Chronic Retention of Urine - Enlarged Prostate

Dear Derek,

Many thanks for your reply and your useful suggestions, which I will follow this week,

I noticed that you had your GL in 2005, the same year I believe that NICE approved the surgery.  I am concerned about the Turp operation as well, and after doing some homework I may try and get a referral to a NHS hospital which is doing this newer type of treatment.

If you have any comments about the Greenlight Laser treatment you had, it will be much appreciated.

Kind Regards

Barry 

I was very satisfied with my GL procedure. It was done on the Friday afternoon and I expected to go home on the Saturday after the catheter was removed. It was totally pain free afterwards. However it took hours for me to pass anything and I was not completely voiding. As I had 130 miles to travel they preferred to keep me another night in case of problems.

Home by train and peeing quite well with initial stinging and a spurt of blood each time. Then pink with the odd small clot. Next day I went to the races and was out and about on my feet for six hours, completely back to normal. I went to the toilet on arrival and had to remind myself to go again before leaving for home.

I was drinking a lot to begin with to flush things out so still getting up three times during the night. My flow was never as good as I expected but the urgency and frequency had gone. 

The Thulium procedure had a longer recovery time for me. I was still passing blood the next day and a lot of debris and some clots so they kept me another night. Still passing blood the next day so they sent me home with a catheter in and told me to come back to have it removed in two weeks. The catheter kept on blocking with debris that you don't get with GL as it burns everything away.

My urine was still quite pink when going to get the catheter removed but after the nurse flushed my bladder out it was clear from then on but after a few days I developed a UTI and had to get a course of antbiotics.

Again I was not impressed by my flow. It did has improve over the next few months.

I thought that all was well until about six weeks ago when I developed prostatitis. My urine showed an infection that an antibiotic evidently sorted out in a week but the painful symptoms remained until last week.

The hospital where i had the GL later got the second generation machine and were pleased with it however they eventually opted for HoLep.

  

 

Hi Derek,

Many thanks for your comprehensive answer to my question in

respect of the GL surgery.

It is good to know that you were happy with this newer type of treatment.

It's looks like the way ahead, I just hope it is suitable for someone like me who has chronic retention.

Kind Regards

Barry

 

Not permanent for all but probable.

I was OK after GL but by the time I had Thulium laser the damage had already been done by tamsulosin (Flomax),  

Hi Inquisitive,

You raised a good point in respect of making the consultant aware that I'm available at any time for this op.  I will make that situation clear to the "Waiting List" team this week.

I have not been given the "drug route", probably because of the large amount of urine retention I had when I did the "Flow Meter Test", which was over 900ml nearly 7 weeks ago.

I have been on a catheter since (not a happy bunny), just want to get this over with.  I am aware of the Retrograde Ejaculation situation in respect of Turp or GL Laser.

Just want to move on and get this sorted asap.

Kind regards

Brian

Hi Brian, Having spoken at length to my consultant, it appears that the necessity to be catherterised is often because the person has delayed reporting issues to their GP and the problem has become more acute. The enlarged prostate has subsequently become too enlarged to allow the bladder to function normally. The preferred route is an extended (6 months) course of medication to reduce the size of the prostate and to monitor urine flow/retention wilst doing so. All 7 of the people I know who were catheterised were not previously on medication, as they too had delayed visiting their GP. All said that they were relieved (no pun intended) by the catheter, as the retention had become very painful and it was difficult to manage their lifestyles. Hence, my being pro-active (and that I used to work in Community Health). I forced the issue by asking my GP to refer me for a consultation with a private health care provider. He was happy to do this and I was seen in 36 hours at a  local private hosiptal by the consultant who also worked in the NHS (cost £175). This cut short the first 12 protocol time. I went straight onto medication (via a letter to my GP) as my condition wasn't yet acute. After 6 months there was no apparent reduction 

My apologies, My wee dog decided to press "send" on my last message before I'd finished. As my medication didn't have the desired effect and my condition worsened, my private consultant moved me on to the next stage by recommending to my GP that I pursue a 'scope via the NHS. This got me into the "system" with a subsequent TURP and recovery. Despite developing Prostatitis with a five month recovery, I am grateful that the problem of BPH is over and that I can get on with a "normal" lifestyle. Can I suggest to anyone that has yet to "tell all" to their GP that they do so at the earliest opportunity. The rewards are great. Best wishes, Ben

Dear Ben,

Many thanks for your high quality letter whcih gives fantastic advice to one and all.  You hit the nail on the head, but you were fortunate to know how the system worked having worked in Community Health

I indeed was diagnosed with BPH some 10 years ago, was given some medicatation (proscar if I remember), I had a adverse reaction to the drug, told the good doctor, no other was drug given to me and nothing else was done, no monitoring etc by anybody.  10 yrs later my problems have got worse, hence my current situation.

I suggest to all who read these emails to pay good attention to Ben's letter, quality advice.

Kind Regards

Barry

 

I took Tincture of Saw Palmetto as Proscar etc did not agree with me, It did relieve my symptoms to quite a degree but did not stop my prostate from growing.

Hi Derek,

Yes I have heard and read a lot about Saw Palmetto.  Some people swear by it, others feel it does not work.  Never tried it myself so I cannot comment on it's effectiveness.

Regards

Barry

Urologists do actually prescribe it in Germany. All I can say is that I was told in 1995 that I needed a TURP as a matter of some urgency. I took Saw Palmetto from then until I was able to get GL/PVP in 2005 and I believe that it helped lessen urgency and frequency. It did not stop my prostate from growing nor did it prevent retention but I was never aware of it and always able to pee. I still had to get up three times during the night.

I bought the tincture from a herbalist as I always feel that liquid is more natural than a dried version in a capsule. I did buy capsules for use when away from home.

The tincture kept on going up in price so I traced the maker and bought 2L at a time for about a third of the price. 

 

Hi Derek,

I, too, was catheterised 5 months ago after a single episode of retention (900ml). A scan showed that I had at least 3 stones embedded in my bladder, which the urologist maintained indicated chronic retention, and he recommended TURP.  There is no way I am having invasive surgery, so I an currently awaiting a second opinion, and taking Saw Palmetto in the meantime. The ridiculous thing is that I am informed that my 'enlarged' prostate is only 56. In addition, I kept the same catheter until last week (when the baloon deflated and the catheter started to come out giving me the same symptoms as those I experienced at the start): no-one had bothered to tell me that the catheter should be changed after a maximum of 12 weeks! 

I am hoping to find a urologist who will agree to give me a trial without catheter and, if I still have retention, fit a plastic stent and perform lithotripsy for the stones. Failing this, I might be willing to consider Urolift. Will let the forum know what transpires. Mike

My late father in law was too weak to have a TURP and had a stent fitted. After a few weeks I suppose lime scale built up on it and it became blocked and it had to be removed. He then had a catheter fitted.

56grms  is quite big. I was initially told when mine was 35 grms that I needed a TURP as a matter of some urgency but of course refused.

Why are you against surgery. TURP yes but the laser surgery operations are much easier on the patient. As I have said previously urolift eases symptoms but it will not stop the prostate from growing so surely surgery will eventually be required.

 

I have never had surgery, or any serious ilness, and, at 71, I do not think it is a good time to start - quite apart from the potential risks and side effects

If you have laser surgery it is no worse than a visit to the dentist. Your quality of life is being affected by wearing a catheter and leads to infections. The next urologist will tell you the same as the earlier one apart from perhaps offering laser surgey instead of TURP.

a: you need to get rid of the stones.

b: your retention will get worse as your prostate grows and it will damage you bladder in other ways as well as possible damage to your kidneys.

Derek is correct in that you can resolve the "stones" problem but your prostate problem will continue. Laser surgery is much less traumatic than what you are envisaging. I was NHS treated and went in at 8am one day was discharged at 3pm the next. My recovery was discomfort rather than pain and far less so than when I struggled with retention. I'm the same age as you and I too had been relatively fit and healthy prior to my prostate problem. Now that I'm fully recovered I advocate early intervention to anyone with the same problem. A friend was stalled by a reluctant GP and eventually had to be emergency admitted to hospital with kidney failure. It seems that the retained urine had caused the urine to "back-up" in the kidneys which became toxic and started to delaminate them, caused damage that needed a lengthy recovery period. Early intervention would have prevented this.

I was 71 when I had my first prostate laser surgery. Done Friday afternoon, home by train on Sunday and a day at the Races on the Monday.

Second laser surgery at 79 with slower recovery because they sent me home with a catheter in as they needed the bed and I later had an infection caused by the catheter.

The urologist who did my first procedure described PVP as a very gentle procedure and had done a 100 grm prostate on a 91 year old. 

At 78 I had my aortic valve replaced so I can say that surgery has not been a problem for me.

Hi Mike,

Please listen to the quality advice from Derek and Ben (inquistive).  I am in a similiar situation to you, I have had a catheter fitted now for 8 weeks plus.

Have a retention of 900 ml.  Currently awaiting an operation.

I am going down the route of Green Laser as recommended by Ben/Derek.  I am just happy to have found this website and got some great advice from these guys.

Hopefully I will get a date soon for my op, will keep you guys updated.

Best Wishes

Barry

Hi Derek, I had intended to send a longer reply to your last message but there are some times of day when this site slows down to almost a standstill, so i gave up! I wanted to ask if your late father-in-law had any incontinence problems whilst fitted with a stent. I do not know anyone else who has had this treatment but, having read up on it, it seems that the stent is retained by the same method as a permanent catheter, which would appear to me to prevent the correct operation of the bladder sphincter which is normally responsible for stopping the flow.

I agree that  my bladder stones would be best removed, but this can be achieved by lithotripsy which uses ultrasonic pulses to break them up. Again, i am not sure if a catheter or a stent would allow the resulting fragments to pass, but I have also read that orange juice helps to dissolve them.

I have already been informed by my urologist that retention can lead to kidney damage, but he seemed to think that my stones were the result of chronic retention, and I would have thought that my kidneys should therefore have already been affected. However, my kidney function is apparently perfectly ok!

 

Sorry Mike I don't know if my father in law had any incontinence problems when fitted with the stent. He was in a care home in Kent and we were living in Scotland at the time. He certainly did not have the stent in for long before it had to be removed.