BPH vs. Voiding Dysfunction

No, but was thinking earlier today that I should check. I've been using single-use self-lubcricated Coloplast speedicath catheters for about 6 weeks and am careful about hygiene, but you never know. I will get a UTI home test today and go to an urgent care clinic if anything shows up. Thanks.

How successful are you with self cathing? Is it easy ? Are you having any pain or bleeding as a result? Self cathing if not done properly may cause problems and worsen your symptoms. Are the Coloplast catheters housed in green pouches?

It is generally pretty easy I guess, but lately I seem to have some pain/difficulty when I try to get through the external urethral sphincter (I think), and the prostate right after that seems tighter than before (but not painful). I agree that I often am sore after catheterizing, and am now going to avoid doing it when at all possible. I had some light bleeding for a couple of days last week, but that has passed (it was only visible on the catheter tip and tissue paper). The catheters are in gray pouches (SpeediCath Flex Coudé Pro). I am using size French 14, but just received some French 12 samples which might be more comfortable. I was really hoping self-catheterizing would improve the quality of my life, based on some threads I read on this site, but you are right it does seem to be worsening my symptoms. I am now trying to reserve it for absolute emergencies when I'm in excruciating pain and cannot void within 30 minutes without heavy straining. I need to stop straining.

I tested negative for a UTI today (home test) and will check again in the morning.

The good thing is you are not using the Coloplast SpeediCath with green pouches. Those are very stiff and caused many injuries, especially among newbies. I am very familiar with the SpeediCath Flex Coudé Pro, and still use them on occasion. They're nice in term of convenience. However I did notice some minor bleeding using them, similar to you, blood at the tips of the catheters. Hopefully size 12 will solve your problems.

My current urologist has only mentioned Urolift, which I'm not interested in, though I haven't told him, mostly because I haven't met with him since last August -- the last few visits I have met with his assistant, who has been focused on trying new medications and showing me how to catheterize. My family and friends have strongly encouraged me to get a second opinion, so I have an appointment with a new urologist in about ten days. Hopefully he lives up to his excellent reputation.

I always have a catheter and baby wipes with me when I leave the house in case of an emergency. Your parking lot story is familiar. Last summer coming back from the beach/dinner with friends I had to pull over in the middle of nowhere and go into the woods to void and it took me nearly an hour. Extremely painful, and painfully embarrassing.

I have received mixed messages about my prostate from urologists. When my symptoms started over five years ago (frequency with pain at end of voiding and persistent microscopic hematuria (per urine tests)), the first urologist I saw did a bunch of tests which found nothing, tried a bunch of medications which did nothing, and then told me he didn't know what else to do for me and suggested I get a second opinion. He apparently ruled out BPH based on a DRE.

A couple of months later I got a second opinion from another urologist and he also ruled out BPH based on a DRE and a PSA test result under 1. He suggested dietary changes, which did in fact help, though there were a lot of ups and downs as I figured out what I could and couldn't eat or drink. At the time I was satisfied that there was nothing serious wrong with me (although I urinated on average 15 times per day), such as bladder or prostate cancer.

Things went downhill about a year and half ago when I started waking up in the night in pain and had extreme difficulty in voiding -- sometimes it would take me more than an hour to go, and in one awful case it took me 3.5 hours. I would have gone to the emergency room, but the thought of driving over and then getting processed in and probably waiting for hours to see someone was too much. I was then referred to a new urologist, the current one, who noted after a cystoscopy in January 2022 that I have a "Small but obstructing gland with central zone elevation and lateral lobe obstruction close to bladder neck," but he also referred me to a pelvic floor physical therapist (who by the way told me "it's not your prostate"). I was recently looking at my urologist's notes from our first visit in December 2021 and he estimated my prostate size at 50 grams (in bold), which I don't believe is "small." Meanwhile, every time the urologist's office checks my post-void residual after I produce a urine sample, they tell me my bladder is nearly empty. Yet last night I woke in severe pain and had to catheterize just 1.5 hours after a natural (although strained) void and out came 8 ounces (a new record), so I do seem to be retaining at times.

I had a pelvic MRI in January which found nothing abnormal (other than lumbar disc issues I already knew about). Interestingly, the urologist's assistant told me that I did not meet the criteria for having a prostate MRI (I believe she said it was because my PSA was so low). She also said a transrectal ultrasound of my prostate would not be useful.

I've never had a flow test. I was going to mention it to the urologist's assistant at our last visit in February, but she brought it up first and it is scheduled for the end of April. But I am getting a second opinion from another urologist on all this in about ten days.

I had my first urine flow test last week after many years of issues. It seems like a urine flow test should be the first test done on a man with BPH symptoms

I am getting a second opinion in about ten days. If he can convince me that BPH is the source of my troubles, he is one of the few urologists in the area who does HoLEP, which seems to me to be the least awful of all the options.

Why do you consider HoLEP to be the least awful option? I don't know much about it

HoLEP enucleates the interior of the prostate within the outer capsule (sort of like separating and then removing the guts of an orange from the surrounding peel, from the inside). Because so much material is removed, it is unlikely you will ever need another procedure again. Recovery also apparently is easier because you don't really have to worry about inflammation or blood clots or chunks of dead prostate tissue clogging the passage. And it appears that you only need to have a Foley catheter in you overnight after the procedure.

Not that I think that this or any other procedure is going to be a risk-free picnic. But if I need to have a procedure, this is the one I'd pick.

What is the expected outcome regarding ejaculation and erectile function?

From what I've read, retrograde ejaculation is guaranteed, but ED is very rare unless you already had problems.