Background: I am male, 57. Good health. Historic of urgency events bringing to consult. Regular ultrasound have shown a constant increase of the post void residual (PVR) from an already high base line (200ml) to huge levels (600-900ml) in about 6 years as measured by ultrasound and as physically removed. Last Dec 2012 I did a cystoscopy + urodynamic tests showing partial obstruction by my prostate which had normal size (about 32ml).
Final decision was to undertake a (bipolar) TURP to correct the PVR and avoid worsening. Status as per today:
• TURP (bipolar) done 19 days ago
• Main reason: huge PVR and potential complications. No apparent effect on the PVR or large doses of tamsulosin (2x0.4mg) and prostate too small for finasteride/dutasteride.
• Surgery went very well. Surgeon very well experimented and cautious (2000+ interventions)
• So far one complication: had to be re-catheterized the very same day they removed the 3 ways surgery cath as I could not urinate at all.
• 19 days after, I am drinking a lot (2-3l fluids), taking normal dose of tamsulosin in the evening (0.4mg) (will soon try to stop this under medical recommendation) plus distigmine bromide (5mg) in the morning (1 every 2 days after the first week) for the hypotonic bladder.
• Can empty 350-450ml typically at night (but going 3-4 times!) but also during day, this looks good. Had peaks at 500ml and even 600ml. Frequency is high as going about every hour.
• Regarding stream I am waiting to see the TURP effect after doc agreed to stop the tamsulosin but does not look bad.
• I am scheduled to test PVR in two weeks time to test PVR.
- After every time I pass a stool (was constipated a couple of days after the first week from surgery) or I stay seated or walk in the house I have very reddish blood at the start of urination. This completely disappears when I urinate after being in bed during the day and of course during the night. Is it normal? How much time I need to wait for this to goes away? I read in other boards this is going to last long, possibly 6-8 weeks, with full recovery after only 3-4 months.
- What about the frequency? Going every 1-2 hr seems too high.
- What else could be expected and eventually preventable? I have read about retrograde ejaculation, risk of stricture. Diet? Did you take supplements? Please share experience.
Lessons learned (so far):
• Research, look for experienced surgeon and ask opinions before deciding on the procedure.
• Try to relax if you are anxious (easier said than done, I was given an anxiolitic after removal of the surgery cath).
• Stay close to an ER for say the first couple of weeks if you need by any chance a new cath. This helps also with anxiety.
• Have at hand a laxative if you got constipated. Plums worked great for me but had to take a glycerin suppository one day I was completely blocked.
• Of course drink a lot (water).
• Have a perfect diet and watch supplements in case you take them; avoid herbs and blood thinning substances for while.
• Keep constant talk with doctor.
• Place yourself in the mind set of taking it very easy and give time to body to self heal.
-Though not perfectly normal it is expected after a TURP procedure secondary to associated mild trauma and is expected to get better in a few weeks. Review by a doctor would only be required if the bleeding is severe, has other associated symptoms or continues beyond 6-8 weeks.
- The frequency is expected to be high following the procedure due to a few reasons such as associated inflammation, increased fluid intake, anxiety etc, this is likely to settle with time.
-Other possible complications of TURP include retrograde ejaculation, incontinence, infections, inflammations, clot colic, stenosis etc. Since you are 19 days post the risk period, the latter ones are less likely.
Hope this is helpful.
I was reading stenosis or urethral stricture might be a late (12-24 months?) longer term risk. Actually that was a concern I tried to address prior to the intervention, when discussing the various methods. In particular I recollect reading a lower risk of stenosis would have been mitigated by a suprapubic cath (not done, opted for TU), a thin resection sheat, limiting the time of the TU cath (done) and the use of prophylactic antibiotics (done).
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