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Worried about TURP

User
Posted 01 Feb 2021 at 16:44

I am 77, and reasonably fit. I have had an enlarged prostate for many years, and when last measured (November 2019) it was about 140ml and described as huge. I experienced my first episode of significant bleeding from the prostate in 2011, and have had a couple of episodes since then, the last precipitated by an inexperienced GP who carried out a less than gentle rectal examination.

After several years of treatment with dutasteride, I experienced painful breast enlargement, and treatment was stopped. I cannot take alpha blockers as they precipitate sudden fainting episodes, so I resorted to Saw Palmetto, which eased my symptoms considerably, reducing nightime loo trips to 2 or 3 rather than 5 or more.

In November 2019 a routine MRI scan, while showing no evidence of prostate cancer, threw up a coincidental finding of a large aortic aneurysm sitting just above the heart. After Covid delays I had surgery to repair the aorta and this was very successful, and I have recovered well.  However, routine follow up blood tests showed very high CRP (c reactive protein) levels and my GP was concerned that I might have an infection that could seriously damage the heart and I was sent to hospital for urgent tests to check this out. Despite being fit and mobile, I was given a subcutaneous heparin anticoagulant, a treatment normally only given to immobile, bed-bound patients at high risk of developing blood clots.  Within a few hours my enlarged prostate symptoms worsened to the point that I was in constant pain, and passing urine became increasingly difficult. I subsequently confronted the consultant who flatly refused to accept that the anticoagulant had caused the problem, so I discharged myself in disgust, believing that my symptoms would return to normal once the anticoagulant had been flushed out of my system.  This was a vain hope, as my urine flow stopped completely and my wife had to rush me to A&E in the small hours to have a catheter fitted.

In the following weeks all the necessary scans and tests were carried out and no evidence of any infection was found, and the conclusion was reached that the high CRP levels were being caused by my very enlarged prostate.

After having the catheter in place for a month I persuaded my GP that we should see if my prostate and bladder were sufficiently rested to allow it to be removed.  All seemed to be well for several hours, but urinary retention returned and another dash to A&E in the middle of the night was required to have the catheter replaced. 

I have recently spoken to a private urology consultant, who recommended  "Bipolar TURP + Insertion of Superpubic Catheter" and did his best to explain what that would involve.  In view of propensity of my prostate to bleed at the slightest provocation, I am worried that the bipolar TURP will trigger heavy loss of blood.  Am I worrying too much about this?  Can anyone comment on alternative procedures that might allow me to return to a catheter free life?

User
Posted 01 Feb 2021 at 17:43

Hi Neal,

Clean Intermittent Self Catheterisation. I made a post about it in this thread:  

https://community.prostatecanceruk.org/posts/t22995-Escaping-the-Catheter#post230873

I can't guarantee it is right for you, but if you can do this it will certainly save trips to A&E . If you only suffer from retention occasionally then, yes you might be able to pee normally and then resort to CISC only when needed. Of course shoving a tube past your prostate moderately frequently may be a problem if it has the propensity yo bleed. 

Dave

User
Posted 01 Feb 2021 at 19:01

Hi Dave,

Thanks very much for your reply. I was not aware of the precise procedure you have used, but self-catheterisation has been mentioned. My consultant seems to be of the opinion that given the state of my prostate (I have a very prominent median lobe) urinary retention was an issue waiting to happen, and the anticoagulant had tipped things over. My understanding is that the median lobe readily flops over and blocks the plumbing, so some sort of surgery is probably the only way to ensure a catheter free life.

I have also found there is an upside to having a long-term catheter - I can sleep right through the night and haven’t slept so restfully in years.  My district nurse (I will add my voice in praise of district nurses) told me about flip flow valves. For those who don't know a flip flow valve fits directly onto the end of the catheter and during the day it allows you to fill up your bladder to whatever level is comfortable. When you go to the loo you just open the tap to pee. It helps to keep your bladder muscles working in anticipation of being catheter free. At night you pug a night bag into the outlet pipe on the tap and it fills up while you are sleeping.

Does anyone have experience of the newer techniques such as laser surgery?

User
Posted 01 Feb 2021 at 19:50

Neal 

No experience of the TURP procedure, on paper the bipolar TURP looks the right way forward in your situation.

I have had an SPC for almost four years and now have it for life. Although it has issues, I found it more comfortable than a Urethral Catheter. For the best of both worlds you can have a leg bag attached to the flipflo during the day and then attach the night bag to the leg bag at night. If you go down the SPC route you can get a urilock for  Bard flipflo valves, saves getting wet.

Hope you get sorted.

Thanks Chris

 

User
Posted 01 Feb 2021 at 20:09

Yes, the full nights sleep is excellent. Going to the pub and drinking a lot of beer and only having to go to the toilet a couple of times. Going for a walk and opening the drain valve where ever you like (well obviously not on someones carpet) are all advantages of a catheter. 

Dave

 
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