Turp vs. Green Light and Other Less Invasive BPH Procedures

Guys  To me it seams like these procedure are going a rye.  Why do men keep on having surgery after surgery for something that is suppose to fix the problem once in for all.  Maybe the new ones  will work alot better.  I hope so. How many time can you have a turp Before there done cutting away they will be down to the bone.  I feel sorry for all the men that have to go through this.  Take care all  Ken. 

Unfortunately, the prostate, keeps on growing for some of us. The Holep surgery sounds like a pretty permanent one, according to what I've read on this forum so far.  Lets hope they come up with better solutions in the future.

Yes Dennis that is true.  I'm 61  Had a urolift done in April of 2015  Just had it checked a few week ago.  Mine got smaller my urologist don't know why PSA was 0.7 so I should be good till next year....They are working on some new one that should be good  Take care  Ken

Wow Dennis I feel bad for you. Did the DR explain why the prostate was so big after turp and why these procedures aren't working? Are you planning another procedure to fix the need for self cathing?

Seems to me urolift is just "pinning back" the prostate since no tissue is removed. Maybe the compression of the gland causes tissue to die?. If it keeps growing it will eventually be a big problem. 

That's what I keep on saying but no one has come up with an answer.

Rather like a lady getting to fat for her corsets.

I think that they just take away the tissue that is causing the obstruction. My prostate was 135grms in 2013 before my Thulium/Holmium procedure and 55 grms after. Yet in 1995 I was told that I needed a TURP (that I refused) when my prostate was 35 grms. 

 

Dennis, have you considered PAE? A report I read the other day from a radiologist (I believe in Miami) who performs the procedure claims that the procedure works best on large prostates. (I'd thought the opposite--that it doesn't work well on large prostates.)

Hopefully no.  I am just doing self-cathing for now.  I'm hoping that I have the same results as JimJames.

Hi Dennis, Could you tell me more about self cathing?I am almost 87 years old and dread the thought of all these tests and surgery . I have urine rentention.Isn't their more of a chance of getting an infection when you sel cath?Is it painfull and how long have you been self-cathing?Does the amount liquid you consume have something to do with the amount of times you self cath?

Thanks very much,

Hi Frank, I'm not Dennis, but happy to share my experience.  I was having some retention issues after the Green Laser procedure, so I learned to do intermittent cathing on my own.  The catheters are single use, and you may have to do the procedure 3 to 4 times a day.    If your hand is steady enough, it is not difficult and it is not painful in my opinion.  A full bladder when you can't pee is painful though.  The catheter used is thinner than the foley catheter, so it inserts more easily.

A good thing about self catherization is that it will allow you to get the bladder completely empty.   So, while the amount you drink certainly could affect the number of times you do it in a day,  Not drinking enough concentrates the urine and that can actually contribute to a UTI.   Don't drink anything for 3 hours or so before bedtime; then self cath and with an empty bladder, enjoy some hours of sleep.

Cleani the end of the penis well, and using a wipe (some here say they use alcohol and toilet paper) is necessary.  You then pull the sterile single-use and pre-lubricated catheter from its wrapper.  The end you hold it by has a larger bell-shaped part you hold it by while letting the other end start into your ureathra.  (The other end is grasping the peniis and hold it it up.)  You can go to YouTube and find videos of the procedure.

Call your urologist's office and ask if they can help you with instruction if you need it.   There is one video here that some don't like as it is overkill with rubber gloves, etc.making it seem like a surgical procedure.  Anyway, just to see the procedure, go to youtube and search for Kevin Johnson self cath and you will see how one person does it.

Hi Glenn, Thank you so very much for that information on self -cath.

I am almost 87 years old, i think at my age i should try to self cath,before surgical procedure. Uroloigst sugessted Turp,the only test he did was cystoscopy. Do you know if the Greenlight PVP is less invasive??

Thanks, Glenn,

 

Hey Frank..  I think you should try CIC.   At 87 you don't want to put yourself through surgery.  Don't you go next week to see about the uro-lift.  Let us kbow what happens  Just be careful  Ken

Hi Ken, Yes Oct4 i see a urologist who does Uro Lift.I don't know how many he's done,i will ask,don't know if i get an honest answer.I guess at my age surgery would be more of a risk than the Uro Lift. If i had surgery i think Greenlight VIP  laser would be better than Turp?

What is your opinion on this?

Thanks,

Hi Glenn, Thanks again for that great info on CIC.

You said you had the Greenlight laser  done ,are you still having to sel-cath?

Why did did happen?

Hi Frank,  Glenn's response says it all.  I use hydrogen peroxide on the tip of my penis, before using the catheter. I take a sheet of toilet paper and dab it with hydrogen peroxide, then dab it on the tip of my penis.  I do this with three separate sheets of toilet paper.  I just want to be extra careful, so as not to get an infection. So in other words, I'm doing it three separate times.  I go really  slowly when I start to penetrate the penis. This way, if it starts to hurt a little, I can stop, and wait, then start over again.  It becomes painless, after much practice.  The rewards, are great...no full bladder!  After the catheter, does its job, and I start to withdraw the catheter, from the penis, I twist the catheter, back and forth, and even rotate it, as it is coming out of the penis.  This is something that I thought of on my own.  I don't know if it is helping, but my thoughts are that, I am getting my urethra, used to the foreign object that is penetrating the penis, on a daily basis, and also to widen the passage way from outside the body, to the bladder...kind of like a daily turp. Congradulations, on reaching 87!  I hope to reach that age someday, with a healthy body and mind.

Hi Dennis, Thanks that reply.I must admit surgery does scare me,even though urologist says he wanted to a Turp? My only problem at almost87 years old is this urine rentention.I remember in 2004 i had a ultra sound of my bladder,they said i was not empthing my bladder. I should have seen a urologist about this but i didn't. {my fault| How  long have you been doing self cath? How old are you Glenn?

Thanks,again

The urologist who did my GL PVP in 2005 regarded it a very gentle procedure and had done a massive prostate on a 92 year old who was not in great health. I said of my PVP at the time that it was no worse than going to the dentist. As you are aware Forums like this attract people who have doubts, fears, complaints and had bad results. It would make me think that America has the worlds worst urologists.

GL is now the proceure of choice in the UK with the NHS. That is because it is more sucessful than TURP and overall cheaper as it has a shorter hospital stay. Go for it and get your life back!

The story of prostate left looking like ragged hanging curtains I had not heard for a long time. The laser (in good hands) smoothes all of the path it has made. Use Google to search Youtube for a video of the procedure by Spains Dr Sanchez. There are many videos online of the different procedures.I'm sure that you don't want to spend the rest of your life inserting catheters several times a day.   

Urine retention is not your only problem as obviously your prostate is getting bigger and retention will eventually damage your bladder and kidneys.

I  thoight HOLEP was slowly taking the place of GL in the UK.

Frank,

I had to self-cath (CIC) because of inflammation and swelling after the GL procedure. The advertised advantage of the GL was that there was less bleeding.  Someone posted on this board that his doctor said GL had a longer recovery time that standard TURP.  I had to have a second procedure (Gyrus Turp) 2 months after the GL to clean things up since the GL left a lot of hanging debris in the cut through my median lobe,.  I don't have retention, but I'm totally incontinent nearly 7 months after the GL procedure.  While my outcome is a rarity, I've read, it's been a personal disaster for me, living in diapers and pads 24x7.  So I could hardly recommend GL, although I'm sure it's worked out for some people.

I know nothing about your general physical condition, but I would suggest you learn to do CIC and see how it works for you.

Glenn

 

Derek, has the 2005 GL procedure continued to produce good results for you 11 years later? GL is also the procedure of choice in my area, Washington, DC. My only compliant about the procedure--or rather the urologists who perform it--is the less than full discosure (and sometimes downright dishonesty) one gets regarding retrograde ejaculation (RE). Some urologists don't mention it all, while others say, "It is a possible side effect." When I asked a urologist at Johns Hopkins (rated #1 in the US in urology) what % of men have RE after GL, he said, "100%--if it's done right." It wasn't the answer I wanted, but I appreciated his honesty. I'm 71, and RE is not a huge issue for me. But I like to know what to expect, and many uros, at least in the US, are less than forthcoming on the topic of RE.

Glenn, would you mind sharing where you had your procedure done? Or is that not allowed on the forum?

We are a long way from that happening. If you read the recent posts by debbie2792 she was unable to find an NHS hospital in Manchester or NW West England doing it for her husband. She did eventually find one of the few doing it privately in that area.

GL took years to get here from America and it took a long time before it became an alternative choice to TURP and then only as Debbie found in some areas. GL was actually being widely done in Turkey before here. There they even had banners over motorways to tell men about it.

I had my GL in a forward thinking hosiptal in 2005 where about five doctors were doing it in a trial. They later went over to the second generation equpment and three years ago changed to HoLep.  

 

I would rather not do that.  It was at a large practice with 12 or 13 urologists on the staff.  My doctor has a good reputation, is F.A.C.S. level doctor who trained at UC Berkeley after graduating from a top medical school.  I'm just regarding it as an unfortunate outcome for the time being.  I do have an appointment at a University teaching facility, hoping they will be willing to move ahead with AUS surgery sooner, rather than later.   I am sick of living in wet diapers and pads.

I understand, Glenn. I feel for you, man! Do the doctors have any idea what went wrong?

 

If he does, he hasn't shared that with me.  At my last visit with him in July, I aske whether any damage had been done to the bladder mouth or external sphincter and he said no.   I'm hoping the doctor I see next week in another city will be able to give me an unbiased assessment.   All I want is to recover some quality of life as quickly as possible.

Some doctors say whatever they like about the other procedures. When I mentioned my previous GL PVP to the one who did my later Thulium/Holmium one. Going back over my history he reacted violently to the mention of PVP. I’ve forgotten the actual words he used but it was to the effect that PVP is a money making commercial procedure and not a cure.

When he came to see me on the second day as I had been kept another night due to pasing blood I compared my recovery with my quicker recovery from PVP. Another tirade on PVP being rubbish.

Depends on what you call a good result. I was happy with it until my prostate kept on growing until it was 135 grms in 2013. But I guess that would have happened with another procedure. It is said here that HolLep may not last more than ten years. Prostates are like a weed that keeps on growing.

I would have happily had another GL but my local hospital did not do it so I had the Thulium/Holmium procedure that had the advantage like HopLet of being able to save tissue for the histologists to check. 

I forgot to add that I did not have RE after the Gl procedure, They said that they try to take great care about that.

I was on the way to RE after taking Tamsulosin before my next Laser version and that finished it off.

I was 71 when I had the GL and 79 when having the other procedure. 

Hi Glenn, Did you take meds ,like Avodart,and Flomax?before you had surgery?I have been taking this medicine 4 months ,still have urine rentention,my urologist says i'm just unlucky , it didn't shrink the prostate.

How long have you been doing sel-cath?Can you sleep through out the night without getting up? Thats one thing good about a foley catherter.

I so sorry to hear about GL and the problem your having.

 

Interesting, Derek. When I told the doc at Johns Hopkins (the one who said that RE is always a side effect of GI, if done right) that I had read that some patients don't get RE after GI, he said that that was true in the early days of the procedure--becuase the docs weren't destroying enough issue. I haven't heard of the Thulium/Holmium proceedure. How would you compare it with GI? Are you happy with the results?

Good luck, Glenn. Let us know how it turns out.

No.I hadn't taken any  special meds before GL.  Afterwards, I was on Finesteride for a couple of months after I had Gyrus TURP, my second procedure.   About 14 years ago, I tried to take Flomax, and one tablet caused me to pass out cold with BP of 65/35 ending a trip by ambulance to the hospital, so I was afraid to try it again.

My current doctor had just prescribed Duloxetine HCL (generic of Cymbalta) for me, hoping it would help resove the incontinence.  (It's an off-lable use.)  I took the first capsule yesterday a.m. and then about 5 a.m. this morning,, I went to the bathroom and started feeling nauseous and dizzy while urinating.  Heading back to bed, I felt like i wouldn't make it so I went to my knees thinking I would crawl to the bed.  Ending up lying on the floor, and my wife got up to check on me.  She's a RN, and thinks I had a small seizure from how I was moving.  I then broke into massive sweating so she brought me some towels.  After 5 minutes or so, she helped me into an easy chair at the foot of the bed.  After another 10 minutes or so, I was able to get on the bed and lie on a large towel as I was still sweating.   Finally, the sweating mostly ended, and she brought me a dry shirt to sleep in; the one I had one was soaked!   So now I and my wife are both afraid of my continuing this medication.  Since I see another urologist on Friday, I will at wait on the outcome of that visit.

 

Hi Derek, Thanks for that info,i do need to make a decision.I do believe getting the right doctor is the answer.How do you get the right doctor?

Are you doing ok sicne your PVP?Did you have this done in UK?It was nice to hear this was done on a man 92 Years old.At almost 87 that does give me courage.Did you have a lot of after surgery bleeding?

Thanks,

The Thulium/Holmium uses two lasers. One to cut out tissue that is saved and the other to to tidy up and seal off blood vessels and could be compared to HoLep.

When my prostate started to regrow I asked to be referred to one of the top two UK urologists who was an early user of GL.  He said that when it started we thought that it was a very easy procedure but we later realised that it needed to be done with more care and that now the second generation laser was a great improvement and could deal better with bigger prostates. The original machine used a laser rod that lasted for about an hour so perhaps that limited how much tissue they dealt with. They could use a second rod but cost (£3000 a rod)  was a factor.

My GL procedure took 57 minutes lasing time. The Thulium one was 59 minutes lasing time but overall the procedure took over 2 1/2 hours of the surgeons time plus preparation and finishing up time.

His NHS hospital did not have the new equipment but his private one did. He said that if he did mine he would 'borrow' one from the other hospital. He decided that I could wait a bit longer to have it done then the Thulium was available locally.

Overall the Thulium has turned out better but it took time. I have no retention or urgency and can pass much larger volumes than before so go much less often. Neither procedure has produced the flow I expected but that is not a problem. The flow is variable mostly slow to medium but other times fast. Seems to be no reason for that as I had a cystoscopy last year where everything looked OK apart from a nodule growing on my median lobe. I do produce more urine during the night for some reason but were it not for the fact that I do not sleep well for other reasons I would probably only go once during the night. As it is any time I waken up I feel that it is better to try now rather than later.  

After the GL my PSA went down to 5.1 from over 9.0. It was over 7.0 when I had Thulium but is only 0.74 now. I'm not sure why that is. 

Wow, that was a scary incident and obviously caused by the med. Otherwise I would have said that it was like my reaction when twice having a kidney infection.

My prostate regrew after the PVP. Yes in the UK by an NHS doctor doing only his eight  procedure and I had total confidence in him although he was the junior in the team.

No bleeding after the PVP just red tinted urine for the first two days that soon lightened. A spurt of blood at the start of urination for about ten days and and a burning in the urethra for a while due to the trauma it suffered from the instruments. The urethra is like a sponge and absorbs blood and that accounts for the blood.

My life was back to normal on day two and I travelled home by train and on day three went to the Races and was out walking around all afternoon and travelled each way there by bus. Believe me my experience was typical as on this site you tend to get the ones with problems.

I don't need this site, I just stick around out of interest and try to help ones like you who need reassurance and to guide them away from the Old Hat procedure that is TURP. TURP is a very general expression and there are now several improved versions of it.

In the people I know only one had a problem but he had a TURP. Men with leakage and wearing pads I never hear of in the UK, 

I've been following prostate NG's and Forums since my BPH was diagnosed in 1995. There is still an old BPH news group now little used where Patrick the worlds first PVP patient used to post. He was so happy with his out come that he bought shares in the company! A few days after his procedure (I refuse to call it an operation) he was able to fly from California to Japan without any qualms.

My late father in law had an enlarged (huge) prostate that he ignored the symptoms of. One day he had a fall in the street and started to pass blood. At the hospital they drained about two litres of bloody urine from him. His health was poor and they did not want to put him through a TURP. Instead they fitted a stent but that did not last for long as it got covered in limescale and it was removed. After that he went into a retiremen home and they used to cath him but he got infections and  eventually they put in an indwelling catheter. 

You're right, Derek--getting the right doctor is key. Where do you live? In many major cities in the US, there are magazines or web sites that independently rate doctors. For example, in Arlington, Virginia, just outside Washington DC, there are two publications, available online--Washingtonian Magazine and Northern Virginia Magazine--that rate doctors based on both patient feedback and other doctors evaluations. Another source of infornation is Angie's List. I've used all three.  

I'm in England. Hospitals and doctors are rated and tables published under various headings. Some cardiac ones in particular, hospitals and surgeons have been stopped from operating until changes have been made.

When I was in having my heart valve replaced one patient died from one particular procedure with one surgeon and another nearly. Another guy came in to have the same and was most annoyed to be told that his was being postponed as they wanted to re-plan his procedure. Some time later he made the papers with three deaths reported.  

Hospitals with poor quality care and results like my local one are under 'Special Measures' by the Quality Care Commission where management is checked until everything is corrected.

Hospital and Doctors surgeries have patient feedback to their web sites.

We have something probably like Angies List called Dr Foster.

Dr Foster works with healthcare organisations to achieve sustainable improvements in their performance through better use of data.

We are the leading provider of healthcare variation analysis and clinical benchmarking solutions worldwide: our specialist teams share their world class expertise with healthcare leaders in hundreds of leading hospitals in twelve countries, including over half of English acute hospitals. Dr Foster is a wholly owned subsidiary of Telstra.

It started off small like this site but got big.

Sorry. I meant to address the above comment to Frank, who asked how to find a good doctor.

Frank, I had some thoughts on how you might go about finding the right doctor, but I addressed my comments by mistake to Derek. See my comments below. Good uck.--Don

Hi Derek, Thanks for that that info. I guess if a guy in poor health at 92 years

came out ok,that says he had a great doctor.How are you doing after your GL PVP in 2005?Your right forums like this can scare you.My urologist sugested Turp> after reading about and hearing from this Forum ,GLPVP is a better option than Turp?I guess you have to quailfy for this procedure?

thanks,