12/5/05
Updated 1/17/08
I write this because so often doctors don't tell you everything about what is going to happen after your surgery. Maybe it is because if you knew all the details, you probably would chicken out of having a necessary operation. Remember, your results may be much different from mine and only your doctor can give you official advice. However, as my mother used to say, Peter, you are unique and special, just like everyone else. So maybe my story would give you some idea of what laser TURP is like.
General background
A brief medical lesson, just so we're all on the same page: For a man, urine passes through the urethra on a journey from the bladder through the prostate gland and out the penis. The prostate is positioned like a donut around the urethra. Its job is to make fluid that accompanies semen when men ejaculate. When we are young, the prostate is about the size of a walnut. For half of us men, somewhere in our 50s, the prostate enlarges and pinches the urethra, slowing our urine flow. This is called Benign Prostate Hyperplasia, or BPH (as opposed to prostate cancer, which is much more serious). One would think removing the prostate would be the perfect solution to the problem, but it is difficult to separate the prostate from the nerves that control urination (countenance) and sexual function. If your surgeon accidentally snipped one of those nerves, you would be wearing a diaper (and a frown) for the rest of your days. There are some drugs that relax the pinching on the urethra to improve urine flow, buying you some time before you resort to surgery. A common surgical solution is the TransUrethral Resection of the Prostate, or TURP. Here, the surgeon hollows out the prostate, making it smaller, and leaving a bigger passageway for urine flow.
My background
I was diagnosed with BPH at age 55 and took Flomax for five years to help relax my urethra and increase urine flow. Eventually, my prostate reached the size of a lemon, where Flomax was becoming ineffective. Also, I was weary of getting up to tinkle 2-3 times a night and of watching my beard grow while I waited to finish. Of the numerous surgeries available, I selected PVP Greenlight Laser surgery, where they blast a laser at the inside of the prostate and vaporize most of the interior, like removing the flesh from the inside of a lemon, leaving just the skin. I selected laser surgery because I heard there was less bleeding and recovery was quicker than with other TURP methods. Besides, for a while my prostate would be able to receive broadband internet and 304 TV channels.
Preparation for surgery
My surgeon wanted to check to make sure I had no cysts in the urethra or bladder. Using an optical device with a probe the size of a long pencil, the doctor was able to take a look inside me. He said the scope had local anesthetic on it and it would sting slightly as he inserted it into my penis. I must be a big sissy, or don't understand the words "sting slightly". When the doctor finished, I suggested we swap places so I could ram the Mount Palomar Telescope up his penis for a looksee! At least the ordeal lasted only about a minute. My penis, expressly designed for one-way traffic, was sore for about two days and bled slightly. The surgeon also did a rectal exam, and an ultrasound of my prostate to determine its size. I used to hate those exams, but compared to the Mount Palomar Telescope, they were almost pleasant. I was also scheduled for a general physical to ensure that I had no hidden conditions that would surprise us all during surgery.
Day of surgery
Having fasted about 10 hours, I entered the hospital for same-day surgery. They suggested I wear loose clothes. I changed into one of those cute gowns that is open from top to bottom. (Hint: the open part goes in the back. Another hint: Use the toilet one more time before they tie you up with pouches and tubes. Also, savor the last "normal" potty visit you will have for a long time.) They had me don these stylish tight socks to protect my legs from blood clots during surgery, and began a saline drip to keep me hydrated during the procedure. As they wheeled me into surgery I started to feel like my pets do when I take them to the vet. The anesthesiologist suggested I be put to sleep for the procedure, a decision I thought was a no-brainer. I still remembered the Mount Palomar telescope, and didn't want to revisit it awake. They wheeled me into the operating room and transferred me to the table. Somebody double-checked my name and why I was there, which reassured me that I wouldn't awaken with an appendectomy or amputation. As I felt the sedative course up my arm, I commented "Gee, I can feel that going... up....my......"
When I woke up in the recovery room I had no sense that time had passed. For five minutes I played a little game trying to focus my eyes on the ceiling tiles. I felt a sore throat, most likely from the air hose they used to keep me breathing while sedated. I soon became aware that I had a catheter emanating from a very sensitive place. After a while, they wheeled me back to the room where I originated, to continue waking up for about an hour. There, I received lessons on how to change my urine bag, and how to remove the catheter the next day.
It is a weird and unpleasant sensation to have a hose coming out of you. You feel every little tug on the sensitive end of your penis, so you move very slowly trying not to wiggle it. I started counting the hours to when I would be able to remove this ungainly contraption. The loose clothing they recommended came in handy as I fished the tubing down a pants leg to a "leg bag" which was strapped to my thigh. My wife drove me home, finding every pothole along the way. We banished the cats to the outdoors, lest they hop onto my lap and give us all the surprise of a lifetime.
At home, we switched to a bigger bag so it wouldn't have to be emptied as often. I was to drink a glass of water every hour and the bag filled with blush chablis. Over the next 24 hours, the blush changed to regular chablis. (Hint: Keep the bag lower than your bladder. Hanging it on the bathroom doorknob so you can drain it can force the juice back into you, a very unsavory feeling indeed. Another hint: The doctor may prescribe antibiotics to avoid infection. I found taking some over-the-counter acidophilus an hour after my antibiotic helped avoid stomach distress.)
Removing the catheter
Some people have to endure their catheters for a couple days. (Hint: A little Neosporin around where the tube leaves the penis may help keep the skin from getting crusty). One friend had to have his catheter removed when it got plugged with a blood clot, then had another reinserted. When that one plugged, the doctor inserted a bigger one, then a bigger one, until on his 5th catheter, the clots would pass out. If that had been me, I'd have passed out. After 24 l-o-n-g hours, it was time to kiss that bloody thing goodbye (not literally).
The catheter is typically two tubes, one to drain you, and the other the surgeon inflates, creating a tiny water-filled balloon inside your bladder to keep the first one from slipping out. Your job is to first deflate this anchor balloon, then pull out the hose. (Hint: Do this in the bathtub so the mess of bloody urine, etc. is easy to clean up. Bring a plastic bag with you so you have a place to dump the debris).
Did I mention being a sissy? As much as I wanted this entanglement gone, I dreaded the ordeal or removing it. With scissors, I slowly cut the balloon tube and promptly squirted myself in the face as the balloon deflated. I kept telling myself it's only water, but it was warm and was coming from a place that usually disgorges waste products only. I disconnected the bag, and being preoccupied with other parts of my anatomy, forgot to pinch off the little valve that keeps it from draining, so my feet got a golden shower. Glad I was in the tub.
Next, I slowly pulled on the hose. Ouch, ouch, ouch, ouch. I felt things sliding inside me as if I were disemboweling myself. Someone had suggested that I twist the hose as I pulled. Every part of me twisted. I don't think it helped. One inch, two inches, then three. I wondered if my surgeon as a practical joke had coiled 3 feet of the stuff up there. After about 10 inches, the end appeared. I breathed for the first time in two minutes. I thought after this it might feel good to soak my face in boiling acid for a while. Ah, freedom. And a shower.
The first tinkle
They told me to drink plenty of water, which eventually had to come out. After a couple hours I was ready to try out my new waterworks. My poor willie was still sore from having a firehose stuck up there, which made me hesitant to open the floodgates. It was a classical psychology approach-avoidance syndrome. I had to pee real bad, but every drop hurt. Six drops is all I could do. An hour later I squeezed off 10 more drops. I called the surgeon to ask if I should stop drinking water lest I burst. He said keep drinking, take a hot bath to relax, take my old Flomax, and try some Celebrex to reduce inflamation.
An hour later I released 5cc of brown urine. Next hour 10cc. Extremely fearful that I might have to revisit the Mount Palomar Telescope or become reacquainted with the catheter, I made tinkling an every-ten-minute endeavor. I imagined waterfalls, stared out the window, and thought of rocket liftoffs. Every squirt was tentative and painful, all the way down and out the end. The surgeon called to check on me and allowed me to cut back on the drinking a bit. (Hints: Avoid coffee, citrus juices, and alcohol, according to the post-operative instructions. Vinegar and spicy foods are also verboten. Cranberry juice, popular for protecting already healthy bladders, may also inflame the problem.) My surgeon said that most of his patients get immediate relief after surgery, but a third experience my difficulty, probably due to swelling. I should just hang in there (like I had a choice).
Finally, five hours after removing the catheter I voided 190cc, and performed a very restrained "happy dance" as I proudly carried the jug out to show my wife. Each hour after that my output equaled my input and I rejoiced at being safe from the Mount Palomar Telescope.
Recovery
By the next day my urine turned back to its natural color, and the speed started to pick up. It still stung, though. With each day the stinging became a little less and the flow rate a little more. I obeyed the doctor's instructions to remain sedentary and not to lift anything heavy for a couple weeks. I enjoyed watching my wife take out the garbage and recyclables.
Another phase of early recovery is urgency! I'd be minding my own business and a millisecond later, I'd have to GO! Family and pets would dive out of my path as I tumbled over furniture and careened down the hall to the bathroom, unzipping along the way. They should make this an Olympic event.
After a week, I suddenly began tinkling red blood, about a tablespoon of it, preceding the urine flow. Following puberty, The Ladies get used to seeing blood in their urine, but for us guys this is an unnatural and disconcerting event. I called the doctor and he said it was pretty normal. My friends who have had TURP also confirmed that after a week of normal urine, blood seems to reappear. I learned to look elsewhere when I began to tinkle so I wouldn't freak myself out, a matter of mind over sphincter.
Two weeks after surgery came the bladder spasms. Right at the end of each urination, something inside me would clench, like I was caving in. It was a little like that pain you sometimes get when you come home needing to piddle, have your key in the front door and you're dancing on one foot while trying to turn the knob. Only it hurts more. And it continues to hurt for about 5 minutes after you finish.
Another little surprise (actually a big surprise) may appear in the first two weeks following surgery: constipation. I don't know why --- maybe it's all the water I drank --- but I had the largest, hardest bowel movement I ever experienced. After giving birth to this concrete block, I made fiber the foundation of my food pyramid for the next month. My TURP friends said they endured similar rights of passage --- save one, who's doctor ordered stool softeners from the start. Don't pooh-pooh the prospect of pursuing salads, veggies, and prunes for a while.
Four weeks after my surgery, here's the score: The flow rate is good. When I need to void, it comes urgently. Each stream starts with a few drops of blood. The end of the stream brings on a painful spasm. (Sitting down to go helps a little; at least I'm already doubled up). My doctor has prescribed an antibiotic and Detrol to relax the bladder spasms. He says it is rare for his patients to have this much discomfort or blood after 3 weeks. Like my mom said, I'm unique. Why I can't be that one-in-a-million when it comes to the lottery, I don't know. Maybe it's penance for my turpitude.
Five weeks: Good stream, no blood, spasms only half as bad, urgency still reigns. There are skid marks where I turn the corner into the john. Friends have told me that it took about 6 weeks before they were completely better.
It's been 9 weeks for me, the spasms are still there, but just an annoyance. The urgency hasn't subsided, though. I've learned that after the first pangs of urgency pop into my head, I have exactly 10 seconds before the stream starts, ready or not, and no amount of hopping on one foot will forestall the inevitable. My doctor now says that about a third of his patients heal as slowly as me and that it might be 6 months before I'm totally back to normal. I wish the doctor would have told me this in the beginning; I still would have had the operation. At least I'm beginning to forget what it was like to watch spiders build condominiums between me and the pot while I tinkled.
Six months: I'm totally back to normal now and have forgotten enough to recommend the operation to anyone who needs it.
Followup
Three years: People who have read my story (they're all men, strangely) call or email me and kindly ask how I am now. The answer is "perfectly fine". I have forgotten enough of the ordeal to HIGHLY recommend the operation to anyone who needs it.
Some have asked why I didn't have the TUIP (Trans Urethral Incision of the Prostate) where they make 2 longitudinal cuts from inside the urethra to relax the tightness of the tube (Imagine if you wanted to push a baseball through a bicycle inner tube, you could slice the tube lengthwise to weaken the walls and make it stretch easier). TUIP has been around a long time and is well known and well practiced. I didn't choose it because I was told the TURP would have longer lasting results, and that there would be less bleeding (I'm a big wuss).
Other readers have asked me how the operation has affected my sex life. Which part, I ask them, thinking about it or talking about it? (I must be doing something wrong - 50 guys call to ask if I'm enjoying sex, but not one woman). Seriously, though, one thing does change; the operation causes many (me included) to have a retrograde ejaculation - the ejaculate flows into my bladder rather than out the penis. It's a nearly dry climax. It feels about the same as it did before, for both parties. And strangely, one's urine doesn't look any different afterward. So in a way, I'm like my 2 cats; I've been "fixed". Unlike my cats, I'm still "interested". So there's still life after TURP.
Web site where others have posted their TURP experiences:
http://users.isp.com/keoni/turp/index.html
Peter Utz
5207 Echo Pines Circle East
Fort Pierce, FL
34951
peterutz@toast.net