After TURP - did it solve/cure nocturia/frequency/urgency issues?

Kenneth,

We have both been on this forum for a long time so I am very familiar with all the procedures. My PAE was easy, but am now 14 months post procedure and it didn't help me. I am getting up every 1 to 1 1/2 hours per night so I never get a good night's sleep. I have studied and considered all other options. REZUM is not covered by my insurance and is not offered in my area - also some report pain and complications. Urolift is possible. My uro does a TURP using the most advanced methods. I am aware of the potential side effects, But, I really need to get some sleep. Last night was really tough. I get to sleep, then my bladder wakes me up, and I have to get to the bathroom, then back to sleep, then an hour later, the same thing - all night. I have to get this problem solved. A second PAE is an option - my insurance fully covers it, but I don't know if this would have the same result as the first PAE.

Thanks for responding,

Tom

Hey Tom Sorry that you are having a problem. Have you talked with your doctor and ask him why it did not work. What was the size of your procedure before the PAE and what is it after. Did it get smaller at all. And what does he say about a second PAE. Before you have any procedure that cuts away at the prostate. Take the time and think about the Urolift maybe that is all you may need. 2 to 4 weeks healing time. And if it don't work you can all way have something else. Maybe a laser procedure less bleeding. I know my Urolift is going good. 3 1/2 years and still wide open.Take care Ken

Tom,

It's hard to give you the right advice without knowing your data. I went trough the same woes but PAE helped me dramatically. I don't know what will be at 14 month, though. What is the size of your prostate currently? What is your residual volume. I have practically zero after PAE, 300 ml before. Urolift works only for prostates les than 70 g, Make sure that you qualify. I doubt that you have such a moderate size given your symptoms. Most likely you need TURP or RESUM. Cutoff for a successful TURP or green laser is 100 g prostate. AUA recommends below 80g, but many URO will tell you that they can go above that limit. Don't trust them. Operating on a larger prostate takes longer time and dramatically increases the chances for complications, ethylene glycol poisoning, bleeding and possible blood transfusion. Let alone standard 90 days of inability to hold urges and need of diapers, wic very few URO will tell you in advance. Mine warned me about these possibilities.

Given what you describe, your options are: Another Targeted PerFected PAE or suprapubic open surgery with preservation of all nerves responsible for erection and sphincters , bladder controls. Very few surgeons perform that operation but you can find them. It will take at least a week in the hospital. I've seen patients undergo such surgery 40 years ago and not in the firts world country, living after it till mid 80th with good erections and no incontinence whatsoever. Your nocturia might be related to the anomalies of the bladder rather than current BPH, but stemming from a previous severe BPH. You need a more detailed diagnosis at this point. In my view as long as PAE is covered by your insurance ( a rare case in US) go for another PAE, maybe with a different radiologist. Try to find a radiologist with less X-ray exposure equipment. It will be you second PAE and radiation has cumulative damaging effect.

Good luck.

Gene

Ken,

Good advice. Yes, I did speak with my IR about the failed PAE. He believes he can "fix" the problem with a second PAE. That is encouraging. Just wanted to have my frequency/urgency issues solved and the sooner the better. Urolift option is still possible.

You said your Urolift is still "going good". Does this mean you are able to get some sleep at night?

Tom

Gene,

Excellent advice. My prostate was 56g before, not sure what it is now. PVR 170ml, so my bladder won't empty, which is likely the reason I am up so frequently at night. I wouldn't do any procedure that would put me in the hospital for any amount of time. I have responsibilities at home, and the boredom of just lying in a bed staring at the ceiling or watching some TV isn't anything I would be willing to do unless I had no other choice. My IR is head of the department - thought he was excellent. As you suggested, if my nocturia issues are bladder related then another PAE wouldn't help much. I did have a cyctoscope earlier this year and my uro found nothing unusual.

Tom

When I do sleep. I'm a night owl I go to sleep at 2 or 3 in the morning. Most of the time I get 5 to 6 hours. It may be worth doing the second PAE and if it does not work you could have the Urolift . Take care and let us know what you decide Ken

Gene,

I'm a little confused by what you wrote: "First 30 days were very challenging with pain and urgency but totally debilitating."

Did you mean to say "not totally debilitating"?

Would you know if Perfected PAE is done by Bagla, Bhatia or Isaacson?

Why are strong pains and PSA spike indications for success? Is that something you came across in a study, or based on anecdotal evidence from guys on this forum?

Thanks,

Michael

Gene,,

My PAE was performed 14 months ago - very easy, little pain after. However, it didn't help me. My IR is top of the line. Fully covered by my insurance. Some on this forum do not get results from PAE due to prostate size and shape. Mine is about 50gm. It isn't the size, but it is definitely restricting urine flow and I just can't empty my bladder, so I have to run to the bathroom every hour day and night. Haven't slept well in years.

Thanks...

Tom

That's correct. I misspelled. I meant "not totally debilitating" Only first two days were very bad with strong need for painkillers because the pain from duing prostate was excruciating. After that I could drive and work from home. It took almost 30 days and almost lost hopes to see great improvements in frequency, urgency and even residual urine on my underwear. Yes, PAE not only took care of the urgency, frequency, nocturia, and quality of life issues but vastly improved the control of the bladder sphincter and embarrassing wet spots on my pants after the visit to th restroom. First weeks the amount of urine hold in the bladder was still 100-150 ml with practically no PVR as measured by US. Later on it became 200-250 ml, which tell me that my bladder which has a diverticulae and thickened walls due to the many years of partial obstruction by BPH has relaxed somehow. I would say that my LUTS are the level of 40-year old by now. I have no idea how long it will last but am ready for another PAE if needed, rather than resorting to a more invasive procedures.

Yes, teh improvements are not that dramatic as after TURP or radical surgery but side effects are much less, while quality of live went up dramatically. The statement of dl0808 that assessment at 12 weeks is favorable for PAE vs TURP is incorrect. While it takes up 12 or more weeks to get rid of incontinence and ED after TURP, effects of PAE can increase up to 9 month post procedural according to my Radiologist experience with previous patients. In case of successful PAE 24 month results are guaranteed, with some patients having lasting results at 60 month.

I belive that the failure of PAE for Tom is due to the relatively small size of his prostate -56 g. PAE isn't evn recommended for prostate less than 60g. In some studies it's a fully disqualifying condition. UroLift with a skilled Urologist is the best and cheapest option. I'm not sure about Ken's failure because I don't know his prostate size.

Good luck to all. I spent so much of my time to describe my opinion and trying to give advice only because I know how embarrassing and excruciating can be BPH problems in their latest stages when medicines stop working, self-administered catheter in the briefcase becomes a daily reality and any trip a frightening challenge with a real danger to wind up in ER room with total obstruction caused by overfilled bladder pressing on your large prostate.

In my view RE is a minor nuisance when compared to a permanent catheter. I can't imagine that it can be a game stopper for anybody older than 60. BTW the chance of the temporary RE with PAE is only 25% according to the most critical review, while is almost 100% for TURP and other invasive procedures. I repeat, RE and orgasm, even its strength are not related to each other at all. Anybody who thinks otherwise is illiterate and superstitious. Orgasm is a complex reaction of the male body to stimulation and results in ejaculation, not other way around. Everybody who experienced a premature ejaculation in their first sexual experience during teenage years knows that having a strong and large volume ejaculation didn't mean strong orgasm, while having multiple sex acts with little ejaculate can bring tremendously strong and prolonged orgasms. Orgasm happens in the brain, not in your prostate...

So anybody who is willing "to kill themselves; due to the RE resulting from medicine or surgical procedure improving their quality of life is simply superstitious.

Peeing normally is much more important for the preservation of you mental health and quality of life.

Of course everybody is different and has different opinions about what quality of life means. Don't blame the doctors who want to save your bladder and kidneys from the fatal failure. Something gotta give.

Of course, ideally a well administered UroLift and PAE when qualified or open surgery with nerves and both sphincters preservation are the best choices for the patients but also the most expensive for insurances. So, vote for the government that will make these procedures, defining the quality of life of most men after age 50 and above, a standard covered procedure mandated for doctors, not making them rich by performing barbarian "gold standard" outdated surgeries. They make gold only for hospitals and sometimes poorly trained Uro-surgeons, who don't even bother to check how well you are qualified for TURP or what type of anesthesia to use, or using bipolar TURP instrument that allows to us water for cooling due to the surgery instead of the body poisoning ethylene glycol, which is not conductive.

Mark,

Great to hear about your results....

Tom

Ken,

REZUM is not available for me locally or covered by my insurance. Also, many here report complications, pain, etc. The TURP is just an option for me, not suggested by my uro. I am aware of the side effects. But, I already have some incontinence and ED issues do to prior treatment for prostate cancer (radiation). I just want some relief from the constant need to run to the bathroom day and night. I need some sleep!!

Tom