Which Prostate Procedures Have Least Incontinence Liklihood?

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Of all possible outcomes arising from a Prostate procedure, incontinence scares me the most. I do not care if I ever have an erection again (66 year old). Despite lifelong intermittent flareups, my condition seems less serious than those here on the forum. Other than continual, but mild epididymitis, hesitancy is my main problem...now being managed well by double-dose Tamsulosin. Someday though I may need one form or another of procedure.

Question is, from you who have experienced a prostate procedure, are there opinions on the procedure least likely to cause permanent incontinence? Thanks.

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  • Posted

    When i finished my research I picked PAE.. I was taking 2 flomax a day ... I had PAE over two years ago and  I am still off flomax which is great. 
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  • Posted

    Nether one.

    MK

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  • Posted

    I am 69 years old.  I did a greenlight laser treatment around 15 years ago.  It worked for around 2 years, but I still had to take medication to get the flow at a decent level. My next treatment was a turp. It was better, but not that much, as I recall. The prostate, grew back as it did with the greenlight therapy and so I did a second turp.  By then, my bladder, must have stretched out so much that after the second turp, I coudn't urinate on my own.  So presently, I am doing cic.  It's the best thing I've done for my condition.  If I could go back to 15 years ago, I would first try the cic.  My bladder, feels really empty after doing cic.  It's the best feeling over the laser greenlight and turp!  If I were you, try cic first.  Less damage to your prostate.  Good luck!

     

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  • Posted

    I had a UROLIFT 3 years.  Never had a problem.  All the others have a degree of incontinence and other side effects.  If you can get off that pill and get something else.  Don't let the problem get to you and cause you other problems  Ken 

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  • Posted

    Following 8 years of hesitancy, retention, infections, nocturia and bladder stone formation, all due to BPH, I opted for the HoLEP procedure.

    In and out of hospital on the same day without a catheter and within a week the incontinence (the occasional dribble if that) had cleared up.  I did make sure that I carried out frequent pelvic floor exercises in the month prior to the procedure which must have greatly helped in ensuring no post op incontinence.

    Two and a half years later, I'm still peeing like a teenager.  Erections are still available should I want them but retrograde ejaculations which doesn't worry me in the slightest.

    Good luck with whatever route you choose to go down.

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  • Posted

    My flow diminished in my mid 40’ and over the years it became all more complicated. Relieving was taking more and more time, although you get used to it to work around the problem. An acute urinary retention brought me to the urologist. Recommendations went from Turp, Urolift, Rezum, Láser treatment. During my research I consulted with several professionals and one in particularly convinced me and I had the treatment done the end of October 2017. On the way to recovery I have experienced several stages. All in all, I am very happy with the outcome. Relieving works very well, I can sleep 3 to 4 hours without getting up, I have control and sex life is good too.  I am glad I did it and really pleased that I am much better off from any angle I look at.  Every person is different and responds differently. Have an open conversation with the urologist you trust and feel comfortable with. In my opinion if the patient and the doctor can connect with each other, the outcome of the procedure is more promising. I also would want to be assured that the doctor always goes with the least invasive option to start with.

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  • Posted

    Hi all, it really depends on whats causing your specific problem, but generally speaking my research says definitely FLA  as it does not cut away anything important and saves all the important bits and without those nasty side affects.

    I have herd horror stories on every type of operation accept FLA, I know of one guy who had incontinence before FLA and now its gone and life is great again, I spoke to a leading urologist who said incontinence from TURP usually happens on the second operation so my reasoning is avoid the first operation by having FLA and without the side affects, I used Dr Karamanian in Houston who is very good.

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    • Posted

      FLA and Dr Karamanian is an excellent option. I consulted with him too and was very close to have myself treated with him. For some reason I went with another professional who recommended a GL / PVP  treatment done. I was warned of potential side effects. None of them happened to me. I have been lucky! As Dr. K said, any surgery has it's risks. 

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    • Posted

      I'm reading good reports of the "Cooled ThermoTherapy" ...apparently a cooled microwave tip with few side effects. There is a doctor 65 miles away who offers the procedure.

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    • Posted

      Brian, I'm curious, do you know people that had FLA that are not on this site? Of the men that have had it done on this site it seems the success rate is about 70%. Of course some of those men had extenuating circumstances. FLA is still my first choice when I eventually have surgery. For now I've responded well to medication. Fernasteride is tough on erections though.

      ED1591, If I did not care about retrograde ejaculation (RE) my first choice procedure would be HOLEP. There is very little chance of needing surgery again, or other problems like incontinence . The only catch is the 80% chance of RE. 

       

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    • Posted

      There is a lot of concern about RE. Isn't it mainly psychologically for us men? The orgasm, the feeling is still there, with the only difference that semen is not expelled out, but in the bladder. The woman doesn't care, except if both have the desire to have children. I think, we as men care for the forward ejaculation, because it gives us the feeling of being complete, to be a man. But, if we take this pressure off, the optics change.

      ?Myself, I have experienced dry orgasm when taking tamsulosin for a couple weeks and also due to the obstruction the ejaculations became smaller and smaller over the years. Quite contrary to the concerns and risks with related with GL/PVP treatments, my FE is better than ever in the past 25 years. Was it pure luck? Is it because every person is different? Was the doctor so skilled? Probably a mixture of circumstances. In any case. I am very happy with the result.

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    • Posted

      I think in a way you are right but why should we have to give up anything just to pee a little better.  I was on flomax and rapaflo.  My orgasm were not the same.  It felt flat and I did not like it.  The built up was there and then nothing   I got off them pills and that is when I had the Urolift.  My orgasm now are more intense they they were when I was younger.  At 62 I am not looking to have any more kids but I will never give up my ejaculation for anything.  Take care  Ken 
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  • Posted

    Its important to note than incontinence is rare with any of these procedures and this forum (or others like it) are not representative of the outcomes of any procedure as the success stories, that far outnumber the problems are almost never posted here. Most come to look for answers after problems, or for info prior to a procedure.

    That said, TURP, Holep and Greenlight all can cause incontinence. Rezum, Urolift, PAE and Focal Laser ablation have almost no reported cases of it, even when the procedure failed to bring relief.

    It sounds as though you don't need anything right now and may never. If you even start experiencing retention, make sure that you deal with it - either by self cathing or via some kind of procedure. Straining to pee and bladder stretching can cause incontinence or render you unable to void without a catheter (self or indwelling) so if that problem develops, don't delay in doing something about it.

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  • Posted

    Are you happy about taking a double dose of Tamsulosin with all of its side effects?
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    • Posted

      I was  on one a day 4mg of flomax for years.. after 8 or so years had to go to two a day. The side effects after long term use were loss of feeling in the penis, no ejaculations and other minor issues. I had the PAE procedure done Oct. 2015. I reduced the flomax to one pill a day right after and then eliminated flomax all together after about 5 weeks. It took about a year to start getting feeling in my penis and started to have some ejaculations. After two years I now have good feeling in my penis and pretty good ejaculations. I will probably have the PAE done again in two years or so. They are more aggressive now than they were then. The self pay now at the University of North Carolina now is 10,500 dollars. When I had mine it was 6500. Medicare will cover this procedure now, but most private insurance will not.

      Had an MRI in Nov. which indicated an area of concern and had a fusion biopsy Dec. 26. All sixteen cores were negative. 

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    • Posted

      75 and still enjoy sex a lot . Glad I got the feeling back. I took flomax for a long time waiting for PAE to become a more common procedure. This is the only procedure for BPH I have had. My prostate was 140 before the procedure and 97 after the procedure. Still large but every thing works. so for so good
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    • Posted

      sounds kind of like my prostate.  It was 141 grams before the turp and 101 after the turp. It must be that my bladder became flaccid, because now I have to cic.
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    • Posted

      Dennis sorry to hear about your bladder.. never had that problem. The MRI indicated the wall of my bladder has thicken a little. But at my age no worry.   Some one posted about a pelvic exercise they use to help their bladder. Not sure it was related to your issue though. I plan to have the PAE again probably next year. I am not on Medicare B so I may change since it covers PAE ..Retained my private insurance since my wife is younger and needed the coverage
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    • Posted

      not real sure Jim.  10 years or so   2 pills a day for the last few years before the PAE procedure. Have not had any since jan. 2016 . Still have almost a 90 days supply of flomax in the cabinet from two years ago. took a lot of other stuff before starting flomax. 

      The major side effects really hit me in the last few years of taking it, probably because I when to 2 a day since the one a day stop working. 

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    • Posted

      It was slightly above 12 before PAE and 6 weeks after PAE was 3.4  It has since gone back up some due to infection of the prostate which for some reason does not effect either peeing or sex. everybody is different I guess
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