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TUVP for BPH w/obstruction - anybody here had one?

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Posted 10/12/2012 9:06 PM (GMT 0)
After about three months research & thought, I decided on an expectant management/watchful waiting approach to my low risk PCa, so my Uro recommended a cystoscopy to evaluate my pretty dreadful BPH symptoms, since we're not going to remove the whole enchilada. I have a moderately enlarged prostate (47g) but the median lobe is poking right up into my bladder and ball valving. Uro recommended a TUVP (transurethral electrovaporisation of the prostate) to reduce the offending lobe and improve symptoms. Seems relatively low risk - anyone had any experience with it here? Maybe I should see a plumber instead? ;-)
Posted 10/13/2012 12:42 AM (GMT 0)

I had a similar situation about 5 years ago.  I had an enlarged prostate, about 58 cc, and central lobe involvement. My local uro prefered TURP to the Green Light laser because it offered more precision.  A 2nd opinion suggested the Holmium laser as a good option.  However, fate intervened, my PSA took a big jump and I ended up having a postatectomy.  These opinions are 5 yrs old and probably aren't valid anymore.  I would go with the procedure that offers the best precision.  There isn't much room for error when dealing with central lobe intrusion.

Posted 10/14/2012 1:05 AM (GMT 0)
I had a vaporization in 2009.  No problem at all.  Just a pesky cath for a few days. Then a little bit of debris mixed with urine.  I understand there are fewer problems with vaporization as compared to TURP, not sure though.  The Dr. here in Erie wanted to do an open removal for BPH, which later turned to PCa.  The Dr. in Clevelandf said "nope" we do a vaporization.  He never heard of open for BPH.  The Dr. in Erie had done three negative biopsies prior to BPH. Didn't find a thing.  I sometimes wonder if the biopsy samples were not laying at home on his work bench. Make a long story short, later DX in Cleveland with PCA.  They cannot save anything from vaporization for pathologist, that is the downside.

 

Posted 10/15/2012 1:45 AM (GMT 0)

Guys,

 I have had a cystoscopy, which showed severe blockage in the prostate but no problems with the bladder and then I had a urodynaamic test which confirmed my severe BPH symptons. On  the pressure side I am way above the graph and on the flow side I am way under the graph. Talk about 2 extremes.

After much research, I have come to the conclusion  that the Holmium laser is the way to go for me. I think the advantage of the Holmium over the Greenlight is the ability to have pathology tests on the removed parts of the prostate. The standard Turp I think is outdated and is now well and truly superseeded by the 2 laser methods.

Even though I have a high gleason, it will be interesting to see the analysis of the removed bits of my prostate. I understand that with the Holmium, the catheter is generally in overnight, greenlight is generally 48 hours and the standard Turp can be 5-7 days (or longer if there are complications). After my previous very painful experience with a catheter I will go with the shortest possible time !

I am booked to have the proceedure on 29th October. So I cannot give any first hand information until after then. I will give some feedback in a couple of weeks.

Posted 10/15/2012 3:14 AM (GMT 0)
Just as a side bar, I recently had a cystoscope exam done as part of my two year post treatment checkup..I've had both surgery and radiation..My urologist found a little bladder stone in my bladder neck and removed it with little trouble. 24 hours later I was in the ER with 100% urine retention. They catheterized me and sent me home..Three days later, cath removed..48 hours later, stream reduced to a dribble..Urologists nurse showed me how to self-catheterize, (a very simple procedure) emptied my bladder and sent me home..She asked me if I consumed caffeine or alcohol and the answer was yes, yes..She said those were major bladder irritants..I went cold-turkey, no problems for 3 days now...Never had to use the cath...
Posted 10/15/2012 11:08 AM (GMT 0)
Fair wind,
Self cath is not as easy as you indicated, I have been down that road and it hurts like hell, particularly when you have severe blockage of your urethra where it goes through your prostate. I want to avoid a repeat go at this if at all possible.
I am also a wimp in this department !
Posted 10/15/2012 5:00 PM (GMT 0)
I was able to insert a 14 French disposable catheter with no pain and little trouble...The secret may be to lube it up good before insertion...But, knock on wood, I have not needed to use this method. But it's nice knowing it's available if needed..WAY, WAY better than a trip to the E.R. at midnight on Saturday...
Posted 10/16/2012 3:02 PM (GMT 0)
Thanks all - looks like my uro is going to use a "plasma" button vaporizer with the focus being a benign (assumed) growth in the median lobe which has become a ball-valve blocking the bladder sphincter. I asked him if it was possible to take a small sample for the pathologist's - he said he did not see the need but would accommodate the request while he is in there. The reason I asked him is b/c my decision to do active surveillance instead of treatment for my apparently early and minimum stage PCa. My thinking is any opportunity to confirm I am making the right decision (aka my prostate is not actually full of cancer) is worth almost any effort. All my reading and research and learning from contributors to this forum confirms a waiting approach given the clinical evidence I have so far, but every now and then I speak to someone who had similar biopsy results, had surgery, and found out through subsequent pathology there was a completely different story in there.

Thanks again for the responses & support - I'll pass on any lessons learned in the process after I get it done Nov. 16th. As a sidebar, I am surprised at how much recovery time is needed - 6 weeks or so as I understand it, whether you are having a full TURP or a limited TVP like me, before you can really get back to full activity & exercise, get rid of pads, etc...
Peace to all!
Posted 10/29/2012 11:58 PM (GMT 0)
Hello all
I had green laser 10 days ago. Had bad bph which resulted in a trip to ER for total blockage.
It is now 10 days and still having painful urination from green laser. I thought this was going to be easier.
Any thoughts would be appreciated
Thank you
Age 57
Posted 10/30/2012 12:39 PM (GMT 0)
jay, welcome to HW. You don't say, but reading between the lines, your condition is side effects from bph treatment, rather than prostate cancer? I don't know that we have anyone here who fits your situation of not having prostate cancer and having the green light laser. If so, they will probably come around shortly. With prostate cancer and bph you are presented with a whole different set of complex issues. Sorry I can't answer your question. Our standard answer here is to ask your doctor, as none of us are medical experts. When in doubt, ask the doc...
Posted 10/31/2012 5:25 PM (GMT 0)
I have PCa and BPH but am not going to actively treat the cancer, so I will be having the same procedure as jay.

jay - my limitted/amateur reading to date is that your experience is on the edge but not outside the norm. I suppose it also depends on the kind of work they have to do in there. My issue is less one of stricture or stenosis of the bladder neck &ff through the urethra, but one of a "ball valve" blockage of the bladder due to a median lobe growing up into the bladder at the top of the prostate. So there will be more work inside the bladder and reducing the tip of the median lobe, and less "roto-rooter" (for those who love the terminology) down through the prostate/urethra. Since I expect less of the latter, I expect there will be less tissue reduction throughout and (hopefully) less pain on urination as a result.

All - seems I am somewhat of an anomaly in having PCa and then having this procedure instead of radical prostatectomy (which I may still have done some number of years in the future after a period of active surveillance). Having been dx'd this summer in the midst of what appeared to me to be a major change in thinking about PCa diagnosis and treatment, I am in the "cure is worse than the disease" state of mind given my minimal dx.
Posted 10/31/2012 5:28 PM (GMT 0)
PS - came across this useful link today regarding radical prostatectomy and QOL r/t incontinence:

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Bladder-neck-preservation-improves-continence-afte/ArticleNewsFeed/Article/detail/792462?contextCategoryId=40183

Might be old news, but I am hopeful there is always room for improvement in the treatment options as time goes on. Seems like a bit of a no-brainer however...
Posted 11/2/2012 7:47 AM (GMT 0)
Guys, my progress this is day 5.

So far I have only had a little dull pain low in the groin. I have had a small amount of bleeding in the first coupe of days. Catheter was out on Wednesday morning at 6am holmium laser turp was monday morning. I still bleed a little at the end of each void, I have no control at the end of the void, some dribble. Also there is some urgency when I feel the urge to void, I am out to about 4 hours between voids whereas I was at about 2 hours pre op. I am drinking lots of fluids to flush out any blood clots whereas prior I was restricting the amount of fluids so this is pretty good. I have to wear light pads because I have a few drops of blood between voids.
Really need to rest up, activity I am sure upsets the works and causes the light bleeding.
The procedure went well took about 90 minutes, the Doctor was happy with the op, said there were no complications. I will keep you all posted on my progress over the next few days.
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