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TRUPS/REZUM What does it improve?

User
Posted 22 Oct 2021 at 21:18

I'm a 67 year old guy living with BPH. This has gradually gone from mild irregular symptoms about 10 years ago, to now being on Alfuzosin or Tamsulosin daily to help control excessive urination at night and urgency problems. I have had the customary investigations and test at hospital, after which the Consultant gave me two options, first was the standard NHS offering of a TRUPS with the Consultant explaining all the associated risks, and a ‘Private Patient’ option of ‘REZUM’ steam treatment for a less risky or more gentle outcome than TRUPS. I decided (the monetary cost wasn’t an issue, just that I just wasn’t ready ‘mentally’ at the time, to endure the surgical discomfort of either procedure, with tubes stuck up me post surgery) to continue with the passive treatment with medication until I had little choice but to do something!

Can some please give me a "Heads-Up" on what TRUPS does improve regarding symptoms...Now as I understand it should improve your urinary flow right, but does TRUPS also improve the frequency for night time urination? I question this as the size of the prostate is not greatly reduce by the procedure as I understand, and so the pressure/irritation of the prostate on the bladder will still be present, although you will be able to empty the bladder more fully, am I right in saying that you may still urinate more frequently that normal?  Regarding REZUM, can someone who has had this done, please tell me what to expect benefit wise and for how long?

 

 

User
Posted 22 Oct 2021 at 22:30
I think you are referring to a TURP? Basically, it works like an apple corer - takes a central tube of prostate away, leaving the urethra clear and reducing the risk of urinary retention. Quite a few members here have had TURP over the years without any apparent problems later. One of the advantages is that they have a good look at the removed prostate tissue and check for prostate cancer at the same time. I can't think of anyone on here that has had REZUM therapy but there may be someone who just hasn't posted about it.

I do wonder though whether you have tried bladder training before you resort to surgery? To be done correctly, you need to see an incontinence specialist (usually a specialist community nurse or incontinence clinic) to retrain your brain. Night time frequency which is worse than during the day is often about a habit and poor sleep quality rather than a physical symptom

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Oct 2021 at 01:42
My friend aged 70, had urinary retention problems because of an enlarged prostate, and he underwent a ‘Green Laser’ transurethral resection of his prostate (TURP), which involved just one overnight stay in hospital.

In his own words, he is ‘pissing like a horse’ now, and couldn’t be more pleased with the outcome.

Best of luck.

Cheers, John.

User
Posted 23 Oct 2021 at 12:10

Yes I do understand what TURP's is. I’m surprised you say: "Night time frequency which is worse than during the day is often about a habit and poor sleep quality rather than a physical symptom". Yes my sleep pattern has changed since I Retired. However, “getting up in the night” is a classic symptom of an enlarged prostate correct? Bladder training therefore will provide a limited improvement I would suggest. My Consultant’s word’s after cystoscopy examination (which was dam painful even though he used an anesthetic gel) were, and I quote, “that’s a big old prostate you have” so the cause of my symptoms is BPH.  :-D

User
Posted 23 Oct 2021 at 12:18

Hi John,

What I’m trying to get to the bottom of is: Does having your prostate “cored-out” by whatever method, drastically improve the need to urinate so often, or does one still have to take medication to subdue the still sizeable prostate 'irritating the bladder' so to speak?

User
Posted 23 Oct 2021 at 13:12

I have never heard the phrase 'prostate irritating the bladder'. The problem with a large prostate is that it can squeeze the urethra which passes right through the centre and hence reduce flow. So a TURP will open up that tube so when you do piss you should be able to fully empty your bladder.

Now for most people a bladder feels full at about 250ml. So as long as your kidneys don't produce more than 250ml of urine overnight you should get a good night's sleep.

In a young person the kidneys are less active at night, sadly in older people the kidneys carry on working through the night so that makes needing to go to the toilet during the night more common.

Also some people get in to the habit of taking a piss at every opportunity, which sounds sensible if you are having problems pissing. However this means the bladder only ever gets half full, and then the signals that you need a piss happen when you have 100ml in your bladder, rather than when it is full. This problem can be overcome with entraining your bladder as Lyn says.

I think it may be worth measuring how many ml you pee each time to see if you are getting full use out of your bladder.

Dave

User
Posted 23 Oct 2021 at 13:55

Dave,

My flow-rate is not ideal :-(  (Alfuzosin or Tamsulosin help with this, & the feeling of needing to pee shortly after peeing). However, after urination I have on occasion still feel the need to pee, the sensation to urinate will not subside. Now I understood as the prostate expands in size in may well constrict the urethra yes, I get that okay..but the prostate also starts to encroach/push into the Bladder Wall which I thought was partly, I’m not saying wholly, responsible for this feeling the need to pee, when you cannot get anymore out (yes I’ve tried double voiding etc.. and it’s kinda normal (pre BPH) for me to have a residual of approximate 100ml ish left behind). Now as I understand, or do I? Tamsulosin for example, relaxes the bladder smooth-muscle and helps with this right?

User
Posted 23 Oct 2021 at 13:57

So getting back to my Question..does TURP's help with this...

User
Posted 23 Oct 2021 at 17:24

Originally Posted by: Online Community Member

Yes I do understand what TURP's is. I’m surprised you say: "Night time frequency which is worse than during the day is often about a habit and poor sleep quality rather than a physical symptom". Yes my sleep pattern has changed since I Retired. However, “getting up in the night” is a classic symptom of an enlarged prostate correct? Bladder training therefore will provide a limited improvement I would suggest. My Consultant’s word’s after cystoscopy examination (which was dam painful even though he used an anesthetic gel) were, and I quote, “that’s a big old prostate you have” so the cause of my symptoms is BPH.  :-D

Yes, frequent toilet visits are a symptom of BPH but you would normally have urinary difficulties day and night. As I said, if you only have problems at night, bladder training could be tried before surgery. If you have problems day and night, TURP should make a major improvement. 

Edited by member 23 Oct 2021 at 23:16  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 31 Oct 2021 at 18:16

In your Profile you mention👉 "So 3 men in my life with PCa," ....can you clarify what the abbreviation is please👍 

User
Posted 31 Oct 2021 at 20:33
Prostate cancer
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 01 Nov 2021 at 14:59

I've been monitoring this Dave over the past week, and I’m beginning to think this night-time peeing may well be partly associated with not sleeping so well as I use to. Although BPH I guess is a condition which aggravates this, I certainly don’t want to Rush into a surgical optional at this stage.

 

I can pee a total of over 500ml in a night, bearing in mind I have always be unable to completely drain my bladder to empty, leaving approximate 100ml more or less behind. Does that help you?

Edited by member 01 Nov 2021 at 15:04  | Reason: Not specified

User
Posted 01 Nov 2021 at 22:37

The average bladder feels very full at 500ml, at 250ml it feels like it wants to pee. I presume it can stretch as my bladder had 950ml in after I had urinary retention which lead to my cancer diagnosis.

How do you know you retain 100ml?

Following thread has my comments on self catheterisation. I think this could help you and at the very least would establish if a fully emptied bladder can result in a good nights sleep.

Cutting down drinking in the evening, possibly seeing GP about tablets to increase anti diuretic hormone at night, and trying self catheterisation, all seem a good place to start.

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

 

Edited by member 01 Nov 2021 at 23:06  | Reason: Not specified

Dave

User
Posted 02 Nov 2021 at 08:32

There are many reasons for frequent peeing at night...

1. Outflow obstruction - a narrowing of the urethra causing you to pee slowly, such as a stricture or BPH or PCa. Peeing too slowly causes Incomplete Voiding - you finish peeing before emptying your bladder (you pee for a set length of time, not until your bladder is empty). If you go back to bed with a half-full bladder, it fills up again sooner and you'll need another pee. In the case of BPH, alpha-blocker drugs such as Tamsulosin or Alfuzosin can help by relaxing the smooth muscle of the internal sphincter and prostate, increasing flow rate around 20%, but with increasing BPH, there comes a point where drugs alone can't do enough and surgery such as a TURP is required. (Alpha blockers won't help much in the case of strictures or narrowing by PCa.) Double voiding (waiting after first pee, and peeing again) can also help in early stages providing you aren't close to going into retention (unable to pee).

2. Unstable Bladder (Bladder Spasms). The bladder is a thick muscle lined bag. The pressure in the bladder is normally low, but when you pee, the sphincter muscle around the bladder neck relaxes and the rest of the bladder muscle contracts to generate bladder pressure and force the urine out. Unstable bladder is when the bladder muscle contracts before the bladder is full, generating a sense of urgency. This can happen if there is something in the bladder which causes bladder irritation. Different things irritate different peoples' bladders, but typical ones are caffeine, alcohol, fizzy drinks, acidic drinks, concentrated urine (dehydration).

3. Unstable Bladder can also be caused by outflow obstruction, where peeing rate is too slow and bladder isn't being emptied.

4. Unstable Bladder can also be caused by inappropriate bladder training. People who have any lower urinary tract symptoms (incontinence, urgency, etc) often get into the habit of using the toilet whenever they get the opportunity. This trains the bladder to expect to not to fill up, so it starts generating bladder spasms when only partially full. Bladder retraining (learning how to retrain your bladder to fill up) can help with this. You can't do bladder retraining during the night (it would stop you sleeping), but bladder retraining you do during the day will improve night time too. Drugs like Solifenacin can help sometimes, but may also result in incomplete voiding.

5. Enlarged prostate, BPH or PCa - a large prostate will generate a significant dent in the bottom of the bladder. This has two effects, it reduces bladder capacity so it will fill up sooner, and it also stretches the base of the bladder, the area called the Trigone where the stretch receptors are which generate the sense of a full bladder, so you may get a sense you need to pee before the bladder is really full.

6. Drinking a lot in the hours before going to bed.

7. Odema. Fluid collected in the lower limbs during the day will typically drain back when you lay down, resulting in excessive water entering the blood stream at night and needing to be excreted.

8. Taking diuretic tablets too late in the day. This will cause your kidneys to still be excreting excess water overnight.

9. Anti-diuretic hormone not working. We release anti-diuretic hormone overnight to restrict the amount of water the kidneys excrete, so we can get a night's sleep without interruption to pee. As we get older, this mechanism can stop working so well. It is possible to be prescribed anti-diuretic hormone to take at bed time, but this comes with risks of high blood pressure and strokes overnight, and a requirement to manage your evening fluid intake very carefully, so it's not often used.

10. Bladder muscle not working. As mentioned earlier, to pee you need to both relax your internal urinary sphincter and to contract the rest of your bladder muscle. If the bladder muscle doesn't contract, you'll pee too slowly to empty your bladder before you stop peeing (another cause of Incomplete Voiding). Bladders usually hold around 500ml, but they are stretchy and can go over a litre. The bladder muscle will no longer work past about 1 litre, and can't force the urine out. If you routinely stretch your bladder, the muscle becomes permanently damaged and won't work even at normal capacities anymore. This can happen with long distance lorry drivers, and some people with phobias about using public or other peoples' toilets which causes them to wait a long time before peeing. It can also happen due to nerve damage.

That's probably not a complete list, but it's off the top of my head at the moment, with the more common causes first.

As you can see, there are a large number of causes and they have different solutions, so it is necessary to identify exactly why you are peeing frequently at night in order to come up with the right fix. A GP might just try things like Tamsulosin and/or Solifenacin to see if they work, but a urology department might do a proper urodynamics test to much better understand the cause, and ideally this would be done before considering any surgical procedure to tackle the problem.

Edited by member 02 Nov 2021 at 08:43  | Reason: Not specified

User
Posted 02 Nov 2021 at 10:51

Well, over ten years ago (I'm 67 now) I wanted a 'PSA' test/check done, as a routine check,  my GP told me, "I cannot have it done as this is only performed when a patient presents with symptoms suggesting a Prostate issue". So I told him... well, I do pee a lot at sometimes and I am concerned! Soooo he sent me to Southend General Hospital to see a Urologist and Endoscopy & Ultrasound Scan of my Bladder AFTER Urinating.  The Nurse said "you don't completely empty your Bladder Mr. Read", I replied that "what else can I do???  it feels there's NO MORE to come-out, I can't just stand around for 15mins trying to get the very last bit out now can I!  So, that was that, and I took the Tamsulosin given to me from time to time. Now, coming to present day, and having another investigation,  I was told the same thing by a Nurse "you don't completely empty your Bladder there's approx 100mls left", well, I know all about that! The Urologist then later confirmed I had a "big old prostate" and offered me TURP's or REZUM if I pay him. 

 

Dave, I do have a problem now, I do not have the "Control" I used to, and if I "got to go" I cannot Hang-On like I used to, as I risk peeing myself...During the day I'm okay mostly as I watch my fluid intake etc, as I am partial to cups of tea.

User
Posted 06 Nov 2021 at 13:36

Terry, you should be doing pelvic floor exercises if you aren't already. They will give you the stamina to hold on.

I would normally also suggest bladder retraining, but as you might already be overfilling your bladder, that's perhaps not safe unless you are advised to do so by a urologist after a urodynamics test.

Limiting fluid intake is something men with lower urinary track symptoms often do, but it can backfire. Concentrated urine is a bladder irritant, which can cause bladder spasms and urgency. Urine should ideally be a light straw colour, and not bright yellow.

User
Posted 06 Nov 2021 at 17:50

I do sincerely thank everyone for their help. But, where does this leave me “decision wise” on what to do? Please bear in mind that NONE of the suggestions on here, were discussed or mention during ANY consultation with my Hospital Consultant, or General Practitioner. So now what do I? Go back to my GP and say “I’ve been on the internet and ‘PC UK’ web-page and have been told: This, that, and the other in a forum context, my doctor may well be irritated by all this to say the least.  Going by past experience telling a GP “I’ve read on the internet that.... just “gets their back up”.

 

For example, I mention to my Consultant that on infrequent occasions, I found taking an Ibuprofen tablet helps with my bladder frequency, if say I am going around Town taking coffee or drinks while out (apparently the bladder’s control mechanism involves releasing prostaglandins when voiding is required, and Ibuprofen dampens that somewhat). The Consultant’s brisk retort was: “You could damage your kidneys”. My god! What on earth do people do when plagued with chronic back pain? Usually take pain killers over and over fully prescribe by their Doctor. My use of the word “infrequent” seemed to have been overlook completely.

User
Posted 06 Nov 2021 at 19:03
You could just ask him at the next consultation whether he thinks that a non-surgical option such as bladder retraining might be worth a go before resorting to surgery, or to explain to you again why he believes surgery is the best option.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Nov 2021 at 20:29
I always find it helpful to write down a list of questions before a consultation. It's easy to forget to ask important stuff.

Best wishes,

Chris

User
Posted 06 Nov 2021 at 21:17

Yes I'll revisit this with the GP at some point soon 👍

User
Posted 06 Nov 2021 at 21:46

Not sure the GP is the right person to discuss with; in the collective experience of this forum, GPS tend to know very little about the prostate. Do you not have a follow up appointment with the urologist planned?

Just going back to your first post and your query about how TURP can help if the prostate is still large. Urinary hesitancy / retention is not usually because the prostate is pressing on the bladder; it is because the prostate is squeezing the urethra. TURP removes a core of flesh around the urethra, allowing you to empty correctly.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Nov 2021 at 22:56

After I had the original investigation I asked the Consultant could I belay the Surgical choice TURPs or REZUM (private patient) for 6 months to see if my symptoms worsen. COVID got in the way a bit, but I was recalled and had another flow test done, and then a telephone consultation, at which I said I have decided to continue with the passive treatment. However, I went on to explain: "When I can no longer cope and/or live with this condition, I shall request some form or surgical intervention". I also ask him to fully inform my GP of this in his report. As I said in my first ‘post’, "I decided that I just wasn’t ready ‘mentally’ at the time, to endure the surgical discomfort of either procedure, with tubes stuck up me, in me, and through me, post surgery", and of course the risk of lost of sexual function should TURP ever be fronted as the best option.

 So currently no further appointments with the Urologist have been made. I do intend as a matter of routine, see my GP and ask for PSA test to monitor for any changes.

User
Posted 07 Nov 2021 at 12:28

As has been mentioned, there are various reasons for urgency and frequency. Over 20 years ago and long before I had a PCa diagnosis, I had this double problem . I had a camera inspection of my bladder via my penis in hospital and was diagnosed with a weak sphincter and was prescribed Tamsulosin which I take to this day. I was also referred to an incontinence clinic where I was instructed about bladder retraining, advised about mainly beverages that irritate the bladder and to take cranberry juice. These measures did reduce my problem so that I only had to get up once a night. However this problem did become a little worse and much so during my RT. I mentioned this to the RT consultant at the time and she said that scans showed I had an Acquired Diverticulum which is a pouch or sac that protrudes out of the bladder wall. This means that when I pee, some of the urine is not expelled. So within a short space of time I needed to pee again (double void). Additionally, I avoid drinking anything 3 or so hours before goingto bed but ensure I drink plenty. Although it may seem counter intuitive  you still need to drink plenty so urine does not become extra strong.

A Congenital Diverticulum, where found in early childhood it is more likely to be dealt with surgically than Acquired Diverticulum in later years like mine, so I haven't pursued this, particularly as in my case it has not led to infections, something that is more likely with this condition, and I have managed to keep to single session each night.

 

 

Edited by member 07 Nov 2021 at 15:33  | Reason: spelling

Barry
User
Posted 13 Jan 2022 at 09:51
i would look google BAUS and look at the patient information leaflets regarding these procedures . these are evidence based and clear

Carpe Diem 

 
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