BPH Good days and bad days.

Do you have the urge to pee when you get out of bed?  I also try to stop liquid intake about 3-4 hrs prior to sleep time.  Usually don't drink coffee after @7:00 P.M.  But when I get up A.M. I don't get much of an urge at all ( I'm still using the urge feeling as an "alarm" when I know its time to cath as to keep bladder at least less than 400cc.  Also use the clock.  I get definite urges frequently when bladder is fillng up but thank God no incontinence.  I was probably using my internal spincter a lot when my bladder next began leaking from being so full.  So its probably pretty strong or worn out; I hope the former.  Anyway, I wasn't getting those urges at all right before I started self-cathing.  Now if the urges are mild enough they will go away so I wait awhile ).  I usually have to cath before bed & then again after about 4 hours but then I can sleep a long time.  I don't know if I could do this if I had a job. I suspect I could; I'd adjust.  But for someone in my situation I think watching/waiting makes a lot of sense.  

I get up two or three times during the night.  I may be awakened 1.5 hours or 2 hours after going to bed, and measuring 250-300 cc.  If I'm fortunate to sleep three hours, it could even be 400 cc.   By morning, the rate of urine production has fallen off to 50-75 cc per hour.  I get up, shower, put on the condom catheter and collection bag.  I can go from 8 until 12 noon, and only have 200-250 cc in the bag, even though my coffee, water and other liquid intake at breakfast is at least 500 cc.

I again agree with what you say. Especially about the drugs as a bandaid for the condition and about PSA. I was first scared about cancer. That is the fear that my urologist was selling. Yes they wanted to do the blind 12 needle biopsy. I did not want that and said no but I wanted to know if I had cancer. I chose to have the MRI done as I felt it would accomplish a lot with one non invasive  quick procedure. This was a diagnostic choice direction that made sense to me before we get carried away with a direction of treatment. Here is what I wanted to learn.

One, do I have cancer lesions that need a biopsy and can it be seen?  3T MRIs are very accurate to one mm on this. If I have cancer we change direction quickly as urination is now secondary. 

Two, what is the density of the prostate, this is a important fact in dealing with a potential cancer diagnosis and the MRI provides the gland density numbers.

Three, what size is my prostate? I did not realize I had a tennis ball in me until the thing was measured in the MRI. My Urologist was quick to give me the DRE but with that he only said it felt soft and supple not that large. 

Four, Is there a blockage location in the urethra or not? I could definitely see on the MRI the area that was pinched off from the tissue inside my gland pushing out and I could see the median lobe pushing up into the bladder. Bladder conditions are likely with those two facts of my MRI and I need them fixed regardless of the bladder I could not ignore them. CIC was a possible short term answer if I needed it but realize it was going to be difficult to get anything UP that pipe. 

Five, is there residual urine in my  bladder after I void. Yes the MRI showed the volume and there was a little the but with a blockage down line in the prostate that made sense at that time. I knew I was a candidate for bladder weakness and issues but I was not going to fix bladder issues with a blocked pipe and a hill pushing up into my bladder causing a residual valley of urine. I needed to know that first and I needed to see the prove of it. 

With the proper 3 T MRI and the right doctor reviewing it, I learned where I was and what I need to do next. Then I could evaluate and compare the options and I could know the collateral damage that each option might present to me. I am not ready to settle and accept certain side effects. Drugs being one of them.

BPH happens over time and slowly. Nine years for me. It causes a chain reaction. Based on where you are in that chain reaction determines what you treat and in what order. Most of the BPH cases do not fall into a single condition or a single treatment. Now add prostatitis to the mix and this is condition that some of us may always deal with one way or another. By the way, a properly trained expert can see the prostatitis condition in the gland on the 3TMRI also. If only the doctors would slow down and work as hard on the proper diagnosis as they do pushing us toward treatments. We could have better result with some collaboration among the practitioners 

Blood PSA was just to get a bench mark number to watch and cancer is a scary thing. It is an indicator only. The urologist was happy to do it and was so excited to offer the biopsy after he called the number "very high" He did not know how big my prostate was and with a prostate the size I had, a 4.5 PSA was a small number. With my PSA number the Urologist was eager to do the 12 needle biopsy through my rectum. I said NO and ask if he would help me get an MRI. He said NO and that it was not needed. I am sure he did not know how to even read one properly.

The MRI made total sense and nothing went up my rectum or urethra at this time. That could come once I knew what I was dealing with so let's just see what we are dealing with then we can start all these other tests. 

The key was finding someone who really knew what they were doing and would work with me to get some direction. It's not easy and I am sure a lot of men can't find anyone and are left to the will of the urologist. Hopefully they will get a unique one that is open minded and willing to work with a specialized Interventional Radiologist. That would be best for the patient. But I don't really think that is likely. Too much ego and need the  money more than the concern for the patient.

Bobcat is a  very young victim of this and he has a lot of options. He need to decide how best to find out what he is dealing with then how to do it and where to go. He has time to do it but that does not mean to wait and watch. He need to have someone show him the situation not just push him to a treatment. 

>Blood PSA was just to get a bench mark number to watch and cancer is a scary thing. It is an indicator only.>>

The PSA level can be an indicator of a couple of other things can it not?  I was under the impression that my "spike" in my PSA level as well as my creatine level were actually caused by my chronic urinary retention as well as most likely causing the Prostatitis.  BTW- the reason I did the blood tests was due to a 4 week SVR (sustained viral response) check during hep c treatment (which was undetected  incidentally.  The Urologist didn't order it but they were the ones that told me the two anomalies were "going in the right direction now" and they attributed that to my self-cathing. They were able to look at these blood tests because they were linked with my GP I guess. Haven't had that PSA test re-evaluated in the last few months but hearing it was dropping was enough to give me peace of mind for now.  I have another appointment in January with the Urologist.