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BHP 43 years old

Posted , 7 users are following.

fenran1
fenran1

Hello. I would like some advice!

O have Bernal developing UTI problems in the last years, so I visited a urologist. I took some test: PSA 0,8 an urofloxometry with a score of 3 ml/min average an 4 ml/min max, and an echographs. At last a cystoscopy that showed that my urethra was perfect but there was an obstruction in the bladder neck: two lobules that seemed to bee from prostate enlargement. My prostate showed to be normal in the echo (about 20 ml) but someway, it’s pressing the bladder giving me UTI symptoms. The lobules are 2,5 cm more or less.

I have been on Tamsulosin for 3 weeks and I feel a little improvement, but if I think in taking medication for the rest of my life, I get depressed.

No side effects from Tamsulosin, just the infamous RE.

So I’m thinking in going ahead with TURP. In the country I live, the only options is standard TURP, but as I am young and the prostate is small, maybe the results will be good.

So guys, what would yo do, being just 43, with a small prostate pressing the bladder (diagnostic BHP)? Taking Tamsulosin for years, with RE and maybe more symptoms in the future, or just going ahead with the surgery? (TURP).

I know TURP gives RE too, but I am already suffering RE from Tamsulosin, so it wouldn’t be a big deal. ED possibility concerns me a bit more, but with my small prostate the surgery maybe would be easier. I’ll try to ask the uro for TUIP but I think they don’t do it here.

Thanks a lot for reading me and excuses for my poor English!

1 like, 37 replies

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  • fenran1
    fenran1

    Posted

    I meant ml/s instead ml/min 😀

  • TKM
    TKM fenran1

    Posted

    Fenran,

    The RE effect of Flomax is temporary and goes away when you stop taking it.  In fact for me the effect goes away 12 hours after taking it so if I time it right it will not affect my sex life, at all.

    The RE from TURP is permanent, so think about that.  There are new procedures that may work for your small prostate.   You should see a urologist first, who can determine if you have an enlarged median lobe.  If you do not have an enlarged median lobe you can try Prostate Artery Embolization (PAE),  which is the least invasive procedure, no RE.  Without large median lobe you can also try Urolift, which is also less invasive than TURP, also no RE.  With or without large median lobe you can try Rezum (steam) which is less invasive than TURP but more than PAE or Urolift.  Rezum has about a 10% chance of RE, but may give better and longer lasting results for flow.  There are some laser TURPs that can avoid RE but you have to find a surgeon who knows how to avoid RE, and there are not many.  Even then it is not gauranteed that you will avoid RE.

    Your flow rate at 3 to 4 ml/sec is very low.  You can also try self catheterization, if your symptoms are difficult, as a way of buying time until you can find something more permanent to do.

    Good luck,

    Thomas

    • fenran1
      fenran1 TKM

      Posted

      Thank you for your answer Thomas. I’ll try the Tamsulosin trick to see if my RE is better in the night (I take it in the morning). Anyway it’s not an issue for me, but I’d prefer normal eyaculation, of course. In Chile, where I live, the options are really limited. I think no one does PAE or UroLift, but I’ll try to ask my urologist for it next time I see it. He said TURP would be easy for me, but I don’t know. I want to have at least 10 quiet years without UTI symptoms, but I’ll try to take it easy. Self cath is not an option for me,  cystoscopy was so horrible that I don’t want to fell anything in my urethra anymore. Thank you very much for your answers and the options you have showed to me. Yes, I’m really obstructed 😞 but at least without medication I’ve never been with continence. Greetings!

    • hank1953
      hank1953 fenran1

      Posted

      If you are so obstructed, you should check to see what your urinary retention is. Too much urine retained in your bladder long term can cause serious kidney problems, which are more important than your flow rate. Hank
    • fenran1
      fenran1 hank1953

      Posted

      Hank my urinary residue was 18 ml according to echo. 
    • hank1953
      hank1953 fenran1

      Posted

      With PVR of 18ml, your retention is almost zero so it's great. Do you have any problems other than just slow flow ? Hank

    • fenran1
      fenran1 hank1953

      Posted

      Stop and go flow, going to the bathroom several times in the day and 2-3 times at night, and problems to start a flow: I’ve to concentrate and relax for 10 seconds for starting to pee. Anyway, nothing to worry too much about.  Greetings Hank!
    • fenran1
      fenran1

      Posted

      Just revised echo and I was wrong: last exam’s residue was 27 ml. Not too much difference anyway.
    • hank1953
      hank1953 fenran1

      Posted

      27 ml is still very good. No retention. What you described is prostate median lobes blocking the bladder neck opening. Alpha blockers like tamsulosin don't help very much in this case. Surgeries do. Since your only choice is TURP, I would go for it. Just expect a lot of bleeding and a long recovery. You're young and brave. You'll recover from it. The good news is TURP will last you for many years to come. Good luck. Hank

    • TKM
      TKM fenran1

      Posted

      Fenran,

      Dr Francisco Cesar Carnevale  at Hospital das Clincas of the University of Sao Paulo in Brazil has been doing PAE for about six years.   https://interventionalnews.com/prostatic-artery-embolization-set-to-dramatically-increase-in-brazil/   However unless you can get insurance to pay for it it may be expensive.  Urolift and rezum just require the inexpensive tool to do them.  They can be done on an outpatient basis in the doctors office, so they are relatively inexpensive compared to TURP or PAE.

      You might find a contact number in the Rezum or Urolift web site that you could call to find out if anyone in South America is doing them.

      Self catheterization is not as bad as you think. The first week or two is difficult, you may get some bleeding and possible UTI unless you keep things very clean. After that you will hardly feel it.  When someone else inserts a catheter or cystoscope it can be painful because they don't know when you feel pain, they just keep pushing it in. But when you do it, you stop or slow down when you feel pain.  You have control of the feedback loop, it is much better to do it yourself. 

      Hope this helps,

      Thomas

       

    • fenran1
      fenran1 TKM

      Posted

      Thank you very much for tasking the time and look into the info .
    • hank1953
      hank1953 fenran1

      Posted

      Just in case, are you generally constipated ? Constipation can give symptoms similar to BPH.

      How much are you peeing each time ? Hint: Pee into a measurable cup or bottle and record the results for few days. Hank

    • fenran1
      fenran1 hank1953

      Posted

      Hi Hank! I’m not usually constipated, son I don’t think that it could be the problem. Cystoscopy showed enlarged lobes up, in the bladder neck. I’ll try to post the image. Thank you!
    • fenran1
      fenran1 hank1953

      Posted

      I’ll try to measure the pee, I pee a lot of times in the day. Sometimes only a few and sometimes more. I usually pee a good quantity and pee again 10 minutes later a good quantity too. But I’ll try to pee in a bottle for measuring. Greetings!
    • hank1953
      hank1953 fenran1

      Posted

      If you didn't drink lots of fluids just before, peeing a large quantity and then another large quantity 10 minutes later, indicated retention. I would question your low echo reading of 27ml. Also, severe obstructions usually are associated with urinary retention. Hank

    • fenran1
      fenran1 hank1953

      Posted

      Hi Hank, that was my echo reading. I usually drink quite water or liquids (I have kidney ‘s stones).

      I don’t usually force myself to empty my bladder because I need a lot of time and I stop when the flow is just drops. Uro told me I have hyperactive bladder too and cystoscopy showed that it already was a bit trabeculated. 

      This is my neck bladder view from the verum montanum:

      https://1drv.ms/u/s!AubV6os8PamkhLN8aYAvSm09ODIZiw

      Greetings!

    • hank1953
      hank1953 fenran1

      Posted

      Regardless, TURP will do you lots of good. Just remember to remind the surgeon of your median lobe blockage. Everything will be fine. Hank
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