Anybody with TURP surgery experience?

Well, we’ve had threads about colonoscopy experience (several recently) and other scary-sounding medical procedures.

Anybody here know anything about, or ever had, or knew someone who had, a Transurethral resection of the prostate (TURP) procedure?

Real briefly (that is, everything I know about it): When middle-aged males begin to get enlargement of the prostate and have trouble peeing, the first remedy is medications (like tamsulosin, aka Flomax). Eventually, it may become necessary to surgically remove some prostate tissue surrounding the urethra to make more room. This is done by shoving some kind of surgical tool up there through the urethra, which then somehow removes tissue outside the urethra.

Anybody know anything about this?
How does it work?
How onerous is the procedure – before, during, and after? (What degree of sedation is used?)
Where does the removed tissue go?
Does the patient pee blood for a week?
How effective is it, after the patient is recovered?

Of course, there’s stuff on-line about it, but I’m looking for what Dopers might have to say about it.

(No, I’m not scheduled for this anytime soon, but I imagine it’s likely in my future somewhere.)

Two ways. Either a laser, or a mechanical device is inserted into the urethra, then into the prostate to remove tissue to allow room for the urethra to allow normal urination.

It can be done with a spinal or general anasthesia. It doesn’t take a long time. Some people can be checked out the same day, usually there’s an overnight stay. You’ll have a catheter in place when the surgery is done. The catheter will stay in for at least a week to 10 days while the urethra heals. They’ll be flushing your bladder with saline solution for hours to make remove blood and make sure there’s no continued bleeding.

No idea. If it’s removed, I assume to pathology to check for cancer and infections, and then in the trash. Anything left in will be absorbed by the body I guess.

Only through the catheter. You shouldn’t be actively bleeding. The catheter is covering up the cauterized incision in the urethra, from the inside.

I don’t know about the exact statistics, but apparently it works very well in most cases. The laser procedure is expected to be effective for less time than the mechanical procedure. It’s going to depend on the reason for the enlarged prostate. Apparently the biggest factor in preventing it from lasting forever is that prostates will tend to increase in size if you needed it the first place. You may get prescribed Avodart to shrink the prostate or minimize growth.

So . . .
They actually cut through the urethra to get at the prostate tissue outside? I didn’t know about that. I thought they somehow magically cut (or laser-burned?) tissue outside the urethra, with whatever tool inside the urethra, without actually cutting through it. I was wondering how they did that. That’s also why I wondered what became of the tissue they cut away.

And the catheter goes all the way up to the bladder then?

Is there much pain or soreness post-op?

Yes.

Not really. Having a catheter in is pretty annoying though. There may be some residual bleeding after it’s removed.

My Dad had it done in October.

Now, according to his surgeon, his recovery ended up being waaaaay out on the tail end of the bell curve, but complications are possible.

To wit:

The bleeding started a week after he was cleared to resume normal activities by his surgeon. It was a really, really shitty week.

Seriously. Take it easy for at least two months post-op.

Not a TURP, but some similar work down there although I may get there too.

General anasthesia, go home the same day, an uncomfortable catheter and a bag for a week. Pills that turn your urine a horrible orange. Good chance of an UTI. Soreness for a month.

Prostate tissue removed by a TURP is sent to Pathology, where some or all of it is submitted for microscopic evaluation. Most of the time this shows benign hyperplasia (cancers tend to develop first in the outer portion of the prostate which is not sampled by the TURP). Most of the time I would think the urologist would make sure the patient’s PSA is in the normal range before doing a TURP.

I thought they just ream you out from inside the urethera. I found a video showing them doing exactly that. (It didn’t make me squeamish but I like watching that stuff. :smiley: )http://www.youtube.com/watch?v=WNCsunVC4Rs

My late father had a similar experience when he had his done years ago. Pretty much at the end of 2 weeks when they thought he was past the worst of it he bled a lot so he had to go back to the hospital for a week to get cleaned out, recatherized, etc. Unfortunately after all of that they left him kind of, umm, loose. (But for him it beat the way he was before since he actually had to have a foley catheter all the time.)

PSA is on the way out as a diagnostic measure, and if you need a TURP, it’s likely to be high.

I had this surgery on 3/20/12. After 45 days with a catheter I had to do something! It was the best decision I ever made! It was done under general anesthesia, one night in the hospital with a catheter, then home catheter free the next day. I had some blood in urine for about 2 weeks as things healed, then nothing. No pain at all. It’s now a year later and things are fine. I go 6-7 hours at night without having to pee,have a good stream, etc. The only major after effect is what they call retrograde ejaculation. (The semen does not shoot out anymore but tends to stay inside). I feel this is a small price to pay at age 62 compared to the benefits. Just my results. Oh, be sure to get the most experienced urologist you can find! Mine had done this procedure about 3000 times!

There’s just something cringe-inducing about the word “transurethral.” Although it’s not as cringe-inducing as the announcement of a new treatment for castration-resistant prostate cancer with bone metastases using radium. I count at least four cringes (well, a cringe and three shudders).

The OP mentioned that he is not interested in internet info, but asks a lot of questions that can be answered here.

http://emedicine.medscape.com/article/449781-overview

I had a T.U.N.A. http://boards.straightdope.com/sdmb/showthread.php?t=426485

I had mine in 2009. Pretty much as **Markbnh1 **describes it, went to surgery under general on Friday morning, came back to the world Saturday morning. Nurses removed the catheter shortly thereafter (the watchwords of my visit came to be “There will be some discomfort.” Yeah. Some discomfort is right. Not excruciating, but definitely ‘some’.) and told me I could go home once I’d peed enough to fill a 250 ml container, twice. Walked the halls and drank everything they would bring me, but managed to meet my goal in time to get home and watch the Belmont Stakes in my own living room.

Peeing bright red was disconcerting to say the least, but after a few days I didn’t mind so much any more. And after several more days everything was normal. Now I have normal urinary function, no difficulty or urgency, and can go hours and hours without a bathroom break.

I am only 8 days post-op and it has been hell. Had surgery on Tuesday, went home on Wed, and had catheter removed on Fri. Fri night I was in ER as I could not urinate and was in severe pain. This came after several “projectile urination” episodes involving multiple blood clots about the size of a newborns fist. My bathroom looked like the prom scene from Carrie. In the ER, they drained approx. 500 cc’s from my bladder (including clots) and reinserted a much smaller catheter. The smaller catheter resulted in several days of having more “urine” in my diaper (yes a diaper was necessary) than what wound up in the bag. After going back to the surgeon 3 days later, a larger catheter was reinserted and worn for 2 days. This resulted in more pain, which during urination actually felt like another blockage. My third (and hopefully final) catheter was removed this morning. My first 2 urinations were extremely painful and not much urine. Finally, several hours later, I have urinated like a 20 year old, relatively pain free. The past week was brutal and there were several complications. Hopefully this is the end of that and things will get better. If I had to do it all over again, I would choose the laser option. I was in the most pain I have ever had to endure the past week.

I had a TURP op in September 2014. Stayed in hospital with a catheter for 3 nights then it was removed and I went home. Once home I had one visit to A&E when a blood clot blocked urination otherwise all things went well.

There was no pain or discomfort, no problems and ejaculation continued as before the op - no retrograde ejaculation. Blood in the urine faded after about 2 weeks.

The whole process was painless and problem free. Results were excellent.

You can cringe if you need to, but my experience went smoothly and nearly without pain

What I had was called “laser ablation” of the prostate, about 20 years ago. Local anesthetic only.

Here’s how it went. I laid on my side. The whole procedure, including explanations, took about 45 minutes, in my doctor’s office.

The anesthesia: A lubricated probe the diameter of a pencil was put into my anus, to reach the back of the prostate. A syringe was slid into the probe to inject the anesthetic, then the probe was removed. It felt like a shot in the arm felt like, and it was the only painful part.

The procedure: A lubricated tube was put into my urethra. The tube contained a tiny camera and a tiny laser probe. By that time, my prostate was numb. The urologist and I watched it all on a video monitor. When the laser probe was inside my prostate, the doc poked it into the prostate tissue and briefly heated up small areas with the laser. After a few days, the heated places shrink. He did that twice on the left side of the urethra and twice on the right. I could feel some warmth, but no pain at all.

That was that. The doc pulled out the laser rig, his nurse wiped off a little lube, and I got dressed.

I was sent up to a hospital room to find out if I could pee, unassisted. If I could, I wouldn’t need a Foley catheter and a pee bag. I needed one. A nurse installed it, and they sent me home. A week later, the cath was pulled out, and I went home, good as new. No bleeding, no pain, and I could pee right.

In fact, in my next visit to the doc, I peed very close to a liter in his urination meter. He joked I had the largest bladder in the county.

I had B-TURP, bipolar resection of the prostate, on August 26, 2016, at the age of 59 years and 8 months.

I had researched alternatives to TURP, which remains the “gold standard” according to most of the medical literature, with HOLEP (aka HOLAP) a strong contender, especially for very large prostates, and other emerging therapies being introduced in far-flung locales which seek to minimize the pain and side effects TURP and, in particular, avoid retrograde ejaculation, which is a feature of both TURP and HOLEP.

After my head-spinning, perhaps-too-thorough research of all the treatments, including steam ablation (four doctors in Texas offering that) and a study at a local hospital of prostate artery embolization, in the end I came back to B-TURP, which is the tried-and-true surgery my urologist in Plantation, Florida, recommends and performs. (To quote the conclusion of one of many articles on the subject, “Bipolar TURP is safer than monopolar TURP because of lower risk for TUR syndrome [not something you want to happen to you], less intraoperative bleeding, and lower incidence of postoperative complications.”

BACKGROUND: As I slid from my 40s into my early 50s, I began having symptoms of BPH, benign prostatic hyperplasia, with the need to urinate more frequently and a progressively weaker and erratic urine stream. Eventually, symptoms of urgency to urinate became a problem as well, which is especially inconvenient when you’re out and about and, for me, even at my place of employment, which in my BPH-filtered opinion has too few bathrooms for the size of the staff. Reluctantly, because I was concerned with side effects including fainting, I began taking tamsulosin around the age of 56, which was prescribed by my primary care physician (PCP). Tamsulosin made ejaculation difficult, somewhat less pleasurable, but not impossible. (And I never fainted.) But in the last year before my surgery, the benefits of tamsulosin petered out (pun intended). I tried switching briefly to Rapaflow, a non-generic cousin of tamsulosin that my PCP said some patients had more success with, but it did nothing for me. I took the next step of seeing a urologist this past March. We talked about surgical options, but he recommended I first try tamsulosin in combination with AvoDart, which had recently become available as the generic dutasteride. I was concerned about the side effects but he told me very few patients experienced the most alarming of these, such as breast enlargement (and a high-pitched squeaky voice—just kidding). And I resolved myself to retrograde ejaculation, which, while definitely not as pleasurable as normal ejaculation, is something that can be improved upon with practice.

The dutasteride began working well within a month, and I forgot about surgery. However, after four months, when my doctor said I should expect the full benefits of the wonder drug, I was already reverting to my previous symptoms, minus the urgency. I would have intermittently strong urine streams followed by weaker ones, and although the frequency of urination had halved itself at night (from about six pees to three or four), the doctor and I ruefully agreed that this was still too much to have a decent night’s sleep. Further, the ultrasounds that I had at each appointment with my urologist showed I was retaining urine in my bladder, which was responsible for the frequency because my bladder didn’t empty completely. The urologist said that if this progressed further the stale urine held in the bladder can lead to kidney damage. Whoa… that was enough to get me back on the surgery bandwagon. As I said previously, after much research and discussing the options thoroughly with my urologist, who candidly told me that every urologist will tell you that their preferred procedure is “the best,” I decided on his beloved B-TURP. (And the guy is only about 40, so he doesn’t do TURP because of some nostalgia for the good old days.)

PRE-SURGICAL TESTING:, My urologist ordered a cystoscopy, to look into my prostate and bladder. The nurse numbed my penis with lidocaine and the procedure was not particularly painful but it was an odd sensation of pressure when the scope went into my bladder. After the test, which lasted about 2 minutes and 15 minutes of prep, the urologist said I had a large prostate (ha!) and no tumors in my bladder (good news and I’m glad I hadn’t considered that possibility before he mentioned it). He also said there might be blood in my urine the next day (not so) and pain on urination (yes, for a day, and bearable).

The next procedure the following week was urodynamics, to test the health and functioning of the bladder. By now I had resigned myself to the embarrassment of having strangers stick things into my pee-hole and, in this case, also a small catheter in the rectum, to help measure “pressure.” This test was not done with anesthesia but was not exactly painful, just very awkward. I also had a couple of electrodes (EKG-style) stuck on my body, and then let the games begin! The technician filled my bladder slowly with a sterile water, and instructed me to let her know when I had an urgency to urinate along the lines of “Okay, you’re at the mall and you have to find a bathroom.” When I felt this way, she noted it on her computer which was purring and clicking while she told me my bladder was doing all the right things. Next, she told me to tell her when I absolutely had to—must—pee. At that point, she instructed me to urinate into a collection device that was part of the chair I was in. Mind you, the small catheter in my penis was still inserted and I had to pee “past” it. The urine stream was much weaker than I had hoped based my sensation of having a full bladder. When I thought I was done, she turned off the program but I told her I had more urine to surrender to the container. “Oh, she said, a double void. Okay. Well, just go ahead. Because I’ve already stopped the test, I may have to ‘cath” you again to see now much urine is still in there after you finish.” At that moment, I hated her, but when I finished my second void she said she thought she could get by with an ultrasound. She had the urologist’s excellent nurse come in and they concluded I had 200 cc left in my bladder. (300 cc if usually considered enough to warrant concern.) However, I had previously had less than that on my two previous ultrasounds and I didn’t think much of it, considering the unique awkwardness of the procedure. And on the plus side, she said that my bladder was perfectly healthy, and that the urine retention was probably cause by pressure from the large prostate, meaning surgery should effectively reduce the amount of retention. Hooray. (This test was followed by another day of painful yet bearable urination, which I believe is par for the course when things go into the penis in the wrong direction).

Next up, I scheduled the surgery four weeks out with the staff’s surgical coordinator, who told me I needed to consult with my primary care physician to get cleared for surgery, which included blood work, an EKG, and a chest X-ray, all of which had to be done no earlier than 30 days from surgery. The tests came back and I was good to go.

SURGERY DAY: I arrived at my hospital at 10:00 am to check in for surgery scheduled at noon. Technically, I was in the outpatient surgical department of the hospital and would be kept for “23 hours” for observation, meaning I’d spend the night in a hospital room but wasn’t formally “admitted.” This is apparently a legal distinction which can make your stay more or less expensive depending on your insurance plan. For me, it was less expensive. I was checked in by a pre-surgical nurse and then interviewed by the anesthesiologist, who told me I’d be having general anesthesia. The nurse put me on a bed and fitted me with an IV line, which would stay in until my departure from the hospital. Later, my two surgical nurses stopped by to introduce themselves. Then the pre-surgical nurse gave me an anti-nausea, anti-vomiting drug through my IV, prescribed by the anesthesiologist, and we all waited for my urologist, who arrived about an hour late with a perfunctory apology. The pre-surgical nurse then gave me what she called an “margarita” through my IV. It must have been Valium or something similar, because as they wheeled me off to surgery I didn’t have a care in the world. I vaguely remember seeing the operating room and the hustle and bustle of numerous people in there before I was out for good. I woke up in recovery where I stayed for about an hour or perhaps longer. I believe I had been in surgery for just about an hour. In the recovery room, I was quite out of it from the anesthesia but at some point did feel some discomfort in the area of my penis, which had been fitted with a Foley catheter after the surgery. The nurse immediately deposited some morphine into my IV, which may have been overkill but I didn’t object. I was wheeled up to my hospital room around 4:00 pm and told I would be on a clear liquid diet. I wasn’t happy about that but understood the reason. For the next 18 hours, I lay in the hospital bed with large bags of sterile water being pumped into and out of my bladder through the catheter. The liquid coming out was initially dark pink and over the hours changed to lighter shades of pink indicating less blood (the prostate is a very vascular organ and bleeding is normal but must be carefully monitored). I slept on and off until early the next morning without pain.

THE DAY AFTER SURGERY: , In the morning, I had enough energy that I wished I wasn’t in a hospital bed chained to an IV and catheter. Fortunately, my urologist called the hospital fairly early, around 8:00 am, and told the nurse I could switch to a normal diet, which meant coffee with cream, not to mention eggs and sausage. The doctor arrived himself around 10:00 am and said that I was going home today, either with or without the catheter. He said that in 20 percent of patients, the bladder isn’t ready to urinate on its own when the catheter is removed. If you aren’t able to pee on your own, the catheter is reinserted and the patient is given a “leg bag” to take home (which apparently will fit under jeans). Then the catheter is removed a few days later at the doctor’s office. The nurse came in and removed the catheter from my raw and inflamed urethra, which was two seconds of hell (but: two seconds). Still, I couldn’t imagine it going back in, so I quickly gulped down two cups of water and waited for the urge to go. The nurse helped me to the bathroom and waited outside. I immediately and joyfully urinated in a strong but thin stream of “pink lemonade” which felt like peeing razor blades. No matter. I knew I wasn’t going to have to have that catheter reinserted and I figured the pain of urination was a small price to pay for my freedom. Within an hour, I was discharged from the hospital and went home with two prescriptions, one for post-surgical antibiotics to help prevent infection, and the second for pain (Percocet). At home, I found myself having the urge to urinate frequently, and I must say for the next six hours or so, each 15 seconds or so of urinating was very painful. (I decided to forgo the Percocet and just take acetaminophen.) But remarkably, by midnight the pain subsided to a milder stinging sensation, and by morning I was alternately urinating pinkish to clear liquid with little to no pain. I was still a bit wiped out the anesthesia but delighted with the quick progress I’d made.

THE DAY AFTER THAT. The next day I actually felt well enough to be driven down to South Beach by my spouse and have a long lunch in our favorite Sardinian restaurant. I was still urinating frequently, but no more so than before the surgery, and my urine stream was becoming so strong it felt like a firehose. That evening, I happily dumped my tamsulosin and dutasteride into the trash. No more prostate medications required. I urinated about four or five times that night, with very little discomfort. It seemed that the only thing that hadn’t improved was the frequency of urination. But my urologist had assured me that this would get better over time. And now I had the entire week off. Although I felt more or less fine, rest is recommended for a week after surgery to allow the prostate to heal and prevent any hemorrhaging from exertion. The doctor did tell me I’d be able to work out and play tennis within two weeks. After all the fears I had reading so many horror stories about this procedure, I was so happy and relieved that things went so well for me, and relatively painless other than a few brief hours.

FIRST WEEK AFTER SURGERY. Surgery was one week ago today, and I’m feeling no pain. Literally. Until yesterday, I had some mild stinging/burning when urinating that lessened each day until, nada! There is still blood in the urine, but unlike the “pink lemonade” urine of the first day after surgery it is now a few drops of blood just at the beginning or end of urinating. I also believe some destroyed prostate tissue is in there from time to time, which can lead to a mild tingling sensation at the tip of the urethra but not really pain. I also experienced a few urgency symptoms that were not like any I previously had with BPH. In these cases, I wouldn’t feel an overwhelming sense of urgency other than that I had to go, but as I got close to the urinal or toilet, I could barely contain the flow of urine. Although I don’t think I had any accidents, I did buy some underwear liners that sop up drips. (Even a couple of drops of blood on underwear is unsightly, and this helps with that. I also have had to urinate very frequently, but no more so than before surgery. I have been urinating three or four times at night until last night, when I got up only twice (could be a fluke; time will tell). Otherwise, my urine stream is very strong, much better than I achieved taking both tamsulosin and dutasteride. Despite the discomfort in the hospital and the first eight hours after removal of the catheter when I urinated, I’ve very glad I had the procedure.

SECOND WEEK AFTER SURGERY. On the eleventh day after surgery, I began bleeding more, usually at the very beginning of urination, and sometimes also a little at the end. Bright red blood, but no pain. I was initially alarmed but found some post-TURP guidelines online that said to expect this between 10 to 14 days after surgery and had to do with the prostate healing and scabbing. So bleeding, as long as it’s not excessive (which would indicate a hemorrhage and would require medical attention) is par for the course for several weeks. I have read that in some rare cases, the blood clots/scabbing can prevent block the flow of urine entirely, in which case you have to go to the emergency room and be catheterized. I have also read a lot of reports of bladder spasms, which sound awful but so far haven’t afflicted me. I still urinate three to four times a night, as I did before surgery. I’m not sure if that will change over time, but I’m used to it regardless. Meanwhile, the urine stream remains very strong, and the occasional urgency I had in the first week post-TURP has lessened. I also had ejaculated for the first time since surgery, and it was more pleasurable than it had been when I was on tamsulosin and dutasteride.

ONE MONTH AFTER SURGERY. It’s been a month and this is my last entry. I still have some blood in my urine about 75 percent of the time but it’s not enough to worry about. The urgency to urinate is gone, the frequency of urination is much less than when I began taking medications for BPH, and the urine stream is that of a 30-year old. Also, with the help of a 5 milligram tablet melatonin before bed, I am now sleeping up to four hours a night without having to go to the bathroom. I have heard that this will only get better. I’m already a satisfied customer, and I’d do it again if I had to. Although I know from reading about it that some suffer from complications of one sort or another, the percentage is by all accounts small and I urge you to explore B-TURP or another option to relieve your BPH if it’s interfering with your quality of life.

Thanks.
Probably in my future.
A quick read of the thread doesn’t reveal anybody who has had incontinence or impotence. I have friends who have had these afterward.