Turp operation or laser ?or leave alone?

Hi Chuck,

None of the procedures require self cathing afterwards unless something goes wrong down the line. But all of the procedures require a foley cath be placed by the urologist afte the procedure, and left in place for some period of time, until the patient can urinate on his own. That's because every procedure swells up the urethra and the foley cath is left in place until the swelling goes down. It may be in place for a couple of hours, or a couple of days or a couple of weeks, depending on the degree of swelling.  

Many people self cath before a procedure because they are blocked up and their urethra and/or bladder neck is basically squeezed shut by the enlarged prostate.

In my case, about 6 months after the Greenlight laser, I had a membrane (scar tissue) seal off the urethra by the prostate and after it was removed I self cathed every 2 to 4 weeks for a year to keep more scar tissue from forming. But that is not a common or expected part of the procedure.

Thank You Bob.  The self cathing really scares me.

Chuck said; Many people self cath before a procedure because they are blocked up and their urethra and/or bladder neck is basically squeezed shut by the enlarged prostate.

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Actually one reason many people catherize (either self catherize or Foley) prior to a procedure like turp, is to rehabilitate a flaccid (stretched) bladder caused in many cases by years of  chronic retention.  Without the proper amount of bladder elasticity, you could have a 'sucessful' turp but still have a retention problem. Therefore better to rehab the bladder with catherization before the operation rather than have to do it after. In fact, some bladders are beyond rehab meaning the turp will not work. Again better to find this out prior to the operation with a catheter rehab program then to have the operation and not get anything out of it except for some of the side effects like retrograde ejaculation.  

Chuck says "The self cathing really scares me" which is understandable, but in my case it was the idea of having a Foley catheter in me for six weeks that scared me. I guess each to their own poison.  

For those that missed some of my posts, I have been self cathing on a regular basis for almost 2 years and for me it's no big deal.  In fact, at least for now it's preferable to having an operation.  My prostate 

Here's a study that shows that self catherization prior to an operation can give a better outcome in cases of CUR (chonic urinary retention). 

http://www.ncbi.nlm.nih.gov/pubmed/15963128

Hi Jim,

My cousins husband cathed for several years 4 times a day. He finally decided to get a turp which worked for a few years. However when it failed he went back to cathing. In his case, his bladder was stretched and he actually felt no sensation of having to go. I'm surprised the turp worked for the few years it did.

Chuck, I think that any BPH sufferer should learn how to self-cath. To me, discovering that your bladder is full and blocked and it's likely to be hours, at least in my location, before you can get any help from a medical professional is far scarier than the thought of the actual cathing. If a Doc or nurse can do it then you can too. I was on the verge of blockage as my meds weren't working anymore so I got two sizes of catheters from my Uro, couldn't get the thick one to go, tried the smaller one and it worked fine.  Just part of the tool kit you need to manage BPH. You can do it. Best of luck.

Ron

That's one of my concerns. Get a Turp and then have to go back to cathing after a few years because of a flaccid (stretched) bladder. I assume his bladder was rehabilitated enough from the 4 years of cathing to have a successful Turp for a few years. So the question is what went wrong. Did his prostate grow back, because if that is the case he could have redone the Turp. But it sounds like he might not have been a candidate for Turp any more because his bladder was too flaccid. Wonder if he had progressive retention issues after his Turp that caused the problem. In theory, his new round of self cathing could rehab his bladder again which might give him the option of a second Turp, if he wants it. Right now, I'm pretty happy with the self cath. My IPSS Score (Internatikonal Prostate Sympton Score) is close to zero, albeit with a little mechanical assist. That's kind of hard to beat unless you're 16 years old, no matter what operation or procedure you have

Hi Jim,

To the best of my knowledge he was self cathing for about 6 years before getting the turp. Maybe his prostate became so enlarged he needed the turp. He was good for a few years but he's  been cathing again several years now. His bladder is totally flaccid and he has no sensations at all of needing to urinate. So if he doesn't cath he will have serious complications. He's 75 and otherwise active. He still works part time and I think he still plays raquet ball. I doubt if he will do anything but cath now, unless something new comes up. His Mom lived to her 90's so he's probably got good genes.

Hopefully, he's ok with it, as I am. I was almost at that point (no bladder sensation) prior to the self-cathing. In fact, they got close to two liters out of me when I showed up at the doc's right before starting self-cathing. Now, I start to have sensations anywhere between 200 and 400cc, which isn't bad. Overall, I urinate about 50% by myself, and the other 50% with the cath. Still too much retention to stop the cathing altogether, unless I want to go back to visiting the bathroom every couple of hours.

I think he's fine with it. 2 liters is a lot. The last time I went to the ER to get cathed I had 1.4 liters and it was excruciating. That's when I learned to cath. When you do cath after urinating, what is your PVR?

I don't always urinate prior to cathing. Maybe 50% of the time. When I don't urinate prior to cathing, I will cath anwhere between 50 to 500cc's but usually between 200 and 500 cc's. After cathing my bladder is completely empty.

If I do urinate prior to cathing, then my PVR is usually between 200 and 400 cc's, as measured by the amount I then cath.  The amount I urinate varies but is usually between 150 and 250 cc's.

As an example, this morning I urinated 250cc's and then right away cathed another 250 cc's which brought me to empty.

The numbers change based on a number of variables including how much I'm cathing, time of day, fluid intake, amount of exercise and how much exercise. For example, after cycling I can usually empty more on my own.

After a while, you kind of get into a schedule/rhythm based on what's going on in your life. A couple of nights ago I was going to the movies so decided to cath right before I left to empty out. Had I not been going out that night, I might have waited another couple of hours before cathing.

"how much exercise" in post above, 2nd from last paragraph, should have read "type of exercise"

It does seem like the cathing is rehabilitating your bladder to some extent. After my Greenlight, after I started cathing twice a month to keep scar tissue from forming, my PVR was usually about 150cc, but could be up to 200cc. At the time my uro said he thought anything up to 250 was OK. But it turned out the real problem was my bladder neck. Last Dec. he removed bladder stones and resectioned my bladder neck to widen it. A year later I had an ultrasound to measure my PVR and it was only 7cc. It goes to show that in my case my PVR and retention problems involved more than just the enlarged prostate.

Hi Peter,

I worked all my life contributing to SOcial Security and Medicare and agree 100% we are entitled to every benefit we get. The NHS and SS are essentially insurance programs. We have every roight to collect benefits. After all, those who all died before they were old enough to collect didn't get a refund! 

I'm not sure I agree that money makes much difference. The choices are limited and a fancy office and high prices doesn't guarantee a surgeon is any better than one servicing the poor and indigent. We are somewhere in the middle and it seems our chances are as good as anyone's. My own opinion is that the state of medicine in dealing with chronic illness is much better than it was 80 years ago. But I believe today it's a money making proposition more than a medical one, so the most expensive treatments are likely to be the ones on offer.

Best of luck for continued success with your treatments.

Bob