2 month post turp visit with uro

No tests were done yesterday, I was given a one month supply of Vesicare 5mg. to start on to see if my symtoms decrease. Prior to the surgery I had to urodynamics test done with the camera  procedure. I feel like I am completely emptying myself but who knows. Of course that will do nothing for my weak flow if there is a restriction. I may get a better flow if my bladder does not what to empty every 45 minutes to an hour. Thanks for the post.

Yes, Vesicare is for oveactive bladder so we're on the same page. As mentioned, it sometimes is a side effect of the TURP procedure. I'm a bit at a loss for words that your doctor didn't do a bladder scan in his office given your symptons and the recent TURP. I assume you had bladder scans prior to the TURP for PVR? As to the 'weak flow', I sometimes think too much is made of that. Yes, it is often associated with obstruction and retention, but not always. I've had a weak flow since my 20's, don't have any strictures, and right now my PVRs are often under 50ml. Bottom line is that a weak or strong flow in and of itself is not nearly as important as your PVR.

Jim

No bladder scans prior to turp, my uro feels that if I pee less often the flow will be better with more urine in my bladder. I am not to worried about the flow I am concerned about the urgency and frequency issue. I have read some guys take longer for those symptoms to go away post turp.

Except that one cause of frequency IS retention. Are you saying your uro did a TURP without ever scanning your bladder and checking for PVR? Forgive the impertinence but I'd get another urologist ASAP. As to "more flow with less pee frequency", sure that's fine, as long as your bladder is emptying properly which you cannot know without a bladder scan. FWIW you won't get kidney damage from low flow, you will get it from retention. I guess your uro never did imaging of your kidneys either?  Again, you need another opinion.

Jim

yes, he did not do a pvr test. only urodynamic test. when I went to see him in Dec. I was peeing every 30 minutes and could not take it anymore. I will give him a call about what you are talking about. Thanks for your help.

In his defense, urodynamics often contain a PVR component. Still, I would think that for anyone contemplating or recovering from TURP would that they would have a bladder scan as part of any office visit. Unless, of course, it was established that you never had retention, which begs the question if TURP was the right procedure for your symptons.

Jim

I called my uro and will get a return call tomorow. I will ask for a pvr before going in for my camera inspection for possible stricture. I will also discuss the results of the pvr portion from my urodynamics test. Thanks again for your comments.

Excuse me for butting in.  Have you measured your flow so you know your CC/second?   I had a balloon dilation about two months ago, and I was measuring around 13-14 CC/sec for about a month.  Then it dropped to 8 or 9 CC/second over a couple of weeks.  (I pee into a graduated urinal and use the stopwatch function on an Ipod to determine elapsed time.  I then divide amount collected by time from start to stop to get average flow.)..   I have no idea if this is considered slow or what.   Thanks.

I've done it with a stop watch at home like you which is probably not as accurate as the machine at the doctor's office because you can't get the "max flow". I don't have the numbers handy but I'm guessing it's up around 12-13 at it's best but probably down to 8-9 a lot of the time. As I mentioned, I don't think flow rate by itself makes much of a difference as it's possible to have a slow flow rates but low PVRs. That's my case. That said, anyone with a low slow rate should have their PVR measured because they do often go hand in hand.

Depends on your age Glen. I had a recent review and had a max of 12cc/sec, which for a 68 year old was considered ok. Dr said anything around 10cc/sec was ok. Apparently, young guys are in the 20-30 cc/sec range. As we get older, it all slows down. My retention was 50cc. Dr said anything less than 100cc was ok for my age. And the method of your calculations is correct. My hospital used a fancy toilet attached to a computer, and as you pee, you can see the results. 

I have to assume my max is greater than the average, being an engineer.  I'll be 78 next month.    I have no idea what my post void retention is at this point.  I wear a bag and external condom catheter from when I get up, and Depend pull ups at night.  During the day, if I'm up and about, the bladder empties, but I can retain some urine while sitting, especially in a recliner, and the most at night.  I apparently got into a (rare) extended sleep last night, and when I woke up at 8 this morning, I collected 375 cc, the most I've had for a while.  The average flow rate was only 6.8, as it took a while to drain.

Thanks Jim.   I'm sure the concern of the surgeon who will (hopefully at some point) install the AMS 800 artificial sphincter is concerned about a flow rate that is too slow because of the way the device works.   The cuff around the urethra is usually inflated, cutting off urine flow.  When you need to empty your bladder, you squeeze a miniature pump that is in the scrotum.  The pump removes liquid from the cuff, sending it to a reservoir, allowing you to empty your bladder.  Once you stop the pumping action, liquid starts flowing back down to the cuff at a slow rate that is designed to give you enough time to empty your bladder if the flow rate is adequate.

If your flow rate is too slow (don't know what the minimum design rate is), then you would have to use the pump more than one time when you pee.  This would shorten the life of the pump/overall AMS 800, requiring a revision surgery sooner than you and the doctor would like.

Hi Glenn,

I'm aware of but don't know that much about artificial sphincters, so thanks for the heads up on flow rate.

 If I remember correctly, your incontinence was a result of GL surgery last year. Has the statue of limitations run out for recovery, as I've read that incontinence sometimes resolves after a year.

If your surgeries removed the obstruction, then it appears either a stricture issue and/or sub optimal bladder performance. Do you know your PVR these days?

I think you've been using condom catheters but have you tried self catherization?

Self catherization (CIC) can help with both. With retention, CIC empties on demand. On the stricture side, I believe they use progressively larger catheters to widen the canal. CIC can also help with the incontinence as well. 

?Jim

I think the long recovery times apply mostly to men who've had radical prostatectomies.   I asked my new urologist whether he thought my incontinence might be caused by the strictures, and whether there was any chance of my regaining any bladder contol if I started doing the kegels again, and he said no.

I only did CIC a few times after the GreenLight after I had an accute retention visit to the ED/ER.  I obtained the catheters on my own, and learned how by watching a YouTube video I found.  (My urologist's office would give me no help, when I paniced about the possibility of another actute retention event in the middle of the night.

Before the GL, I had never had an acute retention, just some frequency of urination and multiple trips during the night.  I was given a pretty ominous picture of what might happen if I didn't have TURP (acute retention, bladder that stretched to the point of being usless, kidney disease and failure, etc.).  So, I went ahead, and asked about GL since I'd read that there was less bleeding from it.  Hr agreed to do the GL procedure.  After he had done the surgery, and I ended up with no bladder control, the doctor said he had almost said "no" to doing the GL, that it was "too powerful" for me, or words to that effect.   I told him that could have accepted "no" to my request for GL...

I have read studies that dilation with rods (medical sounds, I think they are called) have an extremely low success rate.  I've also read that the rods create a lateral stress on tissue during insertion that can cause more damage.  The balloon dilation that I had done, apparently does not cause the lateral stress, but even that procedure  doesn't have a good success rate.

Here's what I do know:   I can stop flow briefly during urination.  Also, while peeing, there is sometimes a spontaneous interruption of flow that lasts briefly, although I don't don't if it's a 100% interruption.  I don't know if its the external sphincter working, or some contraction of pelvic floor muscles.  (God knows I did enough Kegels over the months to make me like Charles Atlas down there!)

  I would definitely prefer to regain natural bladder control.  But, the months I spent going to PT incontinence specialists gave me no apparent improvement, so I'm ready to move ahead with the artificial sphincter implant.  For me, it's not a little leakage.  When I was using the heavy duty depends, I could put on dry pair, and be miserably wet in 30 to 45 minutes.  So, it is not a matter of just a bit of dampness for me.  While the condom catheter is a bit bothersome, I find it much more comfortable for me during the day than changing Depends 6-8 times a day, and having to strip down and wash up each time..  With the drain valve for the collection bag just above the ankle, I can go to a toilet and empty in about 15 seconds, start to finish.

Regardless of what the different uros think, a  cystoscopy and/or retrograde urethrogram can give you a definitive answer to the stricture issue. Or maybe that has been done? If it turns out you do have strictures then it makes sense that could at least in part be slowing your stream which seems to be taking on a more important role now that you're looking into an artificial sphincter. If dilation didn't work, CIC still might as it's more of a gradual thing, of course that assumes you have a stricture. 

Jim

I definitely have strictures, or at least had two of them in early December.  The surgeon who was to do the AMS 800 surgery always starts the implant with a smaller guage scope to check out the integrity of the urethra and bladder.   He was blocked, so he did a balloon dilation, I had a Foley for a week, and was told I would need to wait 12 weeks to see if the dilations were effective.  So I will go back in March for a check when he will go in with a scope (I think he said 16F size, which is smaller) to see how things look.  

I honestly suspect my first urologist knew or at least should have suspected I had strictures, but nothing was indicated in my records, and I certainly was informed.  In fact, I had only seen reference about strictures here, and it never occurred to me that I might have them.  And with months of visits to the theraphists at the 1st urologists office, none of them ever mentioned the term.  And I know I had commented that I didn't think my flow was great.  Keep in mind that I was just dealing with leaking 24x7.  Heck, I even thought a bit of accute retention might be a nice change of pace, so I could be dry for awhile.  I had a supply of #14 caths and knew how to do CIC, so that seemed like a decent trade.