Prostate and Bladder Issues: What to do?

Part 3

I live more than 1,000 miles from Rochester, MN. I flew there on Jan 3, had a required Covid PCR test on Jan 4 and then reported at 5:45am on Jan 5 for surgery. All of the Mayo Clinic doctors, nurses and staff that I encountered were excellent. They are all so professional and pleasant. They really are a fantastic organization. The surgery went well, pretty much as planned. The doctor had estimated before hand it would take about an hour and a half. He told me after the surgery that it actually took 2 hours because my prostate was "larger than advertised". The TRUS had estimated it at 90ml back in October, but the surgeon said he actually pulled out 120grams of material which took a little longer than estimated. I had a catheter in after surgery. This catheter had an additional tube that allows them to irrigate your bladder. It slowly inputs sterile solution to your bladder to flush out any residual prostate material, blood clots, etc. I had no real pain to speak of after the surgery, just a bit of a dull ache in that area. I was in the hospital over night and in that time I was given a 500mg acetaminophen two different times which handle the discomfort just fine. I could see that there was quite a bit of red (blood) in my urine which they told me was normal and expected. The urology department sent somebody to my room every two hours it seemed to examine the output in the catheter collector. They told me each time that it looked fine. A nurse removed the catheter about 9:00 the next morning and told me that as soon as I was able to pee on my own, that I could be discharged. About 30 minutes later I pee'd the best pee I had pee'd in a long, long time! I was amazed and very pleased! To be clear, my urine was quite red still at that point, but they explained to me that "red" was okay as long as it is "clear". In other words, as long as you can see through it and there aren't lots of clots or particles blocking the view through the urine. They also said it should improve slowly over time and that it could take up to two weeks for it to be completely gone. There was a little bit of a burning when I started and stopped urinating, but it was very tolerable and subsided in a few days. Other than feeling tired, I felt good when I left the hospital. I went back to my hotel less than 3 blocks from the hospital and rested and recuperated for the rest of that day and then all day the next day, before flying back home 3 days after the surgery. It has now been about 6 weeks since I had the surgery and I am feeling great, totally back to normal... and better than I have felt in many years with regard to urinating.

Part 4

kayak had a list of questions in his earlier post. I will answer them in regard to my experience noting that my surgery was BipolEP versus HoLEP.

Q: How long were you in the hospital following HOLEP?
A: About 24 hours

Q: How long did you have to have a catheter in for?
A: Just under 24 hours

Q: Was recovery painful?
A: Not at all. Surprisingly little pain with this procedure.

Q: Did you experience incontinence!
A: No. Just a little red ooze especially in the first week. I used Depend for Men light shields in briefs for the flight home and that handled it well. That subsided within 2 weeks and I don't use the shields any longer.

Q: Was there significant improvement in urination?
A: OMG YES! <big smile!>

Q: Was it difficult to get out and about within the first three months?
A: No problem at all. I am 6 weeks post surgery and completely back to normal activities.

Q: Did you lose the ability to have an erection?
A: No. All good in that department. <another big smile>

Q: Did you lose the ability to ejaculate?
A: Yes. Well, as paul55 stated in an earlier post, I have retrograde ejaculations. The semen does not exit your penis as it normally would. My doctor advised me of this before the surgery. On this point... at this early stage after the surgery, I feel like it does slightly diminish some of the physical satisfaction of sex. I do feel the pleasure of the orgasm, but it's kind of difficult to explain. I guess it is sort of like when you feel like you are going to sneeze but then you don't, if that makes sense. I would like to hear other men's opinions on this point. Please post them in this thread.

Whew! Sorry this got so long. I hope I didn't put you all to sleep. I typed it in a word document and then copy/pasted it in here. Apparently it was too big for one post so I broke it up into smaller parts. If anything I wrote spurred a question, please feel free to ask. If anyone with medical expertise finds anything I wrote to be wrong, please correct me!

Hi. I have 2 or 3 posts relating my experience in a different but similar Mayo Connect thread called "Benign prostatic hyperplasia (BPH) Surgery Options". I had BipolEP (Bipolar Enucleation of the Prostate) done at the Mayo Clinic Rochester early in January 2022, so I thought I would update my experience since kayak461 seems to be in a very similar condition as I was.

Part I

Ok, some background on me. Like kayak, I am 69 years old and will be 70 in a couple of months. I have had known BPH for at least 20 years. All the doctors I have seen along the way always said, "Let me know when the symptoms get annoying enough and we will schedule you for surgery." The symptoms progress slowly and nobody ever really wants to have surgery, so we all accommodate and figure out strategies to deal with our issues and keep putting off the surgery until suddenly we can't empty our bladders. About 6 months ago, I started feeling like I was not emptying my bladder when I urinated. I live in a rural area and asked my general practitioner doctor for a referral to a urologist, which took several weeks to get. The day of my appointment, they told me to pee first and then immediately after, they did an ultrasound scan of my bladder to see if I had any Post Void Residual (PVR). The scan estimated that I was retaining 670ml of urine which surprised me at the time because I had no urgency or feeling that I needed to pee. The doctor told me that this is not good, that I was stretching out my bladder, backing up urine into my kidneys and that I needed to get this taken care of sooner rather than later. That was the first time any doctor had even suggested to me that now was the time to have surgery. He scheduled me for a follow up visit a couple of weeks later to do a cystoscopy... a tiny camera on a tube that they stick up your urethra and gives the doctor (and you) a real time view of what is going on inside your urinary track all the way up to and inside of your bladder. I have to say, I was apprehensive about having this done. But it wasn't nearly as bad as it sounds. I have had dental work done that was much more painful and took much longer. The cystoscopy took maybe 2 and a half minutes total. They use lidocaine to reduce some of the pain. The toughest part for me was when he pushed through my sphincter muscle which my doctor told me to expect as he was doing it, and it only lasted a few seconds. My prostate was quite enlarged and the urinary track through my prostate was fairly blocked so the doctor told me he was feeling quite a bit of resistance through there. But apparently there aren't many nerve endings inside the prostate because I didn't feel any "pain" as he went through there, just a general, slightly uncomfortable sensation that there was something in there. Once through the prostate, he then pushed the cystoscope up into my bladder. He was able to bend the camera around and view my bladder neck where the cystoscope had entered my bladder. That was when he saw that I had a large median lobe of prostate material protruding into my bladder. It looked to be about the size of a walnut and you could tell that if the cystoscope had not been there, the median lobe would have been directly over my bladder outlet acting as a ball valve and blocking the flow of urine out of my bladder. The doctor was watching all of this on a large monitor that he positioned so I could also see it and narrating what he was seeing in real time. I asked before hand if he would be recording it and he said he was not able to record it, but suggested that I could record it with my cell phone if I wanted to. So I did and I was surprised how well the recording came out. It was very helpful to have that recording when I later got second opinions and searched for a surgeon who could do HoLEP or BipolEP. As the saying goes, "one picture paints a thousand words". It was a real "ah ha!" moment for me... the moment I saw the median lobe on the monitor. I knew that I needed to have surgery to correct this issue. So men, if you are having serious issues trying to pee, as they say in all of the drug commercials... "ask your doctor if a cystoscope is right for you", haha. It really is the most definitive way for your doctor (and you) to see what is really going on inside of you. I also had a TRUS (TransRectalUltraSound) done during that appointment. It is a more accurate way to measure the size of your prostate, more accurate than a digital rectal exam. The TRUS estimated my prostate size at 90ml. I've noticed that some prostate size reports will use "ml" while others use "cc" or "grams". I am not sure, but I think all of those units of measurement are interchangeable.

WOW. "Be careful what you ask for." I never expected such a thorough explanation of the BipolEP procedure. This is SO complete. Thank you, @jetjock. You outperformed. This explanation is going into my file of BPH treatments for re-reading prior to my approaching appointment with my Urologist. I suspect he will have a set of low-invasive procedures available, and I want to have him address the issues of your story.
I do have one question about retrograde ejaculation. Assuming the spouse is of a similar age as we and procreation is not an issue, are there any drawbacks to retrograde ejaculation other than a slightly diminished physical satisfaction?

How’s your recovery going? Are you having any issues at all following the procedure? We’re you in and out on the same day?

Thank you Paul! Thanks especially for the detail that you experienced not seen in doctors' explanations.
I would like to see others experiences - good and bad - of the various treatments for BPH. We need to be informed with the knowledge necessary when asking questions of our Urologist.

I have been told by two Urologists that I must have my prostate removed. Im considering HOLEP. Im looking to Connect with someone who has undergone this procedure in the past year so that I might ask a few questions about the patient experience. Thank you!

@kayak461 and @rfherald, wow, your questions really garnered experiences, answers and feedback you really can't get anywhere else than through the experiences of fellow patients like @paul55 @bill5letsfixthis @jetjock @bruce1sparkle.

Have the responses helped advance your decision making? What next?

My plan is to proceed with the appointment I have scheduled at the Mayo in Jax in late March. I’m going in open minded and ready to hear what the Urologist has to say about my condition, listen to his recommendation(s), and then act upon the recommendation. Based on the feedback from wonderful guys willing to take time to write about their own experience, I feel more at ease and less panicked about what is around the corner for me. So this Connect Group has helped me more than I could have hoped. The response form individuals was beyond my expectation and I couldn’t be more grateful for the exchange of information with this group. I will do my best to follow up with everyone as to what I experiences I have and the path I follow. I am sincerely appreciative of the people in this Connect group and I’m really glad I decided to ask a few questions.