Acute urinary retention.... Need advice on options please.

Just to reply about Tamsulosin. I have been on this for some time on and off and although it may have caused me some occasional dizziness if I stand up too quickly, (though this could also be the anti-hypertensives I take) the only other side effect has been dry orgasm which does detract from sexual pleasure, and of course would cause temporary infertility, so not helpful if you want to grow your family!- but as far as I know and have experienced, any such side effects are only there whilst actually taking the drug, and things return to normal soon after coming off. 

First - a GP doesn't know enough to be offering advice on this. Suggesting a TURP to healthy 54 year old should be all you need to know about that. HE should see a not too old urologist. The drug doesn't have any permanent side effects - its a reasonable stop gap if it works well enough to ditch the cath. Self cathing is FAR better than that foley. Have the cath removed, get a script for self caths and get some of the ones recommended on this forum - I think the #1 is the speedicath. I think you can get single use protable ones that fit in a pocket - so as long as you can find a stall no one will know. Its fast and lets you live a reasonably normal life - including athletics.

As for the Holep, its very effective but almost always leaves you with permanent RE - which will end the possibility of more children. Urolift, PAE or ReZum are his best options if you can get and offord them. Central lobe size issues preclude Urolift apparently - test results will reveal whether your husband is a candidate. PAE is performed by internetional radiologists, so your Urologist will probably recommend against it,, but there are many in this forum who have had good results with it. It does pretty much the same thing as ReZum, but in a different way.

At 54 with more children a possibility, he should not be considering TURP or HoLep - and at any age, why undergo a surgery when something less invasive with fewer side effects could well work. I'm in the US, so not sure about coverage in the UK - others on the forum can provide guidance on it I'm sure.

Laser surgery does not always mean RE. The percentage is relatively small with a careful Uro and if he can do a bladdder neck staring version.

As fall back a patient can always have some semen stored.

From a Urology Journal. Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate. 

Another interesting finding was that the orgasmic function or overall sexual satisfaction domain score remained slightly decreased throughout the follow-up period after the HoLEP procedure. In the present study, the scores of "ejaculation frequency," one of two items that compose the orgasmic function domain, were decreased throughout the follow-up period after HoLEP compared with baseline, although not significantly so at 12 months after surgery. Therefore, ejaculatory problems may have an adverse effect on orgasmic function or overall sexual satisfaction after HoLEP. This finding is in accordance with the study by Briganti et al. showing a significant deterioration in the mean IIEF orgasmic function domain score after HoLEP and a recent study by Muntener et al. suggesting that the loss of ejaculatory function after TURP is significant and is associated with considerable bother.

You can ask to be referred to any hospital doing the procedure that you want. I managed to be referred from Edinburgh who at that time only did TURP to a Newcastle hospital doing a PVP trial. If they consider the procedure not to be be suitable for you they can refuse,

A friend was referred from Raigmore Hospital in Inverness to Kings College in London for his PVP and was allowed to claim his travel and hotel expenses for the initial consultation and the procedure.

At the moment the NHS are letting patients in South East England get various treaments in a Calais Hospital but they have to pay their own travel expenses.

At 54 your husbands prostate will most certainly grow again. I found LASER surgery to be trouble free was back to normal and went to the races on day three. Needing a second one only eight years later was no problem.

One of the first two surgeons who did PVP with the first generation lasers later told me that at first they thought that PVP was an easy procedure but that they later realised that they had to take more care and remove more tissue.

 

Holep will most probably result in retro ejaculation. Should be no permanent side effects after topping Tamousilin. Self Catherization will not only get him off Tamousilin but will buy you time to explore current options or wait for future options. It will also ease the anxiety of another acute urinary retention episode. No rushing to the ER, etc, just self cath and resolve the issue in a couple of minutes.

Jim

You have to be determined and dig your heels in to get the treatment and hospital that you want. Some areas now give you a list of hospital doing the procedure you need and you can choose and find out waiting times. Hospitals all publish success rates of their procedures if you delve into their sites or ask. Why not record you your conversations with your doctor or urologist. Most don't mind and you don't forget answers.

PVP should not be a problem after retention, A friend had it and had to self-cath for months as he was only offered TURP. He eventually had it done privately and must have created a world record by having sex and ejaculating on day 3. Eleven years later at 71 his flow has reduced and he is taking daily (5mg) Cialis for that with good results.

I did not have retro after PVP but do now after time on Tamsulosin when my prostate regrew and my later Thulium/Holep surgery.

To get what you want it is worth considering paying for it as you have a lot of years ahead of you.

The NHS is OK for life threatening conditions but not so good for life enhancing ones.  In years of seeing urologists I find them the worst people to deal with not only are they ageist and prefer drugs with bad side effects to action most only acknowledge the treatment they do or only have the equipment to do it with. The most miserable men I’ve ever met were at urology testing clinics. I asked the nurse at our local surgery what was her most complained about drug. I was surprised when she said Tamsulosin. Yes, from men I said. She said, No. from their wives!

As you are pregnant beware if your husband is offered certain drugs like Avodart or Finasteride as a pregnant woman should not even handle the tablet much less have unprotected sex with anyone taking it. 

Dutasteride (Avodart) can be absorbed through the skin, and women or children should not be permitted to handle the capsules. Although Avodart is not for use by women, this medication can cause birth defects if a woman is exposed to it during pregnancy. Avodart capsules should not be handled by a woman who is pregnant or who may become pregnant.Decreased fertility has been reported in some men taking finasteride.  Finasteride may increase the risk of certain birth defects, including abnormal formation of genitalia in male fetuses.  

 Finasteride may increase the risk of a certain type of prostate cancer. It can also put your PSA up and in my case I started to grow breasts until I stopped it.

 

Derek76...... Thankyou very much for your helpful reply. 

We we will avoid these drugs while I am pregnant ... Is Tamsulosin safe?. I can avoid handling them but nervous about kissing my husband when he was on them? Gosh.... Self catheterising is getting more and more attractive!

Many thanks again,

Ali

Best to Google Tamsulosin as I can't remember. I refused to use a catheter althought I had residues of up to 650 mls after voiding I always managed pass 200or 300 mls.

I just do not understand many on this forum who are obviously so afraid of any form of treatment that they will probably self cath forever waiting for the miracle cure. I waited ten years for a good form of laser surgery that I was happy with and now there 11 years later there are improved lasers and now PAE.

I don't see how tucking the prostate to the side with Urolift is a cure as it will continue to grow.

Derek, surely it is a matter of one man's meat is another man's poison? Those who tolelrate catheters will adopt this course of action while those who do not respond negatively to drugs will go that way.

I feel sorry for the person does not find a solution anywhere in the market place!

Alan

There is a lot to consider and everyone's situation is different. Their pathology, finances and priorities are all important. Many procedures (other than PAE, REzum and Urolift) are surgeries and bring permanent side effects. The last 5 years have changed the treatment landscape dramatically, and some people who self cath end up getting better with no treatment.

I think its fair to say that in an area with few absolutes, TURP should be a lost resort only. Other than that - if you can get/afford/qualfiy for them, Urolift, PAE and Rezum are worth trying becuase they are non-invasive, rarely bring side effects and don't preclude something more surgical if they don't work.

Some urologists are pretty cruel and heartless and you have to determine your own priorities within the boundaries listed above. YOur GP will have to be directed - recommending TURP to a guy in his 50s who wants more kids and hasn't tried any other procedure is borderline malpractive IMO. But GPs are often not informed enough to treat more than flu like things and basic infections.

Good luck - I HATE cathing, but if my only other option was TURP I'd probabaly do it til I could get something else. But everyone's situation is different.

There is a lot to consider and everyone's situation is different. Their pathology, finances and priorities are all important. Many procedures (other than PAE, REzum and Urolift) are surgeries and bring permanent side effects. The last 5 years have changed the treatment landscape dramatically, and some people who self cath end up getting better with no treatment.

I think its fair to say that in an area with few absolutes, TURP should be a lost resort only. Other than that - if you can get/afford/qualfiy for them, Urolift, PAE and Rezum are worth trying becuase they are non-invasive, rarely bring side effects and don't preclude something more surgical if they don't work.

Some urologists are pretty cruel and heartless and you have to determine your own priorities within the boundaries listed above. YOur GP will have to be directed - recommending TURP to a guy in his 50s who wants more kids and hasn't tried any other procedure is borderline malpractive IMO. But GPs are often not informed enough to treat more than flu like things and basic infections.

Good luck - I HATE cathing, but if my only other option was TURP I'd probabaly do it til I could get something else. But everyone's situation is different.

Well said, everyone's situation is different. In my case caterzation is not an option I'm 64, my insurance will only pay for a Turp. I'm sort of tired about hearing how archaic this procedure is. As with most things on the net we only hear the "bad" not "positive," things surly there are positives regarding the Turp. Again this is my only option with my age and finances. It's very demoralizing hearing all the negatives, my Turp is tomorrow. Denis

Good Luck - I hope it goes well. Health care is not always set up in the patient's best interest - I'm very lucky to have the options that I do.

 

Those who self cath and get better could not have had BPH that is the main problem with most on the forum.

On this Forum so many of us are Brits as it is British run (but like our NHS, all are welcome) so payment is not the problem as opposed to actually getting to the top of a waiting list to be treated. eg. I am No 611 on a 39 week waiting list to see a Neuro Surgeon. OK, I've had to opt out and see the same person as a private patient at another hospital. £250 for an initial appointment and £170 for later ones. £995 for an MRI scan plus £300 for the radiologists report and then eventual surgery if needed.

PVP/Holep here costs around £6,000.  

I waited 54 weeks for a heart valve replacement, my friend in Baltimore waited just three weeks. If I'd had it privately here it would have been £28,000. I'm told in America it would be over $120,000.

Good luck with it. As you say on Forums not many with good results bother to post. The thing about TURP is that it is a very general description and often badly used by urologists of a procedure that has changed over time and has had many variations

I post on my two good laser experiences in the hope of helping others. Personally I found them less trouble than getting a tooth out and my first was done as only the eighth by the Guy doing it. I figured that as he had done a lot ot TURPs that PVP was a piece of cake for him. 

Dennis, I wish you all the best with your procedure. I am 51 and will follow you with my TURP on June 1. I am also tired of hearing only negative comments about TURP and people who never had this procedure are writing the most negative comments about TURP. Some of us either are not suitable for other procedure or could not afford to pay radiculous amount for something with not established truck of success.

I would really appreciate if you would keep me posted with your recovery and experience like pain and incontinence first few days after procedure. After I go through my TURP I promise I will share every bit of my experience and my recovery with you.

As on any other forum, people who post are only those with bad outcome and is not much of them, but others ore only complainers and cry- babies.

In April of 2014 I had my nasal septoplsty, submucosal resection of turbinates and frontal sinus balloon synopladty with drainage.

Found forum about this procedure and 99% of all posters complained about "empty nose syndrome".

I was totally satisfied with my outcome without any side effects and did not suffered single sinus infection for 26 months post op. I used to have 3-4 sinus infections annually.

Guess: I did not go back to that forum to post my excellent outcome.

My bad. 

I am sure, same is here with TURP.

i will keep you in my prayers. God bless you.

MK

 

Thank you MK. Will keep you posted. Will also keep you in my prayers. Would like to share my private email with you, but don't know how to do that here. Denis

Dennis.... I would also like to wish you the very best of luck for tomorrow and would also like to know how your recovery goes if you don't mind sharing. We too may have limited options due to financial reasons as I've spent all our savings on IVF!! Feel quite guilty now! 

 

if it helps my Father had the Turps done a few years ago and is pushing my husband to have it done as he says he's never looked back since! Never regretted it! He has had issues such as retroejaculation and a bit of impotence but does not regret it at all. I sincerely hope it helps you as much.

Best wishes

Ali

The trouble with TURP is that it has had a bad press for many years. When I was first told I needed one in 1995 I did some research and by chance a journalist in The Daily Telegraph one of our major newspapers was researching it as he had been advised to have one. His series was the factor to make me decide to wait for something better to come along. Even my GP shook his head and said 'Too Bloody' 

I read a book by an American urologist who as well as describing the prostate in great detail went through all the available options of that time as well as TURP. He covered cryosurgery as well as microwave TUMP and the research that was being done on lasers.

I had some correspondence with him and he advised me to wait for a good laser procedure. At that time postings were mainly on NG's like  sci med prostate bph that still exists. A lot of information was exchanged there and eventually PVP came on the scene and was the option of choice for all. Patrick the first person in the world to have it told us about his procedure practically as it was happening and a few days later he was flying from California to Japan on business. Actually like Victor Kyam with the shavers he was so impressed that he bought shares in the company. In fact the company did so well it was taken over. At the time Americans were flying around the country to be treated by the few Uro’s doing it and very few had complaints afterwards.

  

I will Ali... Take Care, Denis.

By the way I have a French spelling of my name, "Denis" pronounced "Denknee." Although I'm not French, my mom wanted me to be unique lol.

Have you heard of DEN KNEE highs?

No have not.

Knee high stockings for ladies.

Hello aliL. I too went into acute retention and was catherized. My GP referred me to a urologist who persuaded me that the green light procedure was a better option than a turp. I am not surprised that your GP is not familiar with the green light option. To them it is a turp but with a laser. The one thing that I am grateful to my GP for is that he referred me to a urologist who is a real expert at this procedure and was very insistent that I should go to him and not someone else.

Another thing, and I am surprised your GP has not told you this, but PSA results are totally unreliable while catherised and should not be taken until 6 weeks after the catheter is removed.

Also, if you want to go down the urolift or PAE route, you should check out something called 'patients choice' in the NHS (You can google it. I tried to put the link in but the forum sent it off for moderation).

With me the flow did not return when the catheter came out so I had to get it sorted out quickly. If your husband’s flow returns when his catheter is removed then you have time to evaluate what's best for you. All the best. Patrick

 

Patrick.... Thankyou very much for this info.

no, we were not told the PSa would be affected by the catheter. Thankyou for letting me know or I would have panicked at his results. Unfortunately the hospital has lost his referral to the catheter clinic so we now have to,wait until mid June to get it removed. We are seeing GP tomorrow and I will need to,ask,him how on earth we can monitor his PSA if the catheter is still in? 

I will now Google patients choice...... Thankyou

Hi Patrick... I'm pleased to hear the Green Light for you was effective. For me it wasn't. That is why I'm scheduled for a Turp tomorrow. Denis

A better means of evaluating TURP vs. other procedures is the stats, rather than anecdotes in this or any other forum. 15 % of the time, permanent impotence or incontinence issues happen. I'm sure the skill of the urologist has a lot do with it - the better ones are probably well below 10% in complications stats.

TURP is just an older, more invasive surgery, with a longer recovery and a greater chance of permanent side effects. It's sort of like doing an open knee ACL repair, vis doing it with a scope. The open knee ones worked - pro athletes had it done whe it was state of the art and went back to their sport...but the success rate, complication rate and recovery time are all better with a scope than with a scalpel.

TURP vs. Holep/Laser and REzum/PAE/Urolift is the same comparison. If TURP is all you have available and you don't want to wait or petition for an exception, its your best option. I do know that when inusrance companies say no and you fight back, sometimes they relent and in this case they have a financial incentive to do so, as TURP is the most expensive option there is.

Good luck to all who opt for TURP - may your results be awesome and Godspeed!

Your GP should be able to remove the catheter. All you need id a syringe to drain the fluid in the bubble holding the cath in. I did it myself when I had ReZum. Self cathing is much better than staying with a foley til Mid June - ask your GP to remove it and get you a script for a cath and your hsuband can use one of the oens recommended in the forum. Even if he pees fine after having it removed - having a cath available jsust in case will preclude any uncomfortable waits in the ER.

Thankyou OldBuzzard...... Do you think the GP will be able to show him how to self cath? Without this appt until June at the catheter clinic I am worried that he won't be able to self cath if nobody can show him how

The GP should be able to - or his nurse at the very least. Cathing is something nurses know how to do (at least they do in the US) and its amazingly simple. But make sure someone is available to show him before you have the cath removed!! If you can afford it, it might be worth paying out of pocket for a urologist that can see him soon if your GP can't demonstrate self cathing and get you a script. I know I HATED the foley cath and found self cathing annoying but it allowed me to work out, run and I could never get compfortable with the foley. The forum talks alot about those spedicaths - i think they have portable disposable ones that can allow you to be very discreet - as long as you can find a stall, no one has to know and it only takes a few more seconds than going the natural way.

Go to A&E to ask for it to be removed or indeed your practice nurse should be able to do it.

A lot of things affect PSA, ejaculation in the previous three days, riding a bike, a urologist or doctor doing a DRE before it and any infections plus of course the bigger the prostate. My PSA was up to 9.8 before my PVP though it only came down to 5.0 after it. Up to 7.8 before my last procedure and now 0.74.

What caused it not to be effective?

That is great..... Thankyou! Yes, my husband is finding the Foley cath hard to put up with. His job is very active and its limiting him.... He's walking around like an old man  Ok, so we will push for self cathing lessons tomorrow ( like you advise he wants to learn anyway to avoid another crisis) and also try to get a private referral to speed things up to Urologist. 

Your advice has been invaluable ...... Can't thank you lovely gents enough... Will let you know how we get on,

Ali

How can TURP be the most expensive procedure when it has little required in the way of equipment. I'm not sure if it is still the case with PVP but initially each procedure needed a new laser rod and if it took more than a certain time they needed a second one and the rods cost about £3,000 in the UK.. 

Hi Alil,

I've been on vacation and missed this.  There is not a lot to self-cathing; additioanlly, jimjames or I can offer private info, re how to self-cath more easily than the nurse or doctor is likely to instruct.  Hard to believe, but I never had a nurse who did it as well/comfortably/simply as I have learned to do it.  ALSO:  VERY IMPORTANT!!!  NO RUBBER CATHETERS!  INSIST ON SILICON CATHETERS (SpeediCath and Magic-3 are the brands moast favored on this forum.  They are "hydrophyllic" (pre-lubed) and are easier, simpler to use, and safer, gentler and less likely to infect.  Please be sure to pursue this point, if it's not already been mentioned.  I was in an ER two weeks ago, and the DIRECTOR of the unit had never seen the good catheters.  (I anticipated that they would not have the good ones, and refused their awful rubber one, and used my own, when they needed to have the bladder drained.  Awful, the old-fashioned catheters!  :-P

Anesthesia, hospital stay, follow up all more expensive than procedures done without anesthesia or hospital stays

Right

Yes - he should elf cath as quickly as possible.  Safer and much less painful.  Use speedicath brand.

Hi Denis! I hope your surgery went well and you already started your journey  of recovery. Wish you speedy recovery and best outcome.

Hoping to hear from you soon.

MK

Hi MK, Ali, Oldbuzzard and anyone else on this thread I left out:

First of all I should no better (after all I'm 64) I trusted my urologist. Anyone in the same boat as me should not be as trusting as me or was.

My Turp surgery went well, actually it was 3 hours long. My prostate real-estate was in crouching on my bladder. Not my words but my urologist knew this in the "scope" test. Anyway that is part of the reason it took so long and in my urologist's words just plain huge.

On April 13th I had my last Foley installed and was warned it should not be in longer than 30 days. Do the math, my Turp surgery was on May 24th. I did everything possible with my current urologist to schedule surgery in that 30 day window. I said to my urologists scheduler I need this surgery before the 30 day window expires. I tried to schedule surgery with my urologist's PA

. She said I have to see the doctor.

Now I have a creatinine level of 1.5; normal is 1.2 milligrams. This indicates I have a low level of kidney disease. I feel this was created by this Foley left in to long because my urologist was to busy! I was assured by my urologist this will return to normal blood levels, but I'm not going to trust her. Starting with asking my primary care physician what I should be doing 1st. This scares the heck out of me because I only have one kidney as I gave one to my sister who had kidney disease when I was 38.

Anyway, the surgery went fine but long, really not much pain. My outpatient status changed to a one over night stay in the hospital, because my urologist wanted to make sure the color of my urine was not to "red." Again as I'm typing this is have no pain from my prostate, but a huge migraine, guess from stress and everything else. The migraine has now left me at 11:pm Pacific Time.

I will keep you guys posted how I'm doing with my recovery, Denis

Hi MK... as I recall your surgery was on June 1st, how did it go? Today my doctor took out my "Operation Foley. " my biggest fear is I would have been left incontinent from the Turp procedure, that fortunately did not come to pass. I'm now able to void, thank goodness. My createniant level is heading to normal levels and the tissue from my prostate was negative for cancer. I'm a happy camper, Denis