Preserving Sexual Functioning
Since my early 50’s I have had increased difficulty urinating, which is the result of a growing prostate. This condition is known as BPH or benign prostatic hyperplasia, which is the benign enlargement of the prostate.
For several years, I have taken oral BPH medication. The most effective medication for me has been Rapaflo. While Rapaflo helps with urination, it effectively killed my orgasm. When I reach orgasm while taking Rapaflo, it feels like a tiny flutter. Sometimes I am not even sure I had an orgasm. Very sad.
As a gay man who only came out in his mid 50’s, my sexual functioning is important to me. I love the physicality I experience with my partner, but attempting to reach orgasm is often labored and unsatisfying.
In my search for a treatment for BPH that will not affect sexual functioning, I underwent a procedure two years ago called Transurethral Microwave Therapy (TUMT). TUMT is a microwave device that is inserted up the urethra to the prostate and heats up prostate tissue to the point where it dies and is absorbed back in the body, thereby creating a larger urethra opening. While the TUMIT gave me some relief, the results only lasted for two months before I was back on BPH medication.
Last year my doctor told me about a new procedure called UroLift. What I immediately liked about this procedure was that it was minimally invasive and did not impact sexual functioning. It works by inserting tiny implants into the prostate which pulls the tissue back, thereby widening the opening of the urethra.
I was scheduled to have this procedure about six months ago, but as my wife, who was dying of cancer, got sicker, a medical procedure on my body became out of the question, and I canceled the appointment. After a number of months of debating with myself if I wanted really to go forward with the UroLift procedure, I finally had it done a few days ago.
From discussions with my urologist, there were two options for anesthesia during UroLift: general anesthesia where I was completely knocked out or local anesthesia were I received a prostate block, which is an injection of anesthesia into my prostate to numb it. I chose the prostate block.
I entered the surgical center yesterday with a good deal of nervousness. My tolerance for discomfort and pain is high, so I was not worried about a small degree of pain during the procedure, but I was afraid of a lot of pain.
After my vitals were taken I was shown to the operating room. I undressed from the waist down and lay on the operating table. The nurse, a lively middle-aged woman with bright red manicured fingernails, disinfected my genital area and pumped two syringes of numbing gel into my penis. Once the gel was inserted she put a clamp on the head of my penis to keep the gel in and left me to numb for 25 minutes.
When the doctor came in after my penis had been numbed, the first step was to do the prostate block. My legs went up in stirrups and the part of the operating table my legs had laid on was removed. The doctor inserted an ultrasound device that looked like a long dildo into my anus. The ultrasound had a small hole in the center which allowed him to insert a long needle to inject the anesthetic block into my prostate.
As a gay man who enjoys anal play, I was not uncomfortable or bothered by the intrusion into my anus. The needle, at 8-10 inches long, looked like a horse needle. The needle was attached to a large syringe filled with anesthesia. The needle was inserted through the center of the ultrasound wand and into my prostate. I only felt a small prick as he numbed both sides of my prostate.
The UroLift insertion devices looked like a high-tech laser gun from a sci-fi movie. Each device contained one implant for a total of four devices and four implants. The doctor first inserted a rigid hollow metal tube that contained a camera down my urethra so that he could see the exact spot to insert the implants, and through the tube inserted the UroLift insertion device. When he found the exact location on my prostate to insert the first implant he said, “Ok, one, two, three”. Click.
The UroLift insertion device fired the implant through my prostate. I felt a small prick but nothing more. I mentally took a deep breath. The implant insertion had been a relatively nonevent and I now knew I could get through the next three implants with ease. All four implants were inserted in a relatively short time. The doctor, proud of his work, turned the monitor toward me to show me the high-definition image of my urethra and where the clips had been inserted. He then removed the camera and inserted a catheter to drain my urine overnight.
Overall, the procedure itself was relatively easy. While it was uncomfortable, it was not at all painful. Once the procedure was over, however, the discomfort started. I kept feeling like I needed to pee, but I did not need to pee because a catheter was inserted into my bladder that drained my urine to a bag attached to my leg. The urine had a red tinge as blood from the procedure was cleared out.
Through that first night, I had these moments of what were probably spasms of the bladder, where I needed to immediately sit down and squeeze my bladder muscles to get the spasm to stop. The catheter and the discomfort from the procedure were constant all night. I took two Advil and applied a THC (marijuana) transdermal patch I had picked up on a trip to Colorado. I also drank lots of water to try and flush out my bladder. I had some blood in my urine all through the night. As the catheter bag filled up I woke up throughout the night to empty it. Finally, by morning the urine in the back was clear. Yea!! I grabbed the scissors to cut the seal on the catheter back and pull the catheter out.
From everything I had read online, I expected some urgency and burning while urinating. I did not expect the urgency to hit me so hard forcing me to run to the bathroom to avoid a mess. I also did not expect the burning to be as powerful. But as the morning went on, each time I urinated was a little easier. Now that the catheter was removed, blood from the actual insertion point of the UroLift implants, which had laid behind the catheter tube all night, came out with my urine, along with small clumps of dried blood. This cleared by the afternoon.
I did have a few instances where I could not get to the bathroom in time. The uncontrollable urge to urinate hit a few times. The funniest had to be when I was driving home from an errand. A man from CarMax called to see if I was still interested in selling my car. Just at that moment, the uncontrollable urge to pee hit me. I rushed off the phone, pulled over to the side of the road, opened my belt and fly as fast as I could and grabbed the empty bottle from the tea I had just had, and shoved it onto the head of my penis. Urine flowed, but the head of the bottle was too small and I ended up getting pee all over myself. Luckily I was almost home. I walked in the house, stripped completely naked in front of the washing machine, put all my pee soaked clothes in the washer, and headed upstairs for a shower.
I spoke to my doctor who prescribed a drug that eases the burning and urgency feeling. But there was one catch, the drug, phenazopyridine, turns pee a bright orange-red color. It is not just that your pee turns orange-red, but the color stains clothes. When I first took the drug I was wearing white underwear and white shorts. Big mistake. Little dribbles of pee-stained my undies and seeped through to my white shorts. While I pretreated and washed my pants and underwear, the stain did not fully come out. The good news is that the drug, which acts as an analgesic as it flows through the urethra, eliminated most of the burning and all of the urgency I was experiencing.
My bladder and penis area do not feel totally normal yet. There is a slight discomfort that I suspect will go away in a week or two. The literature on UroLift describes minor discomfort for up to two weeks. My big fear for this day was driving the 250 miles to visit my parents and peeing. I was afraid of the urgency to pee hitting me on the highway and arriving pee soaked looking like a tie-die shirt, given that my pee was now orange-red. I wore very dark colors. Luckily the drug did the trick and I did not have any of the uncontrollable urgency to pee of the previous day.
Things are improving rapidly. I am peeing well with minor discomfort. My bladder and penis still have this slightly uncomfortable feeling but nothing intolerable. I have had minor flank and back pain for the past few days which I am hoping is unrelated. I plan to take the phenazopyridine for one or two more days and then see if I can go off it. I still need to take Rapaflo for two weeks following the procedure, before I go off it. The literature on UroLift says that urinating will improve after two weeks and continue to improve for a few months.
I am crossing my fingers and hoping that this procedure is the one that will get me through the next few years.