PVP Greenlight 12/6/16 My experience!

Men's health
1

Over the next few weeks, I intend to chronicle here my experience following my PVP surgery.  I will attempt to as brief as possible.  I have heard so many horrible stories and warnings from so many men, that I thought I would relay my experience as it happens for those of you who might be planning your own PVP.

Had to be at hospital 0900 today.  Prep was minimal.  first step was to strip down to nothing and remove a wedding band that is now smaller than my knuckle.   Tests for blood sugar (I'm diabetic), blood pressure, and insert IV which took 4 tries.

A visit from the anestesiologist, and then my urologist. I asked him if I could give him some words of encouragement and he said sure.  I said, "Brian, don't f*ck up my dick"!  He gave me a hearty laugh. 

surgery was scheduled for 1200 and by 12-7 they wheeled me out of prep room towards OR, but I don't think I ever saw it.

I woke up at1445.  Groggy as hell and with strong discomfort inside the end of my penis.with catheter inserted.  I got some pain killers, antibiotics, and anti-bladder spasm meds as well as some coaching on emptying the bag.  

The nurse also secured the cath line to my inner thigh so that a tug on the main line wouldn't pull on the line into the penis.  There is not enough lead there and sitting on toilet promotes a pull of it's own.  Can't adjust it because there is a hard plastic connector in the line right there; so no alternative but to leave it be.

Was in the car at 1700  to go home just in time for horrific Atlanta traffic and took 1.5 hours to go 25 miles.

It's 2100 now and am getting used to the feeling of the cath in my trouser worm.  It's very uncomfortable but sensation pain has gone from about a 5 to a 2 or 3.  Bag has been emptied once but needs to be done again before I turn it.  Ate some dinner, a small pasta with broth and an egg around 1930.  Trying to drink plenty of water as advised.

I feel no pain whatsoever except for the point of insertion of the cath.  That is having a very calming effect on me, but, my dick does hurt.

Cath out Friday.  

Report back tomorrow.

2

Your real problems will be during the recovery period with a lot of blood loss. My recovery lasted 8 months.

3

Sorry to hear that Lester, but let's not worry gmoney with something that's at the very bad end of the spectrum - he's at day one and it's good to be optimistic.  He may just have a fortnight of slightly painful pees, which he knows about, then a week of some blood in pees (but no more pain), then begin to see real benefits in terms of flow rate.  Remember to avoid lifting heavy stuff and take it easy for about 7 weeks (or whatever they told you). 

4

Mine was normal for PVP and lasted two days.

5

With normal PVP recovery your reports should not last for long. 

With PVP my one was removed first thing the next morning which is the norm in the UK but one friend left the hospital without one afyer only four hours.. With my Thuliium/Holmium procedure it was left in for two weeks and delayed my recovery. This was due to a misunderstanding between the URO and the nursing staff and was supposed to be removed after a week.  I had reducing blood in it during that time but no more as soon as it was removed. 

6

Yes!  Thank you Paul!  I've heard so many gloomy reports of things gone wrong and very little from those who have good results.  that is why I started this thread.  I'm optomistic about my recovery, obviously and hope that delivering my daily experience can help other men.

7

Slept pretty well last night.  Had to get used to the drain cord between my legs and adjust for turning over, but I didn't have to get up to pee!!!

The bag was pretty full and still dark red.  I am drinking as much water as I can as I'm told that will help clear the urine.  

Have had some bleeding at the tip of the penis which I'm told is normal.  Have to watch tugging from the main cord to prevent unwanted pulls on the cath.  

Yesterday I couldn't really define the pain I was feeling; I just knew my dick hurt.  But, I now understand that all the pain I felt was at the point of entry of the cath.  Movement of the tube attached to the cath exaserbates the pain; but honestly, that is quite minimal.  it is 0930 the day after and I really feel no pain at all while I am still.  Pleased about that.  The downside is that other previous aches and pains, like joints and such, hurt more than the penis.  It's the being still that makes the joints stiff.  I hope to begin trading that off with more movement in the next couple of days.  

Made the appointment to have cath out for Friday, although why they didn't do that at the time of procedure baffles me.  They only had one appointment for that at 0900 and once again, Atlanta traffic will rear its ugly head.

8

The pee pain thing you will experience (no big deal) is different to post-cystoscopic pee pain.  I expect you've had post-cystoscopic pee pain and found it to be "front loaded" - a sharp almost unbearable pain at start of peeing that makes you stop and pause for breath, then you make the glorious discovery that if you "pee through the pain", post-cystoscopic pee pain drops away as soon as you establish flow, so the trick is to empty bladder in one go and ignore the jolt at the start; and after 3 more pees that one is all gone.  Once the catheter is out, drink steady - not TOO MUCH too fast as the urethra and inside of prostate may be swollen from the indignity of having an 18 gauge three way catheter pulled out thro' the operation site (and all the rest that it has just endured); you may not be able to pee AT ALL for 2 to 3 hours (do not panic at this), or just a thin pathetic dribble at first.  An hour or two later (+4 hours post removal) it gets better and you are peeing 50 ml at a time, if like me.  You don't want the catheter put back in, so drink steady at first, don't hurry and drink a lot.  The first pee, you may get a bit of front-loaded post-cystoscopic pee pain, maybe not asmuch as post-cystoscopic pee pain = in THAT case an entire ruddy cystoscope has gone in and out, and once the lidocaine has worn off after the VERY first (painless) post-cystoscopic pee, the painful (second) post-cystoscopic pee = there is irritation from the lidocaine chemical gell that the gell itself of course masked (the lidocaine masked it), yet which is now revealed !  You didn't just have cystoscopy so did;;t just have lidocaine gell up there.  The mechanical friction of removing the cath post PVP is not much, so you may not get much post-cystoscopic pee pain, but you will get a different pain that feels like it's right in the prostate area.  That pain is less sharp than post-cystoscopic pee pain but it lasts longer and is more mid-flow and end-flow, and can occasionally last a further 5 to 25 seconds.  It is never unbearable and you quickly get used to it. It's because you're peeing thro' a urethra with a 3 cm or so slot cut in it, which has closed back into place but the cut is still there.  Bizarrely drinking plenty of water INCLUDING EACH TIME YOU GET UP TO PEE AT NIGHT, does reduce the pain a lot as it reduces strength of pee.  If you do not drink at night the next pee will have you on your knees, I learnt that lesson .... never let the pee get strong.  That also hugely mitigates the risk of symptomatic infection, as your are peeing out the bacteria faster than they can multiply and you wipe out a new infection by peeing it out faster than it can multiply, before it takes hold.  Remember that blood in pee (week 3?) looks worse than it is, it doesn't take much to make base of bowl hard to see and scares you.  One or two of the clots may be large, like 20mm by 20mm by 5mm was my biggest, and feel like a very mild electric shock as they pass out, that scares you too.  Take complete rest if that happens, I did and within 24 hours, no more clots or bleeding at all.  It is only after that that you begin to get the real increase in flow rate (swelling has then gone down), which in my case was truly amazing at 36 ml/second.  I would avoid sex for AT LEAST 7 weeks, the first time will be rubbish (very poor sensation, this progressively self-resolves over next 7 weeks after that) anyway and might disturb the operation site .... avoid for longer if you can.  I have no further advice that I can recall.  Mine was HOLEP not greenlight, but they are pretty similar.  Holep is 50% ablation, 50% intact tissue removal (the latter = more for larger prostates), PVP is just ablation and may remove less.   If you find you can at least at times control your pee (notwithstanding urgency issues = have to run to loo or feel like you would wet yourself) after PVP then well done, you just avoided the main (rare) hazard of damage to the lower, urinary control, sphincter.  Some dribbling on after end of pee is normal and does not indicate a problem, for me that 100% self-resolved - I had it before Holep, now I don't at all, everything ends promptly and cleanly.  They say 3 months to settle-down and know where you are, although complete settling down can take a year.  I could tell that all was well at end week 3 (no more bleeding or dysuria, very fast flow was coming on, and beginnings of resolution of frequency issue - now dramatically fully resolved at +6months exactly today, in fact frequency largely sorted at +4 months after op). 

9

With Holep my cath was removed 2pm the next day (operation had been 9pm the previous evening) - I did google it and the median removal time for the cath post holep is 2.75 days, there are a few who have it for quite a while and some out in a day.  I figure longer gives more time for urethra to heal into new shape and might intuitively reduce risk of stricture, so if they are leaving it in a little longer, annoying though that is, it may be so very bad

10

You Guys in the States are sure unlucky. I've had three cystostcopies including an old time 'rigid' one and not had pee pain.  

11

I meant to end that preceding post, it may NOT be so very bad !!! (I missed out the not, reversing the sense of my intended meaning)

NB if they give you oramorph, or oral morphine, do NOT wait to get constipated with it, by then it will be far too late and laxatives won't work.  Take laxatives WITH the oramorph, plenty of them. They do not offer them until you ask - they can be a bit stupid like that.   Painful straining to poo is not good after a prostate op, and when you do manage to painfully shift a lump of dried out hard pale clay it smells like an egyptian toilet as it has begun to decay inside you already.  Yeuch !!!!  (it took me a week to sort it out - the hospital refused my request for an enema). 

12

A lot of the blood comes from the urethra as it has had a lot of trauma from the instuments and being spongy it soaked up blood.

13

You are right. I repeatedly re-share my tips, as it would have helped to know a lot of the super-practical stuff before my op (I bet it was out there, I just failed to locate it).  It is easy to find websites in which people debate the pro's and cons of different existing ops versus new procedures, but quite hard to find really detailed accounts of people's experiences from one of these ops with the practical points and a very clear timeline of what they experienced and when.  If you share it all, it is for others to judge whether your experience is typical or maps onto them, but it should help them a lot.  A good thing to do.  If you felt able to share your approx age and prostatic volume, that would give them a little more context, too.  Me : I was 49, prostate a trifling 22 cc (22 grammes) - darned thing seemed to have swelled inwards !

14

NB am not in states, am in UK. 

15

The dark urine may also be from your pain killers. If they gave you pyridum it is a dye that also calms the urethra and it gives it a dark orange, like a blood orange color, to your urine. I tried skipping it and in 8 hours my urine turned yellow BUT it stung twice as much so went back on it. Unfortunately it stains your clothes pretty badly so get some Depends urine guards. It is like a woman's sanitary napkin, sticks inside your briefs and is very absorbant. Cheap comfort for keeping clean and dry.

Best of luck. REST, REST, REST. Do not push it.

16

I read about pyridium before my cystoscopy and asked for it - was declined, uro' said cystoscopy doesn't cause much pee pain.  Subsequent research as to how the heck I could get hold of a private supply before the cystoscopy indicated that it is available in USA and Spain NON PRESCRIPTION but I am in UK.  The cystoscopy didn't cause THAT much pee pain apart from the second pee - the first pee you are peeing out the anaesthetic, so you feel nothing and skip out of hospital thinking "that was a doddle, I won't even need the paracetamol...", it's the SECOND one that's a blighter.  Once I learnt to pee thro' the initial jolt of pain all was well - of course you think IF I CONTINUE PEEING THIS IS GOING TO GET WORSE so you stop after the first dribble on that second pee. Then repeat start-stop.  Nobody tells you to just pee on and that the pain goes in a second once flow is established, you have to learn that.  14 hours or so after cystoscopy it is all irrelevant as pain all gone.  This info is not relevant to a laser prostate op. 

17

Don't you just love how our governments "know what's best" for us and how you get different treatment in different countries.

18

Yes, women benefit from pyridium for cystitis too so they have the same issue presumably, unless it's just my uro' that doesn't offer it - I've no idea if actually banned in UK.  Ultimately the whole thing was very transient anyway and probably not worth it.  They just need to tell people that the pain the first non-anaesthetised pee after cystoscopy stops at once if you keep peeing - any normal person's instinct is otherwise, "sheesh that's going to get worse - I'll stop and pee out a dear little bit more after 20 seconds rest, and tackle this task in lots of little pees...." ... worst possible approach !  Having learned that, subsequent pees were a doddle ....

19

I took a stool softener as advised when I got home. The extra water being drunk also helps in that respect as well.

20

Then you have a much better chance of a good recovery:-)

Private or NHS? I had my PVP at the Freeman in Newcastle when they were doing trials and was patient 38 for the team and the eight for Uro doing mine and the Thulium/Holmium in Eastbourne by a very experienced surgeon who had been doing the procedure and demonstrating it for over six years.