BPH symptoms cause bladder diverticulum. Is this inevitable?

Earlier when your prostate was smaller, your only choice was TURP.

GL/PVP has been widely available in America since 2002. I had it in England in 2004,

It was many times discussed on this forum that GL/PVP is very much TURP for smaller prostates <60-80g and except for a day less in the hospital has pretty much the same complications, albeit less bleeding. Given the overheating of the prostate during the PVP damage to the nerve bundles around the prostate can be the same or even worse than during TURP. Not suitable for large prostates.

Totally contrary to my experience and that of friends . No complications and life back to normal on day two. Uro who did mine(75 grms) described it as a very gentle procedure and successfully performed one on a 92 year old with a 120grm prostate.

Why, then so many people on this forum discuss alternatives to TURP and GL/PVP. my URO refused to perform GL on me at age 62 with 90 g prostate. 8 years later I had PAE instead of TURP which brought a lot relive, but probably is not as radical as TURP or GL. it'a nothing gentle in both of these and it was discussed many time on this forum. both are highly invasive. AUA approved TURP for prostates less than 80 g and even less for GL. Thulium laser and PLA are different, but rare to find a skilled Uro . As a rule they are not covered by most insurance plans. What could be gentle about burning your flesh at speed 0.5 g per minute in both procedures? Thulium-Holmium laser is very different, it vaporizes instantly the water in the living tissue and ablates the prostate much faster. Laser type of RESUM. I agree that many younger and stronger patients survive TURP and GL without many side effects except RE, but the full recovery period is not a couple days. It's more like 8-12 weeks of

I have been repeating myself on this Forum for years I turned down TURP in 1995 and waited for something better to come along and that was GL/PVP. I and others I know had it and all were a success and had no long recovery/pain or bleeding or RE. I am bewildered as to where your six to eight week recovery reports come from.

My only complaint was that my flow was not as good as I expected but possibly that was because it was a bladder neck sparing procedure as the team always tried to avoid patients having RE. When my prostate regrew to 135 grms I had Thulium/Holmium Laser in 2013 with 80grms removed. I would have quite happily had GL again but I lived in a TURP dominated area apart from one surgeon who did Thulmium/Holmium. The original, hospital was too far away. They had just switched over to HolLep from GL as they said on a split decision.

Again a quick recovery but it did not again make me pee like a racehorse. First procedure when I was 69 and the second when I was 78. With GL the catheter was out the next morning while a friend left the same day without one. He by the way had sex on day 5 or 6. I waited till day 15.

It took all of the first day to pass reasonable amounts and I was retaining until the second day after which it was negligible and I had no worries about a long train journey home. The next day I was out for about six hours at the races with only two visits to the toilet. Once on arrival and the second before leaving and I had several large coffees during the afternoon.

I passed more blood after the Thulmium/Holmium and rather than keep me for an extra night I left with a catheter in. It was supposed to be in for a week but the Uro's team got it wrong and said to come back in two weeks. All the time it was in my urine showed signs of blood but as soon as it was removed it was crystal clear. I had no retention after either procedure. After GL my PSA went down from about 9.8 to 5.1. After Thulmium/Holmium from over 7.0 to 0.74.

Forums like this attract people seeking help and much of the advice given to them is heresay and rumour and much of it from people fearful of any procedure. My two procedures were as an NHS patient. Friends were a mix of NHS and private. Here most Uro's are employed by the NHS but also do private work.

Forums also bring out the minority who have had problems with their procedures. The successful ones have no need to post seeking help. I just stick around out of interest in the subject and to try to be a voice of reason and reassurance.

What did you do during your eight year wait while your prostate continued to grow ? Did you self cath ?

The following is simply incorrect Gene, you stated; "Once you are prone to BPH, the prostate will grow till you are dead. The only cure is a radical prostatectomy , or early castration 😃. "

Radical prostatectomy is never done to resolve BPH, only PCa. Simple prostatectomy via 3 methods is indicated for BPH.

You probably right, it was my exaggeration, but believe you or not, it was done 30-40 years ago for BPH in many countries. My father in law had in 1976 at age 60 and believe or not his sexual functions were some how preserved till hie died at age 89. Back then I didn't know all the details of the surgery but remember that it was done in open abdomen and cut through his bladder, which took 2 weeks to heal before the abdomen was stitched back. He developed a urethral stricture after that surgery bu never complained about incontinence or importance. If you take into account that the surgery was performed in the small hospital in the third world country, we won't proud ourselves with the huge success of modern Western medicine in the developed countries.

Many non-metastasizing cancers with Gleason score 7 or less t are subject to simple robotic prostatectomy. It's a mater of terminology. Would you prefer to call total robotic prostatectomy not a radical surgery? Of course the capsule is left intact, if possible. It's left intact in some PC surgeries. Am I wrong again?

Here is an experience of one "lucky" guy who underwent this gentle procedure, Derec. His name is Glenn 54030. Write to him and try to convince him that "gentle procedure" takes only a couple days to recover. I took the liberty to copy his testimony from another discussion on this forum:

I had TURP green light surgery Aug 25, 2017. Was discharged and that night a bloodclot blocked the bladder and I had unbelievable pain. I rushed myself to the hospital and demanded triage come immediately. They catherized me and I got relief. I am on coumadin so that complicated things. Was in ICU for 3 days dealing with cath blockage by blood clots. Terrible pain. After discharge the second time had no bladder retention so wore pads. Dealt with that till early November (last year) and now everything is clear. ED after surgery and still taking proscar which also contributes to ED. No great loss. I am 86.

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I've read his posts and probably nearly every other prostate post on this site since it started.

I also from around 1996 read posts on the BPH usenet news group and have over 13,000 posts still on file on file from it. Patrick the very first GL/PVP patient posted there. At that time American patients were flying around the country flocking to the first URO's doing it . That site still exists and most of its posts can still be downloaded though it is little used now. Have you ever looked at YouTube videos of GL/PVP or had a copy of the DVD from the manufacturers to clear some of your misconceptions ? A Spanish URO Fernando Gómez Sancha who used to contribute to the news group did some very good training ones and demonstrated it around the world and lectured on it at conferences.

If GL is as bad as some posters make out would there not have been nation wide protests about it around the world and their share price down to cent instead of it having been subject to takeovers. The equipment has had continued development and is probably now on its third version. As one of the first two URO's to use it in the UK told me many years later.. At first we thought it was a very easy procedure but then we realised that it need more care and time than we originally thought. Perhaps some American URO's have still to take that on board

Would the NHS have ever had it as their preferred procedure ? Only in the past few months have they preferred REZUM due to it being cheaper and with an even quicker patient turnover. Have you read the NICE (UK version of FDA) web site where they detail all proven prostate procedures and medical research papers on their viability ?

"Probably this is now an irreversible condition. Might improve slightly over the years, but unlikely."

Concerning diverticulum, they can be removed via surgery if they are causing issues such as bladder stones for instance. Otherwise in most cases, as you said, once the blockage is removed, bladder issues usually won't be much of an issue other than what you mentioned.