BPH - Toronto, Canada - Options?

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Hi,

I am 56 and have been diagnosed with BPH. I had a CT scan, Ultrasound and Cystoscopy. As per my urologist, I have a small prostate, some thickening of the bladder wall and some limited obstruction. I urinate twice at night due to pain in my lower abdomen. I take Tamsulosin and the only improvement is that I can urinate easier at night. Obviously I did not have a good night sleep in more than four month and a low level lower abdominal pain that never goes away.

I haven't talked more details with my urologist as I didn't know what to ask. Now things have changed after spending my holidays reading this forum.

What are my options here in Toronto, major and minor procedures? What is covered what is not by OHIP? What are the requirements to have that procedure accepted as a medical procedure and claimed on the Tax Returns, in Canada or abroad?

Thank you,

dg

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  • Posted

    Good Evening

    What you should do is call the insurance company and see what they offer for BPH problems and see where you go from there.

    Each procedure has different concerns. You also have to see where your concerns are. 9 out of the 10 top procedure for BPH cause retro ejaculation or some other sexual problem. What every you get you have to get the best doctor for that procedure.

    Start with something less evasive like Urolift, PAE or Rezum and then go from there. You just have to see what procedure they have Then do your research. Your procedure should be up to you not what is offered.

    You have a small prostate. Major surgery may not be the answer. Good Luck Ken

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  • Posted

    I urinate twice at night due to pain in my lower abdomen.

    I assume you mean that its pain that tells you its time to visit the little boys room. I was thinking today about how I didn't realize how much urine I was retaining after my pitiful attempts at emptying my bladder. I was getting out around maybe 50 - 70 cc. Then, increasingly, after a short time I'd need to do it again. I didn't feel the urge to pee, but I did sometimes feel my full bladder especially if I pushed on it or I had a cat in my lap or something. I was thinking how that SHOULD have been a clue. I guess I didn't know what normal was because it came on so gradually. By the time my bladder was getting stretched I didn't feel an urge to pee and had gotten used to my bladder feeling full. My doctor didn't seem to get it either. It became obvious that I was usually way over the 400 ml that is about full for most men. In fact, i'd have to have that much retained before I could force any out. Just because you have a relatively small prostate (I was told the same thing) your anatomy may be such that it still blocks the urethra enough to keep much urine in you bladder. I've been doing cic for over a year and a half now and at least I know that I'm getting fully drained at least 4 times a day. I do it right before bed too so that I can usually sleep at least 6 hours before needing to get up. Individuals vary with that too. Even after all this time I still fell almost nothing when I first get out of bed. Often have to do cic just because I know its been hours.

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  • Posted

    Also, I forgot to mention that I am taking antihistamines on a daily bases for dermographism. The only thing I could do about this is to skip a day when taking the pill. That is why I would avoid putting anything in my body(Urolift and maybe PAE).

    @kenneth1955

    According to "Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update" some of the recommendations are "Convective water vapour energy ablation", Rezume and PAE(I need some more research of the allergy potentials of those beeds). If these procedures are recommended then they must be approved and someone must be performing them here. They do not recommend iTIND due to low information at this time.

    @keith42667

    My pain started before the urinary symptoms started and I did confuse with regular muscle pain and aches. I am working-out four times a week so it was just some sort of sore muscle, especially that was coming and going. I had done an ultrasound after emptying the bladder and it did not show any retention. Also my PSA is 1.00. In general after 3.5-4 hours of sleep I need to go as the pain wakes me up.

    I am looking to hear also from my fellow Canadians as our system is very specific, and how do they approach this situation.

    I have read on this forum that FLA is the best just bellow GG. FLA is on the top of my list in Texas, Florida or California. In Toronto they do a study only for those with prostate cancer. I would have to have the BRCA 1 and2 tests and see if I qualify, not likely.

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  • Posted

    Hi - I live near Toronto and have seen it all. You should ask about PAE. It is covered by OHIP and was developed at the University of Toronto in a series of studies years back. Also switch to Xatral for your Alpha Blocker. It is much more effective with minor side effects.

    Have you had urodynamic testing yet? It is important to understand if your peeing problems are due to bladder issues and/or obstruction. Also what is you PSA and its trend over time?

    Howard

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    • Posted

      Good morning Howard

      Hey buddy. How are you doing on Xatral ( Alfuzosin ) I did a look up on that there are a lot of side effects with this pill. I hope you ware watching.

      Also there are a lot of pill that do not mix with this about 30 and also I was surprised thet you can't have grapefruit juice with it.

      Just be careful with that pill. Be safeKen

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    • Posted

      Hi Ken - great to hear from you. It is funny how we all react differently to drugs. I was given Flomax almost 15 years ago now for my BPH and I fainted right at the toilet while peeing. It did nothing for my peeing. So my urologist switched me to Xatral and I've been great ever since. It is like a miracle drug for me and I've never had a problem with it. If I miss a couple of days it really affects my ability to natural void. The only other prescription drugs I take are Avodart ( pure poison ) and Advair for my asthma. I never liked grapefruits so that isn't a problem.

      Thanks again for your research. I wish there was a reward we could all give you but at least you have our gratitude! Howard

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    • Posted

      Hey Howard.

      It's no problem I just trying to help. I was on Flomax before I had my Urolift. I hated it. It used to make me dizzy and it gave me retro. That sucked

      Yes it is hard to believer some drug work different on different people. I guess you have to try them first. And if it works stay with it.

      Have a great day...Ken

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  • Posted

    Hi Howard31850,

    I did not have urodynamic testing, I am going to ask my urologist for it and also about changing to Xatral. I do not have major side efect just a few days some runny nose and retro is less than 50%. Would you suggest someone to talk about PAE. My urologist is from Humber. Do you know if there are any restriction for other procedures if PAE fails?

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    • Posted

      DG

      With the Tomsulosin has just has many side effects as Xatral ( Alfuzosin ) I don't know which one is best but different meds work different on different men. Please ask your doctor. With any of the less evasive procedure ( Urolift, Rezum or PAE ) there is no restriction on having something else done if the other procedure does not work

      I did a little looking and found thet they do TUMT and Turp at Mouni Sanai. And there are 2 doctor at UHN in Toronto thet do Urolift. Also Greenlight is also do in Canada. Have to look more to see if I can fine something.

      Good Luck..............Ken

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    • Posted

      Hi dg:

      Your problem just doesn't sound like a prostate problem to me. It seems to me that you need a good internist who will give you a thorough workup to understand what is causing your constant abdominal pains. If your prostate is a normal size and you have zero retention from the ultrasound and your cystoscopy did not show any median lobes, bladder stones, urethral constrictions or other issues then I don't think prostate procedures would help.

      For certain you need to start with a urodynamics test which is quick and easy. That should give some good data. Also antihistamines are notorious for causing urinary problems and those of us with BPH are forbidden to ever take them for allergies or other issues. If you could try getting off of them for a week and see how you do that might help.

      There are a couple of urologists I would recommend in Toronto who know all the available procedures in Toronto. One is Dr. Elterman at Princess Margaret Hospital. he specializes in GLL but is also a general urologist. Another one is Dr. Keith Jarvi at Mt. Sinai who does most procedures. He also specializes in testicular pain which may also be an issue for referred pain from your description.

      But other than getting a urodynamics test I suggest you find a good internist and get a referral for some general testing before focussing on the prostate. Also never ever submit to a prostate needle biopsy.

      One last thought: have you been checked for prostatitis? Your symptoms are consistent with that disease and Dr. Jarvi could help you in that regard witha diagnosis.

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    • Posted

      Next time you get your PSA done also ask for the FREE PSA test as it is an early warning sign for prostate cancer. It is part of the same blood test and is covered by OHIP. The number should be high ( >18%) since cancer cells use free PSA for their growth so the serum levels are low when cancer is developing. I assume you get good DREs from your uro.

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    • Posted

      You almost read my mind, more like the back of my mind as I suspect that is not a prostate issue. The pill doesn't do much for me, and at night I still walk around the toilet for a minute or two. The pain is there no matter if I pee or not. It is a low level pain more like a muscle pain. I will follow the internist route and urodynamics. I will keep you posted.

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    • Posted

      A few more thoughts:

      1. You could also have Nocturia in which the kidneys dump a lot of pee at night which makes you get up and go a few times. I have this as well but if I eat a small bag of salted potato chips a few hours before bed then the problem is reduced as the salt causes the kidneys to retain water. Of course watch your BP!
      2. You could have an over-active bladder (OAB) which is easily diagnosed and treated. Both these conditions are aggravated by BPH.
      3. You could have an inguinal hernia caused by pushing too hard if constipated. This could cause the low-level chronic pain.
      4. You could have varicoceles.

      A good screening question for some of these conditions is if sexual activity aggravates or alleviates your symptoms?

      Good luck. Howard

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    • Posted

      Sex does not make it worse or better. I experience more pressure/pain in the lower pelvis for about 10 min after sex and then is back to the regular low level pain. I believe that is due to the partial retro . Also I noticed that sitting on my back when reading is worse than on a side or chair. Other than that no other physical impediments. I will keep you posted with what my urologist suggests.

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