had a Button this past August.  Instead I can now whiz like a 20 year old (wish I could make love like one).  The reason for these statement is to tell folks who are contemplating any kind of prostate surgery to do the research, find the best and most experienced Uro you can find and go DO IT.  There are hundreds of prostate resections done in the Houston area alone on a given day and nearly all are successful.  I and many of my elderly friends have had a procedure of some sort or another and I have yet to encounter a horror story - I know they occur but my point is that the odds are small.  After my shoulder surgery I had to spend 5 months in physical therapy 3 times a week.  I met a bunch of people with knee and shoulder surgeries and not a single one wished that they had not done it.  Life is too short – who wants to be tied down because they have to go to the restroom every hour?    -

 

I appreciate your input particularly since I'm close enough to Houston to do exactly what you did.  That's my only reservation about the HOlep procedure, the distance, 1000 miles, and my reservation about flying with my condition. My long-time uro who does the button turp procedure advised me to go to a colleage and have a simple prosatectomy done, a large incision beneathe the navel into the bladder and coring out all three lobes from the bladder neck. He said it would stretch out the bladder sphincter and I would be incontinent for awhile. (Not doing that) He said my 114 mg prostate was too large for any other method and that the 114 mg measurement may not have included the third lobe. A different uro did the measurement. That uro  suggested that he could remove the third lobe with button turp and if that was not enough he could do urolift. What attracts me to HOlep are several things; it does not matter how large the prostate is or how many lobes are present. Also, this surgeon has done over three thousand Holep procedures, trained most of the surgeons who are using the procedure in the us today and is idolized by his peers.

I'm not sure just how i am going to handle the travel back, though. I won't have the sightest problem getting there but I don't know how long I will have to heal until I can drive a thousand miles. I know that I will have to handle most of the driving myself. I've got to nail that down. Again, I appreciate your input.     

Hi Ron,

Bear with me, ok?  If you don’t like my comments just ignore them which would be fair enough - it is your life and you are entitled to your own choices as you deem fit.

With that caveat, I think you are making too much out of a simple BPH procedure.  Just like cataract surgery, BPH procedures are routinely done these days.  If a person lives long enough they are likely to get cataracts.  Artificial lenses are successfully implanted inside the eye thousands of times each day in the US alone.  The same is true of BPH.  Nearly all males get BPH at some point and while most are initially treated with drugs, this is only a temporary solution as the prostate continues to grow regardless.  Like cataracts, BPH surgery is performed thousands of times each day and nearly all are successful.  Regardless, if I had to choose between an infection of the eye or a retinal detachment (the most common complications of cataract surgery) and prostate complications such as infection or insufficient tissue removal I would much prefer the later.  I can live with a second prostate procedure if needed or for that matter a failed surgery requiring that I go to the bathroom every hour still.  I don’t want to live with a retinal detachment which often leads to blindness.  You had cataract surgery (just like I did) and the risks did not prevent you from doing so.  So why the big concern about a BPH procedure?

If you are still reading I can add “two or three more cents” which I hope will help.  I agree with you completely on the open prostatectomy.  I would avoid an “open” if you can as you could end up incontinent (for a long time or forever) and the pain and recuperation time will be substantial.  People with prostate cancer who have open radicals often end up with some degree of incontinence.  My Button was no big deal but still not fun.  However, even if I have to have it done again I would prefer that a hundred times over compared to an open prostatectomy. 

You mentioned that you saw a second Uro who told you that he could remove the third lobe with a Button and then do a Urolift on the sides.  The later does not make sense to me at all.  The reason for a Urolift is to avoid a more invasive procedure but once he is in there removing the third lobe why not work on the side lobes at the same time.  I would not see this Uro again.

You WILL have problems driving back from Indiana unless you spend a couple of weeks recuperating there.  I was advised to avoid driving or any kind of strain for 2 weeks as this can lead to bleeding (6 weeks for riding my bicycle and sex).  This may have been overkill, however while I did not have pain per se after 3-4 days (other than burning when urinating) I felt pretty uncomfortable sitting down on a given chair for more than one hour or so.  I did best by getting up and walking a bit and then sitting on a different chair that placed pressure on different points.  This lasted for about 2 weeks or so.  After about a month I was back to normal.  You will have the same with HoLep I suspect (maybe more since your prostate is likely larger than mine thus more trauma to your groin).  I think a 1,200 mile drive back from Indianapolis within the first 2 weeks will be miserable so if you decide to proceed I would advise a good motel room there where you can watch the Colts beat the Texans.

Why not consult with a top Uro in the Houston Medical Center before you embark all the way to Indianapolis?  The worse that could happen is that you spend a little money helping our local economy and seeing how well you have it in the Hill Country.  I just did a search and there are 168 Urologists within the 10 mile radius of the Medical Center.  Some of them are certainly experts in their fields.  A close friend of mine had a TURP with Dr. Dov Kadmon (4.6 out of 5 for Patient Satisfaction in Healthgrades).  His TURP went very well with no complications.  Dr. Seth Lerner also is a top rated Urologist in the Med Center (4.9 out of 5 in Healthgrades).  I am not endorsing either of them as I do not know them but you can certainly do research on your own.  In my own area of town Dr. Patrick Zielie is highly regarded and scores 4.8 out of 5 on Healthgrades with great credentials.  Dr. Lingeman in Indianapolis scores 4.6 out of 5 in Healthgrades, no better than the ones I refer to above.  I have no doubt that Lingeman is a top expert in his field but even a good doctor like him gets bad reviews from time to time.  Here is a comment from Vitals about Lingeman:  “Sep 3rd, 2013  Another older doctor who thinks more about their portfolio than their patients and hates to be challenged when their office makes mistakes and tries to blame patient. Remember: Patient is employer, doctor is employee.”  So no matter what research you do you will always find bad reviews and “horror” stories about anyone or any procedure.  You just have to make the best decision you can which will likely result in a good outcome.

If you do decide to go to Indianapolis I would recommend that you to have a driver for the way back and a urinal handy as the urge to go comes quickly right after surgery and lasts about two weeks.

Wish you the best…

C.S.

 

I'm relectant to add my comments because they are probably going to be seen as the voice of doom but having read thousands of accounts on forums the last three years my conclusion is that any bph procedure by any qualified urologist is basically the equivalent of using a blowtorch to burn a hole through a piece of steak. My guess is most of the great results and quick heals are from people who had relatively smaller prostates to begin with.  But for people with giant prostates (mine was over 120G.) everything I have read in the way of personal stories is it's vey possibly going to be a tough 4-8 week recovery with several weeks of extreme urgency and frequency. That's the point at which the posters usually say something like I wish I never had this procedure.  I think the vast majority (way over 99%) change their opinion after a few months. Regarding the need for a second or third procedure, If you get a stricture or a scar tissue  requiring a second procedure, that is not really predictable or preventable. If you get stones, that's not predicatable or preventabe. If you need your bladder mouth widened, you can't blame the uro. If he widened every bladder mouth he'd probably have to deal with incontinence complaints. It's a fine line, too little widening and you need a second procedure. Too much and you have caused incontinence. All this under time constraints and working with an eyepiece inside of a bloody mess.

Bob 

Hey Bob, mine was well north of 100 grams, AFTER 2 procedures (greenlight the useless procedure, and TURP). Dr James Lingeman the HoLEP expert did my last procedure about 2 1/2 years ago. I saw near instantaneous results in all categories (ease of urination, full bladder emptying, reduced urgency and now no urgency, minimal leakage and now rare and minimal leakage, and very quick recovery time.

I am a person who is very skeptical of doctors recommendations, but I would see him before giving up hope because he was the only straight shooter who proved to me the outcome was as good or better than the marketing pitch. By the way, my bladder was probably very stretched from prior prostate problems. Other doctors said it would be a problem for life, but Lingeman said it would go back to near normal within 6 months. I am pretty sure it has. FYI, at parties I tend to last 1++ hours longer before needing to pee versus friends younger than me (I am 58), and my stream is strong and I drain quickly. I may have lost some libido from the procedure, not sure, because it could be due to an infection in between my TURP and HoLEP procedures that did some damage to one of my nuts, caused by a catheter infection. FYI, Bill

Bob, actually I don’t disagree with your comments and I don’t think you are the purveyor of doom.  I think your comments are quite realistic with one caveat.  IMO the people you refer to that have written the thousands of comments on forums are usually those that have had problems as those that do not just go about their merry way.  Seems that I am an exception as I have had a good outcome and I am posting here.  Nonetheless, as an example, in 2007 I had cataract surgery on both eyes (one at a time of course).  My left eye, the first one, developed a minor complication which turned out to be brief, lasted about 2 months.  What did I do?  I went to an eye forum, posted my concerns, and read a lot of gloom and doom.  I also got a second opinion and proceeded with surgery for my right eye which went without a hitch.  Both eyes healed well and they are doing terrific today however I did not return to the forum and posted my good outcome afterwards.  I should have but I think my behavior is pretty typical.

You mentioned that for those with “giant prostates it’s possibly going to be a tough 4-8 week recovery with several weeks of extreme urgency and frequency”.  I think this is correct and I suspect that this will be the case for RonTexan since his P is 114g.  This is one of the reasons I was concerned about his plans to drive back from Indiana after the surgery.  My prostate was large (don’t know the actual size) but likely nowhere near “giant”.  Even for me I would say that the recovery was about 6 weeks and this is what my Uro foretold me.  The 6 weeks were a gradual process, one week with some blood, pain, urgency and frequency, 2-3 weeks with burning and less urgency and frequency - and also some discomfort when sitting down for an hour or so, and then fewer issues after 3-4 weeks but no bike riding or sex for 6 weeks.  I am now near 8 weeks and have no issues whatsoever, no discomfort, no leakage, no urgency and good and steady flow.  My frequency on IPSS is at a 2, I go less than ½ the time in less than 2 hours.  Sometimes I don’t go for 3 hours or more and only once at night or not at all.  This is improving by the week and I hope to be at a 1 on IPSS in this category (less than 1 in 5) in a couple of months per Uro’s experience and what I have read about the procedure.  Retraining the bladder seems to be the last issue to improve - was told by my Uro to expect about 3-4 months.  We’ll see…

For those with a “giant” it seems to me that the 8 weeks are realistic indeed and you should know from your own experience.  However as bad as those 8 weeks may be if the end result is good then they are worth it or so it seems to me.  It took my shoulder 5 months of physical therapy and pain - I was on Norco every time I went to PT and at night and I had to have my wife drive me as I could not drive on narcotics.  However the alternative was not acceptable and I am darn glad I had the surgery as my shoulder is at about 98% ok, essentially all normal.  I did not post my good results in any forum…

C. S.

Hi Bill,

Your recommendation certainly carries weight as it is coming 2-1/2 years after the procedure. Any procedure can look good 6 months out (even my first TUMT - which has been dropped by most urologists as an ineffective procedure - was working well after the two month recovery for a few up to about 6 months out).  Looking at forums, the holep and button turp have the best outcomes and the least number of complaints. The only reservation I would have would be driving 1000 miles to get it. 

Hi CS,

As I mentioned in my reply to Bill, the button turp and holep seem to get pretty universal good marks. I hope you get as good a result as Bill. As I said, and you know, what's more important than good or bad results the first few months is how it will turn out in the years to come. That said, your relatively smooth recovery bodes well for the future outcome. I would also be reluctant to take on a 1000 mile drive after surgery. At the least I'd be looking for someone to drive me both ways, or plan to stay in Indianapolis until I could get through the day without bladder spasms.

Bob

Thanks Bob.  I hope my good results last 10 years or longer but time will tell…  If not I’ll be doing something else.  The success of a procedure is based on how much tissue is removed.  I feel reasonably confident knowing that my third lobe is essentially gone and the lateral growth was 80 to 90% removed.  I was told that at my age (with a typical prostate) a Button should last as long if not longer than a regular TURP, 10-15 years.  I know that there are plenty of people with regular TURPs who did not last as long for various reasons.  However being such a long established procedure there is a ton of statistical data out there and the typical 10-15 year lifespan is well proven in the literature, at least for reasonably sized prostates.

I think the expertise of the Uro is critical.  My Uro had me sign a consent form that allowed him to do a regular TURP if he could not remove sufficient tissue with the Button.  He told me that there was no way to know for sure until he was inside but that for most people a Button is successful and lasts the desired timeframe.  I asked him how often he has to switch to a regular after starting a Button and he told me about 20% of the time, less so for smaller prostates.

I am a scientist by training (now retired) and before committing to any surgery I like to look at data in publications or the like.  I have done this for the three surgeries I have had since 2007 as I tend (like Ronald Regan) to trust and verify what any doctor tells me.  As you mentioned on your post Button and HoLep are the two current techniques getting the most favorable reviews.  GL rarely last more than a few years and is seldom recommended just like the TUMT.  I choose the Button because my PCP, a doctor I have learned to trust over the years, recommended Dr. Steven Sukin.  Sukin had done many of my PCPs patients (including my PCPs father-in-law), all with good results.  I did my own research of course and liked what I saw.  Dr. Sukin trained at Baylor College of Medicine in the Houston Medical Center and he is the Director of Robotic Surgery at St. Luke's Hospital in The Woodlands, about 5 miles from my home.  Coincidentally Dr. Sukin trained at Baylor with Dr. Naveen Kella, a top Urologist in San Antonio who RonTexan speaks highly of in his earlier posts.

In looking at data I learned that the prostate is divided into four zones.  The Peripheral Zone (PZ) comprises about 70% of the prostate in young men.  This zone is also where 70 to 80% of the cancers originate.  The Transition Zone (TZ) surrounds the urethra and is the region responsible for BPH as it grows throughout life.  This zone is small at puberty but grows dramatically as we know so well.  The other two zones surround the ejaculatory ducts and comprise the muscle and fibrous tissues.  The reason I am mentioning this is that a good urologist should stay away from the PZ during BPH surgery.  If a small yet to be detected cancer exists in the PZ getting into that part of the prostate can spread the cancer to the blood stream.  I also learned that when removed tissue is analyzed about 10% of the time it comes back as cancer that had not been detected yet.  So there is a risk in removing too much of the TZ and getting too close to the PZ.  I was told by my urologist that he did not want to get too close to “the outer area” as he put it to avoid potential cancer risks and the above is the reason why.  One concern about Button or HoLep (or others) is that in an effort to remove as much tissue as possible a Uro may be creating a larger problem.  So an 80-90% removal of the TZ sounds good to me and I hope it lasts indeed.  Time will tell…

Best,  CS

Hi CS, Everything I have read in terms of PubMed papers has said the button turp is vastly superior to not only the open prostatectomy but also to the old standard turp.

I wondered why your uro finishes off with the regular turp 20% of the time. The only thng I can think of is that the old turp may be more precise in slicing tissue off than the button.  If there is concern about not getting too close to the capsule, maybe thats the reason.

My uro only removed only about 60% of my prostate tissue and a much smaller portion of the median lobe. I personally think he ran out of time and the two GL tips he brought were used up. He brought two tips and used them up in 70 minutes.

That may be why I needed another surgery 18 months later. With the open prostatectomy I saw on youtube, the surgeon used his finger to seperate the lobes from the capsule and then just cut the connecting bits at the end. It looked just like he was shucking a clam.

It would seem though that with the holep all the removed tissue could be analyzed for cancer. With the button and my GL it's an unknown as the tissue is vaporized.

PC is a whole other topic. Everything I have read says if you are our age (late 60's) leave PC alone unless it is aggressive. I think I read somewhere that autopsies on men over 80 show more than 75% had localized slow moving PC in their prostate.

My uro said he didn't want to go back to take more of my middle lobe unless it blocked my bladder, as he was afraid of damaging the bladder. Maybe he was also worried about getting to close to capsule. This whole topic of bph procedures is quite murky to me. I also trust my uro and have stuck with him so far. It feels like flying in a bumpy storm. Your life is in the pilot's hands, and you don't know how to fly a plane anyway.

Regards.

Bob

CS, I'm sure you mean well and I do appreciate your interest but I haven't found much value in your input. Mostly it is just criticism of some of the finist and most sucessful Urologists in the country. The Dr I have chosen has done the Holep procedure over 3000 times for almost twenty years and is greatly admired by his peers. I have spoken to two of them. I have researched my condition as well as I can and I am satisfied that Holep is best for me because it is the only procedure in which the size of the prostate doesn't matter, other than the "simple prostatectomy" which is not very simple in my opinion.

As far as getting to Indianapolis and back I may just drive four hours to Dallas, take a quick 3 hour flight up and back, surely i can do that.

I'm anticipating a "one and done" surgical procedure that has the best chance of lasting the rest of my life, and I have chosen the most successful and experienced Doctor in the US for the procedure I have chosen. Instead of criticizing my research, why not wish me luck? 

At any rate, I have quit listening (visualize my fingers turning off the CS volume control ........CLICK).  

 

Ron, others find my input of value, you apparently don't and that is ok.  No need to be defensive or nasty about it.

Best of luck, I hope your surgery is successful and you can fly and drive back without difficulties.

You may not realize this but you tend to make contradictory statements in your posts.  For instance you earlier stated that you could not fly in your condition and you did not know how you could get back from Indianapolis after surgery but now you are saying that a "quick 3 hour flight is surely ok".

Even with my rather simple PBVP I could not have gotten on a plane during the first week, I would have been heading for the head regularly and judging by the planes these days I am not sure I would have made it.

Again, best of luck.  Hope all goes well.

   

Hi Bob, I don’t know the answer to your question about why my Uro switches to a regular TURP 20% of the time.  I think your guesses may be the reason or perhaps some larger prostates grow such that he is not able to reach all areas with the Button.  Unless I develop a complication I will not see him until December.

Different procedures have different risks.  For instance I understand that with a Button the Uro has to move the probe back and forth in a steady motion - if he keeps it somewhat still there is a risk of burning or heating the tissue too much.  With HoLep the Uro has to be careful to remove all tissue from inside the bladder as the tissue is not vaporized.  If he leaves some behind there is a risk of blockage, particularly during the early days when all is swollen.

You are right that with HoLep, just like a regular TURP, the removed tissue can be analyzed for cancer and this is an advantage both have over Button which leaves no tissue behind.

Regarding PC, I asked my PCP if I should drop the PSA test now that I am 68.  He felt that at my age it was still wise to continue testing even though recent reports suggest no further testing after age 70.  I just went to the ACS website and copied the following:  “Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit.”  My father passed away of a heart attack in July.  He was 98 and his PCP was still doing PSA tests - I don’t know why since my dad never had PC (actually as you said he probably did but did not know it).  Last year I lost a good friend who I went to college with.  He lived here in The Woodlands about 4 miles away.  John was diagnosed with PC at age 60 during a routine physical PSA.  He was treated by radiation at M.D. Anderson Cancer Center a top organization - initially successfully, but unfortunately it spread.  He suffered a lot during his last 2 years.  So I hope my Uro did not get too close to the outer layer of my prostate - if I by chance have one of those small localized cancers I hope he left it in place.  I rather have a second Button in 10 years than go through what John endured.

I have reread your posts on this page which have been quite informative.  How are you doing now?  Are you reasonably ok with your BPH?  You mentioned that you are taking Tamsulosin 3x a week.  Have you considered taking it every day?  It is generic and inexpensive and once a day is the recommended dosage.  Maybe this would help.  I could not take it because it gave me headaches, a common side effect for some.  I also wonder why your Uro is reluctant to remove your middle/third lobe.  My Uro said that he removed my entire third lobe which had grown into the bladder.  He said that he can do that with the Button probe under most circumstances.  This may be an alternative if you have to go under again.  As you said BPH is like flying in a bumpy storm and different Uros say different things.  Trust and verify like Reagan said…

Regards,

CS

And by the way, here is the last sentence of the post you got upset about:

    "Wish you the best…"

So I did wish you luck!!!

 

Hi CS,

Despite all the set backs I'm reasonably hapy with the outcome so far. After 4 procedures in less than 4 years I'm always waiting for the other shoe to drop, but other than my recent bout with nocturia/insomnia for the last month, things are going pretty well for me. It occurred to me that my nocturia/insomnia about 1 out of 3 nights for the past month started when I took a hard fall on my butt. It also occurred to me that all my retention and difficulty in urination problems started about 4 years ago after a hard fall on my butt while scraping ice off the driveway. I've had problems with frequency and urgency since my 30's, but never had problems passing or retaining urine until about 4 years ago, even though I had bph for at least 15 years. Maybe it's coincidence, maybe not. I'm going for a PSA and Sonogram this week anyway.

Regarding the PSA, I can't see any good reason not to take it. I've had readings as high as 8.9 but my last was 6.5. I've been rising slowly and fairly steadily for the last 10 years or so, anywhere from 1/4 to 3/4 of a point a year. The PSA actually went down after my surgery in Dec. to remove stones and resection the bladder neck.

All my PSA tests indicate a 25% chance of PC, but I don't mind if I do have it as long as it's thge slow moving and not the aggressive kind.

My uro mentioned the possibility of a biopsy after having found pus pockets and abscesses in my prostate during the GL. He also said if we found PC we could zap it with radiation. But he never pushed it and neither did I. Maybe that's why he didn't go too deep in my median lobe. The subject never came up again. If I do need work done on my median lobe I'll look at all the options, even though my uro just does the GL.

I am using the tamsulosin 2x a week just as a precaution to wash out any bladder stones that may be forming. I don't know if it does anything except increase the strength of my flow on those two days. I also get side effects from the tamsulosin, but can tolerate them for 2 nights.

Bob

Bob, thanks for your reply.  Some words of encouragement for us in case we get PC in the future.  I have another friend whose PSA went high and the biopsy showed PC.  It was the slow kind.  He got targeted radiation which is focused specifically on the prostate with little side tissue damage.  The radiation went on for 6 weeks but not a big deal, he said.  His PSA went way down afterwards and today about 6-7 years later he is doing well still.  I think PC at our ages is very treatable as long as it is not the aggressive kind (fortunately most are not).  Hope you get good results later this week.

Hi CS123,

It will be about a week until I get my PSA test results but I got a copy of my ultrasound report today and my PVR (post void residual) was an astonishing 7cc. Because I was late in drinking my water for the test I only had 40cc before voiding, but had only 7cc after voiding.

I guess my Dec., 2013 bladder neck resection really opened up my bladder. The ultra sound tech agreed that the tightness I feel on my bladder is probably scar tissue from the surgery rather than an indication I am retaining urine.

Apparently the large median lobe protruding into my bladder isn't causing any retention issues, though it might be the cause of my weak stream at times. But although the stream is weak sometimes, it apparently gets the job done. I've voided as much as 300cc at one time at night into my bedside urinal so I still have a decent bladder capacity.

I'm still getting up 2 to 4 times a night but am geting back to sleep. My last epsisode of insomnia/nocturia was a week ago. It may be that the hard fall I took on my butt in mid-Sept upset the prostate/bladder apple cart.

Still taking tamsulosin 2 nights a week as a precaution against build up of bladder stones. Notice my stream gets slower as the week progresses, then picks up with the 2 nights of tamsulosin.

Well, so far, so good.

Regards,

Bob

Sounds like you are doing much better and I'm glad to hear it! You have really been through the mill.

We'll soon have another Holep example to discuss as I'm having the procedure done on Oct 31st, just twelve days from now.

I had the procedure scheduled with another Dr in late December but I felt I might not be able to stave off the symptoms that long as Jaylin is barely working anymore. I searched further, talked to the schedulers of five different Holep surgeons, found one opening soon available and jumped on it.

On your advice, Bob I was able to self-cath one time and was retaining 300 cc. Either the catheter bruised my urethra and it closed up completely for about half a day or maybe my empty bladder just doesn't need voiding for half a day. Anyway I haven't tried it again, but it was amazing to go so long.

I'm managing ok and I'm sure that I'll make it until Halloween.  I hope that the Dr is not a vampire  

Well, I should say that all Dr's will reserve a decision to do Holep until they have done a complete examination by ultrasound and cystoscope, EKG, urine culture, complete medical history, etc. All of that will be done on 10-29 and 10-30.

So, I assume I'm doing Holep but we'll see. I had those tests done a few months ago and determined that my prostate is 114 mg and has a third lobe which is pressing up into the bladder neck. Since the size and shape of the prostate is not a factor with Holep and all my vital signs are good I don't know why he couldn't do the procedure that i want.  

The first effect of the coming surgery is that I'm off any kind of blood thinners so I can't take Ibuprofen until after the surgery and after bleeding has subsided.

As I've related here I have been taking Ibuprofen PM, 400 mg, at bedtime every night for the last two years or so. The sleep-aid PM component is an anti-histamine that makes me drowsy enough to stay asleep through the urges to urinate and the ibuprofen helps with the aches and pains that wake me up. So, I'm still taking the sleep-aid component in the form of Wal-Som and I was up twice last nite but that's bearable. I know that an anti-histamine contributes to reducing urine flow so I'm walking a tight-rope there. Man, do I miss the ibuprofen, though!  Every ache and pain I have ever had is back in full force.

The Mayo Clinic requires that you stay overnight in the hospital and then stay in town for two days post surgery, just in case,  so I'll be flying back four hours on Nov 3, as I couldn't get a direct flight and will be changing planes in Houston and that's a bummer. One of my boys will be there to carry my luggage as I'm limited to ten pounds for several weeks. I expect that flight to be the most miserable flight ever and probably the worst episode of my recovery. Flights are hard for me anyway as I'm 6' 4" with painful knees,  I can't sit for more than an hour or so and airplane bathrooms are torture as well. 

I shoudn't complain as I have not spent a night in a hospital since 1944 and I'll bet not many guys can say that! 

I've not finished my remodling project so I'm going to just lock the door and walk away until I recover enough to climb back up twenty-five steps. 

I fully expect a complete recovery, able to knock the bark off a tree and no more uros for the rest of my life. Is that too optimistic? Probably. 

At any rate I expect many BPH sufferers reading these posts to benefit from my example which I will continue to relate here. I have benefited greatly from this forum and some others,  including yours, CS, and I would like to stay in contact. CS, please accept my choice of Doctors and procedures, Ok? 

Let me close this post for now by looking back on my BPH over the last ten to twelve years or so. There weren't that many choices available then. 

But if could begin finding a solution now I would never take any of the meds, I would have Urolift done if I qualified and then when that easy stop-gap procedure had run it's course, in probably five to seven years, my prostate growing all that time, I would then have the Holep procedure done. Or whatever new method had been developed in that time. That's the beauty of Urolift, it buys you time to find a more permanent solution.  We'll see how well I do with Holep.

Wish me luck.        

Hi Ron,

Happy to hear you are close to having your procedure done. Are you going to the Mayo cinic in Phoenix?

I don't think you bruised your urethra unless you saw a lot of blood in the cath. I recall after cathing, the bladder takes a while to fill up again. If you are drinking water it ought to come out. I've noticed my bladder filling rate (I guess it's a function of the kidneys) is not at all uniform. I think we produce about 100ml of urine an hour or 2.4 litres day if we drink about 3-4  litres of liquid. We urinate less than we input because of respiration, and much less if we exercise ansd sweat. There's been days I only urinated a half litre or so during the daytime. There's been nights when I've urinated more than 2 litres, then the next night only a couple of hundred cc. I've found it to be quite variable from day to day.

Wishing you the best of luck. I think you've made the right and best choice based on what's available, and your condition. They have been doing  the turp since 1932, I wouldn't hold my breath for a better procedure than what we now have available coming around any time soon.

On another forum a poster reported he and his friend had the urolift 5 days ago. He is currently having a rough time and his friend has a foley catheter as he is completely blocked up. The doctor told them it will be 2 to 4 weeks before they see improvement. I asked him some follow up questions on their prostate sizes and asked him to keep the forum posted with their progress. Should be interesting as there's very few posts yet on the urolift procedure.

The forum itself started as a discussion of Prostatic Artery Embolization and the Gat Goren procedure, but results from those who have undergone it have been mixed. From what I can gather it takes a year or more for results to show up as prostate tissue slowly dies off. 

My PVR ranged from 250 to 400cc before my GL. That and full retention every night convinced me I had no choice. It seems to me you are at that point as well. Almost 2-1/2 years later I'm finally in decent shape, so other than faith, it seems patience is really required from those looking for answers to their bph issues. Once again, good luck and keep us posted.

Bob

 

Let me reserve very much comment until I am through the surgery. I don't know what I'm concerned about,  I'm just paranoid, I suppose. 

I showed no blood from the self-cath and only a bit of soreness later. I just went to urinate and nothing happened. Then a few hours later I urinated ok. Just seemed odd but I guess I just hadn't produced enough urine.  Fortunately, the Jalyn is semi-ok for now and I only have 12 days to go. I'll tell you though, that if I skip Jalyn one night my flow is much reduced.   

I'm surprised at the results of urolift you relate. That's the first examples of the procedure not working that I have heard. I wonder how much experience the surgeon had. I understand that the procedure is pretty elementery for uros who are used to turp. Makes you wonder though, I thought it was 95% effective. I suppose that I won't be finding out. I hope not, I'm expecting one and done. We'll see. 

I think the morning that I am scheduled to catch a flight back home I'll just take no liquids at alland maybe I can stay out of the bathroom for four hours.     

Hi Ron,

Brian here from UK, wish you all the best.

Keep us updated on how the Holep goes.

Kind Regards

Brian

Hi Ron,

You can do what I did after my GL when I had to go out. Get some plastic snap underpants with elastic on the legs and waist and high capacity adult diapers. You can find them on line. The high capacity ones hold up to a liter of liquid and you can change when you get off the plane and arrive at the airport if need be. This way if the urge hits you, you can just fill the diaper. With the right fit, nothing will get out. Or if you need to wear a foley cath, that will take care of the problem. just attach a one liter bag instead of the 500ml. It's easy to remove the foley yourself. I stood in the tub, removed the leg bag and tube to the leg bag, and cut the small two inch tube that is used to inflate the foley balloon that anchors the foley in your bladder. When you cut the short tube, about 20ml of sterile water will drain out. Then you can gently pull the long foley tube out of you. 

Bob

Bob

Thanks, Brian.

Well, after all it will be Halloween almost. How about if i just go as a sponge? I am quietly taking all this in.  

LOL

Hi Bob, Brian, CS and all the others who have been with me on the journey to find the best solution for my very large prostate with a prominent third lobe protruding into the bladder. I'm flying out of Phoenix back home tomorrow noon, had the Holmium laser enucleation of prostate (HOlep) done Friday AM 10-31 at the Mayo clinic. Dr Humphreys and his army of support staff did the honors.  I woke up with a Foley catheter and was sent to my room in a couple of hours. I was interviewed by two anesthesiologists, several other doctors in Dr Humpreys group and numerous nurses and others. Dr Humphreys  performed the cystoscope and ultrasound personally and announced that my median lobe was indeed protruding prominently into the bladder neck and it would be awhile before the muscles regained their tone and I would have to do the kegel exercises to help the muscles regain their ability to hold urine in the bladder. I was having no pain just some discomfort from the catheter. The fluid flowing from the catheter was pink for a day or so, still no pain. Then the catheter was removed later that day. I had to pee on my own twice before they would let me go home. I was not able to do that as far as retain urine in the bladder and urinate normally with some built up pressure. Nope, not going to happen. My urine flows from the kidneys into the bladder and out the bladder neck and out of my body in a flood unempeded in any way.     

So, I took your advice Bob, sent my son out for some elastic underwear with thick pads inside, checked out of the hospital and I have been wearing them since changing about every three hours or so. I'll fly home tommorrow, only a couple of hours and I'll be sure to take no liquid at all in the morning and til I get home. 

It's only been two days now but I think I'm beginning to lessen the flow , maybe my imagination. I know if I lie down some urine will pool in my bladder and I can pee normally for maybe 200 ML.

I expected to have some incontinence with a bladder neck stretched to the size of a half dollar, I expected some blood but there has been very little. I expected a considerable amout of pain but there has been and there have been NO pain medications of any kind. They didn't even give me a prescription for one. I don't understand it, there must be a raw area of the inside of the prostate capsule at least as large as a man's hand but there has been no pain.  Incredible.

Oh also, when Dr Humphreys came to see me after I woke up I asked him what percentage of the prostate tissue was he able to remove, he replied about 85%.  I asked him if it will grow back and he said no, the likelihood is less than 1%. 

I'll lick the incontinence problem I'm sure but I expect it to take awhile. For those who don't have a stretched -out bladder neck there should be no problem.

So, I am extremely pleased with the outcome overall. The entire Mayo clinic experience is one of great efficiency and professionalism. There's many reasons why the Mayo Clinics have been selected as the top Medical Institutions in the US and I saw many of those reasons in just two days.

I made the best choice and I'm confident I can now begin to work on getting over the effects of years of BPH Meds and that my prostate can never grow back and cause more problems. I'm ecstatic! 

Hi Ron, thats good news mate, I too felt very little pain...unbelievable isnt it...I hope your path to recovery is a swift and easy one.

Dave

Hi Ron,

Glad it is all over for you and you can now get back to the best of health. 

Well Done Ron.

Kind Regards

Brian

Hi Ron,

Welcome back! Glad everything went so well for you! 200ml is a great start. That's about as much as I normally go every few hours around the clock. 

That you have no pain and some pink urine is a real testament to your docs and the procedure. (With the GL I had eye-popping pain after every urination and peed burgundy wine for about 8 weeks.)  You are doing great! I'm pretty certain from reading other accounts of people with that side effect of surgery  that the incontinence will resolve in time. What I noticed was that I had to reconnect my brain to my bladder neck to reconnect my mind to those nerves that probably got damaged during the surgery. I filled my pants constantly after the GL. Also, I couln't feel when I had started or stopped. A few times I wound up leaking all over the floor about a half minute after I had finished. It took the better part of a year for those things to work out for me. But it's all good now. I'm pretty sure your recovery will be faster and just as satisfactory to you as mine finally is for me.

Best Regards,

Bob

Hi Bob. I guess that I was a bit optimistic about the 200 ml retention. It only happens when I sit for a while. I'm pretty slim down there and I think that I am just compressing the urethra and therefore retaining some. When I stand most floods out. I haven't really done much with the kegel exercises for which the Mayo gave me an instruction sheet. I'm going to wait until there is no more pink urine, probably another week or so. In the meantime, I'm using the Depend Real Fit padded underwear. There's no leakage, they are undetectable, and in a pinch I can use just one for four hours or so. Before the trip back from Phoenix I dried out, taking no liquid for eight hours before the first flight. Then I went through three airports, and two flights in six hours. I made it without changing  but that thing was heavy and hanging low by the time I got to Austin. I would definitely not go six hours again. I change once each night also.

I realize now how stupid it was taking road trips with the kids and grandkids and having to stop and find a pee-place every hour or so. I could have gone completely over the devide between Ouray and Telluride Colorado four-wheelling, about four hours, without stopping once. Noone has ever needed to know that I even had a prostate problem. My reluctance to wear adult diapers has caused me a lot of embarrassment and my family a lot of inconvenience. No more, I'm a new man. 

Thanks again for the support and good wishes from all of you who have offered substantial advice and encouragement along the way. If there is any way I can help any BPH sufferer just let me know.  I feel that I have a lot of answers I have learned from my own experience and from all of the examples given in this forum. Best wishes to all of you, I'll continue to relate my experience.

Hi Ron,

Glad your trip home was without incident. The Depend Real Fit are way better than the oversized baby huey diapers I was using under plastic pants just a few years ago. Glad they are working for you. I agree you ought to give yourself more time to heal before starting the kegels. Best wishes for continued improvements.

Bob

Hello, guys, it's now Nov 9th and my progress has been steady, improving every day. The pink blood stopped on the 6th day and any minor discomfort stopped on the 7th. I'm still wearing the Depends Real Fits as i still leak a little but actually no more than before the procedure. Unbelievably, I get the urge to go about every three to four hours and I go stand at the toilet and pee like I did twenty years ago. Tonight at 9PM I'm still wearing the same Depends I put on this morning and it is completely dry.

An amazing development is that I am not having the same urgency as before, where I could not be more than two minutes from a bathroom or I'd probably be embarrassed. As I sit at this computer I felt the urge to go at least twenty minutes ago, it's still not urgent and I am confident I can wait a while longer.  My recovery has been beyond any anticipation.

My fervent wish is that others will read this, go see Dr Humphreys or Dr Lingaman or one of the others of a dozen or so who perform the HOlep technique and that their experience May approximate mine.

I have had sprained ankles that hurt more than this and were more incapacitating. I have done no Kegel excercises at all yet I feel my bladder retaining urine fairly well, just not perfectly this am but maybe it will be tonight. 

I took half a Viagra today just to see what would happen and it appears that functioning in that area will be normal as well.

I received a new post tonight from a fellow who has just undergone Turp on the same day as my HOlep and is suffering a lot. Others chimed in about their continued suffering after months. I'm not going to reply on that thread, I don't want to appear that "I'm wiser than you or I told you so" etc. Many of the posters are Brits who are bound by the orders of their Urologists. I feel for them, it's just another example of the freedom we cling to by our fingernails. I hope we can continue to have a say in our healthcare.

I may yet have a turn for the worse, I suppose, but so far my experience has been way beyond expectations. HOlep is now the new "Gold Standard", and TURP has outlived it's time. I'll probably stir up a hornet's nest with that line. I don't care, all of the suffering is just not necessary for a simple enlarged prostate, no matter it's size or configuration, assuming that there are not other complications which I have not experienced.  

    

Hi Ron,

Glad that everything is going amazing well since your Holep operation.

Keep us up-to-date with future developments.

Kind Regards

Brian

Hi Ron,

I couldn't be happier for you. It seems like all your research and searching has paid off. If you are this far along in your recovery in such a short time, it looks like clear sailing. Thanks for sharing, my friend.

Bob

I have had two TURP operations, the first 6 years ago and another 3 weeks ago as the prostate had regrown. Before the first op Iwas having severe retention problems which was making my life a misery after the op I now pee like a stallion and though I still occassionally have to get up in the night my life has improved enormously and I can sink a few pints of beer without the nightmare of not being able to pee it away.  Sex life is fine too no problems in getting a good firm erection and although I do have dry orgasms their quality and pleasure is in no way reduced.  I am 75 years old by the way.

You seem knowledgeable and probably have considered prostatic artery embolization.  The size of the prostate is not an issue.  The prostate is not cored out and the bladder neck valve, muscles and nerves are not tampered with.  

hi ron can you tell me what dr, gave you a quote for $2500. i need the urolift, and  i have no insurance  so im trying to find a  qualified dr at a reasonable price  thanks  joe

The cystoscope - as I remember - is a lot thicker than a catheter.  

Hello chip.  I looked it up to check it out.  Had 3 done in the last 6 month's the size of the one that is use in the office is 3 FR.  That is a flexible cystoscope with the camera. The one that is used in some surgerys are a little bigger and made of metal. Foley Catheters come in 16in long and are 10 FR to 28FR. Reg or Coude They are all on a french scale.  They but 3 sizes in me in the hospital never got it into the bladder.  The only thing it did was make my pee hole bigger.  Ken      

Hi Ron,

I am writing to you because you have the most posts here and seem to

be knowledgeable. I am 85. 3 years ago I had green light done. It took me almost a year to fully recover. 6 months ago I was in an auto accident and retention recurred. I am still wearing a catheter. Now my urologists want me to undergo TURP. At my age I don't think I will be able to survive it. I have been looking into HoLEP which seems to me to be the best procedure of all but it's endurance is unknown and not too many of them are being done. I value your opinion.

At 53 I would never have a Turp.  I hope it was worth it...Ken

Hi, I may be replying to an old post....but...I had Green Light Laser 2 years ago and TURP 10 days ago. I can't leave my house: frequency, urgency, spasm, nausea, etc.

Reading your post gave me hope. Although I am very active, I am also retired and if I have to rest up for a couple months so be it.

Thank you for your post.

This gets me.  You have one procedure to fix the problem and then you have to have another to fix the problem.  That makes no cents.  It just goes on and on.  Ken

Yep. Turns out my prostate was much larger than originally thought. There are many advantages of The PVP Green Light Laser, but one disadvantage is that it's not very successful if prostate is very large. Lucky me.

He is the TURP should do me well but need a while to recover. Each person recovers at a different rate but seems the a average is 4 to 8 weeks.

We'll see.

Bruno.  Can you tell me before you had the GL done did you look into anything else Maybe some less invasive. That may have work better.  To many side effects with GL and Turp.  I would not do it.  I had a urolift that worked well for me.  Would never have a doctor tell me he has to cut my prostate out for me to pee better.  I would just leave it alone and I would force myself.  I never want retro It sucks.  Hope things are better and it works out for you..  Ken  

Thanks!! I wish you well too.