BPH Treatment, I am exhausted

There you are! So you are happy with results?

Emil, what procedure did you have?

It was a combination of Green Light and Rezum.

He was very careful and mentioned beforehand that there is a risk with RE. We talked about Dr. K's method and he was against it. I trusted the man for some reason and took his advice. Before surgery I had to go up between 1 and 3 times per night. During day time I went to the restroom every 2 hours at least....traveling was a problem and visiting friends felt often uncomfortable with my frequent restroom visits. When I had to go, it was urgent and if I didn't go the entire system got messed up and I had to go thereafter every 15 minutes until it got normal again. 16 months later there is nor more urgency, I go in the morning, the afternoon, evening twice , before bed time and can sleep through. A true blessing. Over time the bladder improves a bit again. I usually can hold 200 to 250 ml, while before it was probably around 100 ml. I was also lucky not to have RE. A lucky straw after all. Good luck to you. Don't hesitate and do something.

It seems a strange combination why does he do that ? Does he do them both on the same day and in what sequence does he do them ?

Your daily output does not seem all that much and 250ml capacity is well below the norm. Despite initially waiting nine years before having GL I avoided bladder problems and after a second laser procedure when my prostate regrew to 135 gm I often ignore the need that passes and eventually pass 600 ml.

Were it not for chronic insomnia I would probably not need to get up during the night.

Derek,

you are definitely an anomaly. After 135 g prostate and two procedures having void volume of 600 g deserves to be recorded in Guinness book. Online medical encyclopedia cites normal void volume 210-300 mL with morning void up to 500 mL. With age our bladders became thicker and can hold less urine for both men and women. Before PAE I used to void 75-100 mL, after up to 250 mL. My bladder slowly improves back to "normal" Of course, during the AUR it could accommodate up to 2L (very painfully though). I don't think that we should aim 600 ml at our age. Time between bathroom visits is the most important. It should be no less than 3 hrs. Currently, I have achieved 3-5 hrs. All that said, PAE produces modest improvements but makes quality of life (and even sex) much better with little or no side effects at all. The improvements tend to deteriorate with time but almost any method of BPH treatment has that shortcoming, unless the patient dies before the the symptoms start to worsen again.

My bladder seems to be in pretty good condition as I'm coming up to 85! I normally go at about 300 ml but if I get distracted the feeling goes. If I need about 9pm I avoid going as then I would not then need before going to bed. I don't restrict my liquid intake despite advice to the contrary.

Why does PAE lose its effect in time as the beads are still in position.

The new blood vessels grow and restore of supply of blood full of testosterone from the testis. Severe BPH is often (if not always) the result of varicocele , typical in older age, when veins from testis are backed up with blood full of testosterone. At least one of the theories claim so. The prostate continues to grow, but at lesser speed in advanced age. Some people claim good benefits in 10 years. Some have repeated the procedure with very modest success. My prostate was 135 g before PAE. Probably around 90 g now, bu can continue to shrink. I don't feel further improvement after 9 months post procedure. So far is a great improvement vs. preop. My PSA dropped from 5 ng/L to 2, where it was 20 years ago. To early to tell, I'm only 12 month postop and hope that it will last 3-5 years at least. Even TURP rarely lasts more than 7-10 years.

So no procedure except complete removal is final.

I wonder at what age it really does stop growing as I had GL at 70 for my 75 grm prostate and Thuluium/Holmium at 79 when it was 135 grms.(reduced to 55grms) that surgeon suggested that I take Avodart to reduce the need for another procedure. I said No, do you think t my age that it has time to grow again. He looked at my age on his screen and said 'Perhaps not'

A friend who also had GL for a relatively small but badly placed prostate in 2004 now has a reduced flow but the Uro said that he has done very well and can get by on Cialis.

10 year redo rate for Holep is less than 1%, vs 10-15% for TURP.

I've read that most of prostate growth is between ages of 50 and 70. I so hope that it holds true for me.

Hank,

No surprise. Holep is a specialized procedure that really cores out the prostate, but takes specialized training - not done in a lot of places. Mayo Clinic, Cleveland Clinic for example.

I have no PAE experience but it seems to me that having a local doctor who you can meet face-to-face and discuss things with is a better approach. Sounds like he actually wants to evaluate your condition before deciding if PAE is the correct treatment. I'm with your wife on this one.

Dr Picel at UCSD in San Diego.