My HoLEP prostatectomy

Men's health
1

I thought I'd report whilst things are still fresh in my memory.

Well, I got home this afternoon (Thurs) after the op Tues @ 7 p.m. And things seem to be working OK. No more Tamsulosin needed, so that's one benefit right there. I'll update after a few days as the the other possible effects.

The anaesthetist chose a spinal anaesthetic, which I was somewhat chary of, prefering to be totally knocked out. Later I remembered that there'd been some research that found that older people who had anaesthetics died earlier, so he was right on that score. He also told me that this way I had a smaller number of anaesthetics (general meant 14!, this way 1 to 3).

I didn't like the thought of being awake and watching the op, but he assured me I wouldn't feel a thing; I wouldn't see anything; and I'd be able to feed and drink more or less straight afterward rather than many hours later. And so it came to pass. Just numb legs for a while. I really didn't feel anything. All over in about an hour. I even dozed a bit on the op table.

However, that night (Tues) was not good. I had a constant feeling of wanting to sh*t. However, no matter how hard I tried (and I used two laxative suppositories), virtually nothing happened. I later found out this is a side effect of the somewhat larger catheter and balloon that was put in place.

So I found it hard to sleep. But just when I did doze off once, the nurse came in for the fourth time to take my blood pressure (2.00 am?). I was really upset and told her not to do any more (all the previous ones had been OK anyway). But by then I couldn't get back to sleep. So I was wretched all the next day (yesterday).

However, last night I got to sleep about 8:30 pm; and slept right through to breakfast. Bliss.

The surgeon had come in on Weds; told me about the defecation urge origin; said I could go home today if my urine was pretty clear by then and the catheter had come out. I see him again in a couple of weeks, when the result of the biopsy will be with him. He also said only 10% need the op again in 10 years; most are fixed for good. Here's hoping.

I was apprehensive about the removal of the catheter. In the end though, it wasn't too bad. I did most of it myself, easing it and rotating it a bit when it seemed to stick. Whew! Great. Then I pee'd  a couple of times to test things; told I was OK to go. I left.

Home by 3 pm today. Then did a good walk (4 miles) and all's well. Still some blood and bits, but most clear. Good flow. Now to see how I am at night.

 

2

Sounds like it went pretty well. Any TURP patients ever do a four mile walk on day two??

After my GL I went to the races on day three and walked two two mile distances on day four or five. 

As you didn't see it watch one on Youtube to see what you missed:-)

Did you drive home or travel by train?

3

I'll pass on the YouTube, thanks Derek.

My wife drove me home (tho' wished she hadn't - travelling along the M25 was dicey).

4

Soon after it opened I was going with a woman who worked for me to a course somewhere in Surrey . She got on to it (Monday rush hour) froze and her face went ashen as she said; I'm going to be sick.

5

You are doing great! I had urgency, bleeding, frequency and pain while urinating for 9 weeks after my GL. A good natural stool softener with no side effects is cold pressed flax seed oil. It's getting hard to find so I buy Barlean's Organic Oils Fresh Flax Oil on Amazon for $12 for a 12 ounce bottle. It has the best taste. Others I've used have a rancid sort of taste, this one doesn't. I keep it in the fridge and if I feel like I am going to have a hard time in the morning I take 3 tablespoons and wash it down with some water. Within 20 minutes I'm ready to go.

6

Thanks for the tip Bob. Fortunately not my problem at the moment (I only felt the urgency to go; seems there was no need to).

Another update: I don't seem to have ED; I may have retrograde ejectulation though.

7

Just a couple of extras for forum colleagues:

I may have tested whether I had ED a bit early. I was in some pain/ache around the operated region yesterday evening and wondered if this was due to exercising the region too soon.

And this news item has just come throuugh, suggesting people up their Vit.D3 intake (prefereably sunshine, but maybe pills) before surgery:

"Low vitamin D levels linked to increased risks after noncardiac surgery" on 

http://www.sciencedaily.com/releases/2014/08/140815102033.htm

8

Did you pass any blood during sexercise?

How clear has your urine been since the operation?

9

Not during the walking. My urine varies from first blood and then clear; sometime all clear; and sometimes (like just now) all pink - I suspect in reaction to my ED test! Little pain/ache though (except last night).

10

Those thinking about having a TURP should now be having second thoughts.

Your procedure seemed remarkably quick. My GL had 57 minutes lasering time but took over two hours over all. My Thulium laser one had about the same ammount of lasering time but overall took three hours.  

11

IanC -  I'm looking at some form of prostatectomy soon for an enlarged prostate (114mg). I have some ed and retrograde ejaculation because of various meds, most recently Jalyn. What was your diagnosis? What was the incision procedure, via the uretha or just below the navel? Did he go into the bladder and then thru the neck of the bladder? Was there any cancer concern, if not why this procedure rather than the more common turp. Had your Doc considered TURP and decided on the prostatectomy instead?. Mine did exactly that and I'm wondering if your Doc's process was the same. I'm really hoping to find someone who has had the procedure I'm facing.  

12

Ron: My understanding is that 'prostatectomy' is the general name for all three of the alternative prstate surgeries. So you can have TURP which is based on surgical cutting out of the intruding prostate lobes, laser prostatectomy using a laser (NICE now recommends HoLEP), and UroLift prostatectomy. The latter is thought best by many, if  there's only two lobes and the prostate is not too large (I don't know the size limits). It involves less invasive surgery; quicker recovery; but it newer and so there's some uncertainty about how long it will last.

Different surgeons will prefer different procedures for the same patient, if my experience is anything to go by. My first urologist thought either TURP or Green-Light laser prostatectomy would be OK; I went elsewhere because of the time delay. This led to contradictory preferences (one surgeon said that because I had had bladder cancer, I could not have UroLift; another said that was not so). A surgeon who did all three thought TURP would be best.

My understanding is that TURP is more invasive (cuts out more) and takes longer to get over; but is the gold standard and works well for most surgeons and has a long history of success. Laser treatments are newer but have been around long enough now to be probably as good (surgeon expertise and history) and are in their third generation (I think) with Green-Light having been superceded by HoLEP, which itself is in the process of being replaced by a newer one (which name I forget). There's less surgical trauma, the area cut-out is effectively cautorized at the same time, so bleeds less and hence recovery is quicker. And UroLift for those whose prostate is suitable, but isn't yet available on the NHS (I think).

In the end, it was my choice. And after reading around, this forum, and wieghing up all that I'd heard, I went fot HoLEP.

As to how the surgeon got to my prostate, it was through the urethra. I am not sure the basis for choosing to go through the navel - I think that is not so frequent. That was never discussed with me, hence I have the feeling it is not often done.

13

Ron:

No laser surgery involves an incision it is all done via the urethra as of course are the now various versions of TURP.

You can look at all the procedures on Youtube

14

I didn't understand what the procedure was, thought it was an actual incision into the prostate. The URO who I have visited for about ten years now uses transurethral vaporization, TUVP in most cases and has suggested that to me for years. When my prostate was measured and determined to be 114 mg and with a third lobe he changed his mind and referred me to a colleague who performs a more invasive procedure. He enters the bladder via an incision beneath the navel and then thru the neck of the bladder into the prostate and hollows out the prostate from the inside. This procedure is supposed to be effective permanently where any other is a ten-year-or-so solution. Recovery will be longer but no nerves are disturbed since they are on the outside of the prostate.

If anyone in this forum knows something about this procedure I would appreciate any information available.     

15

My prostate was over 120 grams and I had Thulium laser surgery (it could have been any of the other laser ones) and he had done MUCH bigger ones than mine. At your age is ten years not enough? Tomorrow can take care of itself if it comes.

Why did you not have it done years ago?

TUVP is pretty much a TURP.

What he has suggested to you is one of the three forms of Open (simple) prostatectomy.

 

16

The reason I did not have turp or tuvp or whatever years ago is that the meds were working great and I under-estimated the long-term side-effects. I know what you mean by "ten years being enough in my case" but I assure you that with my genetic background and lifestyle I should live well into my 90's if Obamcare doesn't kill me. That's just 50-50.

I got off all the meds for several months, taking a reduced dose of cialis or viagra daily and I thought It was going to last but the flow got less and less until I had to get back on Jalyn. I know the procedure recommended by a new uro is called a "simple prostatectomy" but making an incision into the bladder and removing the core of the prostate thru the bladder neck does not seem simple to me.   

17

Hi Ron,

Your procedure, the simple prostatectomy, is described here:

http://www.healthline.com/health/simple-prostatectomy#Recovery and Outlook6

It seems more invasive than a turp or a laser. Only you can weigh the risks and rewards, but with your PVR, it seems your choices are limited to a surgical or laser procedure or cathing several times a day.

There's no guarantee that this will last a  lifetime, regardless what the doctor's say. My uro assured me the GL would last 10 to 15 years. That's what it said in the brochures. But I already figured a better estimate was 5-7 years. In my case It lasted only 6 months because of a stricture (scar tissue blocking the bladder neck), which you can also get with a simple prostatectomy. After a year of cathing once to twice a month to prevent recurrence of the stricture, I was back in surgery due to hematuria.

While cauterizing the hematuria my uro found bladder stones which he removed. This could also happen to you with your procedure. Also, my urologist resected (widened) the bladder neck during this second surgery to improve my flow. You could also have bladder neck issues which the simple prostatectomy doesn't address.

People get so focused on the best way to deal with the prostate that they ignore the fact that many symptoms are due to other factors (strictures, the bladder neck, stones). After all, women have all these same issues and they have no prostate, but they have a urethra and a bladder.  

You could be one of the lucky ones that gets a full cure from the simple prostatectomy. I hoped I'd get a full cure from the 180 Watt GL. But I didn't. I still expect to have issues in the future. Hopefully surgery will address them if and when I need them. Obamacare has nothing to do with it, He's not holding the scalpel.

18

Simple as opposed a radical prostatectomy that takes it all away.

19

True enough, but in comparison turp, tump, tuvp and others all seem more simple. I believe that I'm going to start a new thread about this particular type of "simple prostatectomy". I would really like to hear from others about this method. I haven't found anyone yet who has heard of it. Sort of like urolift  a few months ago. Now urolift is all over the web. I'll take a bit of credit for that. .   . 

20

Thanks for the link, Bob. That one really homes in on the procedure. No, there's no guarantees in any type of surgery, there are two many variables involved as we are all different. The surgeon probably told me that the procedure was done by computer-assisted robotics but I don't recall. I was so so amazed by what he said about going through the bladder neck that I think I heard nothing else. This Urology firm, consisting of a number of specialists within a specialty, use robotics in Turp and Tuvp I know. At any rate this is much more invasive than through the urethra with six weeks recovery time. Wow, how would I endure that much down-time with all I do?

My age is certainly a factor although I'm in good condition with all vital signs excellent for anyone over 50 or so. If I'm going to have that type of surgery I will lose about ten pounds and get the lower abdomen muscle in better condition as well. He stated that he goes through the bladder neck as the nerves are all on the outside surface of the prostate. He did say that a side-effect of this type of surgery is a stretching of the bladder oriface as the instruments enter the prostate there. He said that some exercises will be necessary to restore the oriface and prevent incontinence.  

What I meant by the decline in our current medical-care system is that next year a panel of non-medical bureaucrats will be empowered to review every case of expensive medical care and make a go or no-go decision based upon ones age and likelihood of surviving long enough to justify the expense of the surgery and hospitalization. It's in the bill and it takes effect in 2015 for those 75 or over. Of course it will probably be delayed until after the 2016 elections so the low-information folks who have voted this monstrosity into place won't know about it until it affects their parents or friends personally. Again, thanks for the link, your posts are helping a lot of BPH sufferers. I hope mine do as well.