A Urolift update

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Had my Urolift done about 2 months ago and I am peeing great!   Nice flow/stream and I feel like I am completely emptying out,  However, I have been doing followups with Doc every 2 weeks,  because even after a good pee and finishing out they do a bladder scan and I am still holding 400-430 CC,  and this is every time.   I feel empty and no problems at all.   Just wondering if anyone out there in Uroland  is experiencing the same thing?

Also I have been seeing PAE   and not sure what that is??

Thanks All!!

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  • Posted

    Let me start off by saying I"m unfamiliar with Urolofit, so some of the following may or may not be applicable...

    Did they do urodynamic testing prior to the Urolift?

    I know with TURP, for example, that they suggest urodynamic testing prior to the procedure to make sure the bladder is elastic enough to empty once the operation is complete. If not, they will put the patient either on a Foley for 6 weeks (or a self-cathing program) to allow the bladder to decompress and rehabilitate prior to the TURP. The reason is because if you bladder is Atonic (flaccid) you won't be able to empty properly even after the procedure, which might be the reason you aren't able to empty. 

    So unless this is normal 2 months post Urololift -- and again I"m not familiar with the procedure -- I would assume the remedy is to decompress your bladder for a period or time either with a Foley, Subrapubic catheter, or a program of self-catherization.

    Because if your holding 400-430cc (PVR) "after a good pee", that means you are walking around at time with a bladder holding probably 800cc or more of urine. This just seems too much and will likely keep your bladder stretched out to the point where normal emptying will not be possible. Do you know what your PVR was prior to the Urololift?

    Jim

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    • Posted

      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.

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    • Posted

      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

       

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    • Posted

      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

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    • Posted

      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

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    • Posted

      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

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    • Posted

      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

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    • Posted

      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     
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  • Posted

    PAE stands for Prostatic Artery Embolization and is a procedure done by interventional radiologists.  About twelve hospitals are currently doing clinical trials, and you can get more information from the National Institutes of Health (NIH) website, under clinical trials.
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    • Posted

      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."

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    • Posted

      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!

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  • Posted

    I had mine done in april all is well.  A PAE is where they cut the blood flow to the prostate and have it stop growing.  If you are peeing I done think you need it  Ken
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    • Posted

      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.   
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  • Posted

    Hi Anthony2858,

    PAE is Prostate Arteria Embolization. This procedure is simply "Blocking the arteries that feeds the Protate gland. As we are  ageing, the Gland becomes larger and larger thereby putting prssure on the passage through which we do wee, making is hard to pass wee freely and in some cases we are unable to pass wee. The PAE is to starve the gland from getting bigger, Later on it will die a slow death.

    What I do not know at present is the efferct to the dead gland would have in tha area where is located..

    I had my done 6weeks ago and I am feeling better in terms of wee. It might be too early to get the actual result but I for now have a "A" grade result. Hope my explanation makes sense to you

    Mathy 

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    • Posted

      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.
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    • Posted

      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.

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