TURP vs. Resum

Bobby,

My uro says the risk of permanent incontinence with bipolar TURP is about 1%. I have seen similar stats elsewhere. However, incontinence is not well defined. It can mean anything from total inability to control urination to just a slight dribble here and there. I have had this for decades and wear a pad of toilet tissue in my underwear - absolutely no inconvenience at all, don't even think about it. I have been on this forum for a long time and the risks of any procedure are real - and many here have gone through months and even years of issues with any of the procedures - except PAE (which I had). The only problem with PAE, for me and others, is that it doesn't work well if one has a median lobe that can continue to block the bladder even after the prostate has been reduced in size. I have to point out that old TURP and the newest bipolar version with plasma button cauterization are very different. The old monopolar TURP reqired several days of hospitalization to control the bleeding, but the newer version usually sends the patient home the same day with far less post op bleeding and discomfort. The pure plasma button TURP without the cutting loop is even better at reducing bleeding and from what I have read post op side effects.

Tom

Bobby,

That is the best comment that I've seen about TURP EVER!

I kept hearing that TURP was the gold standard. Does that mean the medical community makes the most gold with it?

Tom,

Yes, I had heard 1-2% for incontinence, but then there is ED and RE too. At 61 I did not want to be one of the 1-2% who suffers for the rest of his life. For the 98% who had a good outcome I say "Thank God". They were blessed.

I chose the path that had a history of 0% negative side effects. The only downside known at that time was that it worked for 85% of men and that the results were only known for 5 years since that is how long the procedure has been in use. Now it has been 7 years and from what I have read still no downside and nobody had had to have it repeated yet. I am hearing that water ablation is also almost as gentle.

All that being said whatever happens I know that I will cope. Human beings can adapt to almost anything. I met with a cancer survivor's support group to discuss how their surgeries have impacted their personal lives. This included women who have had double mastectomies and men who had a radical prostatectomy. The man who had his prostate removed became impotent yet with support from the group he said his sex life improved. Instead of 10-15 minutes ending in ejaculation sexual intimacy now extends for as much time as they wish. He focuses more on his wife's desires and gets pleasure from pleasing her ... sometimes several times a session which elicited smiles an d a few giggles from the group. Then over about a year or so he found that while he did not climax with an ejaculation, he was getting the same release of endorphines, dopamines, oxytocin, etc. in his brain from having his other erogenous zones stimulated for an extended period of time. The result was a much deeper sexual intimacy than they had ever achieved from before. His wife pointed out that all this occurred with a lot of frank communication and a lot of patience. The effort was worth it because she said her husband had become a much more generous lover.

So it all depends upon each of us making the best of our situation no matter our choices.

Bobby,

A few years ago I had radiation for prostate cancer, so my sex life went from fantastic to nothing. So, my present concern is eliminating the frequency/ugency/nocturia issue. I have to pee about every hour to hour and a half, day and night. I never, ever get a good night's sleep. I am up 5-8 times per night, sometimes more. My uro offers three procedures - bipolar TURP, Greenlight Laser, and Urolift. For Rezum I would have to drive to another city and pay out of pocket - not covered by my current insurance.

One of my concerns about the Rezum procedure, aside from pain during the treatment, is the prostate swelling after. I can barely pee now and am retaining about 200ml, so if there is further swelling I might be completely blocked for possibly weeks. I would need a Foley catheter and after that CIC. At some point, the prostate would shrink and I would be able to pee again. I went through this for five weeks after my prostate radiation - had 6 Foley's in and out, and eventually the swelling went down and I was able to pee again.

After my PAE I had swelling, and the urine flow was reduced, but I was able to handle it with 2 Flomax per day and Tylenol for a week. No UTIs because nothing is passed up the urethra. The procedure itself was completely painless and actually pleasant.

Back to Rezum - add a UTI to the swelling and I can imaging running to the bathroom every 15 to 30 minutes all night long.

I really need to hear from anyone here who has had the Rezum procedure to find out two things: how was the pain and what about the next couple of weeks?

We are all in the same boat trying to make the right decisions. My rule of treatment has always been to go with the treatment that is the most effective with the fewest side effects first (for me that was PAE), then if that didn't work, move to the next procedure. Many here believe that to be either Rezum or Urolift. There are so many ways to go it can make your head spin.

Tom

Tom, I think that you're doing the right thing by starting with the least invasive and going from there. I only have experience with Rezum, so I'll offer my suggestions for that procedure. And really there are only three:

1. try to find out beforehand if you have the type of blockage that the Rezum will eliminate. By that I mean make sure that the urologist has a good image of the anatomy in that area. My urologist used a TRUS (Trans Rectal UltraSound) and was able to see the enlarged median lobe that was causing most of my problem.
2. ask for general twilight anesthesia. Rezum can be painful without it. On the other hand, it does only last for a few minutes. It must be rather memorable though, since it gets its share of attention from those who have not had a general anesthesia.
3. learn to self cath before the procedure and don't let them insert a Foley after the procedure. If you self cath, you have control over when you urinate. I self-cathed at least three times after the procedure later that day. I expected some pain because of the procedure but I didn't really feel any.

   Yes, there will be swelling of the prostate for several weeks after the procedure, and so you need to take steps to counter the swelling. A Foley catheter is normally used, but CIC makes the recovery so much more pleasant and less stressful.

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WHAT IS iTind

Ken,

Thanks for the info. My uro did a cystoscope and says I don't have an issue with median lobe, but I am not sure what to believe because another uro said I did have an issue, so I don't know who to believe. Bottom line is the shape of my prostate is preventing me from emptying my bladder - call it a median lobe, or whatever, but I am partially blocked so I have to go to the bathroom frequently day and night. During the day this isn't much of an issue because there is always a bathroom available, but at night I am lucky to get 1 1/2 hours of continuous sleep before my bladder wakes me up and I am off to the bathroom. This process takes about 10 minutes, so repeat that 6,7, or 8 times per night and that's a lot of lost minutes of sleep, and I always feel a bit tired during the day. This has got to be resolved. Sleep should be refreshing, not a torture.

About Foley catheters...I had 6 of them, in and out, over a five week period after my last radiation treatment for the prostate cancer (now gone). After the first couple of days I got used to having the Foley in and never had to think about running to a bathroom, except to empty the leg bag. I was able to get up only once per night to empty the bag - so it really helped my sleep, as there was no build up of urine in my bladder. I found the experience to be easy. My uro wanted me to self cath, but why bother when the Foley just kept my bladder empty at all times.

Back to Rezum. I understand that I can request to be out for the procedure, or "twilighted", but my real concern is the weeks that follow. If my prostate swells up I might be almost completely blocked, so back to Foleys or self cath. I did self cath a few times and for me it was not a good experience, and I can't imagine doing this on a regular basis. I keep some unsealed hydrophilic catheters on hand "just in case". They aren't cheap - cost several dollars each.

One of the reasons why I am still considering a biopolar TURP is that am so tired of being tired and just want this retention and nocturia to be over.

I do understand that everyone has a different post procedure reaction to the Rezum so there is really no way of knowing how it would go.

Again, thanks for taking the time to reply...I really do hope that all your issues have been resolved completely.

Tom

Ken...correction to last reply..I have unused hydrophilic catheters ready to be used in an emergency. They cost about $3-4 each.

Tom

Tom, you made a couple of good points. One is the cost of the catheters. For those of us who are on Medicare and a supplemental insurance program, we tend to forget how expensive things like that can be because we're not paying for them directly.

Also, I mentioned self catheterizing after the procedure because I've read several accounts about how difficult the Foley situation can be, especially when the Foley has been removed, but the swelling of the prostate hasn't gone down yet. In situations where it takes weeks or longer for the flow to improve, I would think that wearing a Foley would get old. That's why I encourage the option of self-cathing: to use them as needed, for as long as they are needed.

What I've come to realize though, from reading accounts of others on here, is that what works for one person may not be the best option for someone else. My particular experience with Rezum was a true 'walk in the park' with no pain, and a quick and effortless recovery. Unfortunately, not everyone gets that some level of satisfaction from the procedure. I still believe that Rezum is a great option for many BPH sufferers; it's just not the perfect solution for everyone.

Ken,

Depends on which catheter you want to use. I need to find out which ones are covered under my insurance.

I was in exactly the situation you described: prostate swelling, unable to pee, had to use 6 Foleys over a 5 week period. Got really easy. I had a system - the drain tube was taped to my leg so no tugging, the tube insertion point at the tip of the penis was kept lubricated with Neosporin, so very slippery and no UTIs, the penis was placed in a horizontal position in my padded underwear, so again, no tugging. So, it was really quite easy and comfortable. After 5 weeks I could pee a bit on my own, so no more Foleys. I did have to self cath a couple of times after the last Foley, but that was difficult and uncomfortable for me, so I would only do that in an emergency situation - not something I would want to do on a regular basis. Some here get used to it. So, for me, having to use a Foley for a few days is "no big deal".

Tom

"What I've come to realize though, from reading accounts of others on here, is that what works for one person may not be the best option for someone else. "

This is good observation. Take your comments about Foley catheters for example. I have had two trans-urethral surgeries for bladder tumors. I had Foleys in place after each, once for 3 days and once for 4. While inconvenient, I had no problems with infection and removed both myself without pain or even discomfort. However, this might not be the case had the prostate been worked on.

I believe one should make medical decisions based on advice from medical professionals and clinical studies. The anecdotal data one gathers from an internet forum is worth what you pay for it!