Harvard experts discuss surgical options for benign prostatic hyperplasia

Nancy Ferrari

Senior editor, Harvard Health

Benign prostatic hyperplasia (BPH) is one of the most common disorders affecting men as they grow older. Yet there is much confusion about the best way to treat this disorder surgically, in part because it seems that every year, a new surgical option is introduced.

Harvard editors invited three experts to participate in a roundtable discussion to share their thoughts about the relative benefits and risks of current surgical treatments for BPH.

Note: Men who decide to undergo surgery to relieve BPH symptoms have multiple options to choose from. Our panel of Harvard experts discusses the most common options, which are briefly defined below. See Table 3 for a comparison of recovery rates and other considerations.

The panel consisted of these experts:

  • Dr. Kevin R. Loughlin, professor of surgery (urology) at Harvard Medical School, who is senior surgeon and director of urologic research at Brigham and Women’s Hospital and staff urologist at Harvard University Health Services, a large university health program that serves the needs of Harvard students, faculty, employees, and their families.
  • Dr. Abraham Morgentaler, associate clinical professor of surgery (urology) at Harvard Medical School and director of Men’s Health Boston. Dr. Morgentaler specializes in diseases of the prostate and has a particular interest in treating erectile dysfunction, low testosterone levels, and BPH. He has published widely on the issue of erectile dysfunction.
  • Dr. Martin G. Sanda, associate professor of surgery (urology) at Harvard Medical School and director of the Prostate Care Center at Beth Israel Deaconess Hospital. Dr. Sanda has extensive experience in prostate cancer and BPH and has devoted much of his professional research to evaluating prostate-related treatment outcomes and developing new therapies.

Transurethral resection of the prostate (TURP). Still the most common form of surgery, TURP is often inelegantly referred to as the “Roto-Rooter” technique. This procedure takes place in an operating room under general or spinal anesthesia. During the procedure, the surgeon uses an instrument called a resectoscope to view the prostate (see Figure 1). The surgeon threads the resectoscope through the penis to the prostate, then uses the electrical loop to cut away the overgrown tissue that’s pressing against the urethra.

Figure 1: TURP

TURP

During transurethral resection of the prostate (TURP), which is performed under general or spinal anesthesia, the surgeon inserts a thin tube known as a resectoscope into the urethra and threads it up into the enlarged prostate (A). The resectoscope contains a tiny camera, enabling the surgeon to view the prostate as the operation proceeds, and an electric loop. Using one type of electrical current, the surgeon uses the loop to chip away at the overgrown prostate tissue (B). The surgeon then applies a different electrical current to cauterize the tissue and reduce bleeding. The area is then flushed with a sterile solution to remove bits of tissue, and a catheter is inserted temporarily into the urethra and bladder until the area recovers. After surgery, the newly enlarged passageway enables urine to flow more easily (C).

Transurethral microwave thermotherapy (TUMT). This is one of several techniques that use heat to destroy prostate tissue. In TUMT, the doctor guides a thin catheter carrying a miniature microwave generator through the penis to the prostate. There, microwaves destroy some of the prostate tissue and relieve pressure on the urethra. A cooling jacket around the generator protects the urethra. The procedure can be performed on an outpatient basis.

Transurethral needle ablation (TUNA). This is a newer thermal approach that uses low-level radio waves delivered through twin needles to heat and kill obstructing prostate cells. Shields protect the urethra from damage. This can also be performed on an outpatient basis.

Photoselective vaporization of the prostate (PVP). Although several options in laser surgery exist, our Harvard experts most often use the PVP laser technique, also known as the GreenLight laser. This uses a high-energy laser to vaporize prostate tissue that is obstructing the flow of urine through the urethra (see Figure 2).

Figure 2: GreenLight procedure

GreenLight procedure

When prostate enlargement obstructs the flow of urine (A), a relatively new laser technique may be used instead of TURP. In a photoselective vaporization of the prostate (PVP), or GreenLight, procedure, the surgeon threads a thin tube known as a cystoscope into the urethra and up into the enlarged prostate. The surgeon then threads a fiber-optic device through the cystoscope to generate high-intensity pulses of light, which simultaneously vaporize the obstructing tissue and cauterize it to reduce bleeding (B). After surgery, a catheter may be inserted temporarily to allow urine to flow while the area is healing. This technique creates an enlarged, uniform channel for urine to flow through (C).

When is it time to consider surgery for BPH?

MORGENTALER: For the most part, it really comes down to patient choice about how to handle the symptoms of BPH. The only situations that are major indications for treatment include acute urinary retention, bladder stones, maybe recurrent urinary tract infections, or a high post-void residual.

SANDA: Surgery is also worth considering if a man isn’t responding well enough to any of the drugs used to treat BPH, or if he can’t tolerate the side effects. In the past, patients really had only two options when it came to surgery for BPH. If the patient had a reasonable-sized prostate, he could undergo a TURP, and if he had an especially large prostate, then perhaps an open prostatectomy. But today a man considering surgery has many more options [see “TURP use declines,” below].

Which surgical procedures do you recommend to your own patients?

SANDA: One trend in BPH management that really has changed in the last few years is the emergence of a later generation of laser therapy that seems to be more effective than earlier alternatives. I’m referring to the GreenLight laser,* which comes close to TURP in terms of removing obstructive prostate tissue and releasing pressure on the urethra, but it’s less likely to cause bleeding and other complications.

*Note: A first-generation GreenLight laser is discussed in this article; a second generation, more powerful laser, which can treat larger glands with shorter duration times for the procedure, has recently become available.

LOUGHLIN: I share Marty’s enthusiasm for the GreenLight laser. I think people need to understand that a TURP is done in an operating room, with spinal or general anesthesia, and it involves a hospital stay. Treatment with the GreenLight laser is also done in an operating room, but it’s day surgery, usually with spinal anesthesia, although general anesthesia is sometimes used. There is no blood loss, and the patient either goes home with a catheter inserted overnight, or stays in the hospital overnight. Some doctors are even sending people home without a catheter, although I have not done so and would not recommend it.

MORGENTALER: I’ve become a fan of the newer heat treatments, such as microwave and TUNA, even though I started off as a complete skeptic. I think that there’s an important role for heat treatments in the surgical management of BPH, although I think it’s also important to recognize that these techniques absolutely do not replace TURP or the GreenLight laser.

Can you tell us more about why you’re enthusiastic about the heat-based techniques?

MORGENTALER: The nice thing about the heat-based treatments is that they’re done in the office. A lot of patients with BPH are treated for symptoms of bother, such as frequency and urgency of urination. In practical terms, they may be getting up multiple times in the night to urinate. Yet many of the men I treat are otherwise relatively healthy. They’re leading busy lives, and the last thing they want to think about is going into an operating room and undergoing general or spinal anesthesia. That’s always been a real stumbling block in terms of getting people to undergo surgical treatment for BPH.

How are the heat-based treatments a better alternative, in such cases?

MORGENTALER: Most men tolerate these procedures well, and when they come back for a follow-up exam four to six weeks later, they are usually quite satisfied with the results. In fact, I’ve never seen any man I treat who is as happy with a medication as he’s been with one of these heat-based treatments. Now, I should point out that I’ve seen men just as happy with the results of TURP. But for men who don’t want an operation, for whatever reason, microwave or TUNA are good options.

TURP use declines

As less invasive surgical procedures for BPH have emerged, use of those that require hospital stays, such as TURP, have declined. In 1994, about 136,000 TURP procedures were performed in the United States; by 2004, fewer than 90,000 were performed.

How long have you been offering these treatments?

MORGENTALER: For a year. Although the numbers of cases aren’t huge, I can say that for the majority of men I’ve treated, these treatments have produced nice results.

LOUGHLIN: One issue we haven’t discussed, but should, concerns the likelihood of having to undergo a repeat procedure. The 2003 Medicare data on BPH surgery reoperation rates indicate that TURP and GreenLight laser are basically equivalent, and if anything, the GreenLight laser seems to have a slight edge, at least in terms of the need for a repeat procedure. But the data also indicate that the repeat operation rate for people who have microwave therapy or TUNA is much higher. So essentially a person who undergoes one of the heat-based therapies is six or seven times as likely to need a second operation as someone undergoing a TURP or GreenLight laser procedure [see Table 1].

Table 1: Reoperation rates

The federal Medicare program tracks data on the need to have a repeat operation for BPH within 24 months after a first procedure. This provides one indicator of how effective the procedures are. The figures below are based on Medicare data for 2003.

Procedure Percentage of men who required another operation within 24 months
TURP 2.2%
TUMT 11.9%
TUNA 14%
PVP laser 2.05%

MORGENTALER: I’m not saying that microwave and TUNA are equivalent to TURP or the GreenLight laser. They’re not. But I think a heat-based treatment can be viewed as an intermediate intervention — more effective than medication for BPH, but not as effective as TURP or GreenLight. So I think heat-based treatments are actually a wonderful advance, in that they can be performed in a doctor’s office, involve less fear on the patient’s part, and have nice results, in my experience.

LOUGHLIN: I agree that a patient needs to understand that a TURP is going to require that he be in an operating room. It also involves longer recovery than microwave or TUNA. But, to me, the 2003 Medicare data are extremely persuasive, in that you’re looking at a 2% reoperation rate versus a 12% to 14% reoperation rate.

What other factors might influence a patient’s choice of surgery for BPH? Or the recommendation that you make as doctors?

LOUGHLIN: A real dilemma for urologists is that if you look at reimbursement rates, there’s about a seven-to-one financial advantage in doing an office-based procedure. If a doctor recommends a TURP or GreenLight laser, it’s done in the operating room. That means the urologist gets about $500 in reimbursement, to use a ballpark figure. If the urologist does a TUNA or a microwave in his office, he’ll get a lot more. That’s a real issue sometimes.

Good point. The Journal of Urology included a study three years ago about the way reimbursement rates affected treatment recommendations for BPH as well as for other conditions [see Table 2].

Table 2: Reimbursement matters

Medicare is the nation’s largest health insurance provider, serving roughly 40 million Americans (mainly those 65 and older). As such, changes in Medicare coverage and reimbursement policies have an enormous impact on the practice of medicine.

A 2004 study in the Journal of Urology found that Medicare reforms implemented in the 1990s significantly reduced reimbursement rates to urologists for surgical procedures done on an inpatient basis, while increasing rates for outpatient procedures. For example, in 1986, Medicare reimbursed urologists $998 to $1,830 per TURP, depending on their geographic location; in 2004, the reimbursement had fallen to $704, regardless of geography.

Medicare also reimburses particular procedures differently, depending on whether they are performed in a physician’s office or in an operating room, as shown in the chart below.

BPH surgical procedure Medicare reimbursement
Performed in operating room Performed in physician’s office
Transurethral thermotherapy (another name for microwave treatment, or TUMT) $552 $4,272 (gross)*
Transurethral needle ablation (TUNA) $585 $4,098 (gross)*
*This does not cover the cost of disposable items, which can be more than $1,000 per procedure, and other overhead costs, so net reimbursement is less.Source: Lotan Y, Cadeddu JA, Roehrborn CG, Stage KH. The Value of Your Time: Evaluation of Effects of Changes in Medicare Reimbursement Rates on the Practice of Urology. Journal of Urology 2004;172:1958–62. PMID: 15540765.

Are there any questions we should have asked about surgical treatments for BPH that you think are important?

MORGENTALER: I think an important issue is, what happens if somebody doesn’t want to undergo treatment for BPH?

Excellent question. What’s your answer to that?

MORGENTALER: The studies suggest that for many men, the urinary symptoms and overall bother of BPH really wax and wane over time. One review found that one-third of men who forgo treatment eventually report feeling better, and if there is an improvement it usually occurs in the first six months. So if some men choose to put off treatment, I think that’s a valid option.

LOUGHLIN: Some men may want to avoid surgery because they’re too frail to risk blood loss, side effects from anesthesia, or complications. If a patient is that brittle, the best option may be to manage his symptoms with medication and with a catheter if necessary.

 

Table 3: BPH surgical procedures compared

Procedure What’s involved Success rates Side effects
Transurethral resection of the prostate (TURP)
  • Performed in operating room
  • Requires general or spinal anesthesia
  • May spend one to two days in hospital, with catheter inserted to enable urination
  • Heavy physical activity may be restricted for two weeks or more to prevent bleeding
  • Full recovery may take four to six weeks
Provides symptom relief in 70%–85% of men treated
  • 6% or fewer men will experience erectile dysfunction
  • May cause ejaculatory problems
  • Blood loss, urinary incontinence, infections, and complications from anesthesia are less common but do occur
Photoselective vaporization of the prostate (PVP or GreenLight)
  • Most patients treated in outpatient setting
  • Catheter remains in place at least overnight for most patients
  • Can resume light activity and return to work within two to three days
  • Can resume vigorous activity in four to six weeks
Improvement in symptom relief similar to TURP
  • Ejaculatory problems similar to TURP
  • Less bleeding than TURP
  • Urinary frequency or urgency in first month may be more troublesome (temporarily) than after TURP
Transurethral microwave thermotherapy (TUMT)
  • Performed on outpatient basis in doctor’s office
  • Procedure takes about one hour
More effective than medication but less effective than TURP
  • Some urinary side effects, such as frequent urination or discomfort during urination, that can last for several weeks
Transurethral needle ablation (TUNA)
  • Done on an outpatient basis
More effective than medication but less effective than TURP
  • Some urinary side effects, such as frequent urination or discomfort during urination, that can last for several weeks
  • More discomfort if done in doctor’s office than for procedures such as TURP or GreenLight

Originally published April 1, 2007; last reviewed April 26, 2011.

Comments:

  1. William Elkman

    William Elkman; June 22, 2018.
    I am 4 months (2/21/2018) post green laser PVP BPH surgery. I continue to have recurring prostate bleeding with clots, blockage for 1-2 weeks per episode, with clear urine for 3-5 weeks in between. My original surgeon indicated he hasn’t seen this before, and has recommended a 2nd PVP, and, in contrast, a referral surgeon indicated bleeding can only stopped with a TURP.

    I am seeking supporting information from patients (or surgeons), who may have had similar PVP post-op issues, and a referral to a urology surgical group, for a 2nd opinion, to help diagnose and recommend/ perform a treatment plan. I am in LA, but can travel for treatment.

    I would greatly appreciate assistance.

  2. Harry Young

    For those with very large prostates, HOLEP Holmium Laser Enucleation of the Prostate – see Mayo Clinic and University of Indiana. Mine was 140 grams. In at 1:00PM out the next day. Catheter in during operation but out the next AM. It was a non-event. Little “discomfort” AKA “PAIN.” R A is a common side effect which I have. It works on ANY size prostate. Again, peruse the Mayo Clinics Website.

  3. Gary (Atlanta, GA)

    Responding to Laura:
    In my experience with Green Light, the bleeding was concentrated during the first 3 days – with some residual, light bleeding during the following 2-3 days. After that, the bleeding stopped. The only concern I would have is related to the extended healing time due to the nature of the procedure and where it is…ongoing use of blood-thinning medications may extend the healing time. Explore this with his doctors – there may be alternatives.

  4. Laura

    HI James.
    I am looking for help for my father who is 87 and is on blood thinners, stroke 10 years ago brought on by anesthesia. Green light is recommended but we are afraid because it sounds so bloody! How can the bleeding be controlled. If there is so much bleeding and clotting he will have to be off of blood thinners which can cause him to have another stroke. If anyone has a suggestion please let me know. Thanks.

  5. James Srygley

    I am 85 with BPH and a moderately enlarged prostate. I have been on Flomax 0.4 HCL about 1 year but the flow of urine is almost stopping and retention is growing. The Urologist is recommending alternate meds but I fear this may only be postponing inevitable surgery. Retrograde Ejaculation and orgasm are not as critical to me as incontinence or urine retention, ongoing discomfort, and need for meds. I am leaning toward green light but would appreciate any informed CON. Thanks.

  6. Somchai

    I am 74 with BPH but no cancer. I had to have a catheter inserted in ER when I could not urinate in March 2018 (it was painful) even though I am taking Flomax for at least 10 years. I have no ED but yes, I have retro ejaculation. Depending on what I am eating or drinking, I need to go to bathroom nearly every hour. I take many other medications for Blood pressure (BP), back pain, etc. My urologist gave me a choice between Greenlight PVP and Rezume. He showed me videos of the procedures, gave me pros and cons, and asked me to read up a lot. I was leaning towards Greenlight as I could not think about something going through my urethra again without me being put away. I am so glad that I found this blog but my BP started going up as I kept on reading until I came to the last two positive 2018 posts after reading overwhelming majority of the negative ones. I request others who had positive experiences to share them to help fellow BHP sufferers to make decisions. Thank you.

  7. Gary from New York

    In response to Gary from Atlanta—good news!! I am 2 years post greenlight and couldn’t be happier. I suffered from the exact symptoms Gary Atlanta did and after having a catheter installed for the first time—after being unable to urinate— I had the surgery. Within a week I was urinating like a racehorse ans sleeping for 6-7 hours without getting up—a change of life. I no longer have any trouble urinating and take no medication—by the way, I’m 70 years old. As far as retrograde ejaculation which is sometimes a result of the surgery, I am happy to say my ejaculations now are fine even though I no longer hit the ceiling—even if I had RE who cares—I now live a normal life. Gary you are right when you say most of these posts are negative—I guess misery loves company. Those with positive stories should share them with men who are living a terrible life and deciding what to do. Things only get worse over time, drugs are a stopgap that barely work. Time to take care of your problems and not procrastinate!!!

  8. Gary (Atlanta, GA)

    I too suffered with BPH for several years now…I am 65 years old this year. Over time, my urination got worse – urgency, frequency – but it happens so gradually over time I just learned to live with it and chalked it up to getting older. Then early in February, my prostate clamped down hard and not a drop would come out. I ended up going to the emergency room where they drained over 1700cc of urine and installed a catheter (a first for me). My urologist first tried drug therapy (Alfuzosin and Finasteride) but without any success. I had the GreenLight (PVP) surgery 8 days ago. Prior to the surgery, I had read tons of blogs on the topic and was absolutely terrified of what might occur. All I wanted was to be able to pee again. No one mentioned I would get that and so much more. The first couple of days were unpleasant only because of the blood and debris which were expelled during urination. Aside from that, I was able to urinate with minimal pain so I was OK with a bit of unpleasantness. Each day that went by got better. What I got was my life back. After 8 days, I can pee with full stream (not weak, no start/stops or dribbles), the frequency is a fraction of what it was like before the issue started and the urgency is nothing like what it was in the past. This is amazing to me – it has turned back the clock almost 15-20 years – to when I was able to pee like a “normal” man. I can drink a cup of coffee and not suffer 20 trips to the mensroom in rapid succession. I can also pee “on-demand” which I don’t think I could ever do! My nighttime need to pee is gradually reducing, I’ve even had a couple of nights where I didn’t get up at all to pee. I know everyone is different, but there seems to be an overwhelming volume of bad feedback, so I thought it would be good to share a positive story. I don’t yet have any feedback to offer on R.E. as my post-op instructions say to hold off for a few weeks before trying that. However, I also wanted to mention that during the past few years, I’ve also suffered from E.D. and at this point, I think that may no longer be the issue anymore – very GOOD news!

  9. Alan Wilkerson

    Great forum! I had green light surgery in 2005 in dfw. I was told it might last 10 years… im going on 13 years currently. I have experienced retro ejac periodically, less frequently as time goes on. Very infrequently now. I’m 72 this year, and am very pleased with the surgery and urologist. Still have urgency, especially at night, but am able to void effectively, even if it takes a bit longer at times.

  10. James Pokracki

    I had green light 23 days ago and got on the internet to find out when the bleeding is supposed to stop ? I did not receive any post opp instructions and when my wife called the doctor’s office the receptionist said to go to an emergency room for help. They found an infection and I have been on Sulfa for it 5 days now and I just had a urine flow that was RED. I passed three chunks of ? and they came through the penis. I have incontenence and have to run to the restroom. A matted Klenex in my briefs allow the drops to not stain my under ware.This has to get better as it is at it’s worst now.

  11. arnaldo Moran

    all your comments are very much appreciated;please researh new very effective an minimmal procedures like Dr. Ordon’s prostate procedure Dr. Kia Mitchell and Rezum treatment ,Dr. Richard Levin. Good luck.A.

  12. Mike Lavric

    Had turp 4 yrs ago at age 62 as i could not urinate.bph and large prostrate. In last 18 months needed a cath..something I hate..about 6 times. Scheduled green light for early April. Will trade the sexual side effects to hopefully never need another foley.

  13. Sayed Gharib

    I am from Atlanta, Georgia,
    I have enlarged prostate since more than 20 years, I am 66 years old now
    and I am still taken hytrine generic called terazosin 10 mg ounce a day
    But I still suffering from difficulties in urinating
    Where can I do the green light laser
    More effective and safe please
    My regards
    Sayed Gharib

  14. Stephen

    Hello. Please tell me where to view the replies and comments on this blog as I am seeing only the questions. I am 56, taking dutasteride (avodart) and flomax. I am intrigued by the Urolift procedure. Are there reviews and who performs this procedure in Phoenix, AZ?

    Thanks and may you all flow freely!

  15. Levi Borunda

    I am scheduled for GreenLight therapy at the end of March, and I have some reservations (reason for reading this blog), but my uro seems to be extremely confident in the procedure, even over Urolyft. I’ve read some negative results here, but it seems the positive outweigh these. I’m 58 and have a pretty large prostate, with very frequent urination at night (3-5 times). I’m praying for the best…

  16. Gio Stelly

    I am form Australia and about to have a Robotic Prostatectomy, is anybody out there had this procedure? it is new technology cutting the prostate from inside making 4 keyholes on the belly.
    I wonder if this is too new….
    Gio

  17. Frank

    I value the comments of this blog, and I intend to add my experience after my decision to receive treatment. Thank you

  18. Denver

    Warning: Some doctors are honest and admit Green Light Laser surgery has a 95% chance of to semen passing backwards into the bladder. We now know this to be anejaculation. Many doctor’s sites “pretend” this is rare. They can’t be bothered to read the many comments.
    Before considering this, do the research on the side-effect.

    Completed Green Light Laser surgery around Dec 18, 2017. Around Dec 25, the process started to heal. Saw very positive results. Took a while to re-train the urinary sphincter control. The doctor told me to wait 2 weeks for sex after catheter was removed. Experienced dry ejaculation. Before surgery it was very productive (age 65). It is very uncomfortable. Seems to be going somewhere, but not out.
    5 weeks later, the orgasm is downplayed with an immediate uncomfortable feeling as the semen flows back into the bladder! This uncomfortable feeling lingers for five to ten minutes. A total mood killer. At 5 weeks the urine stream is good. The blood is just immediate and smaller. But after sex, the blood with the semen is thick. A pain killer is necessary to reduce swelling and discomfort.

  19. Gary R

    I’m 2 years post Greenlight Surgery. Although not as good as 1st year still sleeping 4-6 hours before having to urinate-used to be every 2 hours. Also no fear of needing a catheter as I am always voiding. Changed my life in a very positive way.

  20. Canan Barbarian

    I am 79 years old, and tired of dribble, dribble, dribble. Flomax 0.8 mg no longer useful. Rapidflow should be called Stopflow. Avodart stopped being useful years ago.

    My urologist recommended ONLY the TURP, probably what he is experienced and most comfortable doing

    Had a TURP performed 4 weeks ago in a hospital under general anesthetic. No recovery problem from anesthetic. Overnight “outpatient” stay with solutions fed from bags through a catherer all night to flush the bladder (one tube in, another tube out)

    Catherer taken out in doctor’s office by a nurse 5 days after surgery. Dr. said my prostate was 70 mg, and he took out 30 mg, about 40%

    Lots of blood in urine, but now almost gone. Pain in penis almost gone. Pain when urinating almost gone. Urination aim is getting better

    Urgency still experienced occasionally, need to go during the night once or twice, but my bladder now empties to 1 to 2 oz (30 to 60 ml). For comparison, 6 to 7 oz (200 ml) retention is normal before the bladder signals the brain to void. 1000 ml = 1 liter (30 oz) retention is a serious problem that can lead to kidney failure through backflow and create REALLY BIG PROBLEMS.

    The experience with the catherer was awful; difficult to sleep, carrying a bag with bloody urine around, emptying with a valve, aaaghhh.

    I am dancing for joy now to get this done. Sound of urinating is like music in my ears; wisssshhhh, not tinkle,tinkle,tinkle.

    But be aware, recovery from cutting into the prostrate and removing a good amount is not a “walk in the park.” But a hell of a lot better, I am told, then removing the entire prostate…risky for older men. At my age, retrogade ejection is of no concern, I had a vasectomy over 45 years ago.

    Erection…too weak to matter, and frankly, at this point in my life, don’t care. All I care about is comfort, comfort, confort, and no worries.

    Take time off, relax, no heavy lifting, drink lots of fluids.

  21. Ed Marris

    Thank you to Greg Rober for posting his experience with HoLep and Dr. Kuo in Albany. I’m 69 with a 150g prostate and BPH for many years. My urologist has recommended GL PVP, has a lot of experience with this system and says that the latest GL equipment is capable of treating very large glands. Preserving sexual function is very important to me, as is maintaining continence. I will be contacting Dr. Kuo’s office for an appointment to discuss the HoLep procedure as it does have a history of success with large gland treatment. Thanks Greg!

  22. Justin Prater

    #Urolift #drwalsh has destroyed my life. After surgery had catheter now scar tissue now laser surgery now self catheters 4 LIFE. DON’T DO IT

  23. George Baker

    Why is it that the new Rezum treatment for BPH is not mentioned in any of the comments, that is the information that I am searching for. That is also the treatment that I am very interested in.

  24. Dan yeung

    Just had urolift done 10 days ago, it is great! No urgency, no spasm, still little weak flow, but seems is getting better, I highly recommend to anyone to ask his urologist. My procedure was done in Shands hospital, there are many skilled urologists that can do this. Medicare covered this. Hope this would help someone.

  25. Scott Simpkins

    I am 50 years old been taking flomax for over 10 years I get up to go to the bath room 3-5 times a night, also have a sense of urgency, need to go and can’t. Bad stream flow to the point if I am at a urinal I take the chance of peeing on myself. It just sucks as anybody dealing with knows. My dr recommend the green light laser. I have been trying to get up to date on the latest procedures. One procedure that my dr doesn’t offer is RESŪM. It’s somewhat new and Mayo and Cleveland Clinc both offer this procedure as well as many others in major cities. It just seems to be offered in the larger markets at this time. I like the sound of it because it goes right at the prostate which is the problem instead of reaming out my urethra. Does anybody have any feedback on the RESŪM procedure for BPH?

  26. Jeff Schumer

    Was on 1 Avodart (Dutesteride) and 2 Flomax (Tamulosin). Started to have issues with poor sexual climax. Weaned to Avodart every third day and, Voila!, I’m peeing better with far less frequency and urgency, and sex is back to normal. There can be unintended consequences when taking several drugs. They don’t work the same way for every individual, especially in combination.

  27. Alaina Albert

    The information given in this article is really helpful about latest surgical treatment options for Benign Prostatic Hyperplasia. Thanks for sharing it!

  28. Phil McCaul

    Researching TURP vs PVP Laser, so really appreciate the article.

  29. STEPHEN T WILEY

    I had the PAE procedure done in October 2014 at a hospital in Alexandria, VA. Sorry, I forget the Drs. name. Anyway, it seemed to help my number of trips to urinate in the bathroom initially. Now, 2 1/2 years later and I still go urinate about 20 times a day. So, I cannot recommend PAE personally.

    Now I am studying a new method to treat BPH and it looks very promising. It is called iTend. It is not available in the USA as of 8/12/17. There are however clinical trials going on to get FDA approval. It is being performed in Canada, Spain, Italy etc…

    Below is an email I received from a doctor in Canada

    Hello Mr. Wiley,
    Thank you for your inquiry regarding the iTIND. You are correct in that we are the only location in North America offering the iTIND outside of clinical studies. The iTIND is placed under sedation by an anesthesiologist. I personally perform the entire procedure. The device is left inside for usually 5 days. During that time you can expect some discomfort, but most men can get out and about (though I wouldn’t plan anything too strenuous).
    The current cost inclusive of device, anesthesia, surgeon, nursing, facility is $7500 USD.

    Dean Elterman, MD, MSc, FRCSC
    Urologic Surgeon, University Health Network
    Assistant Professor, University of Toronto

  30. larry loois

    I have been told that the efficacy for the Rezum is pretty much the same as the TUNA; not great.

  31. Gary Hallecy

    Just found this article, Great reading!

    Age 63 and treating BPH with medication, but still getting up 2-3 times a night to urinate and flow is delayed and slow. During day time, flow is mostly normal to slow, but tolerable.
    Had prostate biopsy about 2 years ago with negative results for cancer. PSA went to 10 and back down to 8, with Urologist indicating BPH will cause higher than normal PSA results that can vary. PSA in 2017 is 10 again. Prostate is 60c in volume.

    My question and major concern:
    I am Blood Factor IX moderately deficient and my hematologist recommended and administered Factor IX prior to my biopsy (in office). All went well, but Factor IX is very, very expensive and I have to have it infused the day of and 4 consecutive days after any surgery procedure.

    Which prostate procedure is recommended for my condition?
    Can it be answered or can someone recommend where I can get an answer?

    Thank you,
    Dallas-Fort Worth area

  32. Gary

    I am 18 months post green light surgery. I am now 70 years old. Have extremely large prostate. Surgery went well with no post complications. Had typical pre surgery symptoms- urinating 4 times a night, etc. Am now sleeping 5-6 hours with no urination problems. Sexually life is good with light seminal flow. Green light was terrific choice.

  33. Harvey

    I had the Green Light procedure at age 73, but a reasonably fit 73 – I still do 50 miles of hard cycling a week, 52 weeks a year. The results of the procedure are not too bad, but not ideal. I have reasonably complete sexual function: no seminal fluid, but semen that eventually comes out the right way, and it feels more or less normal, but not as nice as it used to be; the urine stream is about twice what it was, and I no longer get up more than once at night to pee – 4 times a night had been normal for me. I can now go for 4 or 5 hours without the need to pee.

    But there was a lot of pain, even very hard pain in the first days. I remember profoundly regretting my decision to have the procedure, especially since I never really gave the medications a try. But I felt I had to do something due to the risk to my kidneys, and I was afraid that if I waited, our supply of effective antibiotics might be exhausted. There are already bacteria that are resistant to all the antibiotics we have.

    Then there were over 2 months when peeing was a painful, although gradually diminishing, with some small amount of bleeding, with an unpleasant sensation in the minutes after peeing – for the first month this really knocked me hard each time I peed – and some “urgency” issues, but never an “accident”. And there were brief stretches of mild erectile dysfunction.

    Fifteen weeks on, peeing is a little uncomfortable, I am aware of my prostate when I sit, and there is some mild pain in the base of my urethra when I cycle: at the contact with the saddle. The flow of urine is less than it was at first, presumably as the bladder muscles gradually relax after having had to push past my enlarged prostrate. The flow is double what it had been, but was up to over 3x at first.

    Sexually, I am functional, but it is not as pleasant as it was.

    I am not sure, if I had it to do over, if I would have given the pills a try, and hoped for a better procedure to deal with the prostate, but the issue of risking not having effective antibiotics is a very real one for me, so I probably would still go ahead as I have done. Lastly, I made a mistake not going for a spinal block instead of a general anesthetic. I let the anesthesiologist talk me out of the spinal block. I seem to have taken a long time to get the GA out of my system.

    Overall, I feel I can certainly live with the results I have, and given all aspects of the situation, I would do it again, but with a spinal, not a GA.

  34. steve

    There seem to be few resources that describe and compare maximum prostate size limits for each of the procedures. At 101g (very large), options are more limited. Some procedures may not be effective for very large prostates and the risks of damaging the bladder neck are important to consider.
    Greenlight max size is about 50g, so I chose to do HoLEP with Dr Lingeman at Methodist/IU in Indianapolis. He is the grand master of this procedure. For very large prostates, HoLEP is effective and long lasting with less risk. It’s not robotic, but guided manually, so the skill of the surgeon is important.

  35. stanley richards

    what is the size limit of the prostate for the urolyft procedure to work if any?

  36. Dan McElhatten

    Three years ago I had green light for BPH. Three weeks later began bleeding from penis, passing large blood clots and suffering intense pain from clots in bladder. Ended up back in hospital, no one could find where bleeding coming from, after a week transferred to large university hospital. Two weeks later, again no luck finding bleeding, they passed potassium and alum through the tubing going through that area which gummed up the area, a few days later allowed to go home and no further problems. Today had endoscopy, different urologist, found tissue fine around entry into bladder but prostate otherwise grossly enlarged. This doc recommending TURP. Of course very concerned. Any thoughts?

  37. Kenneth Knox

    My recent personal experience with the GreenLight procedure.

    At age 55, and after being on Tamulosin and even advodart to treat BPH, those meds finally failed. I had the typical symptoms of urgency, hesitancy, weak stream, difficulty stopping the stream, and up several times at night to urinate. I had enough of all these symptoms and was informed by my urologist in the Boston area about Green-light laser surgery. He was right up front about how it works, what would happen the day of surgery, and YES even the loss of ejaculation. I knew this going into the procedure. I was in the O.R at 7:30am and home by noontime with a catheter in with instructions to return to the office the next day to get the catheter out. There was absolutely no PAIN from the procedure. The catheter was more painful as it irritated the tip of my urethrea. They took the catheter out and gave you a urinal to go home and drink as much as you can, urinate in the urinal and bring it back later in the day as they scan your bladder to see if you have any residual urine in there after urinating. I went home happy that the catheter was out, but could not urinate, I tried as hard as I could, but could not void. Back to the office in the afternoon and the catheter was back in for another day with instructions to return to have it out, go home, drink and back for another scan. This time I was able to urinate, and was proud to bring my urinal full of urine to the urologist office. They scanned my bladder after voiding, and it was all good. I feel great, glad I did it, and would definitely recommend having the GreenLight laser procedure done.

  38. Gregory Rober

    Three weeks ago, I had a HoLEP operation by Dr. Ramsay Kuo at Saint Peter’s Hospital in Albany NY. I live in NYC and could be operated by Super Duper surgeons at any Super Duper Hospitals in Manhattan, but after I heard and read numerous reviews about Dr. Kuo, I’ve decided to travel to Albany NY. I’m so glad, I did. Dr. Kuo is an exceptional surgeon. His professional skills, experience and willingness to go above and beyond his duties — makes him one of a handful surgeons who perfected HoLEP to the point that immediately after my surgery I had no pain and stopped taking pain medication one day later. The catheter was removed within first 20 hrs after operation. The high rate of flow was so strong and quick, that I could hardly believe it. Before this operation I was catheterized for 3.5 months and all good doctors here in NYC were not able to do HoLEP–The 21st. Century New Gold Standard for very large prostates. I’m so happy that I did the research and found Dr. Kuo, and his team of OR’ professionals, as well as, the Saint Peter’s Hospital’ 6McAuley Team of nurses, who cared for me after the surgery. I will always remember their professionalism and friendly attitude. As a result: it took only 3 weeks for me to return to my usual activities, including work and exercises. I have no issues or problems otherwise associated with any surgery. No uncontrollable leaking(incontinence), no ED, no pain or discomfort. I feel great! I highly recommend Dr. Kuo and Saint Peter’s Hospital in Albany NY.

  39. GARY SIMONE

    ALL,, been on Flowmax for 2 months and side effect, ( dizzy light headed ) is to much to take, It works GREAT no doubt but time to get off meds,, I am looking at GL, I have a uro who I really trust,will look into Holep,, Any suggestions

    • Richard Stripling

      I had the GL procedure and am amazed at the comfort post op and the stream of urine is like the teenage years BUT now I suffer from retroejaculation and no orgasm. It’s horrible. I would never have let the doctor do that procedure if I had known that. I have no sexual release even with satisfactory erections.
      JUST SAY NO!

  40. Bud Hoff

    Would like to hear more from Khaled on his PAE failure. I hear it succeeds in 80% of cases. Did your IR use the Magellan Robotic or manual? Did you have MRI so prostate arteries could be seen? And where was it done?

  41. Khaled

    I have gone through Prostatic Artery Embolization procedure, but it failed. The IR doctor tried for four hours to find the prostatic artery but failed. I have heard it fails in 80% of the cases. Please avoid it.

  42. philip ryan

    Why is nobody talking about HOLEP, which is purported to be safer than Greenlight? I realize that few Drs. are doing Holmium Laser procedures because it’s only been done here in the U.S. for the last 3 or4 years but, there are excellent places now offering this. i.e., the hospital at the University of Indiana, Mayo Clinic, Leahy Clinic to name a few. I can see no reason for anyone doing TURP with the better alternatives available.

  43. Kelvin

    Kelvin
    Age 50 and started diagnosed with bph 4years ago and was on temsulosin. Since 5 months ago my urologist added the avodart with temsulosin for a month and stopped the temsulosin and prescribe cialis 5mg daily together with avodart. Since I hv experienced a headache with cialis and stop by myself. I had a infection once in last Dec. and second time just now.
    Ever since I see the urologist he suggested to make TURP. But I was very reluctant and keep avoiding to do it. Now he suggest to do a Green light laser.
    What should I do. I never have had to wake up at nights for urinating. I do frequently go for it during the day thou.

    • Richard Stripling

      Don’t do it! I had the green light procedure about 5 years ago. No pain and can pee a stream 8 foot without straining BUT I now suffer from retrograde ejaculation and no complete sexual satisfaction or orgasam. Erection is good but just no release. The doctor didn’t address this before and now downplaying the results.
      Just say NO!

  44. RAL

    Ditto AKB’s comments. The original data is probably ?? too old.

  45. AKB

    This is a great forum. That said, the original article by Drs. Loughlin, Morgentaler, Sanda et al needs to be updated. More information needs to be divulged concerning those procedures that have since received FDA approval; i.e., Rezum, Urolift, etc. Any advice is greatly appreciated.

  46. Paul William

    Hello everyone. I was heartbroken because quickly ejaculation each time I’m having sex with my partner. This have cause a big problem in many of my relationship, not nice to satisfy a woman, i had so many relationship called off because of my situation, i have used so many product which i found online but none could offer me the help i searched for. i saw some few comments about this specialist called Dr. Ogala and I decided to email him on: ogalasolutiontemple(at)gmail. com so I decided to give his herbal product a try. i emailed him and he got back to me, he gave me some comforting words with his herbal pills and I’m now very strong in bed, and i can make love for more than 1 hour. My partner now respect me. Thanks to Dr. Ogala. he have save my life and my relationship. I’m so happy.. For those who are have the same situation should feel free to contact DR Ogala on his Email: ogalasolutiontemple(at)gmail. com or you can also call him on the phone 2348110496023

  47. rick morris

    After considerable research about the various prostate procedures I have found one that isn’t mentioned in this post. It is the Holmium laser or hoLep. This is a procedure that has been perfected by several Drs affiliated with the Mayo Clinic. Specifically Phoenix, Minn, and also in Indiana. Even large prostates can be treated and a very minimal recovery time (usually next day) is required. The success rate is very good as I understand. Apparently this laser is more powerful than the Green Light laser. Please check it out… I am scheduled to have this surgery done in early March. Please check this out it seems very promising to me…

  48. Cecilia Bodine

    My husband has multiple physical condition: Heart problems with prompted the insertion of a defibrillator, double bypass surgery,an aortic stent and, most recently a stimulator placed in his back. Since Nov. , he has has a bladder infection off and on, has been on flomax, and a catheter inserted. The FLomax has done nothing for his Enlarged Prostate. I forgot to say he had a great deal of difficulty urinating.

    Dr. said the bladder infections and difficulty urinating were all related to the enlarged prostate. He still has a catheter in and is on anotherantibiotic for a bacterial infection. Due to all his conditions, Dr. has decided not to try any more meds and wants to do Green light Laser surgery. I’m worried because they can’t get him scheduled until Feb. 27. I wonder how much damage a infection will cause and how much more his body can take. Green Light seems the least invasive. The only thing I don’t light is with this treatment, they can’t take a biopsy. I WOULD LOVE TO HEAR FROM YOU. By the way, my husband will be 80 in March. Thank You …Cecilia

  49. George

    If you are scheduled for the Green Light Laser surgery and are at all concerned about being able to ejaculate afterward (or considering still having children), think twice about it. My surgeon never told me about “retrograde ejaculation” before my procedure, so imagine my surprise 5 weeks after my surgery when I had sex for the first time and nothing came out. He says I may have “some” discharge after 2 years, but from what I can gather from personal experience accounts online, it’s never going to happen. Has anyone been able to have semi-normal ejaculations after the Green Light Laser surgery for their prostate?

    • Richard Stripling

      I had the green light done about 5 years ago and no seminal discharge and no complete orgasm. I’m told there is no way to correct this. I feel we have been grossly misinformed and almost considering putting this info on a billboard close to the doctor office. I’m so disappointed.

  50. Dennis l

    Has anyone had GL for Bladder neck incision? My urologist suggested this as my prostate is normal and he said it would be the best choice. I have had difficulty getting catheters in place for prior other surgeries and my last surgery for gall bladder left me a bloodied mess and worst pain in urinating I ever experienced. This just happened six weeks ago. Now my stream is diminished to half or a quarter what it was and my urologists says a simple quick GL will open up my bladder to allow easier flow. . I am scared to death to experience the burning I had (which was a result of them trying to Cath me prior to my gall bladder left my urethra raw. One of my concerned is the equipment used to be inserted in the penis to do the oppression. I am wondering how much more pain that will cause when it is removed and a catheter is in place. Also I requested catheter stay in place to allow some healing of urethra from the thrama of the instrument used. Again any comments would help.

  51. Dennis l

    Has anyone had GL for Bladder neck incision? My urologist suggested this as my prostate is normal and he said it would be the best choice. I have had difficulty getting catheters in place for prior other surgeries and my last surgery for gall bladder left me a bloodied mess and worst pain in urinating I ever experienced. This just happened six weeks ago. Now my stream is diminished to half or a quarter what it was and my urologists says a simple quick GL will open up my bladder to allow better flow. Any comments to this would help. I am scared to death to experience the burning I had (which was a result of them trying to Cath me prior to my gall bladder left my urethra raw. One of my concerned is the equipment used to be inserted in the penis to do the oppression. I am wondering how much more pain that will cause when it is removed and a catheter is in place. Also I requested catheter stay in place to allow some healing of urethra from the thrama of the instrument used. Again any comments would help.

  52. John Eagle My age is 71 from NY state

    1st post here. I am a 71 yr old man in fairly good health. First, some background info: 14 years prior in 2002 I had the microwave treatment done with the prostatron machine. My Doc at that time (not the same Doc I have now) said it was good for 5 yrs, then I may need to have it done again. Well, the microwave treatment lasted 14 yrs which brings me to the present and the GL PVP.

    I had the GL PVP done Dec 8 2016 by my Urologist who is my age and very experienced in urology and well respected in western Connecticut. My prostate was “average” size, I had all the BPH symptoms (again). After 9 months of treatment with both Flomax (tamsulosin)and Proscar (finasteride) which did not diminish the BPH symptoms, my Uro explained that the GL PVP was the best option for me considering all factors (age, size of prostate, general health, etc etc etc). I said OK do the GL PVP (originally I had requested the TURP whch my DOC said was more risky and required more recovery, and was not really necessary anyway in my case).

    Surgery went well under spinal anesthesia. I was home the same day Dec 8. Catheter was placed in the hosp as a routine step. Catheter removed Dec 12. Some bleeding and minor pain upon urination for 4 days, which is expected. Bleeding and pain gone by Dec 13 (1 week later). For the next 10 days, it was strong flow, no pain, clear urine (no blood), and only a few drops of blood at start of flow and sometimes at end of flow (normal).

    Then at days 17-21 I was noticing some blood flowing at the start of each urination. Flow was still strong, and bladder was emptying, and no pain, just the blood at the start of flow. At the follow up Doc visit on day 21, Doc said it’s normal, will bleed from the healing/scabbing cycle. He said the flow will be clear again in a few days, then even after that I may have some blood flow again from the healing process. So I am guessing blood in the urine after GL is to be expected for a while.

    I am happy with the strong urine flow, no dribbling, no pain. However, there is still a minor frequency/urgency problem which the Doc says should diminish over time. The urgency and frequency now is not as severe as before. Hopefully it will disappear soon. It’s almost as if I have been given a new urination plumbing system. Of course the retrograde ejaculation can be expected, but that does not concern me at this age. I have not had sex since surgery, but I expect that to be back to normal, judging from the way I feel now. I will post updates as things change. So far, I have no regrets about doing the GL PVP.

  53. Gary R

    Just a follow up. One year ago I had green light surgery. I’m in my 60s and have a very large prostate. My main problem was having to wake up many times a night to urinate. It was very tiring to say the least I was living with it until one nite I came home after dinner and for the next 12 hours I was unable to urinate. I went to the emergency room and for the first time in my life I had a catheter placed. I knew it would only get worse, so I opted for the green light. The first six months were wonderful–I slept 7 hous before having to urinate. Now I can sleep 4-5 hours before urinating. Definitely a welcomed change of life for me. It’s a shame the only posted stories are negative. Why? Because those men who had positive results have no interests in following a prostate blog.

  54. Lee Elliott

    WTF??? Seems we are F**ked whatever we decide 🙁

  55. Thomas h Simpkins

    What about UROLIFT?????????

  56. Gary R

    Thank u Dr. Berry. Very formative in expressing that no one procedure works 100%of the time. Patients should not blame their doctors for performing surgery that do not produce desired results. Other doctors should express their opinions.

  57. Dr Alex Berry

    Hello.

    I am a urologist who trained with all these doctors at the Brigham and Beth Israel and have been working in Western Massachusetts. Reading through this blog there appears to be some confusion for many of the people logging in regarding management of bladder outlet symptoms.

    First some definitions.

    BPH is benign prostatic hypertrophy – prostate enlargement. This does NOT mean you will have symptoms of weakness of stream etc. It just means your prostate is enlarged. 2/3rd of people with symptoms have enlarged prostates. 1/3rd of people with symptoms have smaller prostates. There are many people who have enlarged prostates and NO symptoms.

    BOO – or bladder outlet obstruction. Is the term applied for men who have prostate symptoms. The symptoms tend to be either predominately obstructive (weak stream) or irritative (urge/frequency).

    For most symptoms an alpha blocker like Flomax is first line therapy (it relaxes the smooth muscle of the prostate). If you have a larger prostate (PSA > 2.5) Finasteride/Dutasteride is very useful (slowly shrinks prostate tissue by 25% over 3-6 months).

    The choice of procedure really depends on the size of the prostate and if obstructive symptoms dominate over irritative symptoms. All of these procedures address obstructive symptoms better than irritative symptoms. This is because irritative often represent bladder instability which may not be addressed by an outlet procedure

    As a note – Mechanical methods such as the urolift do not tend to provide good, durable results (3 years or longer). Urolift was not comparable to any of the methods described below. For similar reasons heating and cooling procedures (TUMT) have fallen out of favor.

    Smaller prostate – 30-40gm
    The British have always said Incision of the Prostate (TUIP) is best in this circumstance. Very low risk of retrograde ejaculation. Can be done in the hospital or in the office with a dual wave laser (that is where I do 80% of them). Catheter for 1-2 days. Good option for younger patients.

    Medium Prostate 40-80 gm
    Multiple available options depending on the size and shape of the prostate. Embolisation (PAE) requires sedation and artery access in the leg (risks of bruising). It works by blocking the artery in prostate leading to death of prostate tissue that then sloughs off. In clinical trials has not been as successful as any of the channel forming procedures (works 60% of the time vs 80% plus with other procedures). This is probably due to the variable shape of the prostate and variable blood supply. These issues can be addressed only at a channel procedure.

    Channel procedures
    Classic TURP – most durable of any procedure. Highest rate of retrograde ejaculation. Normally overnight hospital stay. Catheter for 3-5 days.
    Green light laser – same day procedure. Associated with more urge and frequency than other procedures. Therefore not a good first choice if urge and frequency symptoms predominate.
    Holmium laser enucleation – same day procedure, Catheter for 3-5 days. Technically more demanding than other procedures. Has same durability as TURP.
    Dual wave laser – medium lobe abalation – similar to green light. Can be done in the office. Catheter for 3-5 days. Good first choice for office procedure. This has replaced TUMT in my practice.

    Large Prostate 100gm plus
    Simple open prostatectomy.Either transbladder or Millen technique. 3-5 day hospital stay. 14 day catheterization. Suprapubic tube. Very effective when circumstances required. There are some surgeons who are starting to try this robotically. There have been complications reported from bowel injury.

    How to choose what to do?
    – Find a urologist who does a range of different procedures particularly TUIP, TURP, some type of laser in office, some type of laser in operating room.
    – know that depending on symptoms some procedures will cause different side effect profiles

    What if I have had a procedure already?
    You should have urodynamics to confirm it is a prostate problem not a bladder problem otherwise a prostate procedure could make things worse

    The vast majority of patients have significant improved symptoms after a procedure. However 100% success cannot be guaranteed. If you have a good response to medications like flomax you are likely to have a good response to a procedure.

  58. Layla Forndez

    I have been following this blog for a while now and today i felt like i should share my story because i was a victim too. I had endometriosis for 18 years and i never thought i would ever get a cure due to the terrible symptoms i had and this made it impossible for me to get pregnant even after 12 years of marriage and it was a serious issue. I got to know about Dr. Aleta who treated someone and the person shared a story of how she got a cure and let her contact details, i contacted Dr. Aleta and she actually confirmed it and i decided to give a try too and use her herbal medicine that was how my burden ended completely. My son will be 2 this december and i am greatful to God and thankful to her for medicine too. If you have (Endometriosis, PCOS, Fibroid, Ovarian cyst, Ectopic Pregnancy or any infertility issues) just reach her on (aletedwin @ gmail. com) she has professional advise and a cure too.

  59. chowdhury

    First of all I am really pleased to read all comment here .I am now 63 years old ,but i do not know prostate as before ,once time my doctor advised me take sonogram of my prostate ,then doctor trace me my prostate enlargement 60-70% then he prescribed urimax cap ,i have taken two month ,then stop suddenly one day my urination stop,running urine several time per day ,again go to doctor he advised me pbs test ,again sonogram and admit me hospital insulted cather urologist operation TURP in the year 2013.but i have question my penis do not hard now my sexual now 75% lower ,how I can sexual strong again ? pleased advised me

  60. chuck wilson

    my urologist said they quit using urolift due to infections and atones related to metal left in . don’t know if they had a lot of these issues or just determined it was a concern.

  61. Mala Mukund Joshi

    My age is 72.

  62. Mala Mukund Joshi

    I had undergone TURP operation of the prostate during 1989, for frequency of urination,pelvic pain,urgency,unable to hold,week stream,hesitancy etc.But I did’nt get the desired results.Presently,the condition is a status quo.I had no side effects after the operation.Can anybody answer as to whether I can go for a repeat TURP?The doctors say that removal of prostate may not help.

  63. Mikail

    I understand that private insurance will not pay for PAE. What is the out of pocket cost for those who have had it done.

    My urologist is pushing UroLift and also talks about TURP. At 54 there is no way I will even consider TURP, too many horror stories. The recovery time for UroLift is 4-8 weeks, not sure if I can afford that kind of down time as I do not get paid if I am not at work.

  64. Hector Ramos

    I am interested in Urolift. I live in Monterey, CA. I would like to know if there is a Urologist in the Monterey-San Jose Area that has experience doing such pocedure.

  65. A.NATARAJAN

    FOUND VERY USEFULL

  66. Francisco

    Is it necessary to get a surgery for the benign prostatic hyperplasia? in my case I take a supplement named alpha rise and it has changed my life for better, it has improved my prostate health and the bph symptoms are just past, I dont need to wake up in the middle of the night to pee anymore, I also pee way more that I used to, I didnt need any surgery to cure it. I hope it helps

  67. Reddy A

    My father aged 85 has hypertension and diabetics issues, but both in control with medication. He is diognised with 90cc prostate, facing complete urine blockage and using catheter for the past 4 weeks. Being an x-smoker, he has weak lungs. His criotine levels are high at 1.9%. Our ruogist is of the opinion that he should try medication (use DUTAS) for 3 months and come for a review. Due to advanced age and weak organs, surgery is quite risky according our urologist.YOUR OPINION PLEASE.

  68. tom sheley

    September update from Tom

    Note sent to some of my friends after my TURP

    Almost half of all men over 50 experience some symptoms of Benign Prostatic Hyperplasia (BPH) where the prostate increases in size and radually pinching the urethra, leading to bothersome or uncomfortable or painful urinary symptoms that may include a weak stream, trouble starting and stopping, frequent feeling of needing to urinate, greater urgency when the feeling hits, leaking or dribbling, and the sense that the bladder isn’t empty after urination.
    BPH is probably a normal part of the aging process caused by changes in hormone balance and in cell growth (older cells do not die + new are still being created) as we age.
    About 50% of men between the ages of 51 and 60 and up to 90 percent of men older than 80 experience the effects of BPH, although I have talked to some men that when they were in their 30”s experienced the condition (Doctor told them they had an “old man’s issue”).
    Disregard the following if BPH is not an issue for you or if such discussions offend you.

    Because many of you are aware of my experience last Spring while in China with pain associated with a very full bladder, I thought I would update you on what happened before I went on the trip and after I returned home:
    #1 Following my annual physical Last December (finger wave and PSA test = NO signs of cancer but a noted slightly enlarged prostrate) and my complaint of having to “go” often, I was referred to a urologist for further consolation. The Urologist (with a very poor bedside manner = Gave me the impression I was wasting his time) noted no special concern within my upcoming trip and told me to come back and see him in 60 days.
    #2 Three weeks into the trip I started to notice a sharp pain in my lower left back. Fellow travels and the Chinese doctor on our River Boat part of the trip noted a possible kidney stone and suggested I drink Lots Of Water! = That was a mistake!!!!!!!!!!!!!!
    #3 Due to the pain and inability to sleep = Emergency room attention in China was NECESSARY at 11 PM –> 1 AM (they did a full physical / Ultrasound / Blood test by three nurses and one doctor) ended up installing a traveling Cather (which I greatly appreciated) and thus allowed me to continue my trip on to Thailand. Whole cost was just under $100 and it was a nice hospital.
    #4 When I came back home, a New Urologist (lady doctor) had the Cather removed, conducted various test, instructed me to perform self-catchers 3 times a day and to start taking Tamsulosin .8 MG once a day. Tamsulosin (Generic Flowmax ) is an Alpha blocker and is supposed to relax the smooth muscles of the prostrate and bladder neck to improve urine flow an reduce bladder blockage. FYI -Other medications under the names of terazosin (Hytrin) / doxazosin (Cardura) / alfuzosin (Uroxatral) / silodosin (Rapaflo) also do the same thing.
    #5 SELF CATHER at first was very UNCOMFORTABLE for me and I reduced the process to only 2 times a day.
    #6 One month following #4 the doctor also put me on Finasteride (generic for Proscar) which is a 5-Alpha inhibitor that blocks the product of DHT (dihydrotestosterone) which contributes to prostrate growth. Side effects of the medication were; dizziness, decreased sexual drive, a little depression and problems with ejaculation (minimal flow). FYI – Another 5-Alpha medication that does the same thing is dutasteride (Avodart)
    #7 Not happy with the side effects of 5- Alpha Finasteride the doctor noted that the effects of this drug (to reduce the size of the prostrate) take 4-6 months and to hang in there. After about 4 months I was down to self-cauterizing only once a day (just before bedtime = so I Could sleep through the night) and not feeling my normal self.
    #8 Into the fifth month I wanted to GET OFF those pills (especially the Finasteride) and talked to the doctor about other options. I had already researched all the options of which some are minimal evasive and conducted simply within the office (where they use heat or microwave to burn a path or a stint to enlarge the urine path opening through the Prostrate) or an in hospital process where they use a sharp cutting device within the urinary track called transurethral resection of the prostate (TURP)
    #8 I chose the TURP process as it was the only one that did not destroy the tissue material as part of the process and thus allowed a biopsy of the removed material. Additionally the TURP process had a better track record for effectiveness up to 10 years verse every couple of years with the less evasive processes (plus the stint format may prevent the use of other options in the future). There were “other” options of using an over the counter product like Saw Palmetto, but I felt as though I wanted quicker results and wanted to get off taking PILLS. My research identified that TURP Surgery rarely causes a loss of erectile function, with some men finding a slight difference in the quality of orgasm after surgery. However, most report no difference.
    #9 Went in last Monday for the procedure which is done in the hospital. The actual procedure is done under Anastasia where they put this “thing” that contains a camera / lights / tools / flushing water up your wine, and they scrape (enlarge) the upper part of the inside of the urinary track as it goes though the prostrate. The actual process took less than an hour followed by about an hour in Anastasi recovery before you are sent home with this GARDEN HOSE Cather up you winey.
    #10 The “Installed” Cather (something like the one I received in China but much bigger) is used to pass any residual solids that may show up and is a little uncomfortable for a short period of time but only at the point where it exits the penis (foreign object feeling). Yes blood did show up the first day, but by day #2 it was much less and by day #3 the liquid was normal clear urine. There was no internal pain and the only hassle was trying to sleep with this tube sticking out your penis (for a person that normally sleeps on his side and moves around a lot).
    #11 Day #4 in the doctor’s office they removed the Cather followed by no blood or pain urinating. Results of the biopsy of tissue was NO signs of cancer. The only discomfort was for a day or so with the end of my penis a little sensitive.
    #12 I waited until day #7 to send this “report” out to anyone that may be interested. My urine flow is full force and very manageable. Limitations from my Doctor is “take it easy for a week or so” (I am out OK walking three miles a day) “No lifting heavy loads for a couple of weeks” and “No sex for six weeks”. Doctor noted that with the removal of the material at the top of the Prostrate (where the bladder dumps into the prostrate flow area); when ejaculation does occur from the prostrate the flow may take a path of less resistance and go back up into the bladder verse out through the penis within ejaculation. If so such exits the body afterwards reduces such within normal urination. I have already experienced this reduction of fluid during sex as the result of using that yuck = A- Alpha Finasteride, but found that the “super highs” of sexual ejaculation were somewhat reduced, but it then allow me to recover faster.
    Again I am just sending my experiences along to some friends as I have found most men do not up front talk much about this BPH condition and a some resist doing a lot about it except suffer on. There are TONS of information about BPH and TURP on the internet and from your doctor. If not and you have a BHP issue then learn to self-Cath and take one along on any trip.

    HAPPY CAMPER!!!
    Tom

  69. James

    Is it neccesary to have a surgery for the bening prostatic hyperplasia? because my friend had it but he didnt need it to get better, he wanted to solve it by taking natural supplements like alpharise, it has been effective on him.

  70. Sir Peesalot

    Any experience with Rezum (steam induced heat obliteration of the prostate tissue). Looking for alternatitives the the horrible procedures discussed above. Also – urolift sounds relatively positive, but why wouldn’t a aterial-style stent work in this application?

    Thanks for any feedback

  71. G. Gilbert

    Does anyone know anything about Plasma-Button Vaporization TURP. This is the newest procedure for an enlarged prostate. Outpatient surgery with a catheter for only 3 days. Anyone have this surgery? what were you’re results?

  72. Jayesh Jani

    Nice Blog .
    Thank you for sharing this post.

  73. Tom

    Oh I forgot

    I forgot to note that my prostrate is not overly enlarged and my PSA numbers are normal for my age.

    Tom

  74. Tom

    I am 71 and for the last 3 years have had small volume urination issues. Situation got worse during a trip to china where I though I had a Gallstone issue (pain in the lower back) and was told to drink lots of water. After three days went to the Emergency room. Ultrasound noted a full bladder. Cather installed and 1,400 ML of liquid was released within a 5 minute period. On returning home (and having the Cather removed) Urologist doctor put me on Tamsolosin (generic form of Flow Max) .8 Mg (to open up passages) and Finaseride (to reduce the size of the Prostrate) 5 MG for 4 months.

    Initial reaction was excessive testicle pain (which eventually went away after about two days), there was also some mood side effects (Tired and not acting like I usually did about “things” & being tired) and a total loss of Fluid during ejaculation. This loss of fluid really bothered me at first but I eventually accepted the lesser sensation of climax and have a good sex life with my wife.

    I told my doctor I wanted to get off of medication to get my mood / interest / drive back and am now scheduled for a TURP in three weeks.

    I understand there will be no ejaculation effect (like I am currently experiencing with taking the Finasteride) thus I do not fell that such will be a problem for me.

    Hope I succeed with the operation and this is just a note to those others that feel totally robbed of their Youth ejaculation sensations and might find it manageable with a lower peak during sex. One side note about the lower peak = I find I am now more quicker to respond to more sex (and arousal) sooner after climax then when the climax was more “peak-ish” in intensity.

    Tom

  75. Young

    I came across this site while I was researching different options for treating my husbands BPH problems. I m interested in finding out if there is a clinic who performs PAE procedure hear in Seattle ? After reading a couple of postings here and elsewhere PAE procedures sounded like a
    a god alternative. My husband’s doctor recommended urolift, but he is going to do this procedure in his clinic beginning this winter. Don’t know if we can trust a doctor who doesn’t have a lot of experiences in this relatively new procedure. Sounded like he has done a lot more green light and plasma Button. I haven’t seen any posting mentioning plasma button. Anybody with that procedure? My husband is 75 yrs old, fit, relatively healthy. Appreciate any info concerning the PAE in Seattle, or Urolift in Seattle.

  76. Dan

    The Urolift procedure is a mechanical fix using paired clips to provide a widening of the passage. Think of the paired clips as: |—|, where the “|” are clips and the dashes are suture material connecting them. My urologist says that the “inner” clips can later be cut loose (only on the inside part of the prostate, not on the outer side where the “partner” clip is placed). So, there is some degree of reversibility, unlike surgeries that remove tissue.

    From viewing online film of the procedure and listening to urologists’ discussions during the procedure, the number of paired clips is determined during the surgery as needed to ensure an unrestricted passageway. Their discussions indicate that it takes 10+ patient surgeries for the urologist to become fairly competent.

    There is the possibility of the prostate growing which might require later additional surgery. Also, “However, in about 10% of patients removal of implants that protrude into the bladder is required as they can lead to stone formation (encrustation).” http://www.newyorkurologyspecialists.com/bph/urolift/urolift-problems-complications-side-effects/
    Typical time for this to happen? Seems to be about 3 years – but that will vary quite a bit from patient to patient, I think.

    My decision is to use medication for 6 months to a year to give my urologist time to get up to speed, then I’ll have the Urolift procedure done and I’ll be good for several years, maybe 5-10 years. Sounds the best quality of life option for me at this time. Unlike TURP, this might allow another procedure that becomes available 5 years from now.

  77. Steve Hamiltoon

    I’m have PAE done this fall in Michigan.

  78. Richard Merrifield

    I am 81. I have an enlarged prostate and multiple strictures resulting from an old TURP operation. Recently I have had 3 UTI infections. Urinary retention is the most likely cause of the E-Coli.UTI infection according the E.R. at York Hospital, Me. I enjoyed reading the above medical options, and I am ready to schedule one of the above procedures, preferably Microwave.The fact that I have multiple strictures from an old TURP or inflammation, is the Microwave still an option? Also, does A. Morgentaler MD. still perform this procedure? Any comments will be appreciated.

  79. Bil Dair

    I am 89yrs old and have an enlarged prostate. Right now I am using a foley catheter.I am thinking about using the urolift procedure,my doctor does recommend it,the reason being that my prostate has gotten too large. Your opinnion

  80. Murray

    I’ve been managing BPH using herbs and acupuncture. In the Chinese system, the enlargement is often linked to weak kidney chi, and when I went to a TCM practitioner 6 years ago, I had bad frequency and urgency issues. After the first treatment using 8 needles, I was amazed the same night when I did not need to urinate for almost 4 hours, as compared with the frequency issue before treatment. The enlarged prostate was also confirmed digitally and with ultrasound. I used Chinese herbs for a while, but now use primarily tinctures of nettle root and saw palmetto. Both herbs and especially nettle root have a good reputation for improving flow and reduction of urinary retention. Tinctures are better in my view than capsules, and one can definitely observe their good effects. Don’t like using drugs in general, and particularly with the mention of high grade cancer linked to some prostate drugs. Turned 68 recently and have been researching available methods just in case I need to do more at some point. The heat based methods discussed in this Harvard discussion sound interesting and not too invasive, and therefore have appeal to me. Will be good when we move on from the dark ages. Seems like biopsy will be a thing of the past in not too distant future, with developments in MRI, more refined PSA etc. I think too many get pushed in that direction, but then that’s more about cancer than BPH, which this article is about.

  81. Murray

    I’ve been managing BPH using herbs and acupuncture. In the Chinese system, the enlargement is often linked to weak kidney chi, and when I went to a TCM practitioner six years ago, I had bad frequency and urgency issues. After the first treatment using eight needles, I was amazed the same night when I did not need to urinate for almost four hours, as compared with the frequency issue before treatment. The enlarged prostate was also confirmed digitally and with ultrasound. I used Chinese herbs for a while, but now use primarily tinctures of nettle root and saw palmetto. Both herbs and especially nettle root have a good reputation for improving flow and reduction of urinary retention. Tinctures are better in my view than capsules, and one can definitely observe their good effects. Don’t like using drugs in general, and particularly with the mention of high grade cancer linked to some prostate drugs. Turned 68 recently and have been researching available methods just in case I need to do more at some point. The heat based methods discussed in this Harvard discussion sound interesting and not too invasive, and therefore have appeal to me. Will be good when we move on from the dark ages. Seems like biopsy will be a thing of the past in the not too distant future, with developments in MRI, more refined PSA etc. I think too many get pushed in that direction, but then that’s more about cancer than BPH, which this article is about.

  82. Patricia O'Halloran

    My husband had green light lazer about 4 yrs ago—-he had
    some problems following surgery—catheter blocked because of clots–therefore readmitted to hospital, with continuous saline irrigation , until return was clear—Since then about 3 times each year he has had excessive amounts of blood in his urine, with clots which usually lasts 24 to 36 hours—his urologist says “don’t worry about this unless it continues for a couple days” No further explanation from
    him—What can be causing this? Blood in the urine always
    means a trip to the Dr. and some tests to determine what the cause is!! We are concerned it could be cancer in the bladder, as he had a cyst (benign) removed since the green lazer surgery—Should we ask for a 2nd opinion

  83. Tom

    What is the difference between thulium laser and HOLEP?

  84. Tom

    Does any one here know about the thullium holpe laser for BPH. I not only have that but I have urine retention and because of that bladder stones. I am told that there is a doctor named Okekee who does both holep and thullium procedures he is very good Im told. Does any one have any inform on plasma button procedure or Urolift or PAE OMG so many decisions

  85. EG

    I had green laser light surgery. The only way i can explain the side effect is that my penis seems to have contracted, and I constantly have to adjust it. Have you ever heard of a side effect like this

  86. G R

    I am 69 years old and have a very large prostate. After suffering with urination-most importantly waking up 4-5 times a night- I had Green Light Surgery. 7 months post surgery I am a new man. The surgery itself and the recovery period were minor. I now sleep 4-5 hours before I have to urinate. Wow what a difference. The only negative is that although many surgeries result in retrograde ejaculation, my ejaculation pours out instead of shooting to the ceiling. Basically the same feeling.. Surely a negative like retrograde ejaculaion is well worth the benefits of living a more comfortable life.

  87. Lyndsey Keene

    Lyndsey Keene
    There is a newer treatment. It is called PAE (prostate artery embolization ). It’s worth googling, it is a
    radiology procedure. Most urologists don’t or won’t advise you of this and many don’t even know of this procedure.

  88. Curtis Ruben

    Contact Dr. Royal for sexual problem Azukaspellcaster @ outlook. com he help me to Enlarge my pines.

  89. Tom

    Well I m looking at either plasma button turp or thullim/holep laser. Id sure appreciate anyones input

  90. Tom

    Im worried about long term and maybe permanent incontinence after any of the above procedures. I was told that retrograde ejac is a given after effect.

  91. Tom

    Does any one here know about the thullium holpe laser for BPH. I not only have that but I have urine retention and because of that bladder stones. I am told that there is a doctor named Okekee who does both holep and thullium procedures he is very good Im told. Does any one have any inform on plasma button procedure

  92. Sandra Candy

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  93. Krypton

    Krypton
    I have had bph for 20years in 2005 had GL..My prostate kept growing to 175 gms..all my local ur wanted to do is more proscar…flowmax etc.
    The drugs alone were debilitating..I was wearing a cath for 7 mo. and the prostate was hindering its flow..so large. I opted for Simple supra open prostatecomy. I am 65. The prostate is hollowed out but the shell ,nerves, sacks, shell are left and sujured. Recovery is 4-6 weeks but reblockage is extremely rare No more pills..special diets etc…infections rates are down..My prostate was baseball size …so gl even homium or turp were out of the question and my prostate was growing at 30grm/year rate. Please know that this option takes more time to recover from but like my surgeon who does both gl & homium said..If I gl or homium you ..you will be back in a year on such a large gland. Since cancer was not discovered it may be worth putting this Monster to rest once and for all. Also too that even with gl or homium you will still need to be on drugs because this puppy will
    contiunue to grow. But this surgery is more involved
    The very best to you all

  94. ericl

    I developed urinary retention in August of 14 and needed to go to the emergency room where they inserted a catheter(I am a 75 old male in excellent health).After visiting my uro he put me on Flomax and removed the catheter after four days after which I had no trouble urinating while on Flomax.Flomax continued to work well for me but I decided I wanted to be off Flomax and had TUMT done in March of 16.The procedure was a breeze no pain just a little uncomfortable with Lidocaine sedation of the urethra.In and out in less than two hours.I was on a catheter and Flomax for four days during which i observed some bloody tissue secretions around the tip of the penis which stopped after a couple of days.The catheter was removed after four days and while remaining on Flomax I had no trouble urinating although the frequency particularly at night was high at least five times.The frequency and stream improved significantly over the four weeks after the procedure and I was taken off Flomax after four weeks.The frequency and stream continue to improve and now three months out I do not have to get up at night and the stream is good to very good.I feel that I am continuing to improve.I judge this procedure to be excellent especially since my prostate was large ie 110cc.No sexual problems were encountered.

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  101. Robert Lee

    Hello All,

    I have had an enlarged prostate for years and finally had a TUMT (microwave therapy) in 2012 at age 60 with no improvement worth mentioning. In 2015, my Urologist wanted me to have a TURP. My neighbor who is 70 years old, has the same Urologist as I do. He has had two TURPS, goes through four diapers a day, and is impotent. Naturally, he is very depressed over his situation and outcome.

    Last spring, while researching, I came across a procedure called Prostatic Arterial Embolization, or PAE. It is a noninvasive, non-surgical procedure and is performed by an Interventional Radiologist, not a Urologist.

    I discovered that this procedure was being performed in St. Louis, which is close to where I live, so I contacted the hospital. I went in for a consult, and they accepted my case. Last June, I underwent embolization of both sides of my prostate successfully. I was discharged the same day, without a catheter It has now been a year and life is good, I am 64 years old and teach college. The PAE procedure has left me with no side effects, no incontinence, no retrograde ejaculation and no impotence. I feel so blessed to NOT have had the TURP and have avoided the misery that it has caused for so many men.

    By the way, when first talked to my Urologist about getting the embolization procedure, I thought he would be happy for me. Instead, he threw a major fit in front of everyone in his office and had, what I would call an adult tantrum. He was very disrespectful and stormed off yelling that I would indeed be back to see him, and warned me just to wait and see!!! He acted like a total brat.

    I fired this doctor on that very day and will never, ever go back. I make it point to tell every man I know with prostate problems to avoid this doctor and all of his colleagues in his practice, at all costs. I firmly believe that Urologists don’t want the PAE as a choice out there because it is competition and will hugely cut into the money they make by performing a TURP on the enlarged prostates of unsuspecting men.

    I came across this site while reading tonight, and felt compelled to share my experience with Prostatic Arterial Embolization and I heartily recommend it to every man suffering with BPH. It is not being performed everywhere, so be prepared to do some searching. You will be very glad that you did. Good luck….Robert

  102. Carl

    Thank you everybody for sharing your stories. I am 70 years old.

    I had a hip replaced at the end of February and found I couldn’t pee after the operation to give a sample, so was catheterized for the first time in my life. This was quick, only in long enough to drain my bladder. I had been given a spinal for the surgery and was placed on Hydromorphone for pain in the early stage of my recovery. But the trouble I had with peeing continued and I had to have another catheter installed for a 4 – 5 day stint. My doctor removed it and I went south to Victoria, Canada to meet again with my surgeon. Well, I couldn’t pee again and after a painful night, was taken to emergency to have my third catheter. The operation for the hip actually opened the door for a long-standing problem already developed in my body, and that was a distended bladder (and unknown to me, an enlarged prostate that had been affecting both my urine stream and my semen production). I had been carrying about 2 1/2 litres of urine around with me but never able to void entirely. This catheter stayed in for an additional 2 weeks, during which I developed a severe urinary infection (Big Surprise!). I was to have met a urologist in Victoria, but was hospitalized instead for 5 days. They managed to get the infection cleared up, but I still needed a catheter (#4). My urologist is the top urologist in Canada. He tried to shrink my enlarged prostate medicinally. Yes, flomax, etc. After another 3 weeks at home, I went back to him and the prostate had not shrunk and I still couldn’t pee on my own. He is a specialist in the Green Light Laser treatment (over 800 done) and recommended it over everything else. He did explain what might go wrong, but was clear to point out that nobody that he had treated had had to deal with any of these problems: failure to pee, incontinence.

    The operation is quick, needing anaesthetic in the hospital, is less invasive that other methods, and you are guaranteed to pee within 36 hours. By this point, I was so grateful to have my urinary function back and to be done with catheters.

    I was aware of the retrograde ejaculation. I have always been very sexual my entire life, so this was a major concern. But I felt I really had few choices. I am a gay man so won’t be fathering any children. Even so, I was concerned about the nature of my sexual climax. I have found that, after 3 weeks since the GL treatment, my climax is improving, although there is no semen. A bit strange after a lifetime of mopping up, but I’m so glad to be peeing again and not having to endure that pain. I don’t expect miracles. But the retrograde business is something you’ll have to deal with. Plus, coming to terms with a new kind of climax. Much of life is all about loss. I have just had to wrap my head around it and be grateful that there are treatments to help you overcome the male problem of having a prostate gland that never stops growing. I hope that this account helps somebody out there.

  103. Dan Pahl

    Dan P
    I started suffering from BPH when I was around 35 yrs. old. It was getting worse after I reached 40 so I started taking terazosin, it seem to help for a few years then it got worse again,I needed some relieve. I decided to go for the TUMT in 2014 and it helped a little maybe 50 percent but I still had to take the terazosin which I was hoping I did not have to take anymore. Two years later after the TUMT I could not urinate again just a few drops at a time, camping on the toilet for 15 minutes for a little relieve was not my idea of a good time. The doctor put me on tamsulosin and I hated it, the dizzy spells and heart pumping fast was not good, it did not help that much anyway. I then decided to go for the green light (PVP), it’s been 4 days now and I can urinate like a fire hose, I’m so thankful for the doctors and staff that helped me. I still have a liitle blood and slight burning at first but that should go away after 4 weeks or so. I’m just glad that I decided to go thru with it,I really did not have a choice, my quality of life is already back to 100 percent.

  104. kenneth ptak

    this is for the men that are looking for something that will not cause retro. I had the urolift a year ago and still going strong. It is better they all the others. I would never give up anything to get something why should be Ken

  105. Scot W

    I am 72 and have had issues with BPH for well over a decade. My prostate had been as large as 188 in size with normal range being 25 to 30. I have been taking Flomax, then added Avodart 6 or 7 years ago, and changed to Jalyn (Flomax and Avodart in one pill). The Avodart shrunk my prostate by about 20% over the course of several years and I was only having to get up once a night to pee. However, there are lots of side effects for me. They include ED and lack of energy and sex drive. The drug dries up your prostate and I have virtually no semen. About a year and a half ago, I quit taking Jalyn and went back to flomax only. I had more energy but still issues as I think the avodart, over a long period of time forever dries out and hardens the prostate.

    I am a former bike rider and used to ride a life cycle almost every day plus went bike riding using the older seats, which of course causes injury to the blood vessels surrounding the prostate. I also take blood thinners and I have had periodic blood in my urine which has been diagnosed as coming from the super large prostate, stretching the already damaged blood vessels. Sometimes I would pee red urine with clots in it, pretty gross looking and sometimes would cause an infection of prostate.

    This past Sept. after being off the avodart for close to a year, I awoke one morning and my shorts and bed were covered in blood. Lots of blood. I needed to pee and peed blood and lots of it. The blood did not bother me so much as I had peed blood in the past but never leaked blood. I called my urologist and he told me to come right over and before I left the house, I went to pee and was completely blocked. As soon as I arrived at his office, he inserted a catheter that allowed irrigation of my bladder and sent me to the hospital right down the street. I spent 3 days in hospital getting constantly irrigated and stopped the blood thinners. I went home with a catheter and a couple of days later went in and he removed. The bleeding had stopped and in doing a sonar-gram of my prostate is was ascertained that it had grown back to the 180+ range and that coupled with blood thinners caused the severe bleeding and blockage from the blood clotting. I have been off blood thinner and back on avodart ever since and have had no bleeding since. My urologist does the microwave treatment but it is not recommended for super enlarged prostate but it has been done effectively. I have also gone for a second opinion to one of the most skilled urologists in my metro area. He recommends the green laser. After reading all of the personal reviews, I am like most of you. Unsure of what to do.

    The one thing positive about BHP. I have been told by multiple urologists is that apparently men with very large prostates have a much lower chance of getting prostate cancer, that may be in conjunction with taking avodart I am not sure. I am going to do more research and hope more men contribute to this site so I can check back and learn from others. Thank you to all both the Dr’s and the contributors for sharing this info.

  106. Glenn S.

    I had lived with BPH for over 10 years after a severe reaction to Flomax. (Taken to ER unconscious with BP of 65/35 after one dose.) I’m 77, was in very good health, active hiker and bike rider, but being up 3-5 times every night led to my being steered by another doctor to see a urologist. After assessment, urodynamics testing, I was told I should have TURP procedure. I had never had a blockage, UTI or had a catheter in my life. I was always fully continent. It just that I had frequency of urination and required some time to eliminate.

    In March, I had the Green Laser TURP procedure performed in the morning using a spinal block. I was released that afternoon with a catheter and instructions to come back the next morning to have the catheter removed. The next day, a Friday, it was removed. I was wearing Depends and had leakage which I expected. The next day, I noticed in the late afternoon that I was dry so I thought all was well. It was not, and by 11:30 p.m. I was in agony and not able to pee. I awoke my wife and she took me to the ER. After the delay of checking in, showing medicare and insurance cards and giving two signatures, I continued to wait as there was no ER space for me. (At home, my normally low BP had been 196/95. Finally, a space for me, but then I had to wait for an obligatory and painful ultrasound. Finally, I was given a Foley catheter with 650 ml coming out immediately, and another 200+ before I was released to go home. It stayed in until the following Thursday (Urology office instructions) when it was removed by a technician. After getting home, I became concerned that I might get blocked again, and called asking for an order for a self-cath kit in case of another emergency. ( I had never knew of self cathetering until I looked in up.) I was told they couldn’t/wouldn’t give me the order, so I went to a medical supply place and begged and pleaded until they gave me what I needed. I did require the self cathetering that weekend, and several more times in the following weeks.

    It is now nearly 7 weeks after surgery. I am still totally incontinent; I don’t leak, I drain if I stand or walk. Only by getting horizontal can I retain enough to need to go to the bathroom. (I do get up at night two or three times, usually producing 400 or even 500 ml of urine.

    Needless to say, this has adversely affected my life. I would love to go for a long hike, but the Depends is too irritating. Anywhere I go involves scouting for a restroom with stalls so I can change the pad that I wear inside the Depends. Will it ever end?

  107. Michael A.

    Mike A – I am an Anesthesiologist with 40+ years of experience. I have given many Spinal and General Anesthetics for urologic procedures for the treatment of BPH. First – I would suggest that you ask your Urologist how he/she feels about using the Green Light Laser and how much experience they have with it. If they like it and use it a lot they’re more likely to do a good job. That said – the literature suggests about a 2.5% rate of reoperation. You may be in that 2.5% in which case you will need a second procedure. Maybe too little tissue was removed with the first procedure or scar tissue formed which caused the problem to reoccur. I would suggest a repeat procedure with the Green Light Laser. I too (at age 74) have symptomatic BPH and after a thorough review of the literature I am having the Green Light Laser procedure. Should it not provide adequate relief I will most likely have a repeat of the same procedure.

  108. Billy

    I had the green light surgery about 3 years ago and although I have not had to go to the emergency room for a urine blockage my flow did not improve that much. However, I did get the benefit of the retrograde ejaculation problem. Recently I have been waking 4-5 times at night to use the bathroom. So, last week I went to see the urologist and he said that my prostate had fused and a small opening was causing my problems. His suggestion was the TURP! TURP is the last thing I want to do because I read that it was the most evasive and could really ruin my sex life more so than the green light has. Are there any suggestions out there?

  109. Peter H

    I’m 62, and have all the symptoms of BPH including getting up multiple times a night. I have a friend who had the HoLep procedure done by Dr. James Lingeman at the UI Med Center in Indianapolis. He was very happy with everything about the procedure and the results.

    I am trying to find someone in the western states that has experience with the HoLep procedure. I know this is a new method option for BPH and there are not a lot of physicians who have been trained.Can anyone provide me with some information on a clinic or surgery center that can perform this procedure?
    Also, can you tell me the difference between the Green Light laser surgey and the HoLep surgery>

    Thank you.Pete H

  110. Jeff

    I’m just starting to research treatment options and I’ve noticed that there aren’t happy postings.
    I’m wondering if anyone is happy 2 years post treatment.
    Its kinda scary being faced only options that don’t work and cause whole new problems.

  111. troy grant

    Troy
    Can we have a vote on TURP, Greenlight Laser or PAE (Prostate Artery Embolism)?
    best to all.

  112. Mrs. Kane

    I am doing research for my husband. He’s just been prescribed Finasteride 5mg. and terazosin 2 mg. today. He’s to take them for 80 days. His urgency and frequency is a real issue. He is in his late 60’s.

    My father had what must have been TURP back in about 1980. It required a hospital stay. At the time of the procedure he was 79 and widowed. Sex life wasn’t an issue. Loss of our sex life would be a concern. I heard no complaints and from what I remember he was very happy.

    My husband was told today that surgery would cause impotence as well as incontinence. Neither is an option for either of us. He’s very active and still works. Up till I read these articles and especially all of your comments. I was onboard for the GREEN LIGHT LASER! Now I’m facing a conundrum.

    Any more information would be appreciated from you who have tried the different options.
    A loving wife.

  113. Philip Henderson

    Phil H.
    I am 68 years old and nave been having problems with getting up at night for about 2 ½ years. Started to take Beta and tried several natural pills but found very little results. Then got with my PCP doctor and he had me to try Flomax, then Avodart, then Finasteride. It is the newest one which was supposed to take care of everything which I have taken for 6 months. I had some small results where I now get up just 3 times a night. Problem there is it has caused dry ejaculations and ED sometimes. I would say that this is more symptoms of bother since I can empty completely and am in pretty good health overall.
    I also went to one of the best Proctologists in Denver who was one of the first to do offer the “Green Light “procedure. After going in to see him he did a scope (Not fun) and found I had a small amount of some scar tissue in my urethra but no cancer and bladder is fine. He cleared out the scar tissue with the scope. I just recently went back in to see him and he now is doing the new “UROLIFT “procedure. To me it looks like it is just a temporary solution. The studies are still ongoing as to how long it will last. They have said that in most cases if the prostrate is still growing, which most seem to do, it will cause issues in a few years and have to be cut out and redone. He is also telling me that I will have to be re-scoped and also do an enema so he can measure my prostrate size to make sure he can do the “UROLIFT on me.
    1) I originally went to him because they said the new “Green Light Laser “ was far better than TURP and did not cause any of the problems it does. Then I hear that it can cause ejaculation problems also. IS that True?
    2)About what % who have the laser procedure come out with that problem?
    3) The TUNA and TUMT procedures seem to be somewhat temporary also but do not show that they cause any ejaculation problems, is that correct?
    I can see why my Dr. wants to do this procedure in office, to make the big money and do more each day, instead of going to operation rooms.
    I’m thinking I want to just do this once and be done with it but do not want to have dry ejaculations for the rest of my life. Which way would you recommend?

  114. Dave

    I am 58yrs old having some urinal problems. My doctor says my prostate is grown very big more than average. I did mrt. No cancer was found. But the doctor claim there are other 2 points that should be investigated by biopsy. I have said I prefer greenlight Therapy but he insists on the biopsy. I don’t really understand. Please somebody help me out. Does greenlight destroy the cancer cells. My doctor definitely what biopsy but I don’t what should I do in this case?

  115. Brad

    Urolift seems a great option for those who qualify for it. I had the procedure, but it turned out I was not qualified for it. One result is that part of my prostate is now in my bladder. Now the question is what procedure can be done without causing more problems. Also, must the Urolift clips be removed during surgery?

    I think Urolift is great — if you’re qualified.

  116. Mari donoso

    Hello this is a very interesting forum. Thank you for all this info. My husband is 43 years old and being recommended for TURP but he’s leaning more toward green light has anyone had experience with someone this young getting this surgery and what suggestions do you have? Thank you

    • Khan Sohrab

      I am 65, haVing enlarged prostate. Dr. also found redness in prostate. Now he suggested to have green light procedure. He also explained the after effect of surgery that I may have ejaculating problem. I am worried for that. At this situation what should I do? Please show me the right way.

  117. Mike Robertson

    Gentlemen:

    Prostatic Artery Embolization is the answer. Research it before you decide on any urological procedure.

    I’ve had it done. It was a cinch and was covered by Medicare

  118. Cliff Wilson

    I have full urinary retention. 53 yrs old w/BPH…with a large mediun lobe ;will Tuna work ? Can i try it 1st if a chance b 4 TURP? I have tuna scheduled for tommorow & would appreciate response before then . Thanks 508-509-3434

    • Mari donoso

      Hi how was your procedure, I’m trying to get as much info as possible for my husband he also is young . He’s being recommended for TURP thank you for any suggestions u may have for him

  119. Geoffrey

    i just turned 59 woke up last night and was unable to urinate after 3 days. drank some the red, white, and blue monster drinks, never had them before and never had this experience before 2 hours in the restroom straining unable to go from either hole, exercise, enemas and was rushed to the emergency room and then drained 1750cc of urine from me and put in a catheter. it has been 7 days how long do i have to do this and what kind of pills, diet or supelements can help me they put me on twenty pills of flowmax please tell me how i can shrink my prostrate or relax the muscles that hold urine?

  120. Alan

    Hi, my name is Alan. I am 62 years old. A recent ultrasound revealed that my prostate weighs 70 grams which one doctor described as “huge.” No sign of cancer from the ultrasound or digital exams which doctors said revealed a weight of 50 grams for “the part that counts.” Doctors have also said that I have a medium lobe and that my prostate is intruding into my bladder.

    My last PSA was 4.2. In August of 2014 my PSA got up to 6.3 (my historical high) but it is usually right above or below 4.0. A recent scope of the bladder revealed that the bladder looks fine. I have symptoms of frequency and urgency but they come and go, but it seem lately that recently I always have a low-level feeling of discomfort in the groin area and that I always “have to go” (at least a little). When I have this feeling, it doesn’t necessarily mean that I have anything to void when I go to the bathroom but the low level feeling of “having to go” is always there. A lot of times I think that the feelings of urgency and frequency are “mental” because if I am distracted by a goal or activity, I can go a long time without having to go to the bathroom.

    I gave up drinking ice tea a long time ago (because it worsened my symptoms of urgency and frequency) and very recently have given up on coffee (now only one small cup per week) because it was causing me to need to go to the bathroom 3-5 times per night. Now I am down to 1-2 times per night since I have given up on drinking coffee.

    Historically, and presently, I have found that better diet (no cookies, ice cream, pies, or similar sweets, no pork or red meat, no deep-fried foods, and more fruits and vegetables) have both improved my symptoms and lowered my PSA scores.

    In the past, I have also had success with “Super Beta Prostate” but gave up on that supplement because of the highly aggressive marketing tactics of the company that sells it – at this point, I am ready to try it again.

    I was thinking that it might be time for me to finally have a procedure but after having read this blog I am having second thoughts. My biggest fear is a life of incontinence as a consequence of a procedure and I do not thrill at the thought of retrograde ejaculation although my friend who had his whole prostate removed robotic-ally because of prostate cancer said that retrograde ejaculation has not diminished his sex life at all.

    With all of that being said, my Question No. 1 is: if I do need a procedure, which one is the best for me based upon my test results and symptoms?

    Question No. 2: I presently live in Ecuador and the best treatment for me might be in the United States. If I get into an emergency situation (acute retention) can a catheter buy me time to get back to the U. S. to receive the treatment that I need. (By the way, the health care here in Ecuador is at very high level and beats the U. S. hands down for ready access to your physician if you are paying cash).

    Question No. 3: Can I still beat this thing through good diet, exercise, and supplements or am I doomed to a procedure sooner or later because of my DNA?

  121. mike

    My ex wife had the embolism done 15 years ago for uterine fibroids and it worked great. No hysterectomy and the fibroids shrunk. I am surprised it took this long for the radiologists to do it to men’s prostates. My bph symptoms are getting worse mainly at night. Lucky for me I can go back to sleep by just closing my eyes. 4 to 5 times a night. I figure the Urolift is a second choice in treatments as it opens a channel to pee through but it removes no tissue. That tissue is what presses on the bladder giving us the urge to void at night. I have not read on any forum that it reduced the .nocturia. I am waiting till the PAE becomes available near me before having it done. Right now mostly what I see in the US are clinical trials. I am not bad enough off that I can’t wait for the radiologists to get more experienced doing the procedure.

  122. Steve Brunswick

    I am 71. My prostate is enlarged and I was having difficulty urinating, frequent dribbling, and often an “urgent” need to urinate. My doctor has put me on Tamsulosin (Flomax) to improve my urine flow and Finasteride to shrink my prostate. After several months neither medication has helped much. What has helped is self-cathetering which I do 3 times per day. This has allowed me to lead a relatively normal and active life, golf, running, etc. The self cathing is not painful, takes only about 10 minutes and to a large degree, has relieved me of the problems mentioned earlier. It also (hopefully) is keeping non-vacated urine from backing up into my kidneys which was happening when this problem started. My doctor has recommended TURP surgery, but I am reluctant after hearing about problems that others are having. Frankly, I am not sure where to go from here or whether to just keep doing what I am doing for now and hope better solutions are discovered.

  123. Gary Rothman

    I am 68 and was living with all the symptoms of an enlarged prostate–constant urination, waking up after 3 hours having to urinate but unable to do so except by walking for 10 minutes, etc etc. Finally, about a month ago, after eating dinner and having a few drinks, I came home and from 1 to 6AM I was unable to urinate and in severe pain. I went to the emergency room and a catheter was inserted. I asked the emergency room dr if this was unusual and he told me men my age came into the emergency room with my symptoms all day long. 2 weeks ago I had green light surgery and my nickname is now Secretariat– I urinate like a racehorse with minor discomfort. Last night I slept 6 hours, urinated easily and went back to sleep!! In order for the surgery to work a knowledgeable urologist will almost always perform the surgery with maximum results resulting in retrograde ejaculation. I don’t expect to father any more children and if my orgasm is 75% as enjoyable as it used to be it’s well worth it to enjoy a normal urination life!!!!!!

  124. john in AA/MI

    Great discussion. I’m 66l, PSA holding at 4.1 for several years, and about 150ml retention, retrograde ejaculation without any surgical intervention, 3x per night, Flomax lost effectivity, but my Medicare doesn’t pay for the Rapiflow or 5mg Cialis (now that works to “piss” me off!). Anybody have info on UroLift in SE MI?

  125. Charles

    Thanks for discussion and comments. I’m 86 and have moderate symptoms from returning BPH this year. I thought perhaps a second greenlight procedure might be preferable to again taking Tamsulosin, and also starting Finasteride.
    After scanning and reading negative comments about greenlight results, I think I’ll be patient and stick with what my Urologist ordered. He is very highly recommended.

  126. Philip

    I had PVP done in Dec 2010 and TUNA done in 2008 and my father had TURP done in the 1990’s and Dec 2015 I had acute urinary retention and am going to have TUMT Tuesday, Dec 22, 2015. I am 59 now and PSA is so high but no prostate cancer. No ED after TUNA and PVP and will inform after TUMT if there is ED or not. By far, I fear Prostate biopsy(Transrectal method) more than any laser prostate treatments. Biopsy was done in 2008 and showed no cancer. Flo-Max still use as relief-med.

  127. tod

    I am sure I need turp
    I have read comments about my dr. All bad referring to lack of patience. I really want to know if he is any good but can’t find any help
    Can you help me?
    Tod

  128. G Brown

    My husband (62) had the Green Light Laser Surgery on Tuesday. He had a catheter at home until Friday morning. After removing catheter, his symptoms were about the same, if not worse, than before the procedure. That night, he could not sleep at all and had trouble and pain trying to push the urine out. He feared he might need to go to the ER to get catheterized. he got up from bed and sat at his desk while using his computer. Then after awhile he felt the urge and was able to urinate. He’s very frustrated and wondering if the surgery didn’t work. He’s sleeping in his recliner, which helps! Lying down isn’t working for him right now. I’ve been searching, but I don’t find much info regarding immediate post surgery issues. Does anyone know it it just takes time?? I wondered if swelling from surgery might play a part in recovering. Thanks, all. I hope you all find a satisfactory or great result with what you choose. Signed, a concerned wife of a wonderful but miserable hubby 🙁

    • Mari donoso

      Hi thank you for sharing. Wondering how your husband is feeling. Hope he’s better . My husband is having green light just wondering what to expect . Any advice would be greatly appreciated

  129. wally

    I had a TURP 5 years ago and contrary to what my urologist told me that “the feeling of sex will be exactly the same after the operation than before the operation the only difference is that I wont ejaculate any more.” I feel a little bit confused. The climax is not remotely the same at all as what I had before the TURP and it seems to me that the world of urology don’t know the difference between an erection and a climax. I tried everything but the TURP has totally ruined my life. I hate the climax after the operation and I don’t know how anybody can think that it is exactly the same as before the operation. The problem is that there is nothing that you can do once the operation is done. My urologist told me to get myself another urologist but the problem I have is that he didn’t tell me about any other procedure than the TURP and even after Ive asked him if there isn’t any other procedures , he just told me that they don’t have any results. I did go to another urologist but the operation is done now and he got his money and I will never enjoy sex again because I don’t know how anybody can enjoy sex if you know that the climax at the end will be a total disaster.

  130. Darren

    Hello there is a new procedure for bph that is done by an interventional radiologists that basically reduces the flow of blood to the prostate therefore shrinking it. some insurance companies don’t pay for it .they say that it has no retrograde and no sexual side effects .it is called prostatic artery embolization or pae for short.several centers are doing it . it is outpatient. you can search it in youtube or just google it .also google nx1207 and prx302, 2 new drugs being trialed for bph.spread the word thanks

  131. Marty siederer

    Ps. The daily catheter was my idea which I got from ads on tv!! And thank god for this internet?

  132. Marty siederer

    Hi guys, thanks for the comments, they really help. I’ve been dealing with this prostate enlargement for years successfully with flomax. Many doctors strongly suggest TURP. What has bothered me is that none of the doctors I have seen will discuss the other options, and reluctantly only when I ask. I’ve gotten all the new information from this internet! Do they all think we’re six years old and don’t think we have a right to be consulted on our own fate! The side effects are serious, and possibly life changing.
    My current doctor just wants to do “blue light lazer ” but is afraid for me to go under anesthesia because of a heart condition. A reasonable concern, but he doesent even mention the office procedures like (tuna or tumt)?
    The flomax isn’t working anymore, but I’m surviving with the daily catheter, which is a great bridge until I can try the “urolift” or something that has no side effects. Please be active and involved, don’t let the doctors decide your fate, none of us are six years old. The catheter is a great time buying bridge!

  133. Patrick

    I’m 68 and have BPH for several years with PSA fluctuating from normal to over 25 in June to 7.54 last week. Considered Green Light 2 years ago but declined. Don’t want retrograde ejaculation. Does anybody know if UroLift is available in Ireland or if Cialis is registered in Ireland for threating BPH? I met 2 Urologists during past month. Neither recommended Cialis despite he fact that it is registered by the European Commission for treating BPH – using 5mg daily, it reduces the size of the prostate. I wanted to know if I have prostate cancer. One Urologist said he would do an MRI before a biopsy. The other said a biopsy had to come before an MRI. I am totally confused. Both recommend TURP which is so barbaric I will not consider having it or anything that interferes with normal ejaculation or causes ED or incontinence. If I did have prostate cancer I would have the gland removed by robotic surgery and that would be that. Any ideas about the use of Cialis 5mg daily to reduce prostate size. Also, Arterial Embolisation of the Prostate (AEP)looks promising. Comments?

  134. Ron W.

    This is by far the most informative article on the subject.

    I’m 53 and my prostate is squeezing my urethra so much that I was

    holding 750 ML of liquid!! They Cathed me, what a glorious relief.

    I was about to do the Green light laser but after reading all the

    the comments here, I will not!

    Please, has anyone had the Eurolift recently? Please let us all

    know your experience.

    What doctor leads in this procedure?

    Thanks to everyone, and good luck to all…

  135. Maurice H

    Had my first signs of BPH at 65 and was told “your late.” Still, I get a decent flow and not too often do I have to go. My going again is anywhere from 3-5 hours which is pretty good. The problem though is the terrible pain and discomfort I get when I do urinate. The flow is not as strong as I would like, but it is still coming out. I was told that I am at .5. The Urologist said he has had numerous cases of 1 and 1.5 CC. Still, I don’t know what to do at this point. Do I just grin and bear the pain or do a TURP or TUIT. Green sounds risky…

  136. Joseph

    Nice to meet everyone. I’m 65 and am about to start prostate cancer treatments. I’m prescribed doxorubicin and its not too bad price wise, but my Dr. has suggested Viagra to go with it, and I’m not making a lot of money at the moment. My Dr. also mentioned alternatives such as “generics” and his personal off the record reassurance about Canadian pharmacies as an option, which I am a little skeptical of. Has anyone ever ordered from one of these online sources or have any experience or insight?

  137. Richard LLanes

    DO NOT LET THEM MESS WITH YOUR PROSTATE! You will never have an ejaculation again! Green light laser therapy will ruin you. I walked in a healthy 62 year old man wanting to improve my quality of life and walked out like a 90 year old man who might not ever be able break a nut or father a child again. That Frankenstein urologist never told me their would be these kind of side effects from the procedure. The booklet from American Medical Systems paints a picture like you will be like youthful and healthy after the surgery. They say that maybe 30% of men may experience retrograde ejaculation, but they never say it may be permanent. I told the urologist thatI would have never had the procedure had I known of the effects. I am also urinating more than I was before. This procedure should be treated like removing a female’s clitoris and be banned unless the patient is informed of all the possible things that can happen in writing. The urologists want to make as much money as they can and surgery is the way to enrich themselves. Don’t do it!

  138. another sam

    I’m 73 and have had problems passing urine for a few years now. About three months ago I completely stopped being able to pass urine and had to go to A & E to have a catheter fitted, with an appointment for urology two weeks later.
    After a trial without catheter failed I was fitted again with one for a further eight weeks to see if the tablets would work, but unfortunately no luck.
    So I had the camera up to investigate and was again fitted with another catheter and am now waiting to here about treatment.
    My prostate is quite large and so cannot be cleared in one operation using TURPS so have been recommended the GreenLight laser therapy which I’m waiting to here about. One problem with this treatment is that no pieces of the prostate are available to send for diagnosis as they become vaporised so I’m having a MRI scan first to see if anything looks abnormal…but apart from that almost anything would be better than having a permanent catheter fitted…three months is more than enough trust me.

  139. sam

    where are the answers to the questions raised in blog?

    What is the cost for green light PVP?

    Any practitioner reference for Greenlight PVP in the Ann Arbor, Michigan area?

    • Dale Johnson

      My green light cost $17,000. My insurance covered $14,000 here on the Central Coast of Ca.

      Question: has anyone recovered from Retrograde ejaculation (after green light surgery), over what period of time?
      What about urgency or incontinuance?

  140. dave

    I have very large (over 100 cc) prostate and had acute urinary retention. After weeks of catheterization had TUNA procedure, so far didn’t work. Am curious how long after tuna can you schedule turp if first procedure is unsucessful?

  141. Robert

    Went thru Greenlight 3 months ago. Urgency is worse, flow is not improved and experience almost constant pain. Can’t ride a motorcycle or riding lawn mower. Was not informed of any possible side effects other than retrograde ejaculation. Had heard of scar tissue forming from other sources but discounted it. Should have listened. Had tuip 15 years ago and went great. Would not recommend Greenlight

  142. George

    Not a single mention of self catherization which I am planning to do being as i am 80 years old. Why go through an operation?

  143. Joe

    Well here I am with this condition. I am 71 and very active. I was, that is, biking, running and swimming are my thing. Well, I was visiting a friend and could not pass water. In acute distress, I went to the emergency room and had a catheter put in. My kidneys took a beating. One is still in enlarged. Had an ultrasound and found that my bladder had thickened because it had to push urine through a constricted channel.

    My excellent urologist worked with me. He removed the catheter and gave me some drugs. I drank so much water and could not urinate but a few drops. I rushed willingly back to the office within two hours to get, thankfully, the catheter back.

    It is obvious I have an enlarged prostate. My doctor recommends turp which is conservative. I appreciate this. However, I don’t want to go under, spend time in a hospital, and have a long recovery period.

    In my situation, Green Light seems just the thing. However, PVP and UroLift look very attractive. The latter seems very new though. Quite a quandary. I found this web page very informative, really.

    I never thought that I would say it but the catheter is buying me time. I just wrote a friend about my condition and closed with this line:

    “A Haiku:
    Philosophers say ‘If’
    Is the unkindest of words
    Wrong; it’s ‘catheter’.”

    I say WRONG, WRONG! The catheter in me is saving my life. It is saving me from a prostate that is trying to kill me! “catheter” is good. I never would have said that a month ago!

  144. Neil Sjoberg

    Hugh Kent -they say eat loads of tomatoes and tomato products-stops prostate cancer developing. Am going for a Turp this week-very nervous but having had acute retention twice.Anything is better than that. Had a catheter in for two weeks which is inconvenient but better than not being able to go.
    Thanks for all comments will report back.

  145. Steve

    Any type of laser surgery including Green Light is temporary and will not last longer than a few years before tissue reappears.

  146. naim munshi

    Prostate eatery embolization, a new technique to go for prostate related problems.

  147. Kent Hugh

    I am 76 and have mild BPH. My father and younger brother died of prostate cancer. Do any of the treatments mentioned in the well written article help prevent prostrate cancer or slow it down? Is there any research or information in answer to this question?

  148. Cliff Wilson

    what about PAE Prostate Artery Embolization? Im 52 yrs old & need to cathadorize every time to urinate now . I had the PAE procedure in MA gen. 1 yr ago w/no success. I’m considering other options but don’t want risks of Turp such as sexual dysfunction,long healing time,& loss of ejaculate. Would a 2nd PAE procedure be advised or should I throw in the towel on that & consider TUMT ?

  149. Loren

    I have a larger prostate than most, and Dr. recommended a surgery that includes cutting into the bladder to access prostate to cut away excess. The more invasive procedure has 4X the recovery than TURP. Does anyone know about this procedure and why it is recommended for larger prostates?

    Also, is UROLIFT an alternative for very large prostates?

  150. lewis

    Have any of you stayed on Jaylin,Flomax,and or Rapaflo
    for long periods of time with substantial improvement?

  151. lewis

    All your comments have been very interesting and worthwhile.
    Have any or all of you stayed for long periods of time
    on Jaylin,Rapaflo,and or Flomax.And if so have they shown
    improvement

    • Dale Johnson

      I used Flomax ( Tamulosin) for about a year and had to double the dose. Then it wasn’t working at all after a short time. My doctor told me I needed surgery. He did the green light. It’s been a month and I can hold my urine, I have extreme urgency. I was not informed that the green light could cause this. I also had, before surgery, partial retrograde ejaculation (re), before surgery. Now I have complete re. I thought the surgery would help the re, just the opposite.
      The doc wants me off the Tamulosin, I am going off. Maybe this will help the incontinuance?? I’ll let you all know!
      I have no e. dysfunction, thank God for that. The doc say the re will go away after time, we’ll see….

  152. Scott

    I hear that urologists are getting excellent clinical results with the new UroLift treatment for BPH. This product is made by Neotract. In California, contact Dr. James Meaglia of Orange County Urology.

  153. Nelson

    My message is to Tom. Can you give me the details of the doctors in DALLAS that is/are good with the UROLIFT procedure? It sounds better over the others.

  154. cottonBall

    This article was originally published in 2007 so they don’t mention prostatic artery embolization which was first created in 2009. It still is not FDA approved but it seems to be spreading around the world as a much better first option for treatment that works for about 80% of the people or higher. All they do is enter an artery through your groin and put some tiny beads into the veins that lead to the prostate. The prostate then receives much less blood and begins to shrink after a month or so. That is what I am most excited to try at this point before I try anything else that will physically remove or destroy my prostate.

  155. Warren Fanucci

    I had greenlight in 2004 and was pleased,,,innovember 2013 I had to this done again and did not think I needed it,,,I went through many tests again and after a few weeks had grenlight done again. Now it is a year and 3 months and have been warring a diaper, changing 3 to 4 times per day,,I can not control it and had 10 weeks of kegel exercises with no effect,,,so I think I was screwed up for life,,,now will have a virtue sling implanted for control,,,I would not advise the greenlight for anyone,,,but I am sure some have good luck,,,select your doctor and make sure he isn’t a duck

  156. John Hill

    Great information, very useful website.

    I’m 66, healthy, had moderate BPH symptoms. Went to Doc for DRE cause Dad got prostate cancer. Doc says “no cancer, but you’re getting BPH”. He did the usual stuff: sonogram, pelvic MRI, cystoscopy. He said. “You’re a busy guy, let’s get ahead of this” and recommended Coolwave TUMT.

    Procedure in office, no sedative, lidocaine only in urethra. Zip – zap out in an hour. Temporary use of tamsulosine to keep everything flowing while cooked tissue is absorbed and disappears

    My junk works fine: all good from the next day after TUMT
    If this will work for you, go for it.

  157. Rod

    72, had green light done last July, 2014. It corrected the frequency problem and eliminated the constant urge. This is great but no ejaculation or orgasm anymore. These side effects were never mentioned by my urologist who came highly recommended. I would recommend anyone with BPH learning more about Urolif. If that is not an option then would insist on your urologist being completely truthful as obviously there is no going back. Does anyone know of any corrective possibilities for these side effects?

  158. Leonard Montez

    Hello , I just turned 60 I dont urinate enough to empty my bladder been on flowmax for 2 weeks been wearing a catheter for 2 weeks my Doctor stated that he want to perform the turp procedure I am worried about erectile dysfunction PVP seems from what I have read A 0% chance of erectile and no chance of incontinence which is the better procedure why would he suggest turp over PVP. Thank you

  159. Kalea

    I came, I read this article, I coqueernd.

  160. Sandor A Jakab

    This is interesting. No any medical doctor or patient talks about TURis 2.0 plasma prostate treatment. I like to know , why ? What Detroit area hospital doctors use this medical treatment ? Please give me some answer. Thank you. Sandor

  161. Gazz

    Tom, I’d also like to hear about the outcome of the Urolift procedure. This looks like the best alternative for me at this point. I’m against the idea of tissue removal as a first procedure!

    • Karen

      Did not work for my husband. Seemed to make things worse. Now he has spasms, more frequency, and feels like peeing razor blades. Very little out put. We are so frustrated. He had URO Lyft in June of 2017 now it is March of 2018.

  162. Landon

    This comment is made in response to Tom’s remarks on Oct. 28 about Urolift. I would very much appreciate communicating with him regarding that procedure. I have just cancelled TURP
    surgery scheduled for Dec. 30, 2014 and am eager to explore
    Urolift as a possibility. Thank you, Landon

  163. Sanjeev S

    Mistake above : Any idea of treatment options in Mumbai India ?

  164. Sanjeev S

    I am 55 and am thinking of surgery as I am not keen on taking drugs al my life, but the real fear of erectile dysfunction which I already have to a fair degree and retrograde is high as is the concern about incontinence, and idea of trt avail in Mumbai india

  165. Marc

    Testimonials are lacking on the internet for this. I can find Youtubes from orthopedic patients but none for TURP, Green Laser, etc….

  166. Ira Cohen

    One should research well first hand and weight potential risks very carefully.
    Mild incontinence, less ability to hold than pre-op, 5% of previous erection frequency, retrograde ejaculation, very real post Geeenlight complications for me at 4 months…even by a very experienced doc at a highly rated teaching hospital in a major city.
    64 years & “was” very healthy.

    • Dale Johnson

      Hello Ira, I just had the green light procedure for BPH. I had no warning of retrograde ejaculation or incontinuance. It’s been a month since surgery. I have had periodic blood in urine. I also have r.e. and incontinuance. The doctor says it may take months to get to normal. After reading, I’m concerned I may never be the same. I’m really disappointed that these issues were not explained to me. How long has it been for you?

  167. david

    For those of you concerned about retrograde ejaculation – at 50 years old this was my greatest concern also. You might want to check “Ejaculation Preserving Transurethal Resection of Prostate and Bladder Neck….” Journal of Endourology, Vol.28, no.1, Jan 2014. 90% success rate. I was lucky enough to be in the 90% and to have a great surgeon (he read the paper/procedure…..)

  168. Prashant

    Hi i am from india i must appreciate this useful artical,my father is 65 and supposed to go through with green light surgery for b.p.h,i am anxious since he has lost his health out of mental trauma and taken over illness on his mind,secondly the doctor said it involves certain amount of risk as well by considering his health and age i will be highly grateful if someone may explain me about the risk percentage it involves

  169. Steven Marshall

    I am a Orthopedic P.A. and this discussion was extremely information-packed. Great job Doc’s. THANK YOU.

  170. Jonathon Rosen

    Your discussion is beyond enlightening, especially for patients who are about to undergo treatment. You’ve given me great insights and, most importantly, some extra peace of mind. I’m a lot more comfortable about my upcoming laser surgery after reading this article.

    • Ruth

      Have no fear of the green light laser surgery my husband had it six years ago after having severe symptoms of b p h No pain or bleeding afterwards catheter for one night and no sexual dysfunction. Good luck

  171. Tom

    While vacationing in Key West I met some guys associated wit a brand new product/procedure called UROLIFT.com by NeoTract,Inc.
    This new product has very limited exposure but from the sales reps statements one Coral Gables doctor has implanted several hundred with zero problems. Plus, I spoke with the doctor’s nurse. Also, a doctor in Dallas has done several with zero problems. This is a stint, or several stints that are installed into the prostate. This comes with zero erectile and ejaculatory dysfunction. They also have two Medicare/Cade billing codes – means Medicare pays for most. Anyone with any information or wishing to exchange please get back to me. I’m getting ready to have mine done in Dallas asap.

  172. Sanjeev

    Hi Alan, I have been suffering from this for last few years and it is getting to unbearable stage. My only reason for suffering and not get surgery was retrograde fear. From what I read the green light procedure offers best odds for avoiding retrograde. I am looking for doctor who can give some assurance on it.

    • Sylvia

      I was told that for sure the retro ejaculations was a definite in the lazer method. So now I am confused.
      Who can clafiry?

      • Dale Johnson

        I just had the green light 1 month ago. I’m not happy. I am incontinuance and I have r.e. I was not told of these side affects. There should be a full disclose document the doctors should get signed. How is it different than taking a perscription drug that gives full disclosure?
        My doctor told me these issues will get better in time. From what I’ve read, I’m not too optimistic.

  173. Alan Murray

    Very good article from reputable source. I am a bit surprised that in the discussion on men taking surgery/treatment that not more was said about “retrograde ejaculation”. For me that is the only hinderer in running to the doctor and saying do the procedure. I’m only 51 and not ready to risk that yet.
    I am interested in any procedures where they do not destroy my ability to ejaculate.
    Any tips?

  174. howard rockitter

    im 80 years old and like microwave or tuna.how can I find out any doctors who perform theses procedure in Atlanta ga

  175. Richard Taylor

    The article above is very interesting concerning the latest treatments for prostate BPH problems. Several years ago, I started to experience severe pain in my penis which progressively grew worse each time I urinated during the course of the day. After numerous tests to rule out cancer,I was sent to a pain management clinic. I am currently taking 800 mg Neurontin 3 times per day. For several years this seemed to reduce the symptoms significantly. However, recently the pain has grown severe again, so my urologist added as a supplement 100 mg Elmiron 3 times per day which seems to be helping although I still experience pain. The Elmiron is very expensive, but what concerns me most is that this referred pain from the prostate seems to be getting progressively worse as I get older. Do you think any of the treatments listed above could be a viable solution for me?
    Thanks,Richard

  176. Johne18

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  177. John Somerville

    What about trans urethral INCISION of the prostate. It doesn’t cause retrograde ejaculation. (usually)

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