Prostate surgery user reviews .... turp? rezum? other ?

[rumak]

This subject never gets old .... for those contemplating surgery for an enlarged prostate.  Hopefully there are a number of members that can share their FAIRLY RECENT  experiences.

I have read past threads so please DO NOT  repost old stories about what your doctor or friend told you ,  or give the Google or Youtube info which I and most others have seen for ourselves.

 

Personal experiences of course vary ..... but rarely if ever have i read an account of someone who had prostate surgery and did not have complications.  It would be really nice to hear at least one or two stories where its been a few years and all is well .  Maybe i am hoping for too much 🙂

 

but....... worth a try .  ( i have been to a good urologist... so also no need to tell me to go to one) 

[RayC]

  On 12/4/2024 at 12:39 PM, rumak said:

This subject never gets old .... for those contemplating surgery for an enlarged prostate.  Hopefully there are a number of members that can share their FAIRLY RECENT  experiences.

I have read past threads so please DO NOT  repost old stories about what your doctor or friend told you ,  or give the Google or Youtube info which I and most others have seen for ourselves.

 

Personal experiences of course vary ..... but rarely if ever have i read an account of someone who had prostate surgery and did not have complications.  It would be really nice to hear at least one or two stories where its been a few years and all is well .  Maybe i am hoping for too much 🙂

 

but....... worth a try .  ( i have been to a good urologist... so also no need to tell me to go to one) 

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I don't fit your criteria of 'all being well' but here's my experience.

 

I had lived with an enlarged prostate for +/-5 years and dithered about having an op for most of that time (Medication had no effect,). The decision to have a TURP operation was effectively made for me, as I woke up one day unable to pass urine. The idea of wearing a catheter long term didn't appeal.

 

I had the op. Unfortunately, it was discovered that I had mild haemophilia which fortunately was more of an annoyance than a problem although it did mean that I spent two nights in hospital.

 

Anyway, back home. Retrograde ejaculation is estimated to occur in 70% of TURP patients and I fell into that category. At first, I found it a bit disconcerting to see little evidence of my efforts😉 but both of us soon got use to it and, other than backfiring, the TURP has had no effect on the quality or quantity of our sex life. Of course, if you harbour ambitions to father (more) children then that is another matter.

 

The big positive for me has been the improvement in my quality of sleep. Prior to the op I was up 4 or 5 times every night to have a pee. Nowadays, it's normally once per night. Another immediate benefit of the op itself is that you will know with more certainty whether you have prostate cancer. Obviously that certainly fades with time but it offers some immediate reassurance. Fortunately, my result came back negative.

 

In summary: To state the blindingly obvious I would have preferred not to have needed the operation. However, in hindsight I slightly regret not having it sooner as my quality of sleep has improved greatly.

 

One word of advice: Once again, maybe stating the obvious. Choose your surgeon carefully. A good urologist might not necessarily be a good surgeon.

 

Good luck whatever you decide to do.

[rumak]

Thanks Ray !   Actually i think your post was exactly what i am looking for .  I want to hear about all experiences ,  just so I (and others) can get a better sampling of these procedures.  

Unfortunately , a few other cases posted over the years were not so successful .  From your report... I would say that yours is very positive , and of course I am happy for you. One question i have is how long has it been since your OP ?

I haven't even started meds yet !    Mainly concerned with side effects as my blood pressure has always been on the low side already. 

Hoping to hear from others .... but realistically may not be a lot because of the relatively small forum .   

Thanks again for taking the time .  Stay well !

[swissie]

Had "rezum" done 3 years ago. Infection ocurred, spent 3 months in agony after OP.

Today, my prostate problems (early stage) are back again.I will have to see my Urulogist again.

Had my "rezum" done in a highly respected university hospital in Switzerland. Same hospital denied, that the infection could have occurred in their hospital. (!?!)

Without infection, rezum might be recommendable. But why does the problem re-occur only after 3 years?

Ask your medics, how long their different "cures" will last. Imagine you are getting 100 years old, how often do you have to do a "rezum" every 3 years???

In any case: If a post operative infection occurs, you will be going thru hell for the next 3 months.

[RayC]

  On 12/4/2024 at 4:00 PM, rumak said:

Thanks Ray !   Actually i think your post was exactly what i am looking for .  I want to hear about all experiences ,  just so I (and others) can get a better sampling of these procedures.  

Unfortunately , a few other cases posted over the years were not so successful .  From your report... I would say that yours is very positive , and of course I am happy for you. One question i have is how long has it been since your OP ?

I haven't even started meds yet !    Mainly concerned with side effects as my blood pressure has always been on the low side already. 

Hoping to hear from others .... but realistically may not be a lot because of the relatively small forum .   

Thanks again for taking the time .  Stay well !

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OP = Original prognosis? If so, official confirmation by an urologist was 2013, although I had probably been living with the symptoms of BPH for +/-18 months prior to that. I had the op in 2017. As I mentioned previously, in hindsight I delayed having the op for too long.

 

Tbh imo you would be better looking at the aggregated data from reliable medical sources to inform your decision, rather than anecdotal evidence presented here by the likes of myself.

 

And with that in mind, I will offer another piece of anecdotal evidence! As I mentioned previously, medication didn't work for me, but I have a friend who has taken Tamsulosin for +/-15 years. It works for him and he hasn't experienced any side-effects (although your low blood pressure might make this medication unsuitable for you).

 

If you have a good urologist and have confidence in him/her then talk through the issues with them. S/he should be able to formulate a suitable individualised 'plan of action' for you.

 

Good luck. Hope that everything turns out fine for you.

[rumak]

  On 12/5/2024 at 2:52 AM, RayC said:

Tbh imo you would be better looking at the aggregated data from reliable medical sources to inform your decision, rather than anecdotal evidence presented here by the likes of myself.

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I like everything ( concise and factual ) about your posts .   BUT, disagree with that one sentence above that i have quoted.   Mainly because i do not have trust in Mainstreet "reliable medical sources" .. especially those almost exclusively presented on Google ,which are definitely biased ( the same sources always, and others censored) ,and as such readers can not get the full range of opinions from other medical sources.  

Maybe Kennedy will work to ensure that honest, uncorrupted "information" will once again be the norm.

 

I will be talking through the issues with my urologist ...... who has not pushed Turp on me,  so we will see.   Thanks again for your input !

 

[rumak]

  On 12/4/2024 at 5:09 PM, swissie said:

Had "rezum" done 3 years ago. Infection ocurred, spent 3 months in agony after OP.

Today, my prostate problems (early stage) are back again.I will have to see my Urulogist again.

Had my "rezum" done in a highly respected university hospital in Switzerland. Same hospital denied, that the infection could have occurred in their hospital. (!?!)

Without infection, rezum might be recommendable. But why does the problem re-occur only after 3 years?

Ask your medics, how long their different "cures" will last. Imagine you are getting 100 years old, how often do you have to do a "rezum" every 3 years???

In any case: If a post operative infection occurs, you will be going thru hell for the next 3 months.

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i have been reading some other user reviews about rezum .  Though i understand that most people who post do so when they have a negative outcome.  That said.... there are many .  I for one would post something POSITIVE  about an issue if it was my experience.

Sorry about your story... but thanks for sharing.   One thing we know on this forum is that the members are mostly real people , living or having lived in Thailand,  and are generally honest about their medical experiences.

Not so much regarding their sexual exploits 😅

 

[StraightTalk]

  On 12/4/2024 at 1:29 PM, RayC said:

In summary: To state the blindingly obvious I would have preferred not to have needed the operation. However, in hindsight I slightly regret not having it sooner as my quality of sleep has improved greatly.

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In hindsight would you have opted for the da Vinci Prostatectomy?

https://www.urologists.org/article/procedures/da-vinci-prostatectomy

 

  On 12/4/2024 at 1:29 PM, RayC said:

One word of advice: Once again, maybe stating the obvious. Choose your surgeon carefully. A good urologist might not necessarily be a good surgeon.

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Therein lies the problem. How would one determine a "good surgeon"? Robotic surgery for prostate removal seems to be the least invasive procedure unfortunately not (yet) available in Thailand.

https://www.ttsh.com.sg/Patients-and-Visitors/Pages/Find-Specialist-Details.aspx?specialist=Chong-Yew-Lam

[RayC]

  On 12/5/2024 at 3:13 AM, rumak said:

 

I like everything ( concise and factual ) about your posts .   BUT, disagree with that one sentence above that i have quoted.   Mainly because i do not have trust in Mainstreet "reliable medical sources" .. especially those almost exclusively presented on Google ,which are definitely biased ( the same sources always, and others censored) ,and as such readers can not get the full range of opinions from other medical sources.  

Maybe Kennedy will work to ensure that honest, uncorrupted "information" will once again be the norm.

 

I will be talking through the issues with my urologist ...... who has not pushed Turp on me,  so we will see.   Thanks again for your input !

 

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The fact that your urologist hasn't pushed TURP on you is imo a good sign.

 

I actually saw two urologists; the first - who was immediately available - did push TURP on me with very little discussion about the options and I quickly looked elsewhere. The second - recommended by a friend - was much more open. He would say things like, 'Here are your options'; 'Here are the pros and cons of the various options'; 'If you have questions, ask me. I will try to answer, although I don't know everything'; 'You have to decide what course of action to take yourself. I will furnish you with the facts'.

 

(All this happened in Belgium where we were living at the time).

[rumak]

  On 12/5/2024 at 3:28 AM, RayC said:

 

The fact that your urologist hasn't pushed TURP on you is imo a good sign.

 

I actually saw two urologists; the first - who was immediately available - did push TURP on me with very little discussion about the options and I quickly looked elsewhere. The second - recommended by a friend - was much more open. He would say things like, 'Here are your options'; 'Here are the pros and cons of the various options'; 'If you have questions, ask me. I will try to answer, although I don't know everything'; 'You have to decide what course of action to take yourself. I will furnish you with the facts'.

 

(All this happened in Belgium where we were living at the time).

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exactly .    the second urologist you saw is obviously how ALL doctors should engage with their patients .   Let's be honest :  how many of us have that experience nowadays ?   

BTW:  i forgot to ask :  since 2017  has all been smoothe ?  No further complications from the surgery ?    Most importantly,  no serious side effects ? 

[RayC]

  On 12/5/2024 at 3:24 AM, StraightTalk said:

In hindsight would you have opted for the da Vinci Prostatectomy?

https://www.urologists.org/article/procedures/da-vinci-prostatectomy

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That particular procedure wasn't available to me at the time. Hopefully, I won't need a second operation but If it does prove necessary I'd investigate this procedure as an option.

 

  On 12/5/2024 at 3:24 AM, StraightTalk said:

Therein lies the problem. How would one determine a "good surgeon"? Robotic surgery for prostate removal seems to be the least invasive procedure unfortunately not (yet) available in Thailand.

https://www.ttsh.com.sg/Patients-and-Visitors/Pages/Find-Specialist-Details.aspx?specialist=Chong-Yew-Lam

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"How would one determine a 'good surgeon'"?

 

By research. As I said in a previous post, circumstances meant that the decision when to have an op was rather forced upon me; however, it was almost inevitable that I would need an op at some point and I researched online for reviews of my urologist. There were no accounts of blotched operations - unfortunately, the same couldn't be said for all urologists - and reviews were almost entirely positive. I also  surreptitiously asked around the urology department about the various consultants and the feedback about my urologist (maybe unsurprisingly) was positive.

 

I accept that this is hardly a statistically sound approach but imo it's better than nothing 

 

[RayC]

  On 12/5/2024 at 3:38 AM, rumak said:

exactly .    the second urologist you saw is obviously how ALL doctors should engage with their patients .   Let's be honest :  how many of us have that experience nowadays ?   

BTW:  i forgot to ask :  since 2017  has all been smoothe ?  No further complications from the surgery ?    Most importantly,  no serious side effects ? 

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Touch wood. All good. I have two yearly check-ups.

[BigStar]

  On 12/4/2024 at 5:09 PM, swissie said:

Ask your medics, how long their different "cures" will last. Imagine you are getting 100 years old, how often do you have to do a "rezum" every 3 years???

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The Rezum procedure’s success rate is good. Studies show that less than 5% of people need additional procedures or surgeries within five years after the procedure. About 10% of people need to take prostate medications within those first five years.

     --https://my.clevelandclinic.org/health/treatments/rezum

[Sheryl]

  On 12/5/2024 at 3:24 AM, StraightTalk said:

In hindsight would you have opted for the da Vinci Prostatectomy?

https://www.urologists.org/article/procedures/da-vinci-prostatectomy

 

Therein lies the problem. How would one determine a "good surgeon"? Robotic surgery for prostate removal seems to be the least invasive procedure unfortunately not (yet) available in Thailand.

https://www.ttsh.com.sg/Patients-and-Visitors/Pages/Find-Specialist-Details.aspx?specialist=Chong-Yew-Lam

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Prostatectomy - robotic and otherwise -  is for cancer of the prostate.

 

This thread is about benign enlargement. TURP stands for transurethral resection of prostate, it is not complete removal.

 

OP. see this lengthy thread about people's experiences with Rezum here https://aseannow.com/topic/1274732-rezum-experience/

 

 

Important to note that with Rezum:

* only certain patients are candidates (depends on prostate size)

*skill of the operator is crucial and the procedure has not been done in Thailand for very long, be sure to get a doctor who has done many

*Even worldwide it has not been around that long so not really knonw how long results will on average last, just that it lasts at least 5 years for most patients

 

[StraightTalk]

  On 12/5/2024 at 7:38 AM, Sheryl said:

Prostatectomy - robotic and otherwise -  is for cancer of the prostate.

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Okay, understood.

Could you please share your insights on how to identify a skilled and reliable surgeon for prostate-related issues in Thailand?

[Sheryl]

  On 12/5/2024 at 8:07 AM, StraightTalk said:

Okay, understood.

Could you please share your insights on how to identify a skilled and reliable surgeon for prostate-related issues in Thailand?

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Post the question here and specify where in Thailand you are located

[StraightTalk]

  On 12/5/2024 at 8:08 AM, Sheryl said:

Post the question here and specify where in Thailand you are located

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Could you please share your insights on how to identify a skilled and reliable surgeon for prostate-related issues in Pattaya?

I reside in Najomtien.

[Sheryl]

  On 12/5/2024 at 8:12 AM, StraightTalk said:

Could you please share your insights on how to identify a skilled and reliable surgeon for prostate-related issues in Pattaya?

I reside in Najomtien.

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I rely on decades of experience with the Thai health care system and reports of board members. Also, I look for doctors trained in the west, holding a faculty appointment at a leading medical school,  who have published on the subject in  peer reviewed journals. Active membership in relevabt medical society also a plus.

 

What type of prostate issue exactly? BPH or cancer or prostatitis or what?

 

Have you been told you specifically need surgery? BPH and prostatitis aree normally treated medically, at least at first.

 

Are you open to going to Bangkok? There is no comparison between quality available there vs Pattaya, the latter is a backwater as far as medical experts are concerned. (though if the problem is simple BPH doesn't matter that much, any urologist can treat that initially).

[StraightTalk]

  On 12/5/2024 at 8:21 AM, Sheryl said:

 

I rely on decades of experience with the Thai health care system and reports of board members. Also, I look for doctors trained in the west, holding a faculty appointment at a leading medical school,  who have published on the subject in  peer reviewed journals. Active membership in relevabt medical society also a plus.

 

What type of prostate issue exactly? BPH or cancer or prostatitis or what?

 

Have you been told you specifically need surgery? BPH and prostatitis aree normally treated medically, at least at first.

 

Are you open to going to Bangkok? There is no comparison between quality available there vs Pattaya, the latter is a backwater as far as medical experts are concerned. (though if the problem is simple BPH doesn't matter that much, any urologist can treat that initially).

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I have an enlarged prostate, and my urologist recommended an MRI, which thankfully confirmed there is no cancer. He prescribed DUODART, but I still find myself needing to use the bathroom 3-4 times a night. My annual checkup is approaching, and there’s a possibility the gland may not have shrunk enough. While I haven’t been advised to undergo surgery yet, my query is precautionary in case my urologist recommends gland removal or another procedure. I am open to seeking treatment in Bangkok or even Singapore if necessary.

[Bvor]

  On 12/5/2024 at 8:36 AM, StraightTalk said:

He prescribed DUODART, but I still find myself needing to use the bathroom 3-4 times a night.

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One size doesn't fit all so a  bit of try and see approach maybe required.

For my BPH I find that DUODART (OAP purchase in Oz) combined with unprescribed PENCOR 4 (purchased Pattaya Fascino) has increased my flow rate with 2-3 pees per night.

My last MRI scan did not indicate any prostate shrinkage after approx 4years on DURODART. Slight dizziness and lightheadedness are adverse affects I can tolerate with caution. (BP levels have been lowered but acceptable with my Oz GP)

I have had no urinary retention catheters for last 3 years . Previously and prior to addition of Pencor 4 I had 3 catheter episodes in Pattaya on different visits - he last one with a UTI that required 6 nights in Pattaya Memorial Hospital.

I have no cancer and have managed to avoid surgery thus far ..........and hopefully "full time"

Cheers and good luck.

[Lacessit]

My urologist in Australia has the qualifications FRCS, FRACS. That's as high up the medical tree as one can get. He's also one of the nicest people I have ever met, Malaysian Chinese.

 

Every time he performs a cystoscopy on me, "obstructive prostate" appears on the post-op report.

 

I have been on finasteride or dutasteride for about 8 years, for BPH. I pee about 2-3 times a night.

 

I asked him if having a TURP would be a preferred option. He said in his experience, 90% of TURP patients develop one or more complications. It did not matter what ablation procedure was used.

 

His advice was to stick with the medication for as long as possible, and regard surgery as a last resort. This is a surgeon who makes over a quarter of a million dollars a year from surgery.

 

My only annoying side effect of finasteride/dutasteride is a significant reduction in libido.

[Bvor]

  On 12/5/2024 at 9:52 AM, Lacessit said:

My only annoying side effect of finasteride/dutasteride is a significant reduction in libido.

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Yeah, same same. No probs when I'm in Oz but Patts can still necessitate that I take 1 or 2  tabs of 5mg Cialis from time to time. I purchase Cialis in Oz  on OAP concession as part of my BPH medication  prescribed by my GP.

Ahhh.........such is life!

[StraightTalk]

  On 12/5/2024 at 9:52 AM, Lacessit said:

His advice was to stick with the medication for as long as possible, and regard surgery as a last resort.

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I am 76 years old, and I share the same preference. However, if my doctor were to recommend surgical removal, I would opt for the least invasive method available, which, to the best of my knowledge, is the da Vinci robotic-assisted procedure. I’d like to be well-prepared and informed about the best surgical options and specialists, should that path become necessary.

That said, I have been leaning toward complete removal of the prostate gland rather than undergoing a gland-reducing procedure like TURP, Rezum, or Urolift. But I wasn’t aware that the da Vinci method is typically reserved for cancerous glands and cannot be used as a precautionary measure, similar to preventive surgeries (mastectomy) some women undergo to reduce the risk of breast cancer.

In any case, if my condition becomes critical, I will follow Sheryl’s advice and seek a second opinion, likely from a reputable urologist (yet to be determined) at one of the major hospitals in Bangkok.

[jcmj]

I had the Rezum last year in October. I had been struggling with UTI’s and unable to urinate at times. Was put on meds and that helped a little bit but would end up running in and out of bathroom all day and night. Sometimes I couldn’t even make it. As soon as I went to take a piss and sit back in my chair I had to go again. I ended up keeping a little jug next to my bed. Anyway it got so bad that I went and spoke with my doctor again and said that the meds weren’t helping and he did all the tests and asked me if I wanted to consider Rezum. He gave me the info and told me the pros and possible cons and how it all worked and would happen. 
I read the info, did my research on my doctor who would preform it and decided to go for it. It’s done rather quickly and you’re asleep so you don’t feel anything. I did have to have a catheter in for about 7 days. I think that varies from patient to patient but it was a success. The only side effect that I have is not being able to “squirt” after sex. Lucky I’m older and don’t plan on having any more kids anyway but I do get the sensation it’s just not visible. The doctor tried everything and this was the last option, but for me it’s so much better. No more running to the bathroom all day and night and I haven’t had an infection or been slopped up since. You just have to think about the quality of life you have and do what’s best for you. There are no promises with any surgery. Everyone reacts differently, but for me it was 100% worth it. Good luck. 

[jippytum]

I had the turps op in Pattaya main hospltial in march this year. 

All went well with the op but i reguired a bladder op four weeks later. 

Now no pain good flow but i still have to urinate at least three times every night. 

[Dr B]

I had misunderstood the OP, because the TURP was described to me as a procedure, and was done as an outpatient. I had had an enlarged prostate for a few years (85 ml) with increasing issues of getting caught short, especially when driving. Had a TURP with no unusual issues, just a bit of stinging and bleeding for a few days, but the TURP debris showed some signs of cancer. Carried on for a few years monitoring PSA, which rose from 2+ to just over 4. Was then recommended either surgical removal or radiotherapy, and opted for the latter. Had to have a minor procedure to remove a bit of scarring from the TURP, and also have ADT. The combination of the TURP and the ADT had reduced my prostate back to 25 ml! That meant that I could have the more intensive radiotherapy in 4 weeks not 8. All went well and the therapy was very easy, would have gone back for more! The after effects, stinginag and bleeding, including blood clots, started a few months later and went on for18 months. Now all over, no more stinging, no more blood, quite often do not even need to go once in the night, e.g. last night 6 am. PSA has been between 0.1 and 0.2 since the therapy in late 2019, in Australia. I have now found an excellent urologist at Krabi Hospital. Carried out a endoscopy, and sees me very 6 months. Just one medication which my Australian urologist confirmed was good.

Hope that helps.

[actonion]

I had the Rezum Op 2 years ago.. on the advice of  the Urologist  because i take Blood thinning Pills  & the Rezum causes little bleeding..

Reasons for the Op were  night time Urination  5 or 6 times  plus frequent UTI's, the frequent UTI's have disappered  & the night time Urination has reduced to 2 times a night  depending on if you have had a night out  drinking..

What i am left with is  an urge to Urinate  now & again, & slight Incontinence when coughing sneezing etc, the useless Urologist suggests Kegel Exercises,  which have'nt worked after 6 moths of trying.. I asked if i have Over Active Bladder,  I was told no, but i thought i would self Medicate on  Bladder control Medication 3 months ago,  just to see,  and  hey presto,  they work, so now no more Incontinence  & no more  Urges to Urinate, lets see what happens if  /when I  stop the Bladder Medication which is recommended to do after  3 months

[mauisteve]

I am early 60's and retired, having worked in healthcare my entire career.  I have been living with BPH for about 15 years.

 

When considering prostate treatment options it is important to know your prostate size.  This is generally obtained and calculated from a lower abdominal ultrasound.  Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume).  Smaller prostates are generally more easy to treat than larger prostates.  The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate.  Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe.  A large median lobe can complicate some surgical techniques.

 

Medications are the first line of therapy and are usually quite effective.  Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms.  I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow.   I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin.  In Thailand these are available as Xatral XL 10mg and Urief 4mg.  There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral.  Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy.  Alfuzosin is idealy taken about a half hour after finishing dinner.  Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction.  Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype.  The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation.  The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate.  During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra.  With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder.  For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin).  I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time.  I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective.  I'd also recommend silodosin to any patients trying to pass a kidney stone.

 

The other main class of prostate medications are the 5-alpha reductase inhibitors and these include finasteride and dutasteride.  These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT.  This class of medication is much less effective in patients with smaller prostate sizes.  The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer.   Sometimes these drugs are marketed as combination therapies with alpha-blockers.  The medication Duodart is a good example.  I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart.

 

When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate.  Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital.  The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies.

 

Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that.  This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization.  Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive.

 

Most men, myself included, care quite strongly about preserving normal ejaculatory function.  If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle.  Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys.  During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again.

 

If you don't care about ejaculatory function then don't waste time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life.

 

I'm not going to discuss techniques for complete removal of the prostate as I really only see that as necessary or appropriate for patients who have a prostate cancer diagnosis.

[ujayujay]

10 years ago I had an enlarged prostate operation in Europe that was not caused by cancer. This was urgently needed because the constant need to urinate caused my bladder to enlarge and urine to be forced into my kidneys. The operation went smoothly and luckily I have retained my virility. Since then I have had no more problems with my prostate...knock on wood!

[Peterphuket]

  On 12/4/2024 at 1:29 PM, RayC said:

 

I don't fit your criteria of 'all being well' but here's my experience.

 

I had lived with an enlarged prostate for +/-5 years and dithered about having an op for most of that time (Medication had no effect,). The decision to have a TURP operation was effectively made for me, as I woke up one day unable to pass urine. The idea of wearing a catheter long term didn't appeal.

 

I had the op. Unfortunately, it was discovered that I had mild haemophilia which fortunately was more of an annoyance than a problem although it did mean that I spent two nights in hospital.

 

Anyway, back home. Retrograde ejaculation is estimated to occur in 70% of TURP patients and I fell into that category. At first, I found it a bit disconcerting to see little evidence of my efforts😉 but both of us soon got use to it and, other than backfiring, the TURP has had no effect on the quality or quantity of our sex life. Of course, if you harbour ambitions to father (more) children then that is another matter.

 

The big positive for me has been the improvement in my quality of sleep. Prior to the op I was up 4 or 5 times every night to have a pee. Nowadays, it's normally once per night. Another immediate benefit of the op itself is that you will know with more certainty whether you have prostate cancer. Obviously that certainly fades with time but it offers some immediate reassurance. Fortunately, my result came back negative.

 

In summary: To state the blindingly obvious I would have preferred not to have needed the operation. However, in hindsight I slightly regret not having it sooner as my quality of sleep has improved greatly.

 

One word of advice: Once again, maybe stating the obvious. Choose your surgeon carefully. A good urologist might not necessarily be a good surgeon.

 

Good luck whatever you decide to do.

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It is nice to read your experiences.
Like many elderly people, I too have the same prostate problems and that means I have to get out on average 3 times a night to pee.
But what concerns me and I therefore wonder: do you drink alcohol? I drink 2 glasses a day, but I think it affects the number of times you have to get out of bed at night.