Laser Prostate surgery Post Op Problems

Iam 65 and had a laser scraping two weeks ago. I had a catheter for a few days and developed an infection after it was removed. I had a fever of 102 for two days and my doctor put me on even stronger antibiotics than the ones I was taking. I didn't have a slight tinge of red. I had full out bleeding and I am still bleeding, some days, like that past Sunday, were quite intense. I have tinges all the time but sometimes it is more intense. I see little particles in the blood so I assume this is scar tissue or scabbing coming out. Also, there is a tremendous amount of pain from the prostate area itself. It is a dull ache like I am sitting on the point of a knife. Also, peeing is very painful, not burning anymore but the pressure of the expansion of the urethera when peeing. The pain seems to start in the prostate and travel down through the tip of my penis and it is very, very painful. It feels like I am trying to empty the Hoover Dam but only a stream is coming out. I go back to my doctor on Friday to get a clearance to return to work. Is this normal? He keeps telling me that this will all go away. I dread having to urinate becasue the pain is so intense. My testicals, penis and prostate all pulsate with pain at the same time and the sensation lasts for a good five to ten minutes after I urinate. I am hoping things will improve over the next few weeks. I can't sit very long becasue the pain is so intense. I alternate between my donut and a soft pillow when sitting.

Thankyou for your reply. As I wrote I was quite ok within a couple of days, but now the stream is getting poorer day by day. However, as per doctor's advice I am going to undergo another surgery on 3rd. of May. Let's hope for the best!
So far as I was told by my doctor that bleeding, pain etc should not continue more than 2/3 weeks. I prey for a quick relied.

Thanks for your reply. Today is only the second week since the surgery so I am hoping for the best. I feel I should take another week off from work to make sure that I am okay traveling on trains and going up and down the stairs of the New York City subways.

Good luck with your new procedure. I too pray for quick relief.

rgg

Have just read these helps - they sound what I need to take note of. Have just gone through laser treatment last week - am 64 years old and although was told what to expect before and during the op, was not told what to expect afterwards. Have read all the previous comments which have helped me a lot. Thanks.

I had the laser surgery and my recovery went well. I too had an attack of the gout and still recovering from that. Before surgery I would walk between 2-5 miles a day. It took weeks to start walking again and I am now, 3 months later at 2 miles a day. The gout is still an issue and I am taking medication. The sex 6 weeks after surgery to now, 3 months out, has been improving.

Hi, where in Canada did you have the operation and who was the DR. if I may ask? I was going to do it in Michigan for about $ 4000.00 US it sure would help to save this money. Thank you

Hi, I am Canadian too, and had a lot of problems with the doctors here, because all they think about is money. Yes you pay in US but they know this and is not interfearing in their work. I saw 8 Canadian Urologists and they all just told me you are older and this comes with age. Went to Michigan, (Have a Family there) and the doctor told me had a varicocel in my scrotum in 10 min. When I think of all this idiots I wasted my 3 years and made it worst, I could shoot them. That is the Canadian Doctors. Maybe I could check with your Doctor, to help me? The Michigan Doctor is asking $ 4000.00. Appreciated,

I had green light laser surgery three weeks ago. I am taking Uribel for the pain i am having at the end of urinating. The doctor said the pain was coming from my bladder having spasms. Very painful without the Uribel. Doctor said it could last up to six weeks. Over all I am very happy. It feels great to be able to empty my bladder and I have a very strong stream. Haven't tried sex yet. I still have the urgency sometimes. Over all I am glad that I did it and I would recommend it. 08/20/2013

I am a 55 year-old male with no co-morbid conditions (i.e. no diabetes, no heart disease, normal blood pressure, etc.), except being moderately overweight.  I decided along with my outstanding local urologist that prostate surgery was required due to failure of prostate medication management and BPH interfering with my lifestyle due to significant urinary urgency, urinary retention, and some incontinence.

 

In consultation with my local urologist, I chose to have my surgery done at a major New York City academic medical center.  My surgeon was a nationally recognized super-specialist in PVP who was extremely experienced in the procedure and had done more than 1000 PVP cases.  Prior to surgery, the PVP specialist surgeon completed an office-based urodynamic study with fluoroscopy, an office-based cystoscopy along with a prostate ultrasound examination.  The tests confirmed what my local urologist indicated – my urinary issues were due to BPH obstruction and that based on my prostate size and health status I was an excellent candidate for PVP laser enucleating of my prostate. 

 

The PVP specialist urologist was involved in the design improvements of the GreenLight™ laser unit and related advanced fiber optics and published numerous research articles and lectured nationally on the efficacy of PVP laser treatment.   He, the hospital, and the faculty anesthesiologist were all in-network providers in my Blue Cross insurance plan.  I also specifically chose a hospital setting with an overnight stay since continuous irrigation via catheter lessened the potential for tissue or blood clots to block the catheter and thus require later re-catheterization.  This methodology is not followed in freestanding ambulatory surgery facilities where you are discharged home a few hours post surgery, typically with a catheter in place but no continuous bladder irrigation – a key treatment to reduce complications. 

 

 

 2 Days prior to surgery

 

As recommended by nurses in the urology field, I ate non-spicy foods and eliminated caffeine and alcohol to reduce urinary irritation post surgery.  I would continue this dietary regimen throughout my first post-operative week.    I started taking 100mg Colase knowing that general anesthesia and pain medications cause constipation and it is contra-indicated to bear down after prostate surgery.  I also purchased a Depends product that is a large urinary maxi-pad for men that you place inside your underwear to deal with potential urinary incontinence.

 

 

Day of surgery:

 

 

My wife accompanied me to the hospital and I signed in at the ambulatory surgery unit, changed into a gown and robe, had nursing checks done, met with the anesthesia resident, and then the surgeon came over and I walked with him into the OR.

 

 

The anesthesiology resident started my IV with no difficulty or pain, and shortly thereafter the faculty anesthesiologist came in and general anesthesia was started and I became unconscious.  I had anticipated burning pain in my vein prior to losing consciousness that I remembered during conscious sedation for a colonoscopy, but I did not experience any pain at all.  The procedure lasted about 60 minutes as planned.

 

I awoke in the recovery room with little pain and no sore throat whatsoever from the endotracheal tube that is used during general anesthesia (and removed when you are still under the affect of anesthesia so you have no memory of the insertion or removal of the tube).  I had a large (26 french) 2-channel catheter in my urethra that served to irrigate and flush the bladder with very large amounts of normal saline and collect the outflow for measurement and examination for blood clots, etc.  It was not too uncomfortable.  I also had an IV running at a 125ml infusion rate into a vein in my left hand with no discomfort.   I stayed in recovery for about an hour and then went to a private hospital room for an overnight stay.

 

 

First night post surgery in the hospital:

 

 

I had a light dinner and then ambulated up and down the hallway with the catheter and IV in place.  I knew it was important to walk to avoid post surgical complications such as DVT (blood clots in your veins that can be very serious) so I walked quite a bit with some pain from the large catheter.  I experienced limited sleep that night as a result of normal hospital activity, including routine vital sign checks, medication administration, IV and catheter fluid bag replacements, etc.  IV pain medications were ordered but I only felt the need for one dose.  The two-channel catheter with large amounts of normal saline continued to flush my bladder to remove any tissue and blood clots. 

 

 

First Day Post-Op:

 

 

At 5am the bladder flush was stopped and at 7am a urology resident removed the large catheter.  The catheter removal was very painful but lasted only a few seconds.  I drank copious amounts of water (64 oz.) to ensure continued urinary output and cleansing of my system.  I wanted to flush any residual blood from the catheter removal and continue to clear the residual general anesthesia drugs from my body.  This is when I became concerned and began to second-guess my surgery.  Urination was very frequent with extreme urgency, far greater than I had previously experienced.  My urine was the color of Hawaiian Punch red.  I had both pain at the tip of my penis and burning.  Worse yet, I experienced painful bladder spasms following each time of frequent urination.  My anxiety level was high, as I was not expecting these symptoms, especially the painful bladder spasms.  The nurse explained that the spasms were the result of the catheter and that they would subside as my bladder readjusted.  She gave me a medication to reduce the spasms and clamped off the IV fluids.  After each period of urination the nurse on the unit used a bladder ultrasound unit to measure residual urine in my bladder.  Each time the residual quantity was high (400-500cc) which produced further anxiety as I expected that this would result in re-cathertization.  This process continued with multiple re-scans and painful, bloody urination until it was finally determined at 12 noon that I was cleared for discharge without needing to have a catheter reinstalled.  I was given two prescriptions: one for Keflex 500mg (four times/day) as an antibiotic for 3 days and Oxybutynin 5mg (three times/day) for the bladder spasms for 2 days.  I got dressed in my regular clothes and installed the Depends pad in my underwear.  Next began the drive home to the suburbs with my wife that included two stops at stores along the way to urinate (I did bring a urinal with me in case I could not control the need to urinate in the car.).  On the way home I sat on a soft pillow also as recommended by a urology nurse friend and reclined my seat to take pressure off my prostate.  I began to feel chills suggesting that I had a post-operative fever that I knew was a common outcome.  It is a normal immune response to any invasive, including minimally invasive, surgery.

 

When I got home I decided to go directly to bed.  I experienced very high urinary urge, very frequent, painful and bloody urination and a weak, split stream.  I was alarmed by these conditions and questioned whether my decision to undergo surgery was a mistake.  I was particularly concerned about the weak and split urine stream as most patient blogs reported almost immediate improvement of urinary flow following PVP laser surgery.  Around 2am I awoke in a pool of sweat typically indicative for me that my fever had broken.  As I was still constipated even after taking Colase for 3 days, I decided to eat a large bowl of Fiber One cereal and then return to bed.

 

Second Day Post Op

 

 

On the second post- operative day I began to experience improvements.  Urinary urgency was less, as was the amount of blood in my urine.  The bladder spasms were much improved.  It was still painful to urinate, my urine stream was weak and split and my urinary output was only about 100-150cc each time I voided.  I continued to drink copious amounts of water and had another bowl of Fiber One cereal and finally had a bowel movement.  I got dressed in work out clothes and walked with my wife around our condominium complex to get some exercise again to prevent any post surgical complications such as DVT or pneumonia.  I hydrated heavily with water and diluted cranberry juice.  As night approached I began to feel better.

 

Third Day Post Op

 

On the third day post-op I felt much better.  I only awoke once during the night to urinate.  In the morning I urinated over 300cc and my stream was stronger, yet the split stream was still present.  I assumed the post-operative swelling was diminishing.  It was still painful to urinate but either I was getting used to it or it was also diminishing.  I saw no blood or clots in my urine.  Most importantly, the urinary urgency was much less.  Frequency of urination was also reduced.  Now I was thinking that my decision to have the surgery was correct and that I just needed to be more patient and allow my body to heal and re-adjust.  I did a fair amount of walking and took my medications as prescribed.  I continued to eat bland food and drank several glasses of cranberry juice along with lots of water.  I went to sleep at 10:00pm  and got good night’s rest with only two trips to urinate.

 

Fourth Day Post Op

 

 

Day four postop showed continued and significant improvement.  There was less pain when voiding.  There were no more bladder spasms.  The split stream and the strength of my urine stream also showed significant improvement.  I saw blood at the start of urination only once or twice.  Frequency of urination was less; urgency was still an issue, but not too much worse than prior to surgery.  Urinary output seemed to average 200cc or more each time I voided.  I did a fair amount of walking and took my medications as prescribed.  I continued to eat bland food and drank several glasses of cranberry juice along with lots of water.  I continued the Colase 100mg.  Sitting on hard surfaces was still somewhat uncomfortable.  Sometimes I experienced internal “healing” pain or itching radiating to my penis or anus, but nothing at all significant or concerning. 

 

 

 

Fifth Day Postop

 

 

I noted continued significant improvement and felt that I was very pleased with my surgical decision and my progress.  I had very little voiding pain and no bladder spasms.  I had virtually no blood in my urine and absolutely no clots or scabs as others reported. I attribute this largely to the one night hospital stay and the continuous postop bladder irrigation during that time.  I had a very strong urinary stream and the split stream seemed to have largely ended.  Frequency of urination was much less and urgency of urination was more reduced.  Morning urinary output was almost 500cc.  I continued to take long walks.  I felt well enough for my wife and I to do a little Christmas shopping and we enjoyed lunch at a local restaurant.  I continued a bland diet with no caffeine or alcohol.  I continued to drink large amounts of water.  I planned to return to work tomorrow having been absent for a total of four days plus the weekend.

 

Week Two Postop

 

 

I had a significant amount of blood in my urine.  This was a complete change from the previous days when there was virtually no blood at all.  The bleeding at the start of voiding with pain on urination continued each day during the period of one week postop.  On the ninth day postop I slept through the night for the first time and voided over 600cc in the morning.  I continue to have bleeding at the start of urination and pain and burning on urination. My urinary stream and output were both much stronger than prior to the surgery and intervals between urination were significantly longer.  There was still a pretty strong urge issue, but it was more controllable and less than prior to surgery.

 

13-day Postop - My First Follow-up Appointment with My Surgeon

 

My postop visit was uneventful, except it was noted that I was still retaining nearly 300cc.  My surgeon was not concerned and indicated that it would take some time for my bladder to readjust.  He said the painful and bloody urination is common and would dissipate over the next few weeks.

 

 

 

Week Three Postop

 

At the start of week three the pain and bleeding on voiding continued.  It was getting wearisome and I was dejected and miserable.  Intervals between voiding were longer, urgency was much less, but the pain and bleeding were debilitating.  The pain on voiding exhausted both my physical and mental strength.  I decided to take 400mg of ibuprofen (Advil) every 6 hours to see if it would reduce the voiding pain.  Amazingly, I experienced almost complete relief of pain with little incremental bleeding.  Literally after one dose virtually all of the pain went away and I finally felt nearly completely well.  I cannot emphasize enough the complete change that the ibuprofen caused; pain on voiding went from an 8 (usual pain scale of 1-10 with 10 being the highest pain) to almost ZER0.

 

My 1st visit to the urologist, after ultrasound, they insisted I must be in pain, not at all. The used a catheter and drained 2 full urinals (1700cc),prostate not enlarged, scheduled a biopsy, I was awake, very painful, and they neglected to tell me I would ejaculate pure blood. Negative and told laser was the next step. After surgery, several weeks began bleeding, went to DR. they did a scope, and billed me 150 for another outpatient surgery. Went back next day, Nurse yanked the catheter out with such force, thought everything else was coming out. Not ejaculating, Dr. said damage to bladder muscle(ya think, duh).
Saud it may get better or may not, left room.4 years later, I can still not ejaculate, have retrograde ejaculation, Saw Dr. #2 a few months ago, was told a stint was no longer being used to correct this. found an article where they inject cologne around the neck of the bladder, being used for fertility issues. Dr threw it back at me and said he wasn't treating me, it was unnecessary, I told him if it were him, it would be different, he told me to not come back. Searching for another urologist. They don't mind causing the problem, but they won't fix it, I am now just 57, frustrated, depressed, with no hope in sight. It has been a nightmare. Hope you all have better luck than I did. I am single and it doesn't feel the same, and orgasms still occur, but intensity is diminishing, and shows up in the toilet when I urinate. The desire never gets satisfied, making it worse than before.

You are so right. They did a biopsy of the prostate. believe me, 12 needles into the prostate was not a pleasant experience. Not to mention it was to rule out cancer. The day after the biopsy, I masturbated and out comes blood. I was freaking out. I called the Dr., about 6:30, office was closed so got the Dr. on call. He said, that will happen the first time you masturbate, and should go away after 8-12 ejaculations. It would have been nice if someone told me this. At the time was 53, single male, it makes sense that I'm going to masturbate. Told surgery was next step, no other alternatives were given. He said I might experience problems after surgery . But that it would get better, but it may not. First off, I had never heard of retrograde ejaculation. Much less told what it was there was a High percentage that it would occur. They had said my prostate was not enlarged, the growth inward was causing a problem with the flow and urgency. Finding all this out after the fact doesn't do any good. Surgery is done, damage done. I wish some of these DR.s had this and realize that it is a big deal, and it does feel different. If your in any field of medicine, you should be telling patients all the info you have on their problem, and if there are options. Just had rotator cuff surgery, was told before 4 weeks to recover. 4 Months later, after physical therapy a couple times a week, I was back to full use.

Ziad i am shure you will be healthy Happy New Year ... Svetlana

I had my DaVinci surgery three weeks ago..  As I've been readng I realize there is much more failure than Doctors are admitting to.  I have lots of bleeding from the penis right now.  Before, during and after urination.  And have the urge to pee most of the time..  Thre days ago I woke for the first time having slept through the night without waking too urinate.  During that morning urination I was amazed at the heavy flow.  But the pain afterward was unimagineable.  Then it happened again in the afternoon.  I called the Doctor on call and he prescribed me a med that would numb the urinary tract, he said I most likely have an infection in it.  Three days have passed and I still have alot of bleeding...  I too wonder if I perhaps would have been better off not doing surgery...  Althoug the pathology report came back with 60% of my prostate as cancerous...  Initially thought to be 12%....

I had greenlight prostate surgery approximately 10 weeks ago.  The surgery went well but I expereience continuous bleeding for 3 days.  Even after 10 weeks there is still occasional bleeding and dark greyish cloudy urine.  The biggest problem I have had is difficulty walking.  I have chronic pain in the groin muscles, on the back and sides in the hip area.  I cannot walk more than 1/4 mile before it becomes too painful.  It is getting better but I only notice improvement by weeks (not days).  I can urinate but have the dry orgasms and there is pain in my groin after.  I have been to an orthopeadic doc, a GP, and another urologist who all say that the only treatment is time.  I figure that by this rate of improvement, I will probably be able to walk normally in about 1 and 1/2 years from now.  Have any of you had the type of difficulty walking that I describe?  I am glad that I can urinate better but the surgery seems to have created as many problems as it solved.

How are you doing now?