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Cannot have RP after TURP? - Surgery (prostatectomy / RP),TURP

User
Posted 06 Sep 2014 at 11:22

Does anyone have any knowledge about previous TransUrethral Resection of the Prostate (TURP) surgery making Radical Prostatectomy (RP) surgery difficult?

I have been diagnosed with a Gleason 7 (unknown grade arrangement) , Stage T2c, N0, Mx with a post TURP PSA of 2.01.

I was told, initially, that the treatment options would probably be RP or Radiotherapy.  Brachytherapy would probably not be suitable for me, I was also told.

After having an MRI scan + MRI Spectroscopy I have been recommended to have HT with RT.  I was told that RP surgery would be difficult because I have had a TURP operation. 

 

Would be interested to know if anyone heard of this before.

User
Posted 29 Sep 2014 at 09:34

Hi Martyn

Sorry, only just spotted your post. Have a look at my profile for more details, however..

I had a TURP at the end of 2009 because BPH was suspected. The histology of the residue showed a Gleeson 4+3 so the rocky road started. The specialist I was referred to (one with loads of experience of LRPs) did warn that the prostate removal would be a bit more difficult but that certainly it was not prevented by the TURP. The main issue seems to be the damage done to the neck of the bladder by the TURP, making the later join to the urethra more complex. My LRP was about four months after the TURP, possibly a bit too soon but I was in a blind panic at the time and just wanted to get rid of the thing. As you can see from my profile, I have had a lousy time with incontinence, but this is not necessarily a reflection on the two operations. There are several papers available on the Internet dealing with the combination of the two operations, and the conclusion seems to be that there are additional risks with side effects (eg incontinence) but in the hands of an experienced surgeon, statistics are clearly on the patient's side. Unfortunately due to a big computer crash (yes, it still happens to ex-IT professionals) I have lost the references to the papers. I'll try to find them again.

Looking back, even with the side effects, I am sure I made the correct decision.

Hope this helps. When I find the papers, I'll post the links here.

Tony

TURP then LRP in 2009/2010. Lots of leakage but PSA < 0.1 AMS-800 Artificial Sphincter activated 2015.

User
Posted 30 Sep 2014 at 20:07
Thanks Tony,

Sorry for the slow reply.

I was coming to the same conclusion as you i.e. connecting the bladder neck to the urethra after prostate removal was the potential issue.

I also had a Bladder Neck Incision (BNI) in January 2013 before the TURP in April 2014, which probably contributed to the problem.  

My MRI results showed quite a lot of fibrous tissue in my prostate / bladder neck - I gather.  It was then I was told that an open RP would be difficult due to the previous TURP / fibrous tissue (could not have an LRP due to it would be more difficult). 

Also a further complication is that I have a floppy bladder and have to use an intermittent catheter twice a day which I gather could cause complications after an RP.

 

I asked various specialist nurses and couldn't find anyone who had heard of TURP causing a potential issue for RP.  So that is why I asked the question.

 

I have now found some papers and a book - outlining the issues but with mainly positive conclusions.  I've listed them below in case they are of any interest to anyone else.

 

However, as my surgeon / registrar is not comfortable with RP for me - I decided to go their recommended route of HT and IMRT, they say the intention being to cure it.

 

Many thanks and I hope you get some resolution of your symptoms.

Martyn

 

Some references I found (first three you can only read abstract / conclusion - the last two are good general references I think):

 

 

 

 

European Association of Urology Guidelines on Prostate Cancer.  Page 44 states "Radical prostatectomy may be very difficult after a thorough TURP, when almost no residual prostate is left behind."

 

Reoperative Pelvic Surgery By Richard P. Billingham, Kathleen C. Kobashi, William A. Peters. Page 81 goes through issues and fibrosis is mentioned - viewed on Google books.

 
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