old person OT (OPOT) - TURP or Greenlight Laser to fix BPH

[eddief]

May have to get in line for this procedure. Have scoured the net for info but can't really find definitive on which is better and why. So many say TURP is the gold standard. Info or experience appreciated.

[gasman]

I'm oldish and just had my annual exam (ugh) with my Urologist and we discussed this very question in addition to meds.

TURP is the gold standard but has risks of infection, impotence, etc. I do have a couple of biking buddies that have been very happy though with their outcome-good relief, no side effects.

The green light laser was supposed to be the the answer but my Urologist is less enamored with the procedure as it also has side effects. He said his patients have mostly complained of retrograde ejaculation and "feeling weird" during sex. I've got a buddy who wishes he never had the procedure-but his reaction is uncommon. I know a couple guys who have been happy with their outcome.

We briefly discussed meds but he's not a big fan of them either. His basic takeaway is that nothing is great at this time unless you are really symptomatic.
I'm symptomatic but not enough to do anything at this time.

We did talk about a new procedure called Urolift. It's new and done as an outpatient procedure. It's promising but the numbers of procedures done so far aren't enough to recommend it at this time. My Urologist has done it on about 30 patients and he and the patients are happy with the outcome but it's too early to tell. I think it's the most promising myself but I'm waiting at this time and putting up with 2-3 trips to the bathroom at night.

[Ralph]

I've had the Greenlight. Flomax and pills similar to those didn't help much, and they have side effects also. My Urologist thought Greenlight was the least invasive...for me. Would agree about the sexual side effects. But you have to be able to empty your bladder. That's not optional. And BTW.....I would not say problem is fixed.....I still retain about 100 CC of urine after bathroom trip. But that probably won't kill me. Not sure anything really 100% fixes problem. But I had some bladder issues in addition to BPH from previous injury when I was much younger. Imagine every case is a bit different.

[OtayBW]

Originally Posted by gasman

His basic takeaway is that nothing is great at this time unless you are really symptomatic.

Originally Posted by Ralph

I still retain about 100 CC of urine after bathroom trip. But that probably won't kill me.

And these statements sum up my perspective pretty well. It would have to get pretty bad before I went in for something invasive like this. But, YMMV as they say....

[htwoopup]

My uro put me on meds (uroxitral which is the generic of something). Worked great for a few years. Recently increased from one pill at night to one at night and one in morning. Back to great. Still not perfect but such is life and it is very livable. In my mind, and his, it beats doing anything with side effects and truly invasive/ messing with things a bunch (I have none from the meds but if I did, I would just stop them and go to plan b. With surgery it is pretty much a no going back commitment). He also mentioned some med that I don't need and he thinks will never but he said some folks it helps but it takes 6 months of taking it before it starts working. I forget its name because it wasn't relevant to my case but you might ask your uro.

[eddief]

as I understand it. Proscar takes months to work and it is supposed to shrink it and Flomax works quickly and is supposed to relax it. I am on both and still quite symptomatic. Think I am getting ready for the big time. My Ur is recommending Turp. But if I am a candidate, I think there is little risk to trying Urolift. He said at Kaiser they do Urolift too but for some reason still do it under general anesthesia. He thought Turp major side effect was retrograde ejac but I am ok with that as this age. And then I mentioned incontinence and he said it is relatively rare and never happened under his knife. We did not cover why Turp vs Greenlight.

I just stumbled onto this more or less scientific article that mentions the Holep procedure. It makes it sound like the real best, especially when it gets into discussing hospital reimbursement rates being higher for Turp than Holep. Is that why my Ur is recommending Turp?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446381/

Originally Posted by htwoopup

My uro put me on meds (uroxitral which is the generic of something). Worked great for a few years. Recently increased from one pill at night to one at night and one in morning. Back to great. Still not perfect but such is life and it is very livable. In my mind, and his, it beats doing anything with side effects and truly invasive/ messing with things a bunch (I have none from the meds but if I did, I would just stop them and go to plan b. With surgery it is pretty much a no going back commitment). He also mentioned some med that I don't need and he thinks will never but he said some folks it helps but it takes 6 months of taking it before it starts working. I forget its name because it wasn't relevant to my case but you might ask your uro.

[htwoopup]

I am 100 percent sure that you have thought of this but I only mention it because I am overly conservative about surgery types of things.

I use SMP Forma saddles. While visiting the step kid a couple of weeks ago I had a rental bike with a Spesh saddle on it. After one 45 mile ride I called my Uro in a panic because shall we say the problems went beyond numbness.

Perhaps a small change in saddle (if you haven't already done that) might buy you some time before you have to go down the path.

Again, I am sure you have thought of it/ tried it. I am just trying to be overly cautious yet helpful due to my medically conservative nature when it comes to my own health.

[gasman]

Originally Posted by eddief

as I understand it. Proscar takes months to work and it is supposed to shrink it and Flomax works quickly and is supposed to relax it. I am on both and still quite symptomatic. Think I am getting ready for the big time. My Ur is recommending Turp. But if I am a candidate, I think there is little risk to trying Urolift. He said at Kaiser they do Urolift too but for some reason still do it under general anesthesia. He thought Turp major side effect was retrograde ejac but I am ok with that as this age. And then I mentioned incontinence and he said it is relatively rare and never happened under his knife. We did not cover why Turp vs Greenlight.

I just stumbled onto this more or less scientific article that mentions the Holep procedure. It makes it sound like the real best, especially when it gets into discussing hospital reimbursement rates being higher for Turp than Holep. Is that why my Ur is recommending Turp?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446381/

You're on maximal medical therapy using both classes of drugs for BPH- alpha blockers and 5-reductase inhibitors so if you're still having symptoms some kind of surgery is probably your best bet.

HoLep has a steep learning curve as the article mentions-the local urologists here usually choose one procedure to get the best outcomes they can.The holmium laser fibers are pretty expensive and hospital reimbursement varies wildly. In the end it doesn't impact your doctors charge,so I doubt that is why your urologist is recommending TURP-it's what he's (I'm only assuming it's a male) good at doing and has done a lot. He sounds very experienced.

I think the urolift procedure seems like the bees knees but there just isn't the long term data yet and I personally would be hesitant to have it myself yet. I think the risk of infection is non-zero and gives me pause. Prostatitis can be a bear.

Anyway, I hope others with personal experience can chime in. Best of luck to you.

[fkelly]

Had my Turp more than 15 years ago. A big relief in the symptoms but it doesn't make you 18 years old again. Two pieces of advice:
1. Don't be a hero and rush to get hospital discharge. It's a bloody operation and fairly common to get a blockage after and the pain from that is the worst I've experienced in my life as we rushed in the car to get back to the E.R. Just take your time in the hospital and make sure things have cleared up.
2. If you are having retention (bladder not emptying completely) don't let it go on forever. As it was explained to me the bladder is a spongy substance and the longer the retention goes on (years in some cases) the more sponginess it loses. Which means that when the root problem is resolved through TURP or other means you will still have some retention, incomplete emptying etc.