does having an implant complicate prostate surgery?

[mike123]

I was leaning toward the roto-router job over the Urolift even before I knew I wasn't a candidate for Urolift. Roto-router is easier for the surgeon if there is no implant in place and that probably translates to a better, more complete result. With prostate enucleation there is a very low likelihood of needing a repeat operation in the future. It's not zero, but it is very low and is based largely on how much of the inner layer of the prostate can be removed the first time around. I wanted to make that as easy for the surgeon as I could because I didn't want to have to do it again. As Waynetho says, the same can't be said of Urolift.

I figured I was going to wind up doing roto-router eventually. The only differences between now and a decade from now would be the presence of the implant. With the implant in place, it would be more difficult for the surgeon to do as good of a job and it would also increase the possibility of an infection for the implant. For me, it made sense to do the router-router now so I wouldn't have to worry about it later.

My next question was which enucleation procedure to use. TURP was not my first choice, in fact, it was my last. I would have preferred to do either HoLEP or green light. TURP has a longer healing period and a higher instance of needing a repeat operation in the future. TURP also has a higher likelihood of retrograde ejaculation, though, as I've already said, that part didn't bother me. So why did I go with TURP? It boiled down to the surgeon. I found a surgeon that I trusted to do an outstanding TURP, but I was having a very hard time finding one that I both trusted and who was in network for my insurance to do one of the other procedures. I'm in the Orlando area, so I know there are excellent surgeons here who could have done the job. I just couldn't find them and I was wasting a lot of time trying. It wound up being easier to do the TURP with someone I trusted and just deal with an extra month of healing time.

I'm not saying you should do the roto-router. That's a decision only you can make, but I think it was the right choice for me.

[sweaterfan]

Another factor I have to consider is what my health might be 5-10 years from now and if I should have the roto-router before other unrelated issues arise. Up until I was 59 I had just a few minor procedures - hernia and shoulder surgery, not taking any medications. I was physically strong and had great "stamina". Now I have rheumatoid arthritis and these urological problems, all within the last 5 years. Who knows what awaits me in the near future.

You would think that Austin being the state capital and high tech Mecca we would have world-class surgeons, but sadly that's not the case. For something as serious as a TURP or implant I would have to find someone in Dallas or Houston. My wife's gastroenterologist suggested that she have her ileostomy performed in Dallas because he wasn't comfortable with any of the local surgeons, and I'm glad we took his advice.

I'm so happy I found FT. I need to study HoLEP and green light in more detail.

[sweaterfan]

I just got back from seeing my urologist. He said my prostate is too large for a UroLift (79.4 grams and the cutoff is 80) so he suggested a new procedure called aquablation where a robot uses a high pressure water jet to cut away tissue. He has done a few and it can be used on any size of prostate. Waiting to hear if my insurance will cover it. If it does, then that's what I'll have done. He said Medicare does cover it so most likely private insurance will too. It is so new that only select hospitals are equipped to perform it, and there's one about 20 miles away so that would work out fine. An overnight stay in the hospital is required.

I searched for aquablation in FT but didn't get any hits. As I said, it's new technology.

We also decided to stop the Xiaflex injections since there was no improvement after one cycle and the likelihood of improvement with additional cycles is slim. I have an appointment to meet their implant specialist (800+ implants) in November.

It would be nice to get at least one problem out of the way.

[Waynetho]

I just got back from seeing my urologist. He said my prostate is too large for a UroLift (79.4 grams and the cutoff is 80) so he suggested a new procedure called aquablation where a robot uses a high pressure water jet to cut away tissue. He has done a few and it can be used on any size of prostate. Waiting to hear if my insurance will cover it. If it does, then that's what I'll have done. He said Medicare does cover it so most likely private insurance will too. It is so new that only select hospitals are equipped to perform it, and there's one about 20 miles away so that would work out fine. An overnight stay in the hospital is required.

I searched for aquablation in FT but didn't get any hits. As I said, it's new technology.

We also decided to stop the Xiaflex injections since there was no improvement after one cycle and the likelihood of improvement with additional cycles is slim. I have an appointment to meet their implant specialist (800+ implants) in November.

It would be nice to get at least one problem out of the way.

Any sexual side effects? Risk of anejaculation, retrograde ejaculation (injaculation), climacturia?

[sweaterfan]

According to their website, 100% of sexually active men with BPH maintained erectile function, 99% no longer had incontinence and "nearly all" men preserved ejaculatory function after aquablation.

www.aquablation.com
https://youtu.be/ew--xo8mtRw

[mike123]

I wish I'd know about that a couple months ago. Definitely sounds a lot better than TURP.

[sweaterfan]

FYI, I had the aquablation procedure for BPH on Nov. 2, discharged with a catheter the next day, catheter removed Nov. 5. It's a very bloody surgery - no cauterization but I had absolutely NO pain from the procedure. Yesterday and today I masturbated and the result was a full erection and a large volume of ejaculate. Still a small bit of blood in the urine and ejaculate but that's expected at this early stage of recovery. I already notice less urgency and frequency and more control. I had to pay almost $10K out of pocket because BCBS considers this experimental. The robotics company is going to help me file an appeal.

The best simulation video is
https://youtu.be/jKBlsK9ZDpM

Going to let my best friend heal a couple of more months before subjecting him to implant surgery.

[Waynetho]

FYI, I had the aquablation procedure for BPH on Nov. 2, discharged with a catheter the next day, catheter removed Nov. 5. It's a very bloody surgery - no cauterization but I had absolutely NO pain from the procedure. Yesterday and today I masturbated and the result was a full erection and a large volume of ejaculate. Still a small bit of blood in the urine and ejaculate but that's expected at this early stage of recovery. I already notice less urgency and frequency and more control. I had to pay almost $10K out of pocket because BCBS considers this experimental. The robotics company is going to help me file an appeal.

The best simulation video is
https://youtu.be/jKBlsK9ZDpM

Going to let my best friend heal a couple of more months before subjecting him to implant surgery.

I hear you about "bloody". They outfitted me with a 21 french Foley catheter after my very simple 4 implant UroLift procedure (relatively speaking). After I got home I felt bladder cramping at one point and instinctively went to stand in front of the toilet to void even though I had the cath and collection bag. One squeeze of my sphincter (kegel) and I shot blood around my catheter, all over the toilet and the wall behind it! It was about 2 ounces of blood that shot out, or the equivalent of the first strong shot of semen from a normal heavy cummer.

I was overwhelmed and slightly horrified (mainly because *I* had to clean it up!)

[Waynetho]

The best simulation video is
https://youtu.be/jKBlsK9ZDpM

Going to let my best friend heal a couple of more months before subjecting him to implant surgery.

The device is "currently not for sale in the United States". So - if it's not for sale in the USA, how is it FDA approved in the USA? I'm confused...

[sweaterfan]

That video was made in 2016. The procedure was approved a year or so later.