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TYPES OF SURGERY FOR BPH: TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)
The most common type of prostate surgery, which is used by 90 percent of urologists, is a transurethral resection of the prostate, or TURP. In America, 400,000 men a year get a TURP. It is, next to cataract surgery, the most common operation performed on men who are sixty years of age or older.
The TURP is called a closed operation, as no incision is made. The TURP, regarded as the standard by many doctors, is often called "roto-rapturing" the gland. This type of reference doesn't present an encouraging mental picture for the patientwho wants to compare his operation to that of a snake-like pipe inserted in the toilet bowl to clear obstructions?
American men may feel encouraged to hear of experiments in England in which robots actually perform TURPs. I doubt that many men would stand in line waiting for their turn, but it has actually been performed. Further investigation is underway to see if robot-performed procedures could be the way to handle the backlog of males with BPH problems.
In the standard TURP, which takes about an hour, the doctor inserts a thin hose-like device, called a resectoscope, into the penis.
The patient does not feel any pain, as he is usually under either a local or a spinal-block anesthesia. If you have had arthroscopic work performed by an orthopedic surgeon, you will be familiar with this instrument. The resectoscope has a fiber-optic light source that guides an electrically heated needle to the prostate tissue that is causing the problems. The surgeon then scoops the tissue out, leaving only a shell of the prostate.
A representative sample of the tissue is given to a pathologist, who analyzes it to see if any cancer is present and, if so, what kind. If no cancer is presentgood newsthe blockage should no longer be a problem. (The bad news is that an absence of cancer at the time doesn't necessarily mean that cancer won't develop eventuallybut there are no guarantees in life.) After even a successful TURP, the urologist will probably advise the patient to continue with annual checkups and possibly have more frequent exams. But at least now he can get a good night's sleep and get his exercise in ways other than walking back and forth to the bathroom.
"There is remarkable improvement in symptoms, and the operation is safe," asserts Dr. Patrick C. Walsh. "Almost four out of five TURP patients respond favorably," agrees Dr. Joseph E. Oesterling.
Concerns Long-term complications may include poor bladder control, impotence, or, most commonly, retrograde ejaculation. In 1993, Dr. Steven A. Kaplan, Director of the Prostate Center at Columbia Presbyterian Hospital, said, "The bottom line is if you think you may want to father children in the future, an alternative therapy might be more appropriate." However, there is now a procedure whereby sperm can be separated from the urine after retrograde ejaculation and used for conception.
Dr. John Weinberg also points out problems associated with the TURP. Beginning in 1988, in separate studies of TURP patients, he discovered the following:
Twenty percent of patients who had moderate symptoms before surgery were unimproved after surgery.
Twenty percent of patients needed a second TURP operation within ten years of the first operation. The likelihood of tissue regrowth is especially high among the younger age group because they will most likely live many years after the operation. For senior citizens, it is doubtful that they will ever need a second operation.
Twenty-five percent of patients had short-term complications of varying severity following surgery.
Four percent ended up with persistent incontinence after surgery.
Five percent were impotent.
Up to 25 percent said they were dissatisfied with the results.
But perhaps Dr. Weinberg's most troubling finding related to premature death. He found that TURP patients were more likely to die from heart attacks within five years of surgery than patients who underwent open prostatectomies (see below), a riskier procedure than TURPs. Urologists are at a loss to explain this finding.
Dr. Weinberg's research raised doubts about surgery for some physicians. They recognized the great gaps in their knowledge and became less confident in the outcome of this procedure. It raised all kinds of red flags. The surgical recurrence rate was a shocking revelation. Spurred by these findings, the American Urological Association and federal health officials at the Agency for Health Care Policy and Research formed a panel to review the scientific literature and establish uniform surgical guidelines.
An analysis of deaths in various age groups was provided in a 1992 article in American Druggist: deaths occurred during or following surgery and were due to heart attack, stroke, pneumonia, blood clots, or other causes. In the first six weeks after surgery, out of 1,000 men, four men aged fifty-six to sixty-nine died; seven men aged seventy to seventy-four died; ten men aged seventy-five to seventy-nine died; twenty men aged eighty to eighty-four died; and thirty-four men over age eighty-five died.
Even when the TURP is successful, it involves a hospital stay of five to seven days and a convalescence of at least several weeks. It is expensive not only to the patient but also to the U.S. public health systemthe total cost of TURPs is soon expected to top five billion dollars annually.
A study of medical patients who had a TURP performed in the period from 1984 to 1990 found that the number of TURPs performed has been declining since 1987, conceivably due to increasing availability of alternative treatments or to changes in the treatment preferences of patients and their doctors.
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Men's Health Erectile Dysfunction
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Pharmacy Information
MAINTAINING A GOOD SEXUAL RELATIONSHIP
As superfluous as it may appear, it is nonetheless important to mention at the outset of this discussion the fundamental significance of a clean and attractive body to successful sexual interaction. Sex appeal is most certainly not confined to the marriage bed; it exists between the partners at all times, and should be carefully nurtured. By attractiveness, facial and bodily handsomeness is not implied; rather, attractiveness means scrupulous cleanliness of body and clothing, and taking the greatest advantage possible of all the physical endowments that nature has seen fit to bestow on each of us. Not everyone can be beautiful, but there is no excuse for anyone's not being attractively neat and clean at all times.
A man who is overweight, chronically unshaven and slovenly dressed, and whose breath reeks of tobacco or alcohol, can hardly expect to be considered a desirable bed partnereven after a session with shower, toothbrush, and razor later in the evening because his wife's memories of his earlier unattractiveness will simply detract from the excitement of the experience. Similarly, a woman who neglects to make up her face, sits around home in bathrobe and curlers, allows herself to become significantly overweight or underweight, permits even faint urine, vaginal, or underarm odors to emanate, or does not often shave her legs and underarms is setting the stage for a loss of respect, admiration, and even love; sexual failure cannot then be far behind.
Certainly before joining each other in bed, whether or not sexual activities are anticipated, each spouse should see to it that he has at least a clean body, fresh breath, and neat, attractive nightclothes. To do otherwise is to deny to the marriage bed one of the basic ingredients for a happy sex life.
The sense of smell is almost as important in sexual stimulation as the sense of sight is. There is a physiological relationship between the tissues of the nose and of the sex organs, as was described earlier. Conditioning factors also are frequently present in the relationship between the sense of smell and sexuality. During courtship, for example, the faint scent of a girl's perfume or of a man's after-shave lotion may become associated with their love and subsequent sexual arousal. After marriage, the same pleasant scent may well serve to reestablish the excitement that developed in the atmosphere of courtship. Conditioning quite naturally involves many sensory elements other than smell. Almost any occurrence during the period of courtship that forms an association with love and passion can later be woven advantageously into the fabric of the couple's sexual interaction.
The qualities of courtesy, kindness, and sensitivity to the needs and desires of others are fundamental to all successful human relationships; most particularly are they vital to sexual associations. Bearing in mind the differences in individual needs and desires, it is incumbent upon each person to discover what, precisely, offers the greatest pleasure to his partner in the sexual relationship. Genuine efforts to incorporate these discoveries into one's technique of sexual approach must be made before one may expect complete emotional fulfillment. For example, some partners prefer the conversation during sexual activity to be quite earthy, even to the point that the expressions used would be vulgar under other circumstances. Another couple might be shocked by such utterances, preferring to speak to one another softly in tender and loving words.
Pace, as well as style, is also a matter of individual taste. However, it is ordinarily wisest to proceed slowly and gently, with the goal in mind of bringing gratification to the partner rather than hurrying to satisfy one's own needs. One should not hesitate, furthermore, even to sacrifice one's own present fulfillment altogether if it means giving greater pleasure to the spouse; not only is it a generous and loving thing to do, but it will assuredly pay handsome dividends later. The best, and certainly the least stressful, way for each partner to determine the specific amatory desires of the other is to open wide the doors of candid communication. Neither partner is clairvoyant, and an inadvertently offensive gesture or clumsiness might impede the present response, and inhibit response in similar circumstances at a future time.
Variations in sexual approach and in the settings can add considerable spice to marriage. Too often sexual acts become ritualized, stale, and unimaginative, engaged in only to provide relief to physical urgency. Couples who wish to preserve delight and vigor in their sexual interaction will work as consistently on this aspect of their marriage as on any other. A husband who impulsively sweeps his wife into his arms in the middle of a happy afternoon and carries her off to the bedroom and makes wild love to her, or the couple who occasionally has sexual intercourse while taking a shower, or the wife who surprises her husband by appearing in his study wearing nothing but a smile and two cold, very dry Martinisthese couples are not likely to find sex dull, even after years of marriage. The playing of soft music, using mirrors to observe closely the intimacies of the sex act, perusing sensuous literature and art: all these can help keep boredom out of the bedroom.128 Men and women both want variety in their sexual lives; and if this ideal is reached within their marriage, there is considerably less likelihood that either husband or wife will seek it elsewhere. Imagination and willingness to experiment, coupled with an air of confidence and consideration, will serve most marriages very well.
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Men's Health Erectile Dysfunction
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