Have TURP surgery scheduled for early November. What are some considerations, pluses, minuses, etc. to consider before I proceed?

This message has been edited. Last edited by: Fdan,

quote:

TURP surgery

I had a non-cancerous cyst removed from my prostate. My situation was not elective as I was bleeding profusely into my bladder & my urinary track was blocked by blood clots. Recovery was 2 weeks of misery & 6 more weeks of having to urinate spontaneously.

Had a TURP done in 1999/2000. Must have been insignificant as I don't recall any post procedure difficulties. I know I didn't use any sick leave afterwards.

Had one fifteen or more years ago. Typical surgery with a short recovery of a catheter for a few days. Nothing of note following.

I had prostate cancer diagnosed in 2017. I was told the TURP limited my treatment options to prostatectomy.

I'm not up to date on TURPs at all but it seems I've heard there were now other choices than the mechanical roto-rooter.

Why go thru the urinary tract? The prostate doesn’t actually go into that. It grows around it. Seems like a small incision in the abdomen wall, and recession from there would be easier on the patient.

Or am I missing something completely?

^^^^
You are missing a lot.

An epidural is a great option vs general anesthesia. You may also suffer from incontinence issues while you heal. Don't let them talk you into having a family member remove the catheter at home after surgery.

You may develop scar tissue after surgery. If your flow seems really good for a while after surgery but slows down, go back in for a checkup.

Good luck! The catheter is the worst part.

quote:

Originally posted by BB61:
^^^^
You are missing a lot.

An epidural is a great option vs general anesthesia. You may also suffer from incontinence issues while you heal. Don't let them talk you into having a family member remove the catheter at home after surgery.

You may develop scar tissue after surgery. If your flow seems really good for a while after surgery but slows down, go back in for a checkup.

Good luck! The catheter is the worst part.

Are you responding to me? If so, you haven’t explained why going thru the UT is better than just a one inch incision and removal from there, like a metal tube with nipper in it (sorry don’t know the medical term) like they use for knee work.

Ok, so the TURP only 'cores' out the prostate, and its solely meant for enlarged/obstructing prostate. The prostatectomy that Mike describes is very invasive, requiring the detachment of the urethra from the bladder, and then reattachment following the complete removal of the prostrate. Both require a catheter in place for several days post op.

So, the TURP is what is known as minimally invasive, whereas the Prostatectomy is very invasive, requiring a large incision (open) or several small incisions (robotically).

Ok, that's all I got.

quote:

Originally posted by MikeinNC:

quote:

Originally posted by BB61:
^^^^
You are missing a lot.

An epidural is a great option vs general anesthesia. You may also suffer from incontinence issues while you heal. Don't let them talk you into having a family member remove the catheter at home after surgery.

You may develop scar tissue after surgery. If your flow seems really good for a while after surgery but slows down, go back in for a checkup.

Good luck! The catheter is the worst part.

Are you responding to me? If so, you haven’t explained why going thru the UT is better than just a one inch incision and removal from there, like a metal tube with nipper in it (sorry don’t know the medical term) like they use for knee work.

Yes. Sorry. I didn't think to give a detailed explanation. But there is a great one right below my first post. A TURP is roughly like being scoped or arthroscopic surgery which most people think of for minimally invasive.

I had to make this decision within the past year.

I'm assuming you're considering TURP due to BPH. If this is correct, there are a LOT (as in, around 8 or more) different procedures you can consider. Some are easier than TURP. Each procedure has its own advantages and disadvantages. Which procedures you are a candidate for is based on your specific situation, the size of your prostate, what side effects you are willing to tolerate, and other factors.

In my case, I had BPH, my prostate was about 80 grams (normal is about 25 grams). 80 grams is considered medium-sized for BPH, some patients have considerably larger prostates that eliminate many options.

After reading the potential side-effects of TURP, I decided against it. The potential side effects of TURP included sexual disfunction which I considered unacceptable. Although I know many who have had TURP and had no problem, I didn't want to risk it.

The first procedure I tried was PAE, or Prostatic Arterial Embolization. This procedure is performed outpatient. The doctor goes into an artery in the crotch area, and routes a thin tube into the arteries that supply the prostate with blood (there are two arteries). Then they inject tiny spheres into the artery that restrict bloodflow to the prostate. By restricting the blood flow, it stops the excessive growth of the prostate and even shrinks it. You're in and out of the office in about an hour. The thin tube is tracked using some sort of X-ray so the radiologist can see that the tube is going into the correct artery. This procedure has zero side effects on sexual function. Unfortunately, it was minimally effective for me.

The next procedure I tried (which was VERY effective) is called Aquablation. Basically, a high-pressure water jet is inserted through the penis into the prostate and with roughly an 800psi waterjet, it "blasts" parts of the prostate away. Although it sounds harsh, it's actually more gentle than TURP. What drove me to this procedure was the setup for the procedure. The entire prostate is mapped by computer and the urologist marks areas on the computer mapping that the urologist does NOT want to touch because of risk of causing sexual disfunction or other problems. The computer controlling the water jet will not allow the "spray" to be applied to areas the urologist marks as areas to avoid. The result: MUCH faster recovery than TURP (I only wore the catheter for about 30 hours), easy recovery, and no sexual side effects, and I can pee like a racehorse.

Both PAE and Aquablation are fairly new procedures. TURP has been performed for many ears (Over 40 years I think), so if you have already committed to this procedure, I wouldn't worry about it, just be aware of the side effects.

You owe it to yourself to do extensive research. Look on YouTube - There are lots of doctors describing various procedures and their risks. If you hear about a procedure that sounds intriguing, ask your doctor if you're a candidate.

I had my TURP procedure early last year. Like all surgeries I think one's outcome depends on the surgeon's skills and how one reacts to the surgery. My particular BPH did not allow for the alternatives explained by forum member btanchors.

My TURP was 100% effective in alleviating my BPH symptoms, which were quite severe. I'd heard the horror stories of patients needing to stay catheterized for weeks, but I was able to have my catheter removed with 48 hours. (As others have said, the catheter is the worst part.)

My TURP surgery changed my life for the better. I had no incontinence issues post surgery and the procedure eliminated the overactive bladder and urge-incontinence issues I was experiencing prior to the surgery.

I have no sexual disfunction side effects. Actually, my erections are better post surgery. A sexual side effect of most TURP procedures is retrograde ejaculation: semen is pushed into the bladder so no outward ejaculation. This is harmless and I find orgasm is just as pleasurable, but retrograde ejaculation could be a consideration if the patient wants to have children.

To the OP, if you have doubts on the advisability of your upcoming TURP surgery you should get a second opinion. In my case, I have confidence in my urologist/surgeon who did my procedure, and my BPH was making my life so miserable I felt I had no choice in the matter.

To the OP:

I forgot a couple of things. Ripley alluded to an important one. If you think you might have prostate cancer in your eventual future (Like if it runs in your family) be sure to ask if the procedure you are having (TURP or anything else) limits treatment options. I've had two Urologists tell me that if you live long enough, prostate cancer is likely.

TURP is considered the "Gold standard" by which BPH is treated, assuming you've tried non-surgical options (like medications) that are not or no longer effective. But the outcome is related closely to the skill of the surgeon. One way to tell is to simply ask them how many TURPS they have performed.

The doctor that did my Aquablation used to (and still does) perform TURP, but said since Aquablation, hasn't done a TURP in 4 years. Because of the newness of PAE and Aquablation, there may not be a surgeon or urologist in your area that offers it or one of the other newer options. I had to go to a different urologist to get Aquablation, but my primary urologist told me his practice is adopting it because of better results and faster recovery. However, given the OP is in southern CA, I am sure you can find someone who offers these newer procedures.

I have noticed that urologists do not perform all procedures - some only are willing to offer TURP, some offer a subset of all the options available, etc. All I suggest is simply research on YouTube or other sources about all the alternatives before comitting to one particular procedure.

Thanks for the good feedback. I’ve done a lot of research on the options and my only concern was extended incontinence. A couple days with a catheter is not an issue (had bladder cancer now in remission) so I can survive a few days with a catheter.

Thanks again for the feedback!

quote:

As others have said, the catheter is the worst part.

They heard me yell 6 blocks away when they took or yanked that thing out.

quote:

Originally posted by oldfireguy:

quote:

As others have said, the catheter is the worst part.

They heard me yell 6 blocks away when they took or yanked that thing out.

I dunno, I had a cystoscopy and have had some dribbling since. It’s embarrassing, I had it when I was 40, and staining your pants at that age is upsetting. There are all kinds of side effects to any surgery. Ask the doctor lots of questions. Had I asked if he had found blood in my urine sample that morning I would not have had the procedure. The pain I suffered that day was nothing to the embarrassment I’ve suffered since. I’ve figured it out now. And how to prevent it.

I had the 'non surgical' ReZume tx for BPH a couple years ago, after referral by my long term internist. It had pros & cons just as any other procedure.

It took a while to rediscover more normal control of urinary habits. It produced better recovery than I actually anticipated. And I did have to go to a special physical therapy later to learn Kegel exercises to overcome unexpected dribbles.

There's lots of you-tube style explanation/promotion if you're interested in further research on your upcoming treatment. Good luck.

I am having HoLEP surgery tommorow morning.
Bye,bye prostate, the only damn thing that's twice as big as it should be.
Once and done.

After 15+ years on alpha blockers for BPH, they aren't working so well anymore.

I'm 55, and my urologist does Aquablation, Rezum and of course TURP.

Just trying to choose between the minimally invasive Rezum and the done-in-the-hospital Aquablation.

I guess the Rezum actually leaves you with the catheter longer than the other procedures, and that your urine flow will be worse for a couple of weeks before it gets better.

Aquablation is basically a new and improved TURP, with the prostate being mapped out. I guess the surgeon has better visibility than with TURP.

UPDATE: Had surgery Thursday, spent the night in the hospital, came home today. Procedure went very well and even the catheter wasn’t an issue - came out with minimal discomfort. Dr indicated the healing process will take a couple weeks to optimize results but almost no pain (I’d call it very minor discomfort for a few hours, easily controlled with pain meds). So far, so good, and looking forward to significantly improved “pee-ability”.
Thanks to all for the comments and feedback!

quote:

I have noticed that urologists do not perform all procedures - some only are willing to offer TURP, some offer a subset of all the options available, etc

^^^^^^^^^^^^
Yep. It becomes second nature if you perfrom a procedure over and over. Large othropedic practices have docs that do hips and others who do knees.