Bladder training and PTNS (percutaneous tibial nerve stimulation) alternative to prostate procedure

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I have had voiding issues for many years and my prostate size is "large" - 42-56gm depending on the measurement method used. Three and a half years ago I had successful radiation for prostate cancer and last August had a PAE. I am still having voiding issues and have to run to the bathroom every hour and a half day and night. I never get a good night's sleep, and this leads to frequent headaches. 

I have been in discussions with my urologist about moving forward with another prostate treatment - a second PAE, Urolift, Greenlight, or, as a last resort, TURP. 

He suggested I try PTNS first (percutaneous tibial nerve stimulation), and after reading about this technique I also read about bladder training to help my nocturia and overactive bladder symptoms. 

My last two PVR ultrasounds showed 178 and 172ml of retention after I thought I had completely emptied my bladder. 

My uro is suggesting that the PTNS might help in this regard. 

I am not aware of any posts here about PTNS or about bladder training as an alternative to the prostate treatments I mentioned above. My uro says that even if I get another prostate procedure that is no guarantee that this will help or cure my voiding issues, so better to try something non-invasive first.

I would appreciate any thoughts or advice on this before I move forward with anything else...

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  • Posted

    PTNS is new to me, can't comment there.  But until you have enough info to make a choice, I would recommend CIC (cathing), which I and others on this forum are doing pending finding a reliable choice.  I cath before bedtime, and unless I've been drinking alcohol or too much water late in the evening, I sleep through the night.  Yes, through the night.  Going to bed with an empty bladder gives one a head-start on that possibility!

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    • Posted

      Yes, CIC is a blessing!  It's great to have that feeling of a complete empty bladder.  I forgot how that felt, after years of not being able to empty my bladder completely.

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  • Posted

    I looked up some terms:Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive neuromodulation treatment marketed by Uroplasty, Inc. for use in overactive bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence when more conservative measures have failed. 

    Not sure if this would relate to my problem which is, I think, a combination of two things; weakened bladder by overfilling and an obstruction of my urethra most likely enlarged prostate.  For years weak flow; urgency, waking at night; culminating in overflow incontinence which has gone away since I started CIC.  Don't know if this relates but one of the best pees I"ve had since I can remember followed a short ride on my ATV which the seat, of course, goes between my legs and there is a lot of vibration.  I often wondered if that vibrating down there helped.

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  • Posted

    Hi Tom,

    Don't know a whole lot about PTNS but I would think that you should first try the more conventional therapies for overactive bladder such as Kegels and timed bladder retraining, or maybe you have? Also, in addition to overactive bladder your retention numbers show you also have underactive bladder as well which would be an independent factor with your nocturia in addition to overactive bladder. Not sure if PTNS will help or actually make that worse.

    In an event, I suggest you do a 24 hour void log before you start anything so you can track your progress. Just write down the time and amount of each void.

    Jim

     

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    • Posted

      Jim,

      I have kept a log off and on for several years and know how much and when I void. The problem is I have a strong urge to get to the bathroom then I only void about 75-150ml. My original thought was that I was retaining so much urine already that the 75-150 additional kicked me into "I have got to pee" mode. So, I asked my uro for additional imaging and wanted to consider treatment with Urolift or Greenlight. But, he surprised me and said that these procedures might not help and could make things worse, so he wants me to try other bladder procedures first. I have always thought that an enlarged prostate caused my issues and the "fix" was to reduce the prostate size. So, my question to the forum here is does a prostate reduction procedure cure the urgency/frequency/retention or not? 

      Tom

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    • Posted

      Maybe help with retention. Maybe not help with your overactive bladder. Two issues going on at the same time. I think kegels and bladder retraining is a good non-invasive start even before that stimulation therapy. Have you ever had urodynamic testing? That may also provide some answers.

      Jim

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    • Posted

      Jim,

      Never had urodynamic testing. Am going to move forward with the PTNS and see what happens. 

      Tom

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  • Posted

    PTNS sends electrical stimulation along the tibial nerve to the bladder and helps the issue of overactive bladder. My uro believes that a lot of prostate treatments to improve flow and reduce the issue of frequency/urgency are really bladder issues similar to overactive bladder syndrome and further prostate treatments, like Urolift, Greenlight and TURP might not help and actually could make things worse. 
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  • Posted

    An update on my bladder training progress that everyone here should find interesting and hopefully useful.

    I am not scheduled for my first PTNS treatment for several weeks, so I decided to work on retraining my bladder to hold more urine before triggering the urge to go to the bathroom. Prior to last week, I would go to the bathroom every time I felt the need to pee - and that was about every hour to hour and a half. When I measured the flow it was usually about 75ml, sometimes less, sometimes more. Then, I started to do the opposite - trying to hold in the urine for as long as possible before running to the bathroom. My average flow is now almost twice what it was before, and a couple of times I have achieved a 250ml output "record". This was in the early morning after waking up. I have been able to almost double the amount of time I can "hold it" and have been able to sleep longer than before without waking up. So, I have cut my trips to the bathroom from about 5-6 per night to 3-4. Doesn't sound like much, but I am feeling better when I am finally up. The rate of flow is still slow - less than 4ml/second - normal is 20-21ml/second in the average male. So, I am still blocked, but at least I can sleep longer and believe I could sit through an entire movie if I go to a movie theater.

    In a few weeks I will start my PTNS treatment and perhaps that will help me to last even longer before triggering my urge to pee. After that I am scheduling a second PAE to help increase the flow since I still believe my primary issue is that I am being blocked by my large prostate, as are most here on this forum. 

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