Why the hurry with the TURP?

Edited , 9 users are following.

On Tuesday I had a bladder stone removed and this morning finally had the catheter taken out and eager to go home.

I have BPH and evidently it's quite large and the doctors wanted to do the turp at the same time as the stone removal. I declined as I was concerned about the possible side effects. I'm 66 now and should I last another 15 years these will probably become less of an issue.

I've been put on Tamsulosin and Finasteride, the latter of the two taking 6 months to have an effect. The reason the docs are keen to do the turp is because of the bladder stone and the likelihood of urine retention which they feel will return cause it to return. I'm scheduled for a clinical review in 3 months. I asked the surgeon if the only op they did was a turp and he confirmed it was. I'm reminded of the old saying about if your only tool is a hammer everything looks like a nail.

Has anyone had a bladder stone and been in a similar situation? If so what did you do?

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  • Edited

    I shouldn't really reply because I didn't have a bladder stone, but I did have a kidney stone and some kind of infection (UTI?) at the same time. Some of what you say is true. If 99% of the BPH procedures that a given set of urologists do is TURP, then they will push to do a TURP. It's not just a matter of what the doctors feel "comfortable" with. It is what they have the most experience with. If we look at "managed care" (HMO?), we realize that one of the things we give up to belong to an HMO is that we don't get a lot of diversity of doctors. You are limited by geographical region and then by the actual specialists within that region.

    But don't "discount" urine retention as a cause to speed up the decision process either. In my case, my kidneys are not the best and I have not only a history of kidney stones but also of kidney cysts. I "just" found out that one of those cysts is 10.5 cm long. So, having urine retention that could back up urine all the way to my kidneys was not a good option. In my case, also, it was 100% urine retention. Right after passing the kidney stone (a few days later -- coincidence?), I was unable to urinate at all. Nothing. So I wound up on Foley catheters for an extended time. This was dangerous to my kidneys and continuous UTIs as well so I feel that plus the HMO issue meant not having a lot of time to shop around for too many alternatives. I did ask about Urolift and was told that my urologist had to do a few surgeries to repair urolifts done by others and they didn't recommend that procedure. My concern was incontinence (I'm 69 by the way) and partial or full removal of the prostate was not something I was interested in. I also have bladder spasms so frequent and urgent urination wasn't governed just by my prostate but by the bladder itself. Even with unclogged Foley catheters and an EMPTY bladder, I still had painful urges to urinate. With urine in the bladder, I had a mess with it spraying out around the outside of the catheters.

    I think each one of us is individual enough that we have to evaluate what solution and timing is best for each of us given all of our symptoms and circumstances but, if the concern is time, I would not discount urine retention if there is the possibility of kidney damage in making a decision. But, is it really a concern in your case? I wouldn't know. In my case, I felt it was. So, I had the TURP surgery. Only a month into recovery and now I can empty my bladder in 3-5 seconds flat (make sure that, after surgery or whatever procedure you get, that they check to make sure your bladder is getting emptied). When my urination time dropped to 5 seconds, I was concerned but the doctor's ultrasound said that I wasn't retaining urine. It just feels weird to have my bathroom habits be so different from what it used to be. Since Darlene passed away in 2016, I'm not that concerned about sex BUT supposedly I should be able to try that in a month or so based on my reading although some were told only to wait three weeks. All different. Retrograde Ejaculation (RE) isn't an issue as I don't plan on having kids.

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    • Posted

      Hi Howie,

      Thanks for such a comprehensive reply.

      I haven't discounted the turp but I suppose I've discounted having it too soon. I'd prefer to try the drug route before thinking about other options, which for me look like a turp or nothing.

      I had a kidney stone back in 2008 but nothing more until now. it was only because of the bladder stone that the BPH was discovered so I hadn't considered the symptoms worthy of going to my GP and though enlarged my prostate may be it doesn't cause me any too bothersome problems. I read on one website (Harvard) that BPH doesn't necessarily cause problems for all men. I've never really been questioned about this. Yes I have to get up a couple of times a night but otherwise not much of a problem apart if course from the stone. I've read that not eating meat & dairy, etc. helps reduce the chances of getting another stone and I no longer eat them anyway.

      Whether these things are true I can't be sure but my daughter is a dietitian and says doctors (generally) are clueless about nutrition. So I was wondering if anyone else had a bladder stone, did it recur and did they end up having a turp anyway? Meanwhile once again thank you for taking the trouble to reply.

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    • Edited

      Hi everyone

      I had bladderstones removed 3 years ago and had Urolift done at same time. I did have BPH

      and that was most likely cause of the stones. Recovery was pretty easy. Sore for a few weeks but no big issues. Flow was really great at first. Not as good after 3 years but still adequate. So far no new stones. Ive had 2 ultrasounds to check for them. I understand that this may have been a temporary fix but so far so good. Fortunately I havent had to take any meds yet for the BPH . Im almost 74.

      Tom C

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    • Posted

      I need to get familiar with these various procedures like Urolift, 3 years doesn't sound very long though. I'd hoped these were 1 off procedures. Good to know your bladder stones haven't returned though.

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    • Edited

      They haven't mentioned this to me. I had a standard NHS leaflet listing the options which in practice boil down to just 3, do nothing, take meds, have a turp. As I say I think I need to do some research.

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    • Posted

      Another option which I have chosen is Clean Intermittent Catheterization (CIC) which admittedly isn't for everyone but gets the job done while exploring options and avoiding intrusive surgeries with irreversible side effects. Some here have rehabbed their bladders through CIC and now void naturally without surgical intervention, which is my goal.

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    • Edited

      Patrick,

      C.I.C is a good option as a temporary measure but, if you tolerate the procedure without ill effects, why not adopt this as your final goal? There are a few simple but easy rules to follow. I am well into my 4th year of successful C.I.C. and would be happy to share my experiences, without obligation. If interested just send me a Private Message and we can take it from there.

      In the meantime I wish you all the best!

      alan86734.

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    • Posted

      There may come a time when you cant get a catheter past your prostate. When I was going for a heart valve replacement I asked them if it was all right to come as I had a prostate infection. They said it was OK but in the theatre they could not get the catheter in and had to use a supra pubic one.

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    • Posted

      Alan,

      I am most interested in your experience and will be happy to send you a message. I'm sure others here could benefit from your experience as well so I encourage you to share here on the forum.

      Yes, I am fortunate that I adapted well to CIC and will keep it as an option for a long-term answer to avoid more intrusive remedies with little chance of success and possible irreversible side effects.

      Our common condition has SO many options which should be considered before making a decision. Bottom line, it is up to us individually to make a decision on our care based on careful research and recommendations from our trusted health care providers. Don't get talked into a procedure that may not be the best for you.

      Patrick

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    • Posted

      Hi, Derek,

      Thank you for your comment. As most of us here acknowledge, many factors come into play as we compose our respective decisions. My prostate has remained remarkably stable over the years. I am using Fr-16 straight hydrophilic catheters and, so far, they just slide in effortlessly.

      I'm approaching 91 years old now, and hoping that my prostate will continue to behave itself for the duration!

      I wish you the very best, alan86734.

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    • Posted

      My suggestion of using PMs was to appease Moderators. I got thrown off "Patient" some time ago and I missed many posts before I managed to get myself reinstated again.

      alan86734.

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    • Posted

      The Uro who did my GL in 2004 had a 92 year old patient with a prostate of nearly 100 grms. He did GL as he described it as a very gentle procedure.

      When I has my second procedure in 2013 the surgeon suggested that I take Avodart to prevent future growth. I asked if he thought it had enough time to regrow to need further surgery. He glanced at his screen and said perhaps not. I was 79 at the time.

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    • Edited

      Hi, Patrick,

      I've just read your PM. I see that you are not a complete "newbie", which answers most of my concerns. I would like to know where you are located so that I have an idea of your time zones. I live in Vermont, Northeastern United States. I will get back to you tomorrow.

      Warm regards, Alan.

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    • Posted

      I was referring to my own personal condition after my urologist advised that chance of success for a procedure was 20-30% at best due to my bladder condition. I am hoping to rehab my bladder with CIC before considering any procedure.

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    • Posted

      Good question and one I can't answer. During an ER visit after a fall from my bike last September, CT scans found a "massively distended bladder" and 5300 mls of bloody urine was drained with a Foley. I was sent home with a Foley and referred to a urologist. Up until then, I was urinating normally (if a bit slow which I assumed was normal due to my age of 70) but after my bladder was drained I was unable to void naturally and failed the urodynamics test with the urologist. I was advised this had been happening for years (who knew?) and the culprit was my enlarged prostate.

      So yes, I guess you could say I was late with surgery to treat my BPH but I was unaware that I was retaining urine as I was voiding naturally on a regular basis and had no other symptoms. The ER staff could not believe I was not in excruciating pain after draining 5300 mls. I wasn't, apparently due to nerve damage from the distended bladder.

      So now while the urologist says there may be a procedure down the road ("...no use in expanding the pipe until the pump is working..."), I am researching options while hopefully rehabbing my bladder with CIC which others here in similar situations have done successfully, avoiding more intrusive surgery on the way.

      Fortunately, I have adapted well to CIC and am considering it as a long-term solution, depending on how well my bladder rehab progresses.

      Patrick

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    • Edited

      My late father in law had a similar experience to you. He had a fall in the street when he was 80 and was taken to A&E. Like you he was retaining over five litres and they fitted a catheter. My wife had commented on his swollen tummy that he put down to constipation.

      Drugs did nit work and his health was not good enough for an operation so they fitted a stent. That was OK for a while but it eventually became blocked with granulated tissue and had to be removed and replaced with a permanent catheter by which time he had moved into a care home.

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    • Posted

      Yes, I thought I had just gained a few pounds...but walked out of the ER at least 10 lbs. lighter after 5+ litres were drained. My abdomen was noticeably flatter!

      Hadn't heard of a stent being used...how did that work?

      Patrick

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    • Edited

      From Wiki.

      There are two types of prostatic stent: temporary and permanent.

      Although a permanent prostatic stent is not a medical treatment, it falls under the classification of a surgical procedure. Placement of a permanent prostatic stent is carried out as an outpatient treatment under local, topical or spinal anesthesia and usually takes about 15–30 minutes.

      A temporary prostatic stent can be inserted in a similar manner to a Foley catheter, requiring only topical anesthesia.

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    • Edited

      Mine is permanent now. Went into AF after aortic valve replacement. Second cardioversion put me back into NSR for 15 months . Then I had a colonoscopy where the probe stimulated my vegas nerve and my BP went down to 40/29 and heart rate 30 (bpm. That caused a panic in the room and they pumped drugs into me, Next day I found that I was in AF. Another cardioversion and another 15 months in NSR. Then I had a DRE in 2015 that also stimulated my vagus nerve. BP dropped again but not so dramatically and back into AF. This time permanent as they tell me that the size of my right atrium means that another cardioversion will not work. If I have an ablation that may reduce the size of my atrium ... no thanks.

      I didn't like being on warfarin so had an Amplatzer amulet fitted (£10K )and also have a pacemaker that I'm convinced is faulty as my heart rate has dropped to

      41 bpm. Pacemaker clinic say impossible but on 19th Feb paramedic and A&E monitors showed it. Back to pacemaker clinic on Thursday. My doctor had another patient like that and a lead had become loose.

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    • Posted

      They were when I retired at 59 in 1994 but I ran out of luck about five years ago after having been prescribed cipro and Fluoroquinolones for prostate infection at time of valve replacement and later. It can lay dormant for years until something else triggers it. In my case the antibiotic CLARITHROMYCIN and the cardiac drug

      Bisopprolol (2015) each later triggered a wider range of symptoms.

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    • Posted

      Derek, I"m really sorry to hear of your problems. By comparison my bypass surgery and valve replacement were a child's play!

      Warm regards and best wishes for your improving health, alan86734.

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    • Posted

      So far mine is paroxysmal knock on wood and has always been asymptomatic. It was discovered during a routine new patient appointment with my current PCP, who sent me to the ER where I was admitted and released after a cardioversion returned me to NSR...until my new PCP prescribed FLOMAX a few months later which put me back into AFib.

      Like you, I had an interesting adventure with an attempt to undergo a colonoscopy that resulted in an ambulance ride to the ER. I had been in and out of AFib for several days before my scheduled colonoscopy but my Gastro and EP both gave the green light to proceed, taking me off Eliquis the night before the procedure. While being prepped, my HR spiked at 160-180, so the colonoscopy was aborted and I was transported to the ER where I was again admitted. The doctor there explained that it is not uncommon for the colonoscopy prep procedure (UGH!) to flush out vital minerals and cause dehydration which results in the Tachycardia that aborted the colonoscopy.

      The good news is I started Dofetilide (generic Tikosyn) while in the hospital which returned me to NSR where I have remained since knock on wood.

      Like you, I have avoided an ablation, but unlike you, my AFib is not persistent or permanent. If it was, I might consider the procedure and am curious why you would not?

      Patrick

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