BPH, TURP (and ED)

[Blackwell 288]

According to readings, up to 90% of all males will suffer from an enlarged prostate, called BPH or Benign Prostatic Hyperplasia -as they age.

 

I was diagnosed with this condition some 5 years ago (at age of 62) and have been taking medicine, primarily now Tamulosin and 5mg Cialis. May well have had the condition for a number of years earlier than that. I must admit that I also occasionally have problems with Erectile Dysfunction, which may be related to the aging process, but is sometimes listed as a side effect of BPH.

 

My doctor has now recommended surgery (TURP or Transurethral resection of the prostate). I am aware that one of the side effects of this is retrograde ejaculation, but it is otherwise not expected to have any effect on sexual function.

 

Given that (I guess) a large number of PT members are over the age of 50, I wonder what your experience has been in treating BPH, and if you have had TURP surgery, did it have any effect on your sexual function? Having retired now, I am actively considering moving to Pattaya, but am concerned that if I suffer from ED (as a result of prostate surgery, what would be the point?

 

Thanks for any input.

 

[js007 795]

I'm almost 67 and have never had a prostate problem. Just had a physical and some blood tests, and everything is "normal," according to the blood tests. Anyway, I think I recall reading about two different types of surgeries for BHP, one being "experimental" at the time, but with fewer effects on erectile function. I'll look into it if I remember.

[teelack 9,388]

I have experience with what you have asked about. Thinking of a reply I decided not to give you one for the following reasons. I think that everyone will heve a different outcome and reaction to a TURPS op and even your surgeon will only be guessing. The issue isnt the operation, its about what you may be suffering without it. The only advice that I would give you is that if it is interfering with your life now and you dont have it sorted than I would rule out moving to Thailand.

[awesum4 2,319]

Not helping in your current situation but just of hope for the future. Some Aussie doctors have come up with a system of injecting steam into the prostate via a needle inserted into the urethra. The steam simply dissolves the prostate material which is then absorbed by the body. No cutting involved so no healing time, no side-affects.

I have prostate problems but not to the point of needing an operation. I'm hoping this system is available by the time I do

[Blackwell 288]

I have experience with what you have asked about. Thinking of a reply I decided not to give you one for the following reasons. I think that everyone will heve a different outcome and reaction to a TURPS op and even your surgeon will only be guessing. The issue isnt the operation, its about what you may be suffering without it. The only advice that I would give you is that if it is interfering with your life now and you dont have it sorted than I would rule out moving to Thailand.

 

Thank Teelack for the perceptive reply.

 

I have done a lot of reading of research material, which tends to have differing conclusions. Improvements in Erectile Function (EF) are noted in a number of studies about TURP, but they do note that there is a possibility of thermal injury to the erectile nerves.

 

PVP (Green light laser) treatment seems better in terms of quicker recovery, shorter hospital stays, however there are numerous studies that suggest the heat of the laser damages erectile function, with the recommendation that TURP is used for older men who wish to maintain sexual function.

 

I currently have problems with emptying my bladder, although the 5mg Cialis means that I will often sleep through the night (maybe one toilet visit only).

As you say, this is a problem that would need to be resolved before moving to Thailand.

 

The choice at the moment is TURP or continued drug treatment.

 

Duodart, which is a combination of Dutasteride and Tamsulosin hydrochloride is available in Australia on PBS (only $5.40 a packet). I a not currently taking this, but Dutasteride acts to shrink the prostate, and is thought to have a beneficial effect in delaying the need for invasive surgery. Unfortunately, a major side effects of Dutasteride are impotence, decrease in libido , and difficulty with ejaculation.

 

Sucks to grow old.

 

I am interested in understanding how other members might have dealt with this problem; for myself I will continue with researching the academic literature, and most likely take the plunge have the TURP operation.

[SlipSlopSlap 186]

I had a benign prostate growth and had the TURP April 2017 (I'm 60 now). Unfortunately it was bundled up with a few other serious medical issues over a 4 month period which saw me in and out of hospital for a few major operations. The other issues were not related, they just all fed into each other to delay surgery on one thing while I was having surgery and recovery for another thing.

 

By June 2017 I noticed my piss stream was (and is) better than it had been in years, but I also had an unrelated bladder issue as on of my other medical issues which got fixed separately. EDIT Also my ability to empty the bladder more completely was greatly improved.

 

ED? That had been going downhill for years due to my diabetes and medications, but I think it did improve a bit. Unfortunately, more extreme medications have buggered that up.

 

You seem to sort of imply if you can't have coital sex then you just can't have sex at all. You can orgasm without a hardon (oral sex...)

 

I can't get travel insurance now so I won't be back to Pattaya, but if I were coming back I would suffer some thai maiden gently trying to coax some splooge out of my softie with her mouth!

Edited June 3, 2018 by SlipSlopSlap

[teelack 9,388]

 

Thank Teelack for the perceptive reply.

 

I have done a lot of reading of research material, which tends to have differing conclusions. Improvements in Erectile Function (EF) are noted in a number of studies about TURP, but they do note that there is a possibility of thermal injury to the erectile nerves.

 

PVP (Green light laser) treatment seems better in terms of quicker recovery, shorter hospital stays, however there are numerous studies that suggest the heat of the laser damages erectile function, with the recommendation that TURP is used for older men who wish to maintain sexual function.

 

I currently have problems with emptying my bladder, although the 5mg Cialis means that I will often sleep through the night (maybe one toilet visit only).

As you say, this is a problem that would need to be resolved before moving to Thailand.

 

The choice at the moment is TURP or continued drug treatment.

 

Duodart, which is a combination of Dutasteride and Tamsulosin hydrochloride is available in Australia on PBS (only $5.40 a packet). I a not currently taking this, but Dutasteride acts to shrink the prostate, and is thought to have a beneficial effect in delaying the need for invasive surgery. Unfortunately, a major side effects of Dutasteride are impotence, decrease in libido , and difficulty with ejaculation.

 

Sucks to grow old.

 

I am interested in understanding how other members might have dealt with this problem; for myself I will continue with researching the academic literature, and most likely take the plunge have the TURP operation.

 

I will make this personal. Like you, peeing could be an issue and in Thailand I drink too much. Fortunately I wasnt in Thailand when the catalyst occured. One Saturday peeing stopped and I thought that it would as in the past, 'Come right" Wrong! I was admitted to hospital that night and the amount of piddle that the cathetered out of me was amazing. I had a day of reflection in hospital and realised that I was scared as hell of this happening in Thailand or indeed anywhere other than home and I took immediate action. Believe me, the complaint is worse thah the cure.

[Firepole 181]

Google " Prostatic Artery Embolization ". I don't have ANY experience with invasive BPH treatment but a neighbor's wife asked me to look into available options. They know my background and trust that I can interpret things better than they can. It's a, relatively, new procedure and it's not done in many places.

 

TURP sounds like a horrific procedure to me. In my research I decided that TURP would NOT be my first choice if I needed invasive BPH treatment. Do your research. A LOT of research. One very common complaint with any invasive BPH treatment is a change in orgasm feel and ejaculation. Again, do a lot of research. Don't jump at an option "just to get it over with". There is NO going back with this stuff.

 

BTW, I, personally, don't trust doctors. If your doctor only knows how to perform TURP you can bet he will tell you that PAE(Prostatic Artery Embolization) isn't for you.

[teelack 9,388]

Google " Prostatic Artery Embolization ". I don't have ANY experience with invasive BPH treatment but a neighbor's wife asked me to look into available options. They know my background and trust that I can interpret things better than they can. It's a, relatively, new procedure and it's not done in many places.

 

TURP sounds like a horrific procedure to me. In my research I decided that TURP would NOT be my first choice if I needed invasive BPH treatment. Do your research. A LOT of research. One very common complaint with any invasive BPH treatment is a change in orgasm feel and ejaculation. Again, do a lot of research. Don't jump at an option "just to get it over with". There is NO going back with this stuff.

 

BTW, I, personally, don't trust doctors. If your doctor only knows how to perform TURP you can bet he will tell you that PAE(Prostatic Artery Embolization) isn't for you.

One thing that you have to remember is that every country and district is different. You can travel the world looking for the perfect treatment, as you believe it to be. The practical truth is different. Your own country and surgical practices will have strong attitudes and beliefs about the right way to handle certain conditions and most of us cannot travel the world for a second, third or fourth opinion. If you have to use a national health system then you take what is offered. Also, the older you get the less choices you have. Once you leave the work force you will constantly be bumped down the list for other than urgent life threatening problems. It really is not as easy as demanding what is the current pet Google theory.

 

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[Blackwell 288]

Many thanks for the replies, and thanks to Firepole for the information on Prostatic Artery Embolization. I will ask my Urologist about this. I have done a reasonable amount of research- I use Google Scholar so that I can access research articles- sometimes using a University Library for access to databases like ProQuest.

 

Incidentally, like Teelack suggests, it is not always possible to have these new surgeries in Australia / New Zealand, and the cost can be high. A newspaper article in 2016 suggested the cost of PAE was around $6,000. This compares to $0 for a TURP under public health.

Article AFR

 

Duodart (a combination drug of dutasteride and tamsulosin hydrochloride is commonly used in Australia to treat BPH, as the Dustasteride works to shrink the prostate, and Duodart is available here on PBS, costing just over $5. I have not taken Duodart, because besides its cheapness and ability to reduce the symptoms of BPH, Dustasteride has some nasty side effects, particularly related to loss of sexual function and depression.

There are numerous articles on Dustasteride, including Adverse Effects and The Dark Side.

 

TURP is still regarded as the “golden standard” in treatment, but once surgery is done, there is no going back.

One of my colleagues, suffering from BPH, suddenly found he had complete blockage, and required a urinary catheter for some time until the TURP operation was completed. In my reading on PAE, it seems to be more suited to men who currently are prescribed with a catheter.

 

There are a number of negative side effects to TURP, including the need for a Blood transfusion, presumably due to excessive bleeding. This was given as high as 20% in early studies, but more recent ones suggest it is around 1%, which tallies with what my Urologist said.

It is the effect on sexual function that I am most concerned about.

 

Poulakis (2006) concluded ”The incidence of postoperative, newly reported ED after TURP was 12 %. Risk factors for its occurrence were diabetes mellitus and intraoperative capsular perforation.” (article PDF)

 

However, Jaidane in 2010 “We concluded that TURP improved erectile function in HBP patients with severe urinary symptoms. This improvement of erectile function was observed even in case of capsular perforation.” (Jaindane)

 

There is of course PVP (or GreenLight Laser Surgery). This surgery is quicker, requires less hospital time (1 ½ days vs 3-4 days), quicker recovery time, nil chance of bleeding. Most of the readings on PVP have been positive- except that it is more likely to require repeat surgery in time.

 

But, nothing is free.

 

Brookes (2001) in a study that compared TURP with laser surgery, concluded “Compared with laser therapy standard surgery for lower urinary tract symptoms has a beneficial effect on aspects of sexual function—particularly in improving erectile function and reducing reported pain or discomfort on ejaculation. Older men who need treatment and want to retain or improve sexual function may thus want to consider standard surgery rather than non-contact laser therapy.”

 

I do not have any medical training, and initially found that reading Medical Research Articles was difficult, but by constantly looking up the meaning of the different terms and acronyms that they used, it became easier, and I believe I am now in a much better position to have an informed discussion with my Urologist.

 

As a result of my readings, I will “most likely” opt for the TURP operation.

 

[Firepole 181]

I didn't address availability, or cost, because I realize everyone's location and financial/coverage situation is different. PAE is an option. Whether it's "doable" is an individual thing and up to the individual to determine. I'm confident in saying that if the FDA here in the U.S. has, finally, approved it(or anything) then it has, no doubt, been performed, successfully, for a long time elsewhere(biggest study is out of Spain).

 

IMO, the time to start looking into invasive procedures such as this would be, at the latest, on the day you've been prescribed medication to control BPH. Even with meds your prostate could strangulate the urethra without reason or warning. THAT is NOT the time to start doing research. THAT is the time to have a decision already made just in case it comes down to having a razor sharp instrument shoved up your penis. Hopefully, it won't come down to that but......

 

My neighbor "locked up" and ended up in the hospital at 3am with severe abdominal pain. No history, no BPH meds. His bladder was HUGE because his prostate strangled his urethra and urine "backed up". No warning at all. A catheter solved it for the time being but then there was the scramble to find a procedure when the, subsequently, prescribed BPH meds failed to do anything at all. His urologist, someone I've known(and don't trust but didn't say anything) for a long time, only performed TURP. Guess what he, highly, recommended?

A PAE doctor is 30 minutes away from us. They didn't want to wait because his wife was tired of dealing with the catheter. They're dealing with complications now.

 

If only one person reads all of this and it causes them to prepare, which ends up helping their situation down the road, I'm happy I spent the time blathering on.

Edited June 19, 2018 by Firepole

[Blackwell 288]

In my research for treatments of BPH, or particularly LUTS (Lower Urinary Tract Symptoms), it seems that the TURP operation is still regarded as the “Gold Standard”, and is the operation “most” favoured by Urologists. The TURP operation, requires 3-4 days hospital care, and I have not found any research where it has caused any form of sexual dysfunction other than retrograde ejaculation.

 

However, there are a number of developing “Minimally Invasive Surgical” techniques.

 

“Convective Water Vapor Energy” or Rezum appears to be one of the better techniques now on offer.

According to the Rezum web Site “Rezūm is a treatment for BPH that can be performed in a clinic or out-patient setting…

 

Among the touted benefits of Rezum are that it does not cause any sexual dysfunction – maintaining normal ejaculation (thus suitable for men who might still wish to father children), and it is a day procedure.

 

It certainly seems a better alternative to the TURP procedure.

 

Unfortunately, in Australia, it is not covered by Medicare, and I do not know yet what the cost is, although there are a number of “prominent” surgeons starting to offer the rezum procedure.

 

There is a five year research study due to be released, which concentrates on the efficacy of Rezum, allegedly having results similar to TURP.

[midlifecrisis 4,040]

Been taking Finasteride 5 mg once a day for BHP and for many many years and no ED problems. As you are taking Cialis also regulary, which is for ED, could it be having the opposite effect?

[teelack 9,388]

All the comments regarding new forms of treatment possibly will lead to better outcomes for this problem. For me the problem in getting my head around the problem is as follows. The operation is caused basically because the prostate keeps growing and cuts off the flow of pee. Unless there is some system that will shrink the prostate gland then you will still have to look to the standard operation. The secondary issue is that even after an op the prostate can keep on growing and you may need a second op. The same would apply I assume if all you did was shrink it and this is the nub point. Are other procedures simply a holding op and will need to be repeated on a regular basis (assuming that you can afford it) or has someone come up with a magic bullet that will last a long time?

[midlifecrisis 4,040]

All the comments regarding new forms of treatment possibly will lead to better outcomes for this problem. For me the problem in getting my head around the problem is as follows. The operation is caused basically because the prostate keeps growing and cuts off the flow of pee. Unless there is some system that will shrink the prostate gland then you will still have to look to the standard operation. The secondary issue is that even after an op the prostate can keep on growing and you may need a second op. The same would apply I assume if all you did was shrink it and this is the nub point. Are other procedures simply a holding op and will need to be repeated on a regular basis (assuming that you can afford it) or has someone come up with a magic bullet that will last a long time?

 

I have been taking finasteride for probably 20 years now. I am virtually asymptomatic.

 

If you go to a surgeon, they want to do a procedure.

 

If one medication does not work, try another. Work with a urologist. My dad had this (inherited) and lived without medication in his day.

 

It can be a real nuisance, wake up at night to piss or sudden urgency during the day or a slight slip, but it rarely gets to the point of requiring drastic measures.

 

Prostate surgery can cause permanent incontinence, infection, impotence etc

[teelack 9,388]

 

I have been taking finasteride for probably 20 years now. I am virtually asymptomatic.

 

If you go to a surgeon, they want to do a procedure.

 

If one medication does not work, try another. Work with a urologist. My dad had this (inherited) and lived without medication in his day.

 

It can be a real nuisance, wake up at night to piss or sudden urgency during the day or a slight slip, but it rarely gets to the point of requiring drastic measures.

 

Prostate surgery can cause permanent incontinence, infection, impotence etc

As I pointed out out earlier in the thread, it's not waking up to have a pee that is the problem. It's not being able to pee at all and not knowing when it could happen.

 

Sent from my Nokia 6.1 using Tapatalk

[midlifecrisis 4,040]

As I pointed out out earlier in the thread, it's not waking up to have a pee that is the problem. It's not being able to pee at all and not knowing when it could happen.

 

Sent from my Nokia 6.1 using Tapatalk

 

That is the extreme but there are medications that can help. Catheterization works but it is for acute. Try all different meds before surgery if possible. That is all I am saying. Surgery can ruin the quality of life. It may solve the one problem but how many others replace it?

 

I am not a physician. I am simply one with the problem. The problem has a range. I can of course only speak from my personal experience and the research I have done because of it.

 

Should that not fit another's situation, I apologize for the intrusion but then again I wonder why it was ever open to others.

[teelack 9,388]

 

That is the extreme but there are medications that can help. Catheterization works but it is for acute. Try all different meds before surgery if possible. That is all I am saying. Surgery can ruin the quality of life. It may solve the one problem but how many others replace it?

 

I am not a physician. I am simply one with the problem. The problem has a range. I can of course only speak from my personal experience and the research I have done because of it.

 

Should that not fit another's situation, I apologize for the intrusion but then again I wonder why it was ever open to others.

We are not talking about an intrusion. What worries me is anyone who has had the none peeing problems traveling. It is bloody painful as well as dangerous and the chance of getting an infection from a catheter is quite high. The problem is that there is no one solution fits all for the problem. Like yourself I have been there and while my experience is different from yours I still suggest that anyone who has doubts about travel simply doesn't till they have a permanent solution.

 

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[Blackwell 288]

Prostate surgery can cause permanent incontinence, infection, impotence etc

 

Not sure where this comes from?

 

Yes, prostate surgery can cause incontinence, infection and impotence, depending on the type of surgery you have. I am not happy with having any surgery despite my Urologist telling me how safe it is, and there is a lot of research data to back up the claim that prostrate surgery, or at least the TURP operation, is low risk, and does not effect sexual function (although the laser surgey can). I am unfortunately now at the point where it is either some form of surgery, or risk possible permanent damage to my bladder.

 

I would be careful taking finasteride for too long, although it helps to shrink the prostrate (allowing a “careful wait and watch” approach to BPH, there is plenty of evidence to suggest it is harmful to long time health- in particular depression, erectile dysfunction and diminished libido

 

“Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5á-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life.” Source

 

Teelack is correct, even with the TURP operation, the prostrate continues to grow, and success of any procedure is measured in the need to redo it within 5 years. The retreatment rate range for TURP is 3–14.5% after five years. Similar results are shown for Rezum, although that has only been around for 5 years, so the long term results may be skewed.

 

There are a growing number of minimally invasive techniques for treating BPH, and there is a large market. At the moment in Australia, TURP is covered by Medibank, none of the other procedures are, although some are covered partially with Health Insurance.

[midlifecrisis 4,040]

 

Not sure where this comes from?

 

Yes, prostate surgery can cause incontinence, infection and impotence, depending on the type of surgery you have. I am not happy with having any surgery despite my Urologist telling me how safe it is, and there is a lot of research data to back up the claim that prostrate surgery, or at least the TURP operation, is low risk, and does not effect sexual function (although the laser surgey can). I am unfortunately now at the point where it is either some form of surgery, or risk possible permanent damage to my bladder.

 

I would be careful taking finasteride for too long, although it helps to shrink the prostrate (allowing a “careful wait and watch” approach to BPH, there is plenty of evidence to suggest it is harmful to long time health- in particular depression, erectile dysfunction and diminished libido

 

“Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5á-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life.” Source

 

Teelack is correct, even with the TURP operation, the prostrate continues to grow, and success of any procedure is measured in the need to redo it within 5 years. The retreatment rate range for TURP is 3–14.5% after five years. Similar results are shown for Rezum, although that has only been around for 5 years, so the long term results may be skewed.

 

There are a growing number of minimally invasive techniques for treating BPH, and there is a large market. At the moment in Australia, TURP is covered by Medibank, none of the other procedures are, although some are covered partially with Health Insurance.

 

As to finasteride.

 

No depression, no ED and no diminished libido at 67.

 

laughing at loud at your studies and my point was that there are many medications not just the one I am taking. I am not selling the damn thing. All drugs have potential side effects. If one does not work or causes unwanted side effects, consult with your urlologist. I guess you recommend running off to the surgeon. Fine. We differ in approach to medical problems. So be it.

 

Two issues with an enlarged prostate. Chronic and acute. The vast majority of conditions are chronic with a gradual increase in symptoms from mild to severe. Most men don't wake up one morning and are unable urinate. Most of us with chronic disease end up with severe symptoms because we ignore the symptoms for years until there is a serious situation requiring immediate medical / more aggressive medical attention. I know I had the problem for a couple of years before I talked to my doctor about it.

 

The earlier symptoms are diagnosed, the better the prognosis and the less likelihood of invasive remedies.

Edited August 4, 2018 by midlifecrisis

[wacmedia 277]

Hi,

 

I've had kidney stones and they are performing a cystoscopy as a precaution(they say) Never had blood in urine but my mate got bladder cancer and I fear I might have the same. He has recovered OK. What is a cystoscopy like to endure ?

[Kev 173]

no prob I had a cancer scare just recently but all good. Had biopsies done on prostrate and cystoscopy, all done under anastetic where you are awake, no pain. no drama. Don't sweat...

Edited August 6, 2018 by Kev

[wacmedia 277]

no prob I had a cancer scare just recently but all good. Had biopsies done on prostrate and cystoscopy, all done under anastetic where you are awake, no pain. no drama. Don't sweat...

Hi,

 

Thanks, I asked the Consultant if I had cancer and he said he didn't think so.

[midlifecrisis 4,040]

One thing about prostate cancer in old men. Certainly there is one type of tumor but I have read that prostate cancer in elderly men can be a more chronic condition. Oncologists should be consulted, not just surgeons.

[wacmedia 277]

One thing about prostate cancer in old men. Certainly there is one type of tumor but I have read that prostate cancer in elderly men can be a more chronic condition. Oncologists should be consulted, not just surgeons.

 

Hi,

.

Black men seem to get a deadlier version. A black chap I knew got it and he was gone very quickly. I told him a relative was cured but he was aware that his was a deadlier version and he was toast