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Urinary Disorders

BPH Surgery- TURP or PVP?

03/04/2009

Question:

I`m a healthy 54 year-old with BPH (up every 2 hours at night to urinate, failed Flomax and Avodart, had the prostate ultrasound and my prostate is enlarged but not huge-can`t remember how many grams). The symptoms are driving me nuts and my primary care doc referred me to a urologist and she recommended prostate surgery.

My question is: is the regular TURP and better than the newer greenlight PVP procedure? I got a second urology consult; one recommends the regular TURP because it has a longer track record and the other recommends the PVP because of less bleeding, probable lack of a post-op catheter and being an outpatient procedure. Both urologists are great and both encouraged the second opinion and neither has anything bad to say about the procedure that the other is suggesting. From what I have read, the PVP is less stressful and has a pretty long track record; the doc recommending the regular TURP had one himself and was satisfied with it. The doc who suggests the PVP (a woman, of course) said that she has had a lot of experience with both and suggests the PVP. I would apperciate any insight befoer I flip a coin. Thanks.

Answer:

Both the TURP and PVP would do well with a moderate size prostate (not huge as you have mentioned). The TURP definitely has a longer track record than PVP but the PVP has been around for sometime now. The advantage of the PVP would defnitely be less bleeding and a possibility of same day discharge possibly without a catheter. Sometimes with significatly large prostates the TURP may be preferred since the operative time for PVP can be longer in this situation; sometimes a combination of the laser and TURP may be used in this situation.

From your information it seems that your primary symptom is waking up every 2 hrs at night to urinate. Do you also have obstructive symptoms such as straining to void and poor stream. The reason I mention this is, patients with obstructive symptoms usually respond better to prostate surgery than someone who primarily has irritative symptoms (such as nocturia, frequency, urgency) without any significant obstructive symptoms. If you have primarily irritative voiding symptoms at your age of 54 (relatively young as far as prostate problems are concerned), I would consider evaluation of the bladder (overactivity) as a cause for your symptoms (with a test called urodynamics) or trial with medications (called anticholinergics) to relax the bladder.

The Flomax/Avodart often might not work in this situation (overactive bladder) and these irritative voiding symptoms can sometimes persist even after the surgery (upto 20%). Overactive bladder is more common in females but can also occur in males. You could discuss this issue with your urologist in further detail if required.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati