Transurethral Resection of the Prostate (T.U.R.P.)

So you want the gory details about Transurethral Resection of the Prostate (T.U.R.P.)? OK. I am happy to oblige. Here is the nitty-gritty about how I came to have a T.U.R.P., how it went, and how I feel now that it is done.

WARNING: This essay is explicit about symptoms and body parts associated with prostate problems. If you do not want to read about this stuff in gory detail, go read my other article, Prostate: Unintelligent Design at Its Worst instead of this one.

Transurethral Resection of the Prostate (T.U.R.P.)

Transurethral Resection of the Prostate (T.U.R.P.)

First, the good news: Two weeks after surgery, I can tell you that the surgery prep was way worse than the surgery. I got immediate relief from my BPH (benign prostatic hyperplasia) symptoms. There has been virtually no pain. Had I known this up-front, I would not have waited so long to have my T.U.R.P.

Several years ago, my PSA got high enough that my primary care physician sent me to a urologist. He stuck his finger up my butt and told me that I had an enlarged prostate and that we would keep an eye on it. He also gave me samples of Flomax, which helps the prostate relax but does not shrink it.

After a couple of weeks taking Flomax, I did notice some improvement in urination. It did not take me as long to get started or to finish peeing and that was a nice enough benefit that it made up for the hassle of going to see another doctor for something that I did not think was a problem.

Little did I know.

About every year or so, I would stop  by the urologist’s office for a follow-up visit. On roughly the same schedule, I would complain that the drug I was on was losing effectiveness. I was having to get up more often at night. It was taking longer to pee. When I was done peeing, I did not feel like I was done but nothing more would come out. During the day, sometimes I would go racing to the bathroom because my need went from zero to urgent in no time at all.

My urologist would switch me to a different med and things would get better for awhile. Better. Not good but anything was an improvement.

Eventually, I landed on Rapaflo. $75 co-pay. Ouch. If you have to take this drug, head over to the Rapaflo web site and sign up for their savings program which will bring your co-pay down to $15. This program is a crock of shit since anyone can sign up for it. Why don’t they just cut the price instead of play stupid games? Anyway, sign up for the program. The medication works and it’s free money. Take it.

When my urologist prescribed Rapaflo, he also talked to me about the alternatives if/when Rapaflo did not work. To wit,

  • There are some drugs which actually shrink the prostate. They work for 50-60% of the men who try them. A lot of the guys have side effects, like impotence.
  • There are some office procedures to cut away some of the prostate with microwaves or small probes. These are marginally effective and many men who have the procedures done need retreatment within a year or two. There usually are not side effects but impotence and incontinence do get mentioned.
  • There is transurethral resection of the prostate (T.U.R.P.), the “gold standard” of surgery for relieving the symptoms of BPH. It is the most invasive procedure but well proven and generally effective for up to 15 years. Some men have side effects, most commonly impotence or incontinence, but both consequences are rare.

Of the choices, none sounded attractive to me. I did not want someone messing around near my penis with the possibility of impotence or incontinence. I do not like reading about those problems, even in relation to other men. I sure did not want to consider them for myself.

I took the pills and left my urologist’s office. Fortunately, within a week, it was obvious that the Rapaflo was making my life much better. I had a much easier time urinating and I did not have to go as often or as urgently. I slept better at night, too.

That latest for a few months. My symptoms would ease and worsen in cycles. I would have good weeks and bad. Then I had a really bad spell, culminating in a trip to the emergency room because I could not urinate at all. I got to meet my first urinary catheter. I returned to my urologist who checked me out, told me that T.U.R.P. was the best course for me, and sent me home saying, “You’ll tell me when you’re ready.”

How right he was.

Over the next year, my symptoms got worse and worse. I got better and better and managing my life so that I could postpone the surgery. I learned that I slept better (never through the night but “better”) if I did not have anything to drink with dinner… or after. I learned to have a cup of coffee before work and maybe a cup of tea before lunch. I learned to drink very little with lunch.

Then I learned to stop peeing standing up, because it just took too long. I would sit every time I went to the bathroom, which played hell with my hemorrhoids but at least I could urinate. Then I learned that going to the bathroom was, generally speaking, going to take 5 minutes. Then 10. Then often more. I learned to keep my iPad in the bathroom and I surfed Google+ a lot. Day and night.

Finally, in October, I got fed up and scheduled a surgery date in mid-December. Within a week, through the sheer perversity of nature, my symptoms abated. I did not do anything differently but the urgencies  which had driven me to surgery vanished so I cancelled the surgery. (I had gotten really good at postponing surgery.)

By December, I was back to thinking seriously about surgery. I had a cruise planned in January. My wife and I were due to celebrate our 15th anniversary on Valentine’s Day, and I had a business trip scheduled for the end of February. I figured that I would schedule the surgery for March.

Not.

During the cruise, my urination problems got worse and worse. By the fourth day, I could barely pee. I was in the bathroom more often than every hour, day and night. On the fifth day, I gave up and went down to the medical facility on the ship, requesting a catheter. The doctor obliged and they drained almost a liter of urine out of my bladder. Can you spell R-E-L-I-E-F? Sure ya can!

Walking around a cruise ship, and flying home, with a tube stuck up your penis, is not fun at all. It was, however, my only choice. I took small steps, so as not to tug on the tube which would tug on my penis which stung like all get out. I saw my urologist three days later. He removed the catheter (thank goodness!). I told him that he was right, I would tell him when I was ready for the T.U.R.P. and I was ready. He smiled. He sent me home with, “I just hope you can pee.”

I could. For one whole day. Then things started getting worse again in a hurry. 43 hours after getting my catheter out, I was back in the emergency room, have another inserted because, you guessed it, I could not urinate at all.

I was on the phone to my urologist at 9:30am. Could they move my surgery up? As it happened, they had had a cancellation four days hence; would I like the slot? Does the bear shit in the woods? Is the Pope Catholic? I took the slot.

STATLOCK

STATLOCK device for stabilizing a catheter tube

Here is a piece of practical advice, from a man who has had four urinary catheters in a little more than a year: Instead of having the tube taped to the inside of your thigh, ask them for a STATLOCK. Immensely less uncomfortable. Trust me.

The surgery prep was a pain. It was worse than a colonoscopy because it dragged on through three days but at least it did not involve enemas, so I guess there was something to be thankful for. I got two days of low-residue diet followed by a day of clear liquids. Low-residue means no fruits or vegetables or anything with fiber. Clear liquid, in this case, means tea or coffee or water but anything “good,” like Jell-O or bullion, has to be cut 50/50 with extra water. On days two and three, I got to drink multiple doses of Epsom salts dissolved in water. This stuff is just plain gross. If you have to do this, do it like a shot and have a spoonful of honey standing by to flush the taste out of your mouth!

By the time surgery day arrived, I was more than ready. I had had a catheter stuck up my penis for almost two weeks. I had not had a decent meal in days. I would have been happy if Roto-Rooter had showed up to do the job.

Compared to the run-up to the surgery, the day of the surgery was a breeze. An anesthesiologist came by and patiently explained what he would be doing. He took all the time I wanted and answered all of my questions. I learned, for instance, that balancing the pain meds post-surgery is tricky because my need for the meds would change as the anesthesia wore off.

A resident started an IV drip into my arm. She did well with the needle, hitting my vein on the first try, but bobbled the tape. I got a nurse to replace the tape because it was too tight and was pulling on my skin, causing some pain. Lesson to the wise: if you are in pain in the hospital, tell someone; they can probably get it fixed for you.

My urologist came by and answered more questions. I was bemused to see him wearing yellow rubber boots. I guess, in his line of business, he would want something waterproof.

A nurse anesthetist came by and injected something into my IV tube. It was supposed to make me feel like I had had a glass of wine. It did, which is to say that I felt nothing. Then they wheeled me down to the operating room. Once there, they asked me to slide over onto the operating table. And then I woke up in the recovery room. Surgery was a non-event for me. Easiest thing I have ever done.

I had my own nurse in the recovery room who, whenever I was awake, was incredibly attentive and aggressive about assuring that I felt no pain. She was good! She knew that I was ready to go when she asked if I needed anything and I requested pizza. I did not get pizza but I did get wheeled down to my hospital room and my waiting wife.

Did I mention that I had another catheter? Yeah, you get one of these after surgery but it usually comes out two days later. I was discharged to home with my catheter still in place and instructions to remove it myself the next morning. More on that in a moment.

The night in the hospital was easy. I got a little achy around bed time so I asked for some pain meds. They brought me a Vicodin which, no surprise, knocked down any pain and let me sleep peacefully (except when the usual hospital routines woke me up). I kept waiting for the  pain to return; it never did. After than single pill, I have not wanted any oral pain medication. Please be assured that I am a wimp when it comes to pain. This is not some Macho Man who toughs it out. I truly have not had even enough pain to want an aspirin or a Tylenol.

The next morning, the nurse encouraged me to get up and walk around the halls a bit. I did, s-l-o-w-l-y because walking with a catheter is no fun at all and I was tired, even after a night’s sleep. Despite the discomfort, I was thankful to not be in pain and to have the surgery behind me.

My urologist stopped by to tell me that the operation went well and that I had really needed it. The two sides of my prostate had enlarged and squeezed together, largely closing off my urethra. Additionally, my prostate had pushed up into my bladder, forming a bulge like the flapper valve in the bottom of a toilet tank. Whenever I started to pee, it would fall forward, blocking the entrance to my urethra. He cut that away, too.

My wife drove me home and I slept most of the rest of the day. I continued to have no pain at all, other than the catheter in my penis being generally uncomfortable.

The next morning, I wakened about 5:30am and decided that that was “morning” and that I was going to remove my catheter. By then, I had had one inside me for most of two solid weeks. Enough was more than enough!

I got in the shower and cut the ends off the catheter tubes. This allowed the bulb to deflate (the inflated bulb holds the catheter in place). Then I gently pulled and the catheter slid out. You may have heard that this is painful; it is not. It is kind of a weird feeling but I would not call it “pain.” Regardless, in a few seconds, I was tube-free and gleeful. It was kind of startling to see how much hardware had been inside me. A Foley catheter is a formidable device, indeed.

Earlier, I mentioned not needing any pain meds. My doctor had prescribed Pyridium, which alleviates stinging inside the penis. It also turns your pee bright orange and, so I am told, stains your clothes. I took that from the night before I removed my catheter for a total of three days. Since I was not experiencing any stinging at all, I quit. Without the Pyridium, I very occasionally have a little bit of stinging for a few seconds, but nothing anywhere near requiring meds to control.

I was worried about incontinence so I wore Depends for a couple of days. That turned out to be overkill to I switched to “dribble pads” stuck inside my underwear for a couple of days. Even that turned out to be unnecessary so I quit using those, too. I think I am lucky to have no incontinence at all, not even when I cough or laugh.

While I am on the subject of potential bad side effects of T.U.R.P. surgery, I should mention that I am not impotent. That had worried me. Under the “right” stimulation (like simply seeing my wife naked, since it has now been several weeks since we have had sex), I do get and hold an erection. I think impotence worried me the most about this procedure but, when it got to where I could not pee at all, even this fear was not enough to make me hesitate any longer.

Since the surgery, I pee like the proverbial race horse. Words cannot express the pure delight I feel every time I walk into the bathroom, expeditiously do my business, and walk out again a few seconds later. After years of struggle and months of sitting on the toilet for 10-15 minutes at a shot, several times a day, I had forgotten what it feels like to function like a normal human being.

There is some blood in my urine, and I was told to expect it. “Rose is good. Burgundy is bad,” the nurse in the hospital told me. So far so good.

I pee a lot but that is because I am drinking a lot. Since I can pee and since I have been told to drink a glass of water every hour or two, I have been enjoying all of the hot and iced tea and coffee that I want. I have got years of self-deprivation to make up for. In between the tea and coffee, I drink a lot of water. When I do need to go to the bathroom, it is not an urgent OMG-gotta-go-now! situation. It is an easily controllable, OK-I-have-to-go-to-the-bathroom-soon feeling. So I go at the next convenient time and do my business. No fuss.

The only unexpected side effect is how quickly I tire. I work from home. My “commute” involves walking downstairs to my office. I sit in a chair and work on a computer. By early afternoon, I am pooped and ready for a nap. As I write this, it has been two weeks since surgery and I can still easily take naps lasting one to two hours. My wife, who has had several surgeries, smiles indulgently at me when I have nap attacks. She knew this would happen. I was in denial.

So that’s it, possibly way more detail that you wanted to know. I will be happy if you take just one thing away from this essay: Do not hesitate to get a T.U.R.P. if you think you need one.

Posted in Health, Men

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