A Urolift update

Hello Jim,    the Urolift is basically some clips installed on the prostate to hold it in a more open configuration.   Which works well.

My PVR prior was in the neighborhood of 800-1000 ,   pretty bad i know.

My Doc is monitoring my bladder to see if any improvement is being made.

A urodynamic test was not done prior,  not sure what that is ??   Is that where you pee through a mechanical wheel to test flow volume?  

I was told that the bladder once expanded can not get back to its elasticicity??    I go see him again next Thursday and would like to ask him about some things other guys are doing to hedge against this.

Hi Anthony, 

Urodynamic testing is a series of tests done to determine how well the bladder and urethra function in term of storing and releasing urine. From this certain predictions can be made as to the probability of bladder emptying once an obstruction is removed by either surgery or a procedure.

Unless the literature (or someone here who has had the procedure) says that your high PVR is normal 2 months post Urololift -- then I would guess the problem indeed is atonic (flaccid) bladder. 

As to the bladder "once expanded..can not get back to it elasticiity", this is false. Just do a search for "bladder rehabilitation" and you will find this out. I will also try and dig up a study that talks about how bladder rehabilitation prior to prostate surgery improves outcomes. So check your Private Messages later today or tomorrow. 

I can also personally attest to bladder rehabiliation, because prior to my self-catherization program two years ago, my PVR was also in the 1000 ml range. Earlier this week it was measured in my urologists office at 30ml. 

Not sure what your urologist is waiting for. As mentioned, the bladder can be decompressed and rehabiltatred either with a  Foley for several weeks, a Subrapubic catheter, or a program of self-catherization. Personally I would choose the latter as it will give you the most personal freedom. 

If he doesn't come up with a good explanation of what is going on plus a plan of action that addresses your high PVR, I would seriously consider getting a second opinion.

Jim

 

Jim,  thank you for that information.    Nice to hear that you went from 1000 down to 30.  That is exciting news to me.

I will keep an eye out for your mail, and will indeed discuss this with my urologist!

Anthony

Hi Anthony,

I just sent you a PM with a link to the study. And while the study dealt with TURP, I see no reason why the same principle should not be applicable to your procedure, since the issue is bladder elasticity. 

I just want to add that my results without any surgery (from 1000 PVR to 30 PVR) are just that. My results. And again, my urologists were surprised that I was able to rehabilitate my bladder to this extent without surgery. That said, I don't think I'm a total anamoly and I'm sure that it it worked for me it can work for some others. What per cent I have no idea.

However, the point of the article was not that CIC can replace surgery, as was in my case. The point is that CIC prior to surgery will results in better outcomes by increasing bladder elasticity. And I think the world of urology is in agreement on that and if your urologist is not on board I would consider getting a second consultation. 

For others interested, I will post a link to the study in a following post, but posting a link puts a post "in review" so it may not appear for a few days. But here is the conclusion:

"The present results emphasize the usefulness of CISC (clean intermittent self-catherization) in ensuring the recovery of bladder function in men with CUR (chronic urinary retention). Measuring the voiding pressure before TURP can predict the surgical outcome. Both CISC and immediate TURP are effective for relieving LUTS (lower urinary tract symptons)and result in a better quality of life. A preliminary period of CISC before TURP for men with CUR and low voiding pressure may be valuable. The presence of upper tract dilatation is associated with high end-void and end-fill bladder pressures, and such men have a good outcome from surgery."

Jim

Here is a link to the study referred to in my last post. Study title is:

 A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention.

http://www.ncbi.nlm.nih.gov/pubmed/15963128

Jim

Hi. I was wondering if I have understood your message properly. Did you resolve your BPH problem without having any surgery? I am on a wait list for TURP, but having read up on UROLIFT it seems a much better procedure, but not widely available on the NHS and too expensive to go private. Anybody with any ideas or help, much appreciated.

Dave

William  I hope your not having a Turp just because it's available.  It can have alot of side effects and alot of bleeding.  It will take alot of time getting any sexual things back if you do.  many doctor Don't tell you that..  When they start cuting the prostate.  If you are able to get it back you know you will have retro orgasm.  They will tell you it will fell the same  but there not.  I had them with a pill I was on they hurt by bladder and with nothing coming out I felt useless.  Please think about it. You may fine something else.  I live in orlando and had the urolift done last year.  After the first week I was fine.  No med and sleep all night.  There has to be somewhere near by that you could get it done.  Also a Turp is done alot because that is what the urologist know most and been done for many years.  Please get as much information you can before you do anything.  A turp may not even work and once it's done you can't go back   Ken     

What is the purpose of a PAE?

In the descriptive words of Tampa General Hospital:

"Prostate artery embolization (PAE) is a promising, new procedure for patients suffering from the symptoms of benign prostatic hyperplasia (BPH), or an enlarged prostate. The outpatient procedure is performed through a catheter smaller than 1/16” through the femoral artery in the groin.

During the procedure, the small catheter is directed to the tiny arteries that feed the prostate. Microscopic particles are then used to block off the blood supply to the prostate (called embolization). The procedure is performed under light sedation and Foley (urinary) catheter is typically only required for three to five hours.

A patient can expect to spend approximately six hours in the hospital and be discharged with anti- inflammatories, narcotic pain medication and antibiotics. Post-procedure symptoms typically last about one to three days and include pain during urination, mild pain at the base of the penis and possibly a small amount of blood in the urine/stool.

PAE is currently being evaluated in research studies and by the FDA, but is not FDA approved. The procedure is approved in Europe. TGH is the only hospital, outside of the Miami area, performing the procedure in the southeast US."

Thank you, that was a wondeful explanation!   I will show  it to my urologist.

I think I may be good with out it.   ??     But sounds like something that needs to be approved!

Thank you, Ken.    I do pee pretty darn good now!    I  just  still carry approx 400 cc after Im done,  but feel like I am finished.   

Mathy, where was yours done?  Was it in one of FDA sanctioned clinical trials, or in Europe where it seems to be an approved procedure?  I am considering this in the clinical trials being done by Tampa General Hospital, but would like to hear more about results from the early trials first.

Hi Carry-on CMDR,

I had mine done in Sydney Australia. It was done in one of the best Hospital here. as said earlier, I cannot say that it is an end to the problem. But I am feeling good. the PAE is working for me. Just after  weeks. Its not bad at all.