Turp operation or laser ?or leave alone?

I'm 82 years old, and have had BPH for a number of years, and have been on Flomax for about 8 years. My urologist started by self-catheterizing about a month ago, as there was too much residual urine left in my bladder after normal urination (about 250cc). He is now recommending surgery, and said the TURP procedure was the best for me, but at my age, I'm not inclined to subject myself to the trauma. He also mentioned that the procedure sometimes doesn't offer any relief.

I have no problems with self-catheterizing about 4X/day, and am wondering if continuing this procedure is a viable option to surgery.

I'd say keep catherizing. Get yourself a 1 liter plastic urinal with ml markings to empty your urine into with the cath after peeing without the cath (if you can) so you can measure how much you are retaining after a normal pee. After a Green light laser I was still retaining from 125 to 250ml. It is not always the same. My urologist said 250ml was OK because I originally had been retaining 400ml and was blocked up. Eventually I had to have another Greenlight laser and a turp because of spontaneous bleeding of the prostate and bladder mouth due to the first Greenlight laser. After the turp I only retained 34ml. and can go OK, but it took three procedures to get there. From wikipedia: "On April 18, 2012, [Dick] Clark died from a fatal heart attack at the age of 82 while undergoing a transurethral resection procedure [TURP] to treat an enlarged prostate."

I'm reading these posts now in 2020 and I realize that many are 6 years old and, for others, this date may be long in the past but I think it's important that we document the procedure even though there may have been changes over the years or decades in the actual procedure and out come. So, As of January, 2020:

I stopped urinating in November of 2019 and was placed on a catheter,. I've been on one catheter (Foley) or another since that time. Any attempt to void-test or remove the catheter was met with full urine retention. That is, these procedures have NOTHING to do with "being able to pee better" as some have suggested. You have to have a catheter or you will become very ill when your bladder is full and cannot be emptied, even a bit. Yes, you can stay on catheters for a long time (like I just did) but the infections you get and the bladder spasms shooting urine and/or blood outside the catheter and all over your clothes, floor, bathroom, car, etc. make that difficult. Every urine culture made since this started resulted in a nasty infection, requiring doses of Cipro 500 mg. Three courses, so far. My doctor's office said the policy is that any catheter must be removed before 30 days. So, how many did I have? Many.

OK, so I was scheduled for TURP and you can do a web search to see what it is all about. However, it was just done a few days ago (today is Monday; the surgery was past Wednesday) as outpatient surgery. Had to be at the hospital at some ungodly hour of 7:30 AM with the actual surgery starting around 9:30 AM (got off to a bit of a late start). Prep included antibiotics, setting up IV, a dose of OTC but strong pain relievers and some insulin (I'm diabetic). Got wheeled in close to 10:00 AM was out by 11:30 and in recovery with yet a NEW catheter. In terms of size, this one was 22 mm. I know a month earlier some nurse tried, in vain, to insert a 24 mm catheter and the pain was so bad, she could not inflate the balloon. But, under a general, a 22 mm was OK. I was on a 20 mm at one point.

OK, went home the same day. Had a friend drive me. Urine through the bag(s) of the catheter started out clear, then yellow/normal, them red the next day with some blood clots, then back to yellow by Friday. Saturday evening, my "butterfly" stabilization device came off (cheap paper one) so I decided to do a massive irrigation (4-5 pumps in and out) followed by a shower so I got cleaned up and put on a new butterfly clamp. Next morning, Sunday, I was up at 7:30 AM and noticed less in the output bag than usual. Emptied and went back to bed. Woke up at 11 AM and noticed night bag "bursting at the seams" with blood and blood clots. It's now Monday and I'm still bleeding and huge clots/scabs. OK, at 9:00 AM had visit with my urologist who said that everything was normal and I can expect to continue to bleed for a while. At 10:00 AM, I had a void-test which I passed and, without a catheter, I went on my way. Pee'd at least 10 times today with strange things. A lot of blood but not massive and some big clots.

OK, urinating hurts/burns especially when you get to the end of the stream. If you pass any size blood clot, your penis vibrates and hurts but only lasts a second or less. So, was it worth it? Well, if the only alternative was a "permanent" catheter and peeing into bags then the answer is definitely "YES". If you think you'd like the bag and the infections and the painful bladder spasms and doing laundry 2x per day and mopping the floors and avoiding baths, I'll take this. About incontinence: The doctor said that for this TURP procedure, Kegel floor exercises should not be needed (anyone?). I'm not "incontinent" but... I've noticed that the difference between peeing and not peeing is just a twitch. So, I have to be careful. But, I'm not wetting my clothing anymore. Good sign. And, there will be improvement. If I'm having issues with leaks, etc. after 2 months, we will revisit the exercise question then. But, regardless of the burning and the weird passing of clots, this was well worth it. Not to pee better, but to pee at all. Right now, I'm on adult diapers to stem leaking and having to do more laundry. Not terrible; like cheap underwear.

I'm also getting the idea from reading posts that everyone's experience is DIFFERENT. So, I can only tell you what I am experiencing and not what you might experience. Especially, if you are reading this years from now, like I am doing with the original date of the posts.