Hello Everyone, I am 61 years old and can probably safely assume I have had BPH for at least the last 20 years. However, not any more. About 10-weeks ago I underwent a Simple Robotic Prostatectomy and wish I had done it years ago. For at least the last 10 years I was told I had a large prostate. Never paid much attention to it because sex was good, peed okay, and nothing much else caused me any concern. My PSA was always high, and my urologist at that time (9-10 yrs ago) always wanted to do a biopsy. Under his care I had two done and each time there was nothing. I finally got tired of having my prostate treated like a pin cushion and stopped seeing the urologist all together. More back story: While I could pee, I also fought having a bashful bladder. Walking up to the urinal meant taking a deep breath, relaxing, and then letting my pee go. Kind of minimal pushing and a light splash in the water (weak stream). If I had to stand next to another guy, or have a bathroom that was real quiet with other people, I struggled to get started, but once started, no problem. Over the years this got more pronounced, but manageable. Just chocked it up to a large prostate and bashful bladder. Well this last year I started going through some real urinary retention issues. To make this long story short, I had multiple ER visits, numerous catheters, void tests, attempts to self-catheter (terrible experience), and three different urologists. One urologist did an rectum ultrasound and measured my prostate at 343 grams. Another one did a MRI and measured it at 265 grams. No matter how you look at it, my prostate was on the Top 10 list for being enormous. How I was peeing at all is a mystery to me, but I was until all the urinary retention problems quickly reared their ugly heads. Finally I got the right urologist and he told me all other approaches for my problem was off the table. No other operative steps, no medications (which I have never taken any, including today), etc. My only option, if I wanted to pee and not live life with a catheter, was to undergo a Simple Robotic Prostatectomy. My urologist said he could make me a garden hose. He said he could hollow out my prostate capsules like an avocado and spare my nerve bundles. All good news to me and I said let's do it because I was hating life on a catheter. I am now 10-weeks post-op. Had to use a catheter for 2-weeks after the surgery (healing process). At 2-weeks the doctor removed the catheter and performed a small void test-no problem. The real aha moment came 3-hours later after my wife and I finished lunch at a restaurant. I had to pee for the first time. I went into the stall, and no sooner did I pull it out, I was peeing like a race horse. It actually surprised me at how much volume came out so quickly. Doctor was right, I had a garden hose. I walked out of the bathroom with a smile on my face. I could not tell you when I ever peed that well before. No more bashful bladder and no more relaxing and just letting my pee flow out. I am pushing and forcing pee out at record speed and volume. The pushing took my bashfulness away. When I go pee now, I hit the water on purpose because I can make the loudest splashing sound in the bathroom, and I finish faster than anyone else. I just wanted to share and I am more than willing to share more, if interested, at how I have had no erection problems (sex right after the catheter was removed), my orgasms are good, and prostate fluid still passes, but just a little differently. My life is great now and getting better each day that I continue to heal. I never wish a catheter on any man. If a Simple Robotic Prostatectomy is your only option, all I can say is that it worked great for me. Dave P.S. Pathology report on my hollowed out prostate mass was benign. I am very lucky and feel fortunate. My only problem was a prostate that insisted on growing to an enormous size and causing me urinary retention. I have a picture of it removed if you want to see it.
Hey Dave so happy that all worked out for you. I think you were one of the lucky one. The results do not sound like a simple Robotic Prostatectomy. More like a Helop where they do the same hollow out the prostate and leave the shell. Glad the sex life is good and are you saying you do not get retro. All that matters is that you are happy. Take care and I hope all continues Ken
SRP works so well for u, congratulations!
another option as oppose to SRP is HOLEP, which is a minimum invasive surgery. Literature reports that the largest prostate that had been removed by HOLEP was 800cc.
just wondering if retrograde ejaculation is one of the complications of SRP. HoLEP will give its patients RE with about 88% certainty.
Hi Kenneth:
No, I did not have a HoLEP. There was no entry through my penis, nor was my urethra (or urethra neck) cut on in any way. Through the use of robotics, my doctor made six (6) incisions in my abdomen area, along with a wide one right above my belly button to remove the prostate mass in one piece. Through the incisions, my bladder was filleted open and my prostate was accessed through the bladder. Robotic equipment was used to hollow out the prostate in one piece and remove it.
As for retro, yes this has happened, but no worries. I have precum that flows out my penis during foreplay, but during my orgasms, I have the waves of feeling good, but nothing actually ejaculates out (less messy according to my wife). I have to tell you, my volume before with an enormous prostate did not produce much either, and ever so often, I would have retro with the large prostate. Post sex now, when I am cleaning up, I can squeeze/milk out fluid. None of this concerns me because when the doctor could spare my nerve bundles, I knew I would continue having healthy erections and satisfying sex. My procedure provided this, at least for me. I hope others have had success as well. As I continue to heal, I will watch for changes in all this. It has only been 10-weeks.
Dave
From UC Berkeley, healthandwellnessalerts (Nov 2017): "More serious complications of an open prostatectomy, although rare, include heart attack, pneumonia and pulmonary embolism (a blood clot that travels to the lungs). Performing breathing exercises, moving the legs in bed, and walking soon after surgery can reduce the risk of pneumonia and blood clots. Long-term complications, including ED, incontinence, and retrograde ejaculation, are slightly more common with open prostatectomy than with transurethral prostatectomy."
I find the minimally invasive statement interesting. To me, a radical complete prostate removal (cancer based), with a large abdomen cut without robotics, as a maximum all-out procedure with the most lasting side effects. All others are touted as minimally invasive. I researched all the alternatives for my situation, which many were not going to work for my situation, and considered the Simple Robotic Prostatectomy as the best long-lasting approach with positive results.
I guess many men prefer to sneek up on their problem and take small steps first. I have a friend that had a TURP a few years back and now he is experiencing urination issues again. To each his own, but the number one thin I wanted with the right doctor was to fix the problem (long-term), not treat the symptoms.
I was walking within 24 hours after surgery. This was also the same day I was released from the hospital. At home I walked multiple times every day as I was recovering. I never took anything stronger than Tylenol and Motrin (I am anti-narcotics). I returned to work within 10-days (could have went back sooner, but I took advantage of PTO and stayed home where I was most comfortable). Back in the gym (cardio & weights) at 6-weeks.
Dave Yes I know that you did not have Holep but it sounds the same when you were explaining it. Because that is what they do but through the penis. My doctor said it is like a orange when you take all of the orange out and leave the skin. Your doctor was very good. That is the main concern to any procedure a good doctor. I still don't know why you have pre cum. You may be getting some from what is left of the prostate. If you see your doctor again Can you please ask if he touched the ejaculatory ducts at all. Because if he did not you may get some after you heal. Glad all is good Take care Ken
Well, Dave, sounds as though you got fixed things good and proper! However, the very last sentence in your excellent post, "...I have a picture of it removed..." You had your prostate removed?
The shy bladder you talk about is fairly common to men, myself included, and is referred to as paruresis (if I have the spelling right).
Warm regards, and I hope you have many more years of voiding copiously, alan86734.
Sorry, Dave, you did explain everything clearly but it was all "off screen" on my system. Still getting used to the new and improved format. alan86734.
Congrats again for ur remarkably short and complicationless recovery. It seems that it could be more of an exception than a norm.
Obviously. I have had neither simple robotic prostatectomy nor HoLEP. But I also hope readers know that HoLEP is an excellent option for large prostates and is indeed a minimum invasive surgery compared to STP. Since I am not qualified nor creditable to voice an opinion, I could only cite published literature given below.
Source: ncbi?nlm?nih?gov/pmc/articles/PMC4446381/#!po=15.0000 (In the above, replace the sign ? by a period I.e. a dot) free access.
title： HoLEP: the gold standard for the surgical management of BPH in the 21st Century authors: John Michalak, David Tzou, and Joel Funk
Only one section of the above paper related to open prostatectomy is given below.
“HoLEP and OP Since the origin of HoLEP in the early 1990s, it has revolutionized the surgical treatment of men with large prostates. Men with adenomas deemed too large to resect endoscopically are often advised to undergo open prostatectomy-a surgery associated with high transfusion rates, lengthy catheterization times, and hospital stays averaging as many as 5.4-10 days [9,14]. Contrary to TURP, HoLEP is a size-independent procedure. The consequence of this is that HoLEP will eventually make OP all but a historical operation for even the largest of prostates. HoLEP has been used to successfully enucleate adenomas as large as 800 g [5]. Numerous well-designed studies have demonstrated that HoLEP outcomes, catheterization time, and hospital length of stay are independent of pre-operative TRUS volume. Lingeman, et al [1] retrospectively reviewed 507 patients who were stratified into three groups based on preoperative TRUS measurement - < 75 g, 75-125 g and > 125 g. They found no significant difference in hospital stay, catheterization time, post-operative AUA-SS, and post-operative Q max among the three groups. Similarly, Kuntz, et al [11] prospectively followed 389 patients who were stratified into three subgroups (< 40 g, 40-79 g, and > 80 g). They found no differences in catheter time, hospital stay, complication rate, or post-operative symptom score across the cohorts. Furthermore, the blood transfusion rate was zero in all three subgroups.
HoLEP and OP outcomes have been directly compared in multiple, well-designed, RCTs. Kuntz [9] demonstrated that HoLEP could be used to resect adenomas greater than 100 grams with similar efficacy as OP, but with radically decreased hospitalization stay, catheterization times, blood loss, and transfusion rates (see Table 1). Naspro, et al [14] performed a similar randomized, prospective study comparing HoLEP to OP in 80 patients with prostates > 70 g at 2 years of follow up. They found almost equivocal functional outcomes but a lower transfusion rate (4% vs 17.9%), decreased catheterization time (1.5 vs 4.1 days), and shorter hospital LOS (2.7 vs 5.4 days) in patients who underwent HoLEP vs OP, respectively. Moody and Lingeman, et al [15] retrospectively compared HoLEP to OP in prostates greater than 100 gm and found that patients who underwent HoLEP benefitted from a minimal change in postoperative hemoglobin (1.3 vs 2.9 gm/dl), a shorter length of stay (2.1 vs 6.1 days) and greater amount of adenoma resected (151 vs 106 gm). Furthermore, efficiency and efficacy of the operation were not compromised; procedure duration and AUS-SS improvement between the two cohorts were equivalent. Table 2 demonstrates the staggering reduction in LOS, catheter time, and transfusion rate that HoLEP patients enjoy.”
....................................TABLE 2................................ .................................................Kuntz (2008) Naspro (2006) ....................................................HoLEP/Open......HoLEP/Open Length of stay (d) 2.9/10 2.7/5.4 Catheter time (d) 1.3/8.1 1.5/4.1 Tissue removed (g) 93.7/96.4 59.3/87.9 Procedure time (min) 135.9/90 .6 72 .1 /58 .3 Transfusion rate (%)0/13 .3 4/17.9 Hemoglobin loss (gm/dL) 1.9/2.8 2.1/3.1 Prostate size (g)> 100/> 100 > 70/> 70 Change in Qmax +20.6/+20.7 +11.4/+11.8 Change in AUASS/IPSS-19/-18 -12.2/-13.5
hello ken,
hope all is well with u!
keen observation. indeed, the result looks more like from holep than SRP, but both will give patients RE to their patients.
all surgeries may produce results that fall in the outlier region. this could be one.
Thanks for sharing, dl. From the description from Dave, the SOP was a major surgery, way more invasive than most BPH procedures. HolEp seems to be a better choice? Perhaps Dave had a good reason to go with OP. Hank
Dave,
I am so glad that SRP worked so well for you. It was really your only option, besides full open surgery. You have forgotten to mention to us that underwent serious spinal (or intravenous) anesthesia for that surgery. Most likely were operated in up-side-down position to remove the pressure from the bladder on your prostate during at least 2-hr surgery. Also you were very lucky yo have an artful surgeon, who was well trained in SRP technique with sparing all the corresponding nerves and sphincters responsible for the erection and ejaculation. You were operated by an artist. Most URO surgeons offering SRP will just cut-off your prostate. You seemingly are in a good physical shape and relatively young for a BPH patient. At age 60 I didn't no that I have BPH. Most of the BPH patients, who are ripe for the surgery are in their late 60th or early 70th and typically in much worse shape. So their results can differ dramatically from yours. I would say, youe case belongs to these 10% of very lucky ones. I have two friends who underwent SRP surgery in their mid 60th due to BPH complicated by an early PC and spikes in their PSA. They both(now 72 YO) were successes but both told me,if you can avoid it, avoid. Their stream is excellent (as race horse according to them), but one has RE and another admitted that his sex life was over after SRP.
So, not everybody is so lucky. That's why I have chosen PAE for me as a first step. Maybe in the future it will be SRP with a well qualified surgeon. My father is 101 -year old, suffers from BPH since age 60 but resited any surgery. He have taken Avodart in his 80th (didn't experience any loss of libido and erections) and still can pee, albeit with difficulties and almost every hour. He is in a good mental shape so far and claims that BPH is not his worst problem.He has no signs of PC and definitely is not a candidate for any of discussed procedures. URO prescribes him antibiotics for frequent LUT infections. Everybody is different and there is no "one size fits all" in urology.
I am really glad that it worked for you so well. Ther many cancer survivors who went through SRP and lead an active professional and sexual life. It depends often on how rich you are and what access do you have to the best medical care. Unfortunately US medical system gives it only to a few privileged patients.
Best of luck to every participant of this discussion.
Gene
hello Hank,
hope all is well!
from all the papers that i have read, for large prostates, holep is the more preferred choice that prostatectomy, which dave probably would not agree. the question is do we want our stomach and bladder or prostate cut open to remove the adenoma or let a laser enter thru the penis like in cystoscopy? I had watched several open prostatectomy on youtube and they were bloody and were major operations.
the holep enucleation way of removing the adenoma is very similar to the open prostatectomy, very complete, thus they have about the same functional outcomes, such as Qmax and PVR. other than that holep seems to be better in all other categories.
did u ask me about insurance for holep? sorry, i lost ur post so couldn't reply. medicare and BCBS will pay for holep, i suspect all other insurances will pay for it as well, as holep is one of the most studied surgeries and has been around since 1998.
Thank you DL I sent Dave a few questions on a PM. It intrigued me. He had a very quick recovery and he is having per cum and there is fluid present. And a very good erection. His doctor did what he told him he was going to do. I wish we had more good out comes like that. Being that the ejaculatory ducts are not touch ( I know the connection of the seminal vessel are destroy with the removal of the prostate ) The pre come may be from what is left of the prostate. Maybe after 3 or 6 month's he may get a small ejaculation. Who know. But I am happy that it worked out for him. I forgot to ask where he had it done and what was the doctors name Take care Ken
Going in this Wednesday for procedure. You have given me some hope I was reading your story and thought I wrote it. I has two green lights and am still quite blocked when I go. I have a Gleason 6 and could do a close watch, but my doctor voted for the robotic pros. I am at the Mayo Clinic so profit is not really a motive.I am 67 yo and not in great shape. So say a prayer Best, Tom
dl0808,
you are right, HoLEP is doing the same as open or SRP surgery, but is less bloody due to coagulation with Holmium laser. I'm not sure, though, taht it''s covered ny Medicare or more precise, if very few doctors, who perform HoLEP will accept Medicare. I was looking for one in San Diego and LA and was not able to find one. My primary HMO offered only TURP or SRP without preservation of surrounding nerves. There terrible complications after HoLEP, which are well reflected on this site, albeit they are not so frequent as after TURP or green laser. Results of operating on a huge prostate are rarely predictable. That what pushed me towards PAE as apart of a clinical study. BTW, what do you know about Medicare coverage of PAE? The argument almost scholastic. According to my search in Southern CA, very few doctors offer HoLEP covered by Medicare. Maybe things are different in SF or NY. Out of pocket cost of HoLEP is around $20,000, from what I learned on this site.
Tommy Sorry to hear you are not doing so well. Are you having the same surgery as Dave or are you having the radical. I wish you the best. And I hope you heal just as fast. But I have to ask you a question. You said that you could do a close watch because you ARE AT 6 You may not have a problem for 5 or 10 years but your doctor voted to do the surgery. If your doctor told you that you should wait would you wait. You know the surgery is really your choice. Good luck Ken