BPH Prostate surgery. Turp, HoLEP, REZUM etc
Discussion
I had HoLEP done two years ago.
The consultant I was referred to gave me the choice but said she would only be able to do Turp herself and to have anything else done I would need to be referred to another consultant in another geography because they didn't have the right kit in her trust.
She recommended I go with Turp as it's such a well established procedure, the risks & probabilities of success / consequences are incredibly well understood compared with other options which appear to have good results and certain advantages but which don't have the same weight of case numbers and / or long term data behind them.
She gave me some info on all the options and enough of a starter to allow me to go and do some of my own research.
I decided not to take her advice and to get referred out of area to someone who is apparently the go-to person for HoLEP.
The main reasons were that the prostate tend to regrow over time and Turp tends to remove less tissue than HoLEP. If you have the Turp done at at a relatively young age (I was 53 at the time of the surgery) there is a chance that you will end up with the same urinary problems again, but much later in life and potentially when you are too old for general anaesthetic and therefore disqualified from meaningful surgical intervention. This is exactly what happened to my Dad who had Turp when he was in his early 50s and ended up with an enlarged prostate again in his late 70s.
While Turp uses heat to remove tissue HoLEP uses a laser, they tend to only use HoLEP for larger prostates (mine just qualified) and they remove all but the very outer layer of the prostate. The chances of a properly executed HoLEP treated prostate regrowing to the extent that you get renewed urinary problems in later life are next to zero (although the procedure hasn't been around for as long as Turp, so there's less data on that).
In additon, and from memory so you should definitely double check this, the recovery time was quicker with HoLEP. The risks of incontinence and impotence post-op are about the same with both procedures I think.
The above describes the thinking behind my choice - read on if you're interested in my experience of the procedure etc.
There were multiple delays and problems related to the process of my case being passed from one consultant to the other. It was incredibly frustrating not even being able to determine whether or not the new team had me in their system, if they had my notes and the likely timing of any stages in the process leading up to any surgery.
I wasn't expecting an early date for the surgery, but I did want to understand when such a date was likely to set, even if the actual appointment was a long time in the future - nobody was able to give me any comfort that my case was moving through the system in any meaningful way.
Eventually it became apparent that in addition to his regular weekday surgeries, the consultant sometimes also did surgeries on a Saturday, if the theatre wasn't being used for anything else - would I be interested in getting a 'last minute' call if such a slot came up?... Errr, yes I would.
So I ended up getting one of these last minute saturday specials, probably about 8-9 months after the referral was passed from the first consultant to the second.
When I woke up from the GA I still had in the catheter that was used during the op, I was told to drink plenty and that the catheter would stay in overnight, when they were happy they would remove the catheter and then I would need to empty my bladder twice into one of those cardboard container thingys and they would check the contents for volume & anything that shouldn't be in there, that if everthing was OK I would then be free to go home the following morning.
The catheter was particularly large - I'm sure it has a specific name, but essentially it had something for fluid in, something for fluid out and also something for access to camera & laser etc for the procedure. It's removal was one of the most unpleasant things I've ever experienced, but thankfully it was all over very quickly.
My first pee into the cardboard was distinctly average - no more flow than I'd had in the years prior to the operation, not a lot of volume and there was lots and lots of blood.
So I expected similar for the second. Oh my God. It came out like niagara falls - a thunderous stream of sweet sweet piss. It was still bloody, but the volume, the flow, the noise... did I mention the flow?
I was sent home shortly afterwards with instructions to drink plenty, a warning not to do anything that might physically impact the site and an expectation that there would be blood (and as the internal scabs healed) occasional lumps and clots passing through for a number of weeks.
The pleasure I got from my thunderous peeing over those weeks - I cannot find the words.
Two weeks after the op I ignored the guidance against physically testing the site of the procedure and went to collect and ride home (2 hr trip) a new motorbike - no pain, no problems.
Four or five weeks after the op, all traces of blood gone, all sorted.
No subsequent problems with impotence (dry orgasms take a bit of getting used to) or incontinence (do need to make sure at the end of peeing, that you're definitely finished though).
It has made a huge difference to my life - no more 'toilet mapping', can enjoy social and work situations in a totally different way - it's been transformative.
Sorry for the very long post, hope it's of some use.
The consultant I was referred to gave me the choice but said she would only be able to do Turp herself and to have anything else done I would need to be referred to another consultant in another geography because they didn't have the right kit in her trust.
She recommended I go with Turp as it's such a well established procedure, the risks & probabilities of success / consequences are incredibly well understood compared with other options which appear to have good results and certain advantages but which don't have the same weight of case numbers and / or long term data behind them.
She gave me some info on all the options and enough of a starter to allow me to go and do some of my own research.
I decided not to take her advice and to get referred out of area to someone who is apparently the go-to person for HoLEP.
The main reasons were that the prostate tend to regrow over time and Turp tends to remove less tissue than HoLEP. If you have the Turp done at at a relatively young age (I was 53 at the time of the surgery) there is a chance that you will end up with the same urinary problems again, but much later in life and potentially when you are too old for general anaesthetic and therefore disqualified from meaningful surgical intervention. This is exactly what happened to my Dad who had Turp when he was in his early 50s and ended up with an enlarged prostate again in his late 70s.
While Turp uses heat to remove tissue HoLEP uses a laser, they tend to only use HoLEP for larger prostates (mine just qualified) and they remove all but the very outer layer of the prostate. The chances of a properly executed HoLEP treated prostate regrowing to the extent that you get renewed urinary problems in later life are next to zero (although the procedure hasn't been around for as long as Turp, so there's less data on that).
In additon, and from memory so you should definitely double check this, the recovery time was quicker with HoLEP. The risks of incontinence and impotence post-op are about the same with both procedures I think.
The above describes the thinking behind my choice - read on if you're interested in my experience of the procedure etc.
There were multiple delays and problems related to the process of my case being passed from one consultant to the other. It was incredibly frustrating not even being able to determine whether or not the new team had me in their system, if they had my notes and the likely timing of any stages in the process leading up to any surgery.
I wasn't expecting an early date for the surgery, but I did want to understand when such a date was likely to set, even if the actual appointment was a long time in the future - nobody was able to give me any comfort that my case was moving through the system in any meaningful way.
Eventually it became apparent that in addition to his regular weekday surgeries, the consultant sometimes also did surgeries on a Saturday, if the theatre wasn't being used for anything else - would I be interested in getting a 'last minute' call if such a slot came up?... Errr, yes I would.
So I ended up getting one of these last minute saturday specials, probably about 8-9 months after the referral was passed from the first consultant to the second.
When I woke up from the GA I still had in the catheter that was used during the op, I was told to drink plenty and that the catheter would stay in overnight, when they were happy they would remove the catheter and then I would need to empty my bladder twice into one of those cardboard container thingys and they would check the contents for volume & anything that shouldn't be in there, that if everthing was OK I would then be free to go home the following morning.
The catheter was particularly large - I'm sure it has a specific name, but essentially it had something for fluid in, something for fluid out and also something for access to camera & laser etc for the procedure. It's removal was one of the most unpleasant things I've ever experienced, but thankfully it was all over very quickly.
My first pee into the cardboard was distinctly average - no more flow than I'd had in the years prior to the operation, not a lot of volume and there was lots and lots of blood.
So I expected similar for the second. Oh my God. It came out like niagara falls - a thunderous stream of sweet sweet piss. It was still bloody, but the volume, the flow, the noise... did I mention the flow?
I was sent home shortly afterwards with instructions to drink plenty, a warning not to do anything that might physically impact the site and an expectation that there would be blood (and as the internal scabs healed) occasional lumps and clots passing through for a number of weeks.
The pleasure I got from my thunderous peeing over those weeks - I cannot find the words.
Two weeks after the op I ignored the guidance against physically testing the site of the procedure and went to collect and ride home (2 hr trip) a new motorbike - no pain, no problems.
Four or five weeks after the op, all traces of blood gone, all sorted.
No subsequent problems with impotence (dry orgasms take a bit of getting used to) or incontinence (do need to make sure at the end of peeing, that you're definitely finished though).
It has made a huge difference to my life - no more 'toilet mapping', can enjoy social and work situations in a totally different way - it's been transformative.
Sorry for the very long post, hope it's of some use.
Thanks for taking the time to reply in such detail.
I only know two people who have had this done and the one who had the TURP had a much longer recovery than the one who had the laser.
But he did have prostate cancer.
I get what you are saying about the "new" procedure's.
I have the offer of either but with a longer wait for laser.
They can't give me any timescale as yet other than months!
Easty
I only know two people who have had this done and the one who had the TURP had a much longer recovery than the one who had the laser.
But he did have prostate cancer.
I get what you are saying about the "new" procedure's.
I have the offer of either but with a longer wait for laser.
They can't give me any timescale as yet other than months!
Easty
Well then I guess it depends on the following specifics of your situation:
- How bearable is it for you now - say you have to wait for 2 months for Turps and 7 months for HoLEP, is that extra 5 months going to be torture?
- How old you are and how concerned you are about the chances of regrowth after Turps
- The degree to which the extra weight of data around Turps matters to you.
Good luck with your decision & feel free to ask any other questions if you'd like to.
- How bearable is it for you now - say you have to wait for 2 months for Turps and 7 months for HoLEP, is that extra 5 months going to be torture?
- How old you are and how concerned you are about the chances of regrowth after Turps
- The degree to which the extra weight of data around Turps matters to you.
Good luck with your decision & feel free to ask any other questions if you'd like to.
Downward said:
Rezum is the best but you’ll have to see which hospitals offer the service as it’s “New” (5 years ago) to the NHS and not all Trusts can afford to offer it.
Rezum isn't always effective, whereas the others tend to be. My mate had Rezum, made no difference at all. Then had TURP 2 years later, and the surgeon said because of the way his prostate had enlarged, Rezum was always going to be useless. I had a TURP 6 years ago, aged 55. My surgeon said they'd taken loads away, and he said I should be clear of any regrowth effecting me for 35 years, so that takes me to 90, if I get there. Happy with that.
It's totally changed my life, and I'm one of the 10% who didn't end up with dry orgasms (retrograde ejaculation). But that's just the luck of the draw.
I did get two UTIs in the following 2 months which was a nightmare.
A few years ago a carpet fitter I used told me he had prostate cancer and decided to go private for a treatment that wasn’t available on the NHS. I think it involved radiotherapy but was directed only to the target area instead of blasting a more general area. Cost him about £20k I think. It was such a success that He then became an ambassador for the company providing the service.
Anyone know what this procedure would have been?
Anyone know what this procedure would have been?
The Gauge said:
A few years ago a carpet fitter I used told me he had prostate cancer and decided to go private for a treatment that wasn’t available on the NHS. I think it involved radiotherapy but was directed only to the target area instead of blasting a more general area. Cost him about £20k I think. It was such a success that He then became an ambassador for the company providing the service.
Anyone know what this procedure would have been?
Linac maybe.Anyone know what this procedure would have been?
https://www.radiologyinfo.org/en/info/linac
mark387mw said:
For those that have had any procedure, has it reduced the frequency of emptying the bladder?
For example, too many cups of tea in the morning or too many pints in the evening causes me an hour or so of VERY frequent toilet visits. One symptom I’d like to be rid of.
Have you been diagnosed with an enlarged prostate?For example, too many cups of tea in the morning or too many pints in the evening causes me an hour or so of VERY frequent toilet visits. One symptom I’d like to be rid of.
If not you need to see a doctor to find the cause of your symptoms,
An enlarged prostate tends to effect you all the time.
TURP or HoLEP if executed properly will give you back full flow and will mean you can empty your bladder fully. So you should see significant reduction in frequency of needing to go, and significantly more productive and speedy visits when you do go.
However, if you've had years of impeded flow and rarely if ever had a properly empty bladder in that period, your bladder may have developed some over sensitivity, meaning that you feel the need to go even when your bladder isn't very full. That may not go away post TURP or HoLEP so you may never regain all the comforts of your younger pre-enlarged-prostate self.
However, if you've had years of impeded flow and rarely if ever had a properly empty bladder in that period, your bladder may have developed some over sensitivity, meaning that you feel the need to go even when your bladder isn't very full. That may not go away post TURP or HoLEP so you may never regain all the comforts of your younger pre-enlarged-prostate self.
Update on this.
Having been waiting since June and hearing nothing I managed to contact my consultants secretary and was told I was on week 38 waiting and that I was likely to be operated on at around week 65.
This will be May next year!
My condition is deteriorating and things are getting to be quite a struggle.
I feel it's unlikely I will make it to May without being put on a catheter which I really don't want to do.
So I have decided to go private.
Their wait is 6- 8 weeks, I saw the consultant on the 22nd November and I am booked in for the 2nd of January.
This is for Holep, I did ask about rezum but one they don't do it, and two he recommended I had the Holep for maximum removal.(well he would wouldn't he?)
I feel very let down by my NHS consultant, I pressed him for a time scale for my treatment in June and he refused to give me any idea other than "hopefully by the end of the year"
His secretary could easily tell me that the wait was 65 weeks and I even said that if it was going to be into next year I would consider going private.
You would of thought he would have jumped at the chance to get me sorted and off the NHS?
My private consultant was staggered at this, saying that all the time I'm waiting I am doing damage to my bladder and suffering.
Thank god I can just about afford it.
Having been waiting since June and hearing nothing I managed to contact my consultants secretary and was told I was on week 38 waiting and that I was likely to be operated on at around week 65.
This will be May next year!
My condition is deteriorating and things are getting to be quite a struggle.
I feel it's unlikely I will make it to May without being put on a catheter which I really don't want to do.
So I have decided to go private.
Their wait is 6- 8 weeks, I saw the consultant on the 22nd November and I am booked in for the 2nd of January.
This is for Holep, I did ask about rezum but one they don't do it, and two he recommended I had the Holep for maximum removal.(well he would wouldn't he?)
I feel very let down by my NHS consultant, I pressed him for a time scale for my treatment in June and he refused to give me any idea other than "hopefully by the end of the year"
His secretary could easily tell me that the wait was 65 weeks and I even said that if it was going to be into next year I would consider going private.
You would of thought he would have jumped at the chance to get me sorted and off the NHS?
My private consultant was staggered at this, saying that all the time I'm waiting I am doing damage to my bladder and suffering.
Thank god I can just about afford it.
Easternlight said:
Update on this.
Having been waiting since June and hearing nothing I managed to contact my consultants secretary and was told I was on week 38 waiting and that I was likely to be operated on at around week 65.
This will be May next year!
My condition is deteriorating and things are getting to be quite a struggle.
I feel it's unlikely I will make it to May without being put on a catheter which I really don't want to do.
So I have decided to go private.
Their wait is 6- 8 weeks, I saw the consultant on the 22nd November and I am booked in for the 2nd of January.
This is for Holep, I did ask about rezum but one they don't do it, and two he recommended I had the Holep for maximum removal.(well he would wouldn't he?)
I feel very let down by my NHS consultant, I pressed him for a time scale for my treatment in June and he refused to give me any idea other than "hopefully by the end of the year"
His secretary could easily tell me that the wait was 65 weeks and I even said that if it was going to be into next year I would consider going private.
You would of thought he would have jumped at the chance to get me sorted and off the NHS?
My private consultant was staggered at this, saying that all the time I'm waiting I am doing damage to my bladder and suffering.
Thank god I can just about afford it.
Thanks for the update, I like to keep abreast of peoples experiences as I'm age 52 and last year was was diagnoses as having an enlarged prostate which affects my bladder. Also had an MRI and then prostate biopsy which thankfully was all clear. I anticipate that at some time in the near future my enlarged prostate will get worse and so it's useful to know what my options for treatment might be.Having been waiting since June and hearing nothing I managed to contact my consultants secretary and was told I was on week 38 waiting and that I was likely to be operated on at around week 65.
This will be May next year!
My condition is deteriorating and things are getting to be quite a struggle.
I feel it's unlikely I will make it to May without being put on a catheter which I really don't want to do.
So I have decided to go private.
Their wait is 6- 8 weeks, I saw the consultant on the 22nd November and I am booked in for the 2nd of January.
This is for Holep, I did ask about rezum but one they don't do it, and two he recommended I had the Holep for maximum removal.(well he would wouldn't he?)
I feel very let down by my NHS consultant, I pressed him for a time scale for my treatment in June and he refused to give me any idea other than "hopefully by the end of the year"
His secretary could easily tell me that the wait was 65 weeks and I even said that if it was going to be into next year I would consider going private.
You would of thought he would have jumped at the chance to get me sorted and off the NHS?
My private consultant was staggered at this, saying that all the time I'm waiting I am doing damage to my bladder and suffering.
Thank god I can just about afford it.
I joined my employers private health scheme this year which will pay out for treatment to existing conditions after the 2nd year of membership, which could come in useful.
Personally I've found that from the age of 50 health problems can be expected in some form or another.
I've just been reading up on options for BPH to relieve symptoms and come across Prostate Artery Embolisation (PAE). This seems the least invasive treatment method but it doens't seem to get much press or recommendations? Similar cost to other treatments and reported equal success without the risks the others carry?
I’ve recently had my prostate rebored after years of struggling to pee. I’ve been on Tamsulosin for around 8 years and although it’s helped, the effectiveness has decreased over time.
It got to the point where I’d end up sitting on the loo for
10-15 mins at a time to have a pee which made life very difficult away from home. Any sort of public peeing has been seriously stressful and now looking back, has been a major issue in day to day life.
I was terrified about having any sort of procedure, the pain, bleeding, lack of improvement, incontinence, erectile dysfunction etc.
What finally convinced me to get it sorted was that I had a scan to investigate a small lump by my belly button which turned out to be a hernia. The technician asked me if I needed to pee, which I didn’t. He said that the scan was showing my bladder up above my belly button and it contained at least 1.8 litres of fluid. I went off to have a pee, not much happened and I certainly didn’t feel like I needed to go. On checking again the technician said I still had 1.5 litres and that I needed to get it investigated.
The report on the hernia went to my GP along with the bladder/prostate issue and I got a referral to see a private Urologist as I have access to private healthcare via my wife’s work. I saw the consultant within 2 weeks and had a flow test, another bladder scan and a camera into my bladder to check on the prostate and kidneys. The consultant observed that my prostate wasn’t actually particularly enlarged, but it had closed up which was causing the issue. He commented that he was surprised that I’d not had any kidney infections considering how much fluid I was retaining.
Appointment for surgery was made within 4 weeks and I was in and out in a day. Amazingly, there was no pain at all post op and I had to keep a catheter in for 5 days which had a small valve on the end to open up to drain my bladder. Pee was quite pink at first but the flow was good. Having the catheter in was uncomfortable, particularly at night as it was easy to turn over and trap it between my legs. I ended up wearing some of those Tena pads to keep it all in place which was ok.
After 5 days, back to the hospital to have the catheter out. As someone else said, it was the most distressing part of the whole thing. It didn’t really hurt and the nurse had it out in seconds, but it was very intense - more psychological than anything else. Had to pee 3 times before I was allowed home which took a little while.
Now I’m 6 weeks post op the results are absolutely life changing. The flow is very good (my wife jokes that she can hear me peeing as it’s so powerful) blood has now all stopped, all the other functions work as they should and the consultant tells me that things should improve further over the next few months as everything heals up fully.
I should have had it done years ago. It’s made me realise how much time I wasted trying to pee, how it ruled my life away from the house and now it’s actually still a novelty to just go to the loo, have a pee and all in just a minute or two.
It got to the point where I’d end up sitting on the loo for
10-15 mins at a time to have a pee which made life very difficult away from home. Any sort of public peeing has been seriously stressful and now looking back, has been a major issue in day to day life.
I was terrified about having any sort of procedure, the pain, bleeding, lack of improvement, incontinence, erectile dysfunction etc.
What finally convinced me to get it sorted was that I had a scan to investigate a small lump by my belly button which turned out to be a hernia. The technician asked me if I needed to pee, which I didn’t. He said that the scan was showing my bladder up above my belly button and it contained at least 1.8 litres of fluid. I went off to have a pee, not much happened and I certainly didn’t feel like I needed to go. On checking again the technician said I still had 1.5 litres and that I needed to get it investigated.
The report on the hernia went to my GP along with the bladder/prostate issue and I got a referral to see a private Urologist as I have access to private healthcare via my wife’s work. I saw the consultant within 2 weeks and had a flow test, another bladder scan and a camera into my bladder to check on the prostate and kidneys. The consultant observed that my prostate wasn’t actually particularly enlarged, but it had closed up which was causing the issue. He commented that he was surprised that I’d not had any kidney infections considering how much fluid I was retaining.
Appointment for surgery was made within 4 weeks and I was in and out in a day. Amazingly, there was no pain at all post op and I had to keep a catheter in for 5 days which had a small valve on the end to open up to drain my bladder. Pee was quite pink at first but the flow was good. Having the catheter in was uncomfortable, particularly at night as it was easy to turn over and trap it between my legs. I ended up wearing some of those Tena pads to keep it all in place which was ok.
After 5 days, back to the hospital to have the catheter out. As someone else said, it was the most distressing part of the whole thing. It didn’t really hurt and the nurse had it out in seconds, but it was very intense - more psychological than anything else. Had to pee 3 times before I was allowed home which took a little while.
Now I’m 6 weeks post op the results are absolutely life changing. The flow is very good (my wife jokes that she can hear me peeing as it’s so powerful) blood has now all stopped, all the other functions work as they should and the consultant tells me that things should improve further over the next few months as everything heals up fully.
I should have had it done years ago. It’s made me realise how much time I wasted trying to pee, how it ruled my life away from the house and now it’s actually still a novelty to just go to the loo, have a pee and all in just a minute or two.
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