Balloon Dilation of the prostate for BHP and risk of stricture
Posted , 3 users are following.
Does anyone know if there is a percent dilation which will not result in damage and future stricture of the urethra. For example, if a size 14FR catheter is comfortable, would expanding the urethra in the prostate to 20FR cause scarring and later result in stricture? Would the use of a balloon catheter in the prostate over 5 hours to slowly expand the urethra by 50% (say 10% per hour) cause damage?
OOPS, I meant BPH but can't fix that typo in the title.
0 likes, 8 replies
TKM george29339
Edited
If you try to widen the urethra with a large catheter you have to start small and slowly work up to larger sizes. Certainly, if you cause bleeding you should back off.
You could run the catheter up to the bladder sphincter where it will stop if your not putting too much pressure on it. You might not have to push the catheter through the sphincter, if your purpose is the widen the prostate region. It seems like pushing a large catheter trough the sphincter into the bladder may be painful, and it would not be necessary. You don't want to widen the sphincter you want to widen the prostate urethra.
There have been some discussions about this previously on this forum.
george29339 TKM
Edited
I agree on the positioning of the balloon. The trick will be to make sure I am in the middle of the prostate and definitely clear of the lower sphincter. The balloon is only about 1" in diameter. I mean length because as you mentioned I am only going to inflate it to a cylinder and only a little at a time. I am pretty comfortable with 14 FR but tried a 16 FR a week ago. I was sore after that and a little worried because I was not sure if I scraped the far bladder wall with the more rigid tip on the 16. I tried the 16 because I ordered some 16 FR Duette dual balloon catheters before I saw that they have the size 14 FR. Anyway, after my experience the other night with the size 16 I went ahead and ordered 14 FR Duette catheters. The tip even on the size 16 Duette is very soft and I don't think it will scrape the bladder wall. So now my plan is to start with the size 14 FR (when I get them) and go very gradually with multiple sessions. I am going to do as I usually do to avoid creating a false passage and feel for the tip of the catheter to enter the lower sphincter (some less squeamish folk here will guess how this is done). Then I will measure another 2.5 inches to make sure the second balloon is past the lower sphincter. The other tell will be when I get some flow so I will know the first balloon is in the bladder. The port openings on the dual balloon Duette is between the two balloons.
george29339 TKM
Posted
Hi again TKM, you mentioned previous discussions and I found a couple of threads on CIC with thousands of replies. I try to sort on the latest but this site is a bit difficult to navigate. Sorting by the latest comments does not actually get me to recent replies. I read about a fellow who was using size 30 Fr catheters! I remember reading about fellows who leave the catheter in for hours and get some relief for days or even weeks. If I could find those guys I would like to see if I could write to them for their experience. I got the 14 Fr Duette catheters and find that the balloon part at the tip is more like 16 Fr. My plan with the dual balloon catheter is to get the first balloon into the bladder and inflate it to anchor it like a Foley. On the second balloon I would inflate it much less. If I proceed I will likely inject just 0.2 to 0.3 ml into the second balloon and target a size 18 to 20 Fr in the prostate area. This way I figure there will be little risk of damaging the lower sphincter if I somehow am not in the right place inside the prostate. The objective is to have a plan that cannot damage to the lower sphincter. I am not sure if I will inflate with air or water in the balloons. Air may be more forgiving and not force the urethra to a larger size initially. On the other hand, air may not inflate the balloon in the prostate at all. I read in one balloon dilation trial that they used 150 psi to inflate the balloon and crush the prostate tissue.
bcb1 george29339
Edited
Good question but honestly I doubt you will get a solid, accurate answer here, as this forum is mainly guys sharing experiences and opinions about various procedures.
There is the iTind device which goes in for 5 days, slowly expands and cuts grooves to enlarge your bladder channel and then is removed. My guess is that might do a lot better than a balloon dialation for a few hours.
george29339 bcb1
Posted
I like the iTind as an option and believe it has very low risk. If there is a place in the US southwest that does it I may try it. My Urologist's office said he is in training for it but I guess it will take a while before he has 50 to 100 procedures done.
Other thoughts on this are that if I have the iTind done and I end up with this 'crushed' triangle for a cross-section of the urethra would dilation then still be an option? I wish the Optilume was available but I would be a little concerned about the chemo drug. My reasoning is that dilation into a larger diameter cylinder shape would be good to do before the iTind. Cylindrical dilation before the triangular dilation.
bcb1 george29339
Edited
My urologist office in Alexandria, VA does the iTind, not sure how much experience they have with them but I understand they are going to be very popular since I think Medicare upped their reimbursement rate on them. And they are an in-office procedure which I think doctor's prefer doing. I would not touch Urolift, as there are far too many failed, painful experiences that I've read on them. For every one guy that's happy, there is at least one that is not.
I have to agree, with iTind there isn't much in the way of data or user experience right now. But with a 5 day procedure time - heck, you can survive 5 days of pain and bleeding, if the end result is a good one, and there is nothing left behind so no worries there.
To me, the only no-brainer procedure is PAE. It's done through the artery in your groin (or wrist if you are short enough), and is such an easy procedure, I'm glad I did it even though my results were not night & day improvement. I did get definite improvement, but only for about a year. I will say though, it stabilized me - to where I am about the same as I was in 2017. Before then I was getting a bit worse as time went on.
Of all the other procedures around, Aquablation and Holep are the ones I seriously considered. Holep is sort of a no-go on a smaller prostate like mine, which leaves me with Aquablation.
Good luck with whatever you decide to do!
george29339 bcb1
Posted
I would like to know more about Holep as the folks at the Mayo Clinic recommended that for me at >65cc size prostate. I should have taken notes but the doctor said that side effects are low. I am not sure I want to give up the function of the upper sphincter because I believe Holep would likely remove enough of it to insure retro from then on.
I was all set to sign up for Rezum but read enough on this site to decide against it for now. From the images on the way iTind works it looks like it expands the upper sphincter and could result in retro.
george29339
Edited
Well, I find that 18 Fr is too much for me. The balloon catheter I used is labelled 14 Fr but the tip with the dual balloons is more like 18 (17.5 measured). Insertion was a bit uncomfortable but with it in the area of the prostate it was fine and I tried a dilation of 20 to 22 Fr with no issue. But when removing the deflated catheter I found it painful so the area of the lower urethra was not OK with 18 Fr. I had to use some AZO for the pain and burning for a couple of days. I will not try to get Foley size 10 or 12 Fr and hope they are not over 14 Fr in the area where the balloon is. I thought I would use the dual balloon with one balloon to anchor it in the bladder and know where it was but did not need to to that. I can tell by how far it is inserted that I am in the bladder.
I have read that others have flow around the outside of the catheter before even getting through the lower sphincter. I am confused by this (I have this as well). If the restriction is in the prostate, then why would the flow start when the catheter is not even past the lower sphincter?