TUVP 4 Years Later

I see a lot of posts about recent prostate surgeries of all types and the immediate post procedure recovery problems, but rarely any about the long term impact. I'm a 74-year-old male who is no stranger to genitourinary issues. I had a urethral stricture treated first with dilatation (a medieval practice IMHO) and a visual internal urethrotomy in my 30’s. Then a high bladder neck incision 10 years later.

When my prostate started growing around age 50, I was treated medically with Flomax, Uroxatral, Avodart and finally Cialis, the best of the brews. However in 2019, during a trip to New Orleans, I experienced urinary retention and spent the whole week on vacation wearing a bag. That’s because my prostate kept growing and drugs were no longer effective.

My urologist was interested in Aquablation, but it was not approved by Medicare at the time. Urolift was not an option because of the size of my prostate; nor was my urologist a big fan of the procedure. So he performed a TUVP in November 2019. It resulted in catheterization and irrigation on two occasions over a three-week period (one of which entailed an agonizing trip to the emergency room because of the blood and clot flow).

I believe some of the bleeding was attributable to Plavix and baby aspirin that I take for coronary vascular disease and that I stopped taking just prior to the TUVP (but resumed after the procedure).

In general, I believe that urologists, in an effort to reduce patient anxiety, minimize the recovery from this surgery since, apart from a prostatectomy, TURP remains the gold standard for BPH. It can be bloody, painful and full recovery can take a while. This is often the consequence when you consider that your prostate is being hollowed out using any one of the current techniques, aside from Urolift.

Besides the catheterization, there are other ongoing side effects, well documented in this forum and particular to each patient, that can prolong the recovery period.

Finally, each urologist has determined what they consider to be the optimal medical treatment and the timing for surgical intervention when it becomes necessary. So one size does not fill all, and results will vary from patient to patient.

4 years into my procedure and at two cystoscopies later, my urethra remains patent and my flow is much improved. I do experience retrograde ejaculation, as is the case for most patients who have gone through TURP. I am not looking to have any more kids (despite Robert DeNiro @ 80 and Al Pacino @ 83 becoming new fathers) so it’s not that big a deal. Orgasm is not impacted, although I do miss the ejaculatory experience.

I am no longer on any of the drugs mentioned above that either relax or shrink the prostate. At this point, they wouldn’t help.

From time to time, I have vague discomfort and more frequency that could be associated with Lower Urinary Tract Symptoms or Chronic Pelvic Pain Syndrome, two conditions that continue to bedevil the medical establishment. My urologist claims that it’s possibly low-grade asymptomatic inflammation of the prostate, although from my perspective, it’s hardly asymptomatic. He also mentioned the possibility of a bacterial infection deep in the prostate that is undetectable on a urinalysis and resistent to antibiotics that generally resolves on its own.

My biggest issues is nocturia. I experienced it prior to the TUVP and continue to get up 2 to 3 times at night. These trips to the bathroom produce low to high volume and, oddly, some tumescence, as in ½ way to an erection. As it closer to dawn, the trips to the bathroom become more frequent with lower output. The doctor put me on Ddavp (desmospressin). It did nothing. I asked him about Mybetriq (based on a recommendation from another urologist) but my surgeon dismissed that medication as inappropriate.

I stop drinking any liquids after 8pm and do my best to elevate my legs in the evening, but apparently my nocturia is the result of the mobilization and movement of a considerable amount of liquid from my lower extremities to my bladder during the night, resulting in a lot of trips to the john.

I consider the TUVP procedure to be a success, generally speaking, although the repeated interruption of sleep at night – a problem I hoped the surgery would cure or alleviate – persists, and it has all kinds of effects on an individual's overall health.

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