More than 1 in 3 men over 50 have symptoms related to an enlarged prostate.* CRUSH Reader “Kraig“ wrote to me volunteering to share his experience with his prostate enlargement diagnosis and treatment. After trial and error — and leaning on a wide circle of informed friends and top doctors in Boston (a city renowned for its leading medical institutions) — he shares how he finally found the best solution for him.
Thanks for sharing your experience, Kraig.
I’m not a doctor, but I’m hoping that the perspective of being just a normal dude dealing with something that can be very stressful and disruptive could be helpful. God knows I did a LOT of research on the ways to address prostate enlargement that would minimize potential sexual side effects. I am 57 and not ready to lose any sexual functioning. (Spoiler alert: I’m happy to say that the modality I chose worked perfectly in that regard (confirmed post-surgery last week).)
Addressing this, from start (first urologist visit) to finish (post-surgery) has been a three-month haul.
When and how did you recognize that there was an issue?
I was urinating 4-5 times a night, clearly not emptying my bladder. And obviously not getting good sleep.
I visited my PCP and he suggested I see a urologist.
Walk us through the visit with the urologist.
The first step with a urologist is a test to determine how much urine is being retailed. This is done with a simple ultrasound over the bladder. You then urinate and repeat the ultrasound. After that, she looked at me and delivered the news, "you have a liter of urine in your bladder after urinating.”
And the issue with you “retaining urine” is?
The concern is that the urine backs up and starts to damage the kidneys.
The solution, after your first appointment?
A catheter in my penis. Terrifying to say the least. My immediate response was "I need to go home and spend the weekend getting my head around the idea of a catheter being installed.”
I went back to the urologist the following week and took the leap. A catheter was placed in me and I went home with 3/4 inches of tubing hanging out of my penis. "Just think of it as a long penis, Kraig" is what my doctor said. "You mean long(er),” I replied. That got no laugh from her, by the way, but I still think it was funny.
A catheter is barbaric. As my buddy Greg put it "I'd rather be mauled by a bear". Truthfully, you deal with it. I had a cap on the end of mine that I would empty in the bathroom every couple of hours. I played (and won) my pickleball championship match with it in and even went to two concerts at Fenway. Imagine emptying your bladder from a catheter in the disgusting Fenway park bathrooms?
Hey, congratulations on being a pickleball champion! You must be good. But back to the installed catheter and why it was problematic (beyond the obvious).
The catheter allows you to empty the bladder fully and then to further test to see if my kidneys had been damaged - one had slight damage (swelling). I had the catheter removed after one week (it's unsettling to have it placed in and taken out but it’s a mere seconds). After a second catheter went in, I got violently sick with a bladder infection - hell of a way to lose 16 pounds in a week!
It was then that I started to do additional research and spoke with a 30-year old graduate of Yale School of Medicine who is a urologist, and friend of a friend. “Kraig you have to stop using the installed catheters. They are fucking cesspools of bacteria and that's why you got sick. You need to self-catheterize. It's easier than flossing". A terrifying thought but after being sick and dealing with a tube hanging out of my penis, I tried it.
How does a “self-catheter” work? And for how long?
Self-catheters are basically 16" long, thin, thoroughly lubed and incredibly efficient to use. They come in a box of 30 or so and are individually wrapped. Each catheter has a gel pack that you squeeze before opening which lubricates the “stick”. It's very scary to start to slide it in your penis and feel it pass your prostate before penetrating your bladder (very subtle pinch and zero pain) — which leads to urine shooting out the other end. After emptying your bladder, you slowly pull it out. The first time I did it might have been the most scared I've ever been. But after a few times, it does become easier than flossing.
I self-catheterized for about 6 weeks 3x a day. Morning, afternoon (at work), and before I went to bed. I NEVER got up to pee once after emptying my bladder before crashing. The plan was to use the self-catheter process up to surgery which was, after full testing, diagnosed by my urologist. If you ever have to take this on, do it. It’s very easy and painless.
And then what? What were your options?
There are a few different modalities that urologists specialize in. My urologist performs GreenLight laser treatment, which uses heat to shave the prostate tissue blocking the bladder. She explained the % risks for side effects like Erectile Dysfunction (very low), incontinence (very low), and retrograde ejaculation (very high). Retrograde ejaculation, she said, is basically a "dry" orgasm. The odds of the first two {ED, incontinence} are quite small but the third, the inability to shoot semen, is highly common after this process. Put simply, with retrograde ejaculation the sensation of orgasm remains the same but the semen enters the bladder versus coming out of the penis. With some medications, I experienced dry orgasms and found the feeling to be very, very odd.
There is another option called TURP {transurethral resection of the prostate} but off the bat, I didn’t consider it because it is more invasive.
And there are medications, like FLOMAX (Tamsulosin) which (like the name suggests) aim to maximize the urine flow to empty out the bladder. This is one of the medications that causes the dry orgasm mentioned above.
What other option did you have besides GreenLight laser treatment and TURP?
I then researched a new(er) procedure that is called aquablation therapy.**
Tell us more about aquablation therapy to treat an enlarged prostate.
Aquablation uses water and maps the prostate using a camera (called a cystoscope) with robotics for a very precise procedure. Results from the clinical studies show a low rate of complications like ED and incontinence. And critically, I was told that the sexual side effects drop to less than 1%. With the absence of heat and greater precision, it seemed like a better option. And as I said, I wasn't ready to lose any of my sexual functions.
So you had the aquablation therapy? How did that go?
I went with the aquablation procedure and had it done by the top urologist at Massachusetts General Hospital for this. It's about a 1.5-2 hour surgery, under anesthesia. I woke up with a catheter that I had to keep in for three days to monitor bleeding. I also had to spend one night at the hospital - the GreenLight and TURP procedures allow most patients to go home the same day.
How long ago was your surgery? And how are you doing now?
My surgery was roughly a week ago. I'm in recovery and things are progressing nicely. It burns when I pee and I have to go quite often but that's all part of the deal. It will take 3-4 weeks for my bladder and prostate to start working well together but I'm catheter free and everything is working great, including normal orgasms!
Wow, that’s great to hear.
It's a stressful time but a very common thing that men deal with. My advice is to get your PSA score annually, see a urologist if you find yourself urinating frequently, and find the best possible doctor for whatever procedure you may need to choose from.
May I ask, were you actively dating, or did you have a romantic partner while you went through this?
I did date while dealing with an enlarged prostate and didn’t have any issues with ED or orgasms. Other than having to occasionally take a break from the action or just get up throughout the night to pee, it wasn’t an issue for me. However, once I started on medications, I saw a difference. Flomax (Tamsulosin) caused retrograde ejaculation (dry orgasms). The orgasms are normal in intensity but barely any semen exists - again, it’s an odd feeling.
How did it affect your sex life, both before diagnosis and after diagnosis (but before the aquablation therapy)?
Besides less semen after starting on medications, my enlarged prostate did not have any impact on my sex life. Note: my prostate was “large” but not excessively large.
If you were dating, how did it feel to bring it up? And how did you bring it up, anyway? When and where? Was it a long-term partner? How did your partner react?
Obviously, once I had a catheter installed, it was important to “have the talk”. I had been on a few dates with a woman and we were advancing to the stage of intimacy so the timing wasn’t great.
I think it came up as were were making out on my couch - BTW, a hard-on with a catheter is not real comfortable (as you can imagine).
She was incredibly supportive and we were able to work around things but it definitely was a burden.
*National Health Service
**I have confirmed with Kraig that he derives no financial or other benefit from sharing his experience with aquablation therapy.
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