Best procedures for less in evasive surgery for acute urine retention

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Hello. All.........'m from the West Michigan area..Kent county . I'm looking for anybody that had any experiences pro and cons with any prostrate surgery. I've. been battling urine retention for quite awhile lately. A few years ago I was booked to go in for TURP procedure but I backed out at the last minute. I didn't like the the side effects that may come with it and plus the Doc that was going to do it was arrogant and snippy with me saying I was too young. Since my early thirties I've been diagnosed with a stone on my prostate and ever since then I've battling BP and UTI's infection. and urine retention. I'm looking for good advice and opinions ... Thanks Andrew

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  • Posted

    You need a full workup before considering any procedure. That includes being scoped to measure the size and shape of your prostate and a urodynamics test to measure bladder function. IF, the tests show that much or all of your problem is prostate size, Rezum, PAE and Urolift are all possibilities. If you have an enlarged median lobe, PAE and Urolift are out - but Rezum will correct a bulging median lobe well in most cases.

    None of these require anesthesia, side effects are minimal and if yo are matched to the right procedure it should work. Also, none of these preclude something more invasive like TURP if for some reason you need it.

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    • Posted

      I recall seeing a study - coauthored by Dr Isaacson, I believe - that demonstrated PAE efficacy for median lobe intrusion into the bladder

      I'll try to find link

      Michael

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    • Posted

      I could not cut/paste the URL into this comment box so I will try to type out the link below (if the mods will allow it).

      A small sample size from UNC-Chapel Hill, but encouraging results, Re: PAE results for median lobe protrusion. Sounds encouraging and there may be some hope for guys, like myself, in this situation.

      https://www.jvir.org/article/S1051-0443(15)01405-0/pdf

      Hopefully, this will get posted.

      Michael

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    • Posted

      I tried to post the link to the Chapel Hill study on PAE for median lobe protrusion but it's being held up.

      This is a fantastic forum, but posting links is frustrating. Have to respect the decisions of those running this site, however.

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    • Posted

      oldbuzzard,

      I do believe, if you research further, you won't categorically rule out-of-hand PAE for any and all men w/ a protruding median lobe. It's a hurdle but from what I've read, not an iron-clad insurmountable one to overcome.

      Respectfully,

      Michael

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    • Posted

      Here is the key statement from the link not yet approved. Note that this was a very small study.

      Results: Eighteen patients with Protruding Median Lobe were identified. Mean

      baseline IPSS and QoL were 24.2 ± 5.8 and 4.9 ± 0.8 respectively. Mean IPSS at 3 months was 5.8 ± 5.7, a 72.4% decrease.

      Mean QoL at 3 months was 1.3 ± 1.5, a 73.5% decrease. Clinical

      success was achieved in 15/18 (83%) patients. Data stratified by

      degree of PML are included in the accompanying table.

      Conclusions: In this small cohort, a high rate of clinical

      success was achieved after PAE despite PML.

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    • Posted

      Lee,

      Thanks for inserting the study's conclusions.

      Yes, it is a small sample size. However, the results are encouraging w.r.t. improvements in Quality of Life and IPSS score.

      Any man w/ a large median lobe considering PAE should ask the interventional radiologist to look at his MRI and see if he/she has had success with similar cases. Any doctor should be honest enough to tell a patient the pros/cons/prognosis of a treatment option for his/her patient's condition.

      It would be nicer if the study was done on several hundred, instead of 18.

      Michael

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    • Posted

      There are a lot of (admittedly anecdotal ) stories on this site of PAE failures with PAE. Rezum is probably the best non surgical option at this point - they've done tens of thousands and the results have been excellent.

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    • Posted

      No, I see your point and it's a good one.

      I haven't looked much into Rezum. I recall somewhere that it may present complications for very large prostates .... but I could be wrong. Perhaps that concern was over Aquablation.

      It is good that we have a number of options, and hopefully-prayerfully, men will have more options and more successful outcomes as techniques are perfected by practitioners.

      Back in my father's time, it was basically TURP or nothing.

      If I do go with PAE (over HoLEP) I will ask someone like Dr Bagla if the median lobe poses a technical challenge that would drive down likelihood of a successful outcome.

      I appreciate this exchange as this is a constant learning process and you're helping me along the journey.

      Thank you,

      Michael

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  • Posted

    There are a variety of procedures available. It is important to research them and decide on what best fits your individual needs. It seems that Uro Docs have favorite procedures that they "specialize" in, and that may be determined by your insurance coverage or their personal experience with the procedures. I had the Rezum done due to AUR about 2 months ago and am seeing favorable results thus far. Hope you find the right solution for your needs.

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