Urolift Procedure - February 2017

Men's health
1

To give back to the onlilne community, I want to pass on some information about my Urolift procedure for BPH.

First the patient - I am 68, 6ft 172 lbs.  I have had one BPH operation about 10 years ago (TUNA) from the same doctor who did the Urolift.  Other signifcant conditions - HBP and hypothyroidism treated by medicine,  Fairly active physically.  Working very part time.  Enjoying my children and, especially, grandchildren.

Impetus for the procedure - failure of tamsulosin (less than 1 year) to improve flow and with unsatisfactory side effects.

Confirmation procedure - Physician did a cystoscopy 4 weeks before the procedure to confirm this procedure was correct for the geometry of my prostate.  Topical pain medication used.  Was recovering well.  Soreness while urinating was going away after a couple days.  Was given 1 antibiotic pill.  Either from my anatomy or something I did, it wasn't enough and I developed a urinary tract infection.  Very painful 7-8/10.  Needed additional anti-biotic.  In a follow up visit 1 week before the Urolift procedure, things were better and we decided to go forward.

Urolift - Pre-Op:  Was told to stop medicines (including herbal) that would contribute to bleeding - e.g., low dose aspirin and Lovaza (gen).  I stopped the few other herbals that I took.  Continued with the thyroid (levothyroxine) and BP (valsartan/hctz) - the latter was stopped the day of and taken later when I got home.

Surgery location - like many, this was done in an ambulatory surgery center, not a hospital.  In my case, the center was run by the urology practice.

Procedure:

Cost - I am not going to focus on cost, because everyone's coverage is different.  As I understand it there are 3 bills - urologist, anaesthesiologist, facility.  The latter asked for a same day payment.  The others bill.

Procedure schedule - 1:30 pm s

1)12:30 pm -- Reception review and confirmation of information and stoppage of food/water/medicines 12 hours before procedure

2) 1:00 pm -- prep for surgery, viitals, IV started.  Met with urologist for last minute questions (mostly on activity after the operation).  Met with anaesthesiologist - she doubled checked food/water stoppage and looked in my mouth (I realized post facto looking for dentures).  Administered fetanyl - following was told by others

3) 1:30 procedure - was told it would take 30 minutes.  My wife was shown before and after polaroid of the opening of my prostate.  What she described looked like the photographs in the Urolfit pamphlet.

4) 2:30 pm approx - As I came out of the fetanyl, I was not as groggy as I expected.  Strong urge to go, but nothing coming out. I walked to the bathroom myself holding onto the pole containing the saline feed for the IV.  I had 4 bloody (medium) urine drops come out.  They said that was enough.

5) Given instructions on post-op procedure - primarily minimal activity for a week.  I was given the ok to do walking.  Which I tried 2 days later.

6) Prescribed antibiotic for 5 days.

Ride home - I live 30 min. from the surgery center.  We had plotted places to stop in case I needed to before I got home.  Did not have to stop.

First day - very sore starting and stopping urine flow.  Later that day it seemed flow was stronger, but hope might have colored my perception.  Ate sourdough waffles (my wife is great) late afternoon.  Ate a light dinner later. Forced myself to drink more water than I usually do (thanks to my wife) Sat up.  Couldn't go to sleep until 3:30 am.  Slept for 2 hours.  Went to the bathroom. Slept for 2 hours.  Note on clothing.  Since I expected some bloody urine, I bought and used Depend pads for a couple of days until the blood stopped.

2nd day - soreness about the same as the cystoscopy procedure.  Sign of blood was fading (didn't want to look too closely, though).  Stream seems to be stronger (my wife said she could hear it too).  Once I get the urge to urinate, I have to get in there fast.  Urine flow starts quickly.  Had to change pants once as I was not careful.  Stopped the use of the Depends pads as there was no blood visible and I started having better control of the stream.

I will post follow ups.  I am scheduled for a Uroflow PVR (check of flowrate) and urologist follow up two weeks after the procedure.

I am writing this to help people who are faced with the decision on what to do with their BPH.  I am not an advocate for one procedure or another.  This is a personnel decision.  As you know, this is anecdotal.  We are all different.  Yet, we are also all the same.  I would like to thank the others who have posted on this forum.

2

Thanks for posting your experience so far, hope you continue to have a good outcome. Why did you decide to go with urolift as opposed to prostate artery embolization or focal laser ablation

3

Thanks mark for your detasiled post. Best wishes for a speedy recovery

4

Thanks, this is a well-described anecdote, and very useful for others.  My experience was similar.  Within less than a week virtually all symptoms resolved in my case.  After settling down post-op, I had to aim carefully to avoid surprises, because the stream was so much stronger than previously, with impromptu cleaning up around the toilet.  Now, a little less than a year post-op, I notice the stream slowing, but still a major improvement, with very little trauma.   Several reports are here about doing a 2nd urolift procedure, but so far it doesn't look likely that it'll be necessary in my case.  

5

Congratualtions Mark,

Sounds like things are shaping up for you. I wish you luck. I had the proceedure over a year ago and there was not a bit of improvement not to mention the very uncomfortable (to say the least) "recovery" process.

6

Lester are you considering another type of procedure?

7

I had a Urolift procedure that irritated my urethra, caused acute urinary retention and hydronephrosis ending up with me catherizing to prevent kidney damage. The procedure was a complete failure. Ultimately had a PAE with Dr Bagla which was a stellar success and I am no longer catherizing and am urinating totally normally.

8

Richard,

You are more knowledgeable than I am.  I have been using the same urologist for 10 years.  He performed the TUNA (needle ablation) 10 years ago.  It was partially successful.  But, as my prostate grew, the night time trips to the bathroom increased.  By the time that I reached the point where something should be done (I was 67), I was under medicare rules.  I don't know if that was why he tried tamsulosin.  I tried it for a few months.  At first I didn't understand why I couldn't run any more (recreational jogger).  Then I started to understand how an alpha blocker worked.  The alternatives he discussed with me was Urolift and TURP.  It is quite possible that he does do PAE.  In fact, it wasn't until after my procedure, I started reading more posts on this site that I actually found out about PAE.  In my case, I stuck with a known urologist and took his advice.  I wish you good fortune on your choice.  Another procedure might be best for you.

9

Though, the observations on this site are anecdotal, they can help us make an informed decision.  My report is a small pay-it-forward for the help I have received.  Whether successful for me or not, this information could help someone make a better decision.

10

Thanks,  soreness has gotten continually better.  The 2nd night was great - slept 6 hours straight (partially because I only slept 4 hours - interrupted half way with a bathroom trip).  The 3rd night was disappointing - up 3 times.  Recovery is not always linear.  But, I am very glad to be off the tamsulosin.

11

Lester, our experiences -- good and bad -- can help people we will never meet.  As I replied above to "uncklefester", 2nd night was better than the first, but third was worse. Even if the stream returns to pre-surgery level, getting off the tamsulosin is a plus for me.

12

Wonderful!!!  I didn't know about PAE before my surgery.  Your experience will help others make an informed decision.

13

Nope. Just using meds as I was before.

14

You lucky guy. Hope it holds and you have continued success!

15

Had mine in July of 2015.  Rode home with a blanket over my lap and my penis dangling in a pee bottle.  Glad I did...but was a 135 mile ride back home.  Love the results.  Takes time to heal, but we do. 

I was told up front that insurance was good to go (Arizona blue cross and medicare and medicare supplement)...wound up getting a bill because all three insurance outfits refused to pay.  Was over $18K.  Turns out the urolift people have a team of lawyers to appeal.  And they did.  I wound up with a copay of $1,200 which I was glad to pay.   Had fun with it.  When I got the bill I called the hospital and told them I was my brother and that I had been found dead on my living room floor clutching their bill...

16

Mark, sounds like things went well for you, and your post will definitely help others.  To my brothers-in-suffering, I might offer a gentle reminder.  Guys, let's not forget about a phenomenon called POUR (Post Operative Urinary Retention).  It's a strange condition, and here's what I mean by that.  I've had several minor surgeries ... on the feet, and two major surgeries ... on the hips.  Think about it.  The surgeons were nowhere NEAR the prostate, but I lost the ability to urinate completely on several of these surgeries.  The etiology for this condition isn't known.  Logic tells us, however, that if urination can be affected by seemingly remote surgical procedures, the likelihood for urinary retention would increase exponentially, when surgical procedures are performed on the prostate.  Please keep this in mind. 

17

Good point alan. My understanding is the anesthsia is the culprit. On a side note kind of, I had no retention after my colonoscopy  which used conscious sedation Maybe a different thing IDK

18

Thanks Alan.  Some information to file away for the future.

19

Final Update

I stopped the tamsulosin (flowmax) on doctor's advice immediately after the operation.

I started walking 1.5 miles on the 48 hours after the procedure.  I had to take it slower than usual.  I noticed a couple of twinges in the area where the prostate surgery was.

The next day (3 day after surgery) I saw blood again in the urine and a small clot came out.  Even though I knew it was possible, because the bleeding had stopped, I was surprised.  No bleeding after mid-day on the 3rd day.

Rested the next two days.  On the 5 th day walked 2 miles, no reaction and no bleeding the following day.

Resuming activities - the week after I began light weights at the gym.  I even tried jogging a mile.  As you might guess, not jogging for 9 months, it was 2/3 run 1/3 walk. Getting off the tamsulosin was a big deal. I anticipate my enurance will improve.  Note: I am a 10 min/mile pace for a 10K - no speed demon.  I enjoy running which I started 40 years ago to prevent/delay type 2 diabetes (father/grandfather - successful so far).

Nocturnia - Before the op, there were nights when I was up every hour.  Average was about every 2 hours.  The night following the procedure I could not sleep until 3:30 am.  I slept 4 hours and woke up once to pee (some pain controlled by ibuprofen).  2nd night - 6 hours without waking up.  That hadn't happened in years.  In the two weeks since the operation, once or twice a night.  Mostly once.

Stream - day after the operation was the strongest stream.  Presently, there is a noticeable improvement from pre-surgery.  There is a still a slight sense of urgency.  I think some of it is psychological.  Before the op, I had a few accidents.  I think the embarrassment of incontinence is a big deal.  I can go longer between bathroom visits during the day.  Urologist says that the urgency will diminsh over the next few months.  I am hopeful.

Blood Pressure Medicine - I took home readings of my blood pressure since I stopped the tamsulosin.  As I guessed it would, my pressure increased.  I called my cardiologist and asked for a prescription.  I had my bp med lowered soon after I started the tamsulosin.  So, I am going back to the original level.

Post Op Evaluation - Drank the liter of water and had flow measured 1 hour later.  Ultrasound of bladder revealed no retained urine.  Addressed a minor concern about stone formation.  Urologist said that he has seen no issues regarding that with this procedure.

Conclusion - I am greatful that the procedure recommended by my Urologist worked out successfully.  My quality of life has improved.  I am also greatful to the men who have posted on this forum.  Some of us have had success.  Some are working through issues.  All of us have helped others with the discussion of our experiences.  All of us will help our sons and grandsons find better treatment.

20

HAHA.  I should use spell checker (or learn how to edit posts) - "nocturnia" - because I am starting piano lessons (nocturia).

"greatful" - no excuse (grateful).

Hopefully my wife, the teacher, won't read this.