does having an implant complicate prostate surgery?

[sweaterfan]

I have an enlarged prostate (79 grams vs 20-25 grams) and am taking medication to shrink it. I suspect that some day I will need some kind of surgery to reduce the size or remove it. My PSA is normal, thank goodness. If I get an IPP now, will it complicate any future prostate surgery?

[mike123]

I was in the same situation a month and a half ago. My prostate was almost as large as yours and I needed an implant. I was taking tamsulosin to keep the prostate under control until I stopped working for me.

I spoke to my uro. He said he could take care of both issues but was emphatic that the prostate be taken care of first. An implant does make the prostate surgery more difficult, but his greater concern was infection. The greatest risk to an implant is infection and prostate surgery introduces a much higher likelihood of infection which could spread to the implant.

I had TURP for the prostate on 7/27 and am waiting for that to heal. I don't know how big it is now but the surgeon said he removed a lot of tissue. He said to expect the healing process to take two to three months. I have a follow up with him in about two weeks. Hopefully we'll be able to get the implant scheduled at that point. I'm hoping for the next surgery somewhere around the middle to end of October.

[Waynetho]

It can make rigid cystoscopy more difficult but there's at least one example from the UK where a patient had UroLift implants inserted into his prostate (intraurethrally) via rigid cystoscope after being implanted with an IPP and did not sustain any damage to the implant. I don't have the references on that case at my fingertips now but if you search my posts from November 2019 through February 2020 I believe you'll find my comments to another person about the case that also cites the medical paper that was written on it.

I would strongly encourage you to look into UroLift though. It uses metal anchored monofilaments to hold open the urethra through the prostate kind of like sashes on window curtains. I had my UroLift implants installed in September last year and my IPP was installed about 46 days later (Sept 12 to Oct 28).

[Waynetho]

I was in the same situation a month and a half ago. My prostate was almost as large as yours and I needed an implant. I was taking tamsulosin to keep the prostate under control until I stopped working for me.

I spoke to my uro. He said he could take care of both issues but was emphatic that the prostate be taken care of first. An implant does make the prostate surgery more difficult, but his greater concern was infection. The greatest risk to an implant is infection and prostate surgery introduces a much higher likelihood of infection which could spread to the implant.

I had TURP for the prostate on 7/27 and am waiting for that to heal. I don't know how big it is now but the surgeon said he removed a lot of tissue. He said to expect the healing process to take two to three months. I have a follow up with him in about two weeks. Hopefully we'll be able to get the implant scheduled at that point. I'm hoping for the next surgery somewhere around the middle to end of October.

I didn't want to be Roto-Rooter'd so I requested the Uro-Lift procedure and didn't even consider TURP. I also didn't consider the other intraurethral prostate resections and such that used steam or other methods. I wanted my prostate to be fully functional without any chance of urinary incontinence, retrograde ejaculate or anejaculate. I like being able to hold my urine and being able to shoot my load too much to endanger them.

[mike123]

Unfortunately, Urolift wasn't an option for me. My medial lobe had grown so much that it extended a good way into the bladder which created a ball flap of sorts. Urolift can't fix that. I needed some form of prostate enucleation. TRUP, HoLEP, Green light, etc. I went with TURP.

Have you had a cytoscopy yet to verify that you're a candidate for Urolift?

[Waynetho]

Unfortunately, Urolift wasn't an option for me. My medial lobe had grown so much that it extended a good way into the bladder which created a ball flap of sorts. Urolift can't fix that. I needed some form of prostate enucleation. TRUP, HoLEP, Green light, etc. I went with TURP.

Have you had a cytoscopy yet to verify that you're a candidate for Urolift?

I read somewhere that enlarged medial lobe is no longer a big contraindication for the Uro-Lift procedure. I can't recall what medical paper I read it in but I'd be willing to bet that many doctors still ascribe to the original letter of the rules laid down stating that the medial lobe must be less than a certain size.

It might be worth looking up that detail again but unfortunately even if it's true, the information wouldn't help you now, mike123.

[mike123]

Because of the way the medial lobe had grown into the bladder, Urolift wouldn't have worked for me. But you're right, too late now.

My concern with the TURP was incontinence. That has not been an issue for me since the surgery. I'm past having kids and already had a vasectomy, so retrograde ejaculation also didn't bother me. In fact, I rather liked the idea of sex not being so messy. I even asked the doctor if there was anything he could do to increase the chance of RE without also increasing the chance of incontinence. I do have RE now. Orgasms do feel a bit different but are are no less enjoyable. I can't have penetrative sex until I get the implant, but what I am able to do is indeed much less messy. I like my RE.

[sweaterfan]

I have not had a cystoscopy, just a rectal ultrasound. I just did some searching on this board to learn more about TURP and Urolift and I have a lot more reading to do. I read that Urolift may not work in the long term if the prostate continues to grow to a certain size. Mine is above average in size for a 64-year-old.

Thanks so much for all the advice, gentlemen. I'm glad I asked before making a big mistake!

[Waynetho]

I have not had a cystoscopy, just a rectal ultrasound. I just did some searching on this board to learn more about TURP and Urolift and I have a lot more reading to do. I read that Urolift may not work in the long term if the prostate continues to grow to a certain size. Mine is above average in size for a 64-year-old.

Thanks so much for all the advice, gentlemen. I'm glad I asked before making a big mistake!

sweaterfan, Uro-Lift is considered a stop-gap fix. If you qualify, it will likely give you 5 or more years of comfort before you start to get back to a degree of LUTS symptoms again. It may last longer than 5 years but the jury is still out because it's only been around about 6+ years as far as what I heard when I got mine last year.

It was effective for me and as I'm almost 60, I figure five years or more of easier urination without sexual complications is worth it to me. It IS reversible if you need to have it removed later. As long as the urethral anchors aren't buried by the urethral epithelial cells, they can remove the inner anchors and release the monofilament tension which allows for return to previous condition. Having the UroLift procedure also doesn't contraindicate a later decision to have a more invasive surgery with more complications. In other words, getting the UroLift now will save you troubles for a few years and later if you need to get the Roto-Rooter job done to open things up again, they still can. The cystoscope CAN be used even with an inflatable implant, but it's just a little more difficult to get the urethra ruler-straight for the scope to go through. It's not impossible. In worst case situation, the cylinders could be explanted and your IPP could be revised after the latter surgery. I don't see that needing to take place though based on the UK case I cited. Take the chance on IPP damage and if no damage due to cystoscope, you're good. If it's damaged, get a revision for the damaged IPP after the prostate procedure is healed.

[sweaterfan]

My urologist did mention that the prostate was "poking up into the bladder", so based on what mike123 just said a UroLift may not be possible. I'll see him next week for a follow-up for my Peyronies and ask him about it. Maybe the medication will shrink it enough to make a UroLift possible.

I very much appreciate the information and your experiences!