Experiences with TURP

My doctor has said I should have a TURP eventually, especially if I elect radiation therapy for my PC. Could those of you who have had a TURP or the less common laser ablation provide me your insights. I have had problems with urination for years so if I will need it eventually I am wondering if I should have it sooner rather than later for the relief.

I had a green light laser procedure to remove a protrusion of prostate tissue into the urethra that had been causing urinary issues. Prostate size 61cc had shrunk down into the 20's from HT and radiation, but this anatomical anomaly didn't change, hence the need for green light laser.

This was done 6 weeks prior to seeding. So in my case it was a minor "trim". It was performed in a hospital, under anesthesia so I don't remember anything about the procedure itself. Was discharged shortly after the procedure. The worst part, most memorable, was being discharged with a "garden hose" type catheter. Removed the next day. No lasting side effects and was able to urinate full stream ahead afterwards

It depends what they are trying to accomplish and how extensive the area being removed is. This type of procedure was recommended by my Radiation oncologist in the middle of my treatment plan.

As 81 asked:

BTW, is prostatectomy not an option in your case? If it is, wouldn't it, if done, automatically do away with any need for a TURP?

That would be my question. Sure fixed mine!

Cheers, Doug

Well, that answers that question! Best of luck, you'll make the right decision for you.

Cheers, Doug

I remember researching this at the time. Certainly not without risk, see below.

(TURP) is also the most invasive. It has the highest risk for serious complications, including blood loss, erectile dysfunction, and urinary incontinence.

Less Invasive Procedures. Minimally invasive procedures use some form of heat to destroy excess prostate tissue. The heat may be delivered by:

Radio frequency: Transurethral needle ablation (TUNA)
Microwave: Transurethral microwave thermotherapy (TUMT)
Electrical current: Transurethral electrovaporization (TUVP)
Hot water: Water-induced thermotherapy (WIT)
Laser: Interstitial laser coagulation (ILC) , holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization (PVP)

As far as reducing the prostate size, radiation and short term hormone reduced my prostate size by 1/3.
Maybe you should look into that, just hormone treatment alone can do that. In his book, Dr Dattoli states that the prostate being too large for seeds is a myth. So I wouldn't rule that out

Shiny,
I have had Holmium Laser (HoLep) in October 2012, this was for urgency and frequency. I was voiding up to 16 times a day. The procedure went well except I had an issue with some scar tissue which brought on urgency. In February 2013 I had to have a small clean up. Apparently this is not unheard of. There really was no pain after on both occasions and I was in hospital for 3 days on the first and 2 days on the second, both times I was done on a Tuesday and was back at work the following Monday, the first time the catheter was removed in the afternoon of the second day and the second time in the morning of the second day. I had slight bleeding for a few days after when voiding. I needed to wear pads continually after the first operation and would use 3-4 a day, but after 3 weeks for the 2nd op I could use the one pad all day just for the occasional drip. After 3 months I was pad free.
I have been delighted with the results I now void every 3 hours during the day and I need to get up once a night (sometimes twice depending on what I have to drink and how late.)
I sometimes still have some urgency and just have to head for the toilet when I get the signals, but overall as far as I am concerned it has been completely successful. I was told I may need another in 10 years or so, this is also quiet common.
Geoff

JStars,

I believe you are incorrect about the teaching moment. I had a 120+g. prostate and had 70g removed with the XPS GL laser a couple of years ago. My understanding is the urethra and prostate tissue inside the prostate are both removed during the procedure and cicatricial (scar) tissue forms a new urethra inside the prostate. If you look at youtube videos of various turp procedures you can see a large tunnel burnt or sliced all the way through the prostate to the bladder neck. There's no urethra left inside the prostate.
On another web site I saw the following description... "TURP is done injuring prostatic urethra. This portion of urethra contain a transitional epithelium. All prostatic tissue is ressected. The limit is only the prostatic capsule. The differences of densities allow us to feel when to stop the use of wire sharp. After surgery, the transitional epithelium is replaced by a cicatricial tissue...the inside of the prostate forms the new urethra."
I believe this is true of all laser turps as well as the classic wire turp. It really is a roto router job, hence the various problems that some people experience afterwards. It's not uncommon for some people to have additional procedures done within a year or two of the original.

Bob

JStars said...
Shiny,

Wow, 137cc prostate!! That is a new world record around here. Mine was around 110gm when it came out after Prostatectomy. (yes they use CC's when estimating after Biopsy (since they see only volume) and grams after surgery since they get to actually weight the darned thing).

Also on TURP .. of any kind. This might be a good time for a quick Teaching Moment (which i also added here a long time ago).

Guys always cringe at the thought of a TURP thinking it is roto-routing out the actual urethra. That is not the case. The laser or electrodes are passed thru an incision IN the urethra way up next to the prostate and then dives down a bit INTO the prostate where ablation of the BPH tissues are done. When enough of that tissue has been removed you are then 'relieved' of that added pressure and hopefully your flow is back to normal at least for a few years.

But, even if not actually roto-routering .. it still would not be painless afterwards-- sorry.

And yes BPH can be cured by a prostatectomy. My Uro offered that as a possible before my PCa was detected. Not sure tho if insurance would ever pay for a Prosta instead of a TURP. I doubt it.

J

Post Edited (Bob_NJ) : 7/16/2014 10:40:02 AM (GMT-6)

Hi JStars,
From youtube videos I have seen, the pic with the tool is how they start the procedure. They cut a channel on one side of the prostatic urethra, then on the other, then remove everything between. The whole procedure and the reasons why it works well or not seem pretty mysterious to me. For example, I don't understand why before the GL procedure, I could be almost blocked one day, then have a good stream the next. I think the bladder is a big part of the issue, though it's generally not addressed until problems show up after the turp. Two years after my GL turp I had to have a bladder mouth resection and removal of bladder stones. The turp is a pretty barbaric approach but nothing better has come up yet. The scary thing is the prostate continues to grow at 5% or more a year, so it's just a matter of time before it will need to be trimmed again. My urologist is fond of saying the prostate grows like a weed. I guess that is why his office is always crowded.
Bob

Ken, as long as your PVR (post void residual) is less than 200cc and you are not straining to pee, or have the feeling you are peeing razor blades, or only able to pee very small amounts, I wouldn't worry about getting up at night.

My last post was more than a year ago. Six months ago I had a second bout of unexplained hemorhaging from my prostate (the first was in Dec 2013, 18 months after my first GL laser). It was fresh blood and clotted within minutes. Emergency surgery entailed the use of the classic wire turp, which removed another 70g of prostate and the median lobe protruding into my bladder. My uro said all that's left was a 40g prostate, including a 15g non protruding median lobe.

Needless to say my stream has been good and my PVR less than 10 cc ever since. However I still get up 2 to 5 times a night to urinate. Whatever is causing the nocturia has nothing to do with any prostate or bladder blockage or protrusion of the median lobe. There also seems to be no correlation to what I eat or drink during the day. If I pee a lot one night, I will pee very little the next night. I void every few hours during the day with no problem. I'm not on any meds or supplements.

My PSA was between 6 and 7 beore the turp, and was between 5 and 6 afterwards. All of the turp procedures will only help getting up at night if it is being caused by a blockage. The blockage can be guaged by your stream and quantity of void as well as the PVR. If there's no blockage, the turp may not help with nightime frequency. And even if it does reduce it, it likely will not eliminate it.

I'm 69 and I haven't slept the night in 20 years. But using a bedside urinal and voiding in the dark lets me go back to sleep.

Ken said...
All of the above is why I put up with getting up three or maybe four times in the middle of the night to pee.