I have a large prostate, 93cc, it has been growing by about 20cc every 3 years. I am 61. I have urinary retention > 150ml. I don't get up at night to pee, and honestly pee about 8 times per day. But my stream is really weak and medication don't seem to help. I could live with my current situation but getting worse with time, but retention sometimes is very high, over 250ml. Doctors are afraid of kidney damage and eventual blockage. I have looked at many less invasive procedures but they all seem out of reach for me. I have been told to have TURP. I am nervous over the recovery and side effects/complications. I have had a coronary stent in the past and fear the blood loss and other issues with TURP. Am having a consult about Aquablation for resolving my flow issues. For a very large prostate, 93cc, does anyone have any experience with TURP, Greenlight lase, HOLEP or Aquablation? and any recommendations?
I had a successful aquablation procedure last September with a 70+ ml prostate with a severe median lobe protrusion into my bladder. It's been performed successfully on prostates over 300 mls though the current AUA guidelines specify 30-80 mls and the Medicare/CMS local coverage determination that was approved 11/20 specifies 30-150ml. Most urologists who perform a lot of them consider it size-independent but that doesn't mean your insurance will cover the cost of it. I had no issues with blood loss as in late 2019 most surgeons began performing focal bladder neck cautery using a very specific procedure that takes 5-10 minutes to close off any bleeders which are primarily in the bladder neck area. Your surgeon may refuse to perform an aquablation if you have blood clotting issues.
TURP with a monopolar electrode poses a risk of a dangerous condition called transurethral resection syndrome because of the type of irrigation fluid that must be used during a monopolar TURP. This limits the time the surgeon has to resect tissue as the amount of irrigation fluid absorbed in exposed venous tissue increases with time. TUR syndrome is not an issue to that degree when using a bipolar electrode during a TURP.