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.
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