Do I need TURP

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I posted another thread about catheter size and the problems I have had inserting the catheter into the bladder. My primary care provider has scheduled me for a Urology consult which I thought was just for a cytoscopy but after reading the order I see she also wants an evaluation for TURP.

I am not convinced that my problems are caused by an enlarged prostate. I was in a car wreck about 20 years ago resulting in a severe TBI and damage to my cervical spine. I had a MRI a week ago and it showed moderate narrowing of the spinal canal at C6 & C7 along with severe narrowing of the nerve canal on the right side at C6 & C7.

When doing CIC the cathether seems to pass thru my prostate fairly easily, its only when it reaches the bladder that I have problems with insertion. From doing some research it seems TURP is focused on making the passage through the prostate larger, I'm not sure if this will help my condition.

Is there a way that they can actualy tell if it is the prostate causing the problems or the damaged nerves and brain ?

I'm a veteran so I get all my care from the VA. I'm scheduled to see both Urology and Nuerosurgery on the same day in the next couple of weeks. I'm just trying to prepare myself to know what questions to ask when I see them. I suspect I'll continue with the CIC but would appreciate any insight others may have... 

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  • Posted

    Great question, which I can't answer. However, if it's an evaluation for TURP, isn't this exactly what your appointment is for so that you and the doctors can check for the correct treatment in your individual case? Why would you think they would make such a graring error as to do the TURP without questioning your individual issues? I was scheduled for TURP in April this year by a NHS Locum Urologist following a year of repeat episodes of Urine Infections. I had all the pre-checks for operation day. However my own Urologist didn't go ahead with the TURP on the day and sent me home with different advice, because he knew my history and checked whether the procedure was really the best approach before doing it. Maybe I was too trusting in agreeing to do all the preparations, but it was ultimately a reassurance that my Uro didn't want to do surgery on me if it wasn't going to deal with my problem! I've followed his advice since and haven't had any further UTIs and have even come off the previous medication (Tamsulosin).

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  • Posted

    Electromyography (EMG) which is part of Urodynamic testing will help differentiate whether your bladder problems are being caused by an obstruction (large prostate) or nerve damage. Urodynamic testing yields other results as well and is therefore suggested before procedures such as TURP.

    Jim

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    • Posted

      Thanks for the info.

      Becasuse I'm getting my care with the VA I deal with lots of interns and residents the first go round. I've found its a good idea to know a little about what is ailing me before talking to them, I eventually will see someone very well qualified but getting past the beginners can take a bit of time unless I have an idea of what they are looking for...wink

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  • Posted

    I meant glaring error - sorry for the typo!
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  • Posted

    I wish you luck and a good outcome on whatever is decided for your condition.  I can't answer your questions but I know there are test to confirm what should / need to be done.  Good luck

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  • Posted

    Normally they do a Cystoscopy, the camera inserted up the penis and they checked mine after doing the TURP and it showed a round edge cut out of my Prostate with plenty of room for catheters. Previously they struggled to get an 8mm catheter in.
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  • Posted

    The scope will show them if it's a prostate problem

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    • Posted

      The scope can suggest a prostate problem but it can not rule out a nerve problem. You can have both and one can be dominant. Proper urodynamic testing will tell you if it's a nerve problem or  not. In any event, urodynamics is recommended as part of a TURP evaluation, so you shouuld have it anyway if you're thinking of that direction.

      Jim

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  • Posted

    Urodynamic testing would help but also ...how large is your

    prostate? ...SONOGRAM of the prostate would be very helpful

    to confirm size and configuation of the gland. Not always but

    as a rule the larger the prostate the chance of obstruction is

    greater...As mentioned on this forum many times Holep is the

    preferred method of operation if needed..yield less complications

    and a less chance that reoperation would be needed. Others

    have gone with a PAE..this is done by radiologists not

    urologist so...they probably wouldnt be recommending a PAE.

    But look into these if you can wait..and get all the workups done

    before proceeding.

    Good Luck

     

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    • Posted

      Prostate size is not necessarily related to the severity of BPH. You can have a large prostate with few symptons or a small prostate with significant symptons. Sonogram is helpful but it will not rule out nerve damage because even if it showed an obstruction you could still have nerve damage in addition which would mean that even a "successful" TURP wouldn't work because the nerve damage would not make the bladder empty correctly. Personally, I think the likelihood is that it's obstruction and not nerve damage, but you won't know for sure until Urodynamics are done where they actually can measure the nerve impulse (or lack of it).

      Jim

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  • Posted

    When it comes to TURP, uros are kind of 'trigger happy'. Just like you, when I CICed, I felt almost no prostate resistance, only sphincter resistance. I was referred to an uro after a kidney scan that showed urinary retention. The IPPS score was only 7. Yet the uro suggested TURP right away. I politely postponed the decision and chose CIC instead. I am not sure that TURP or any other procedures will help me and I do not want to make a bet on that.

    Hank

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    • Posted

      The original plan was for me to take Finesteride and self cath for the next 6  months. Which seemed reasonable to me.

      It seems because I couldn't cram a 16FR into the old bladder they want to change everything. I do have a lot of numbness and tingling in my right arm and both legs that the MRI seems to valiidate which leads me to think the nerves are involved. Just dont see why they have changed from a conservative approach I can live with to possible over treatment that I can't live with..

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    • Posted

      Read about Finesteride both here and elsewhere. It has side effects, possibly irreversible, that many don't like. What size catheter are you now using and are you having any problems? Normally, they start with size 14, not 16. A lot of here have then moved to the next smaller size which is 12. You will find a hydrophillic catheter much easier to insert because they are very slippery. One popular model here is Coloplast Speedicath with Coude Tip. The Coude (bent) tip makes it easier to get around an enlarged prostate.

      Jim

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    • Posted

      I did read about the Finesteride I had some concerns about the side effects but after 6 weeks have not noticed any. 

      I'm mostly using the Coloplast Speedicath 14 straight tip now but occasionally use the 16 when I can't get the 14 into the bladder. As  I'm with the VA don't really have any choice as far as the manufacturer goes. I'm finding with practice and maybe just getting used to the idea of sticking something up there its becoming alot easier. I'm thinking of asking the Uro guys for some samples of the Coude Tip.

      I monitor the urine output every week or so, its consistantly between 2700-2900 ml/day and I void about 15 times a day. The RV from the catherization is usually between 200-300 ml. I've been checked for conditions like diabiates that could account for the 15 times a day and they found nothing. I just need to go all the time...

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    • Posted

      Hi Supertractorman,

      My urologist listed these possible side effects with the Finasteride, impotence, problem having an orgasm, retro ejaculation, swelling in hands, feet, and breasts (man boobs), and dizziness. But the one that really got my attention was that statistically, if I developed prostate cancer in the future, chances are it will be a more aggrassive form of cancer. He also told me it takes a long time (6 months or longer) to show results and might not fix my problem. I decided not to take it. I do take Tamsulosin.

      John

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    • Posted

      Hi Jwrhn,

      You say that 200-300 ml comes out of the catheter on average. Are you able to urinate just before you catherize and how much on average? Also, how many times a day are you cathing? 

      As to high urine output, how long have you been self cathing? I also had a high urine output like yourself when I started to self cath but now it's closer to 2000ml. One reason may be that the kidneys really unload when you start to self cath as they have had back pressure prior. Have you done a fluid intake log? You may also just be drinking more.

      Jim

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    • Posted

      I would not try Finasteride unless I know that I have a fairly large prostate. Even then, I would only try for 6 months to see if it helps. If it does not, I would stop due to various potential side effects.

      Hank

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    • Posted

      Jim

      I usually cath around 3:00 am and 3:00 pm. (My sleep pattern is a mess due to the brain injury.)  I don't urinate first as I find it more likely I will be successful in getting it into the bladder if I don't. It seems that I get about 100-150 ml more by self cathing than not. 

      I haven't kept an input log as I just tend to drink alot of water, always have. Up until the last appointment with my provider when the ultrasound showed about 120ml of residual volume right after voiding I just figured that was normal for me espically since multiple urineanalysis showed nothing abnormal with glucose or anything like that. 

      I think they believe the prostate is enlarged because my PSA has been stable at 9 +/- 1.5 for at least the last 5 years or so....

      Thanks

      Joe

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    • Posted

      Well I'm done.  Im tired of being yelled at for my opioion.  Which we all have a right to. There are many men on here that I feel have alot of things to give but I have had it.  I don't like the turp surgery and I feel that no man should have his prostate cord out.  I feel that with all the other options you should fight to save it and it functions.  I have rised my kids to fight for want  they believe in.  I have enough to worry about and I'm done.  I will not be on here again.  I don't need it.  Whatever you men pick just get the information and don't let the doctor talk you into anything Good luck to all  Ken

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    • Posted

      Hi Jwrhn,

      One of the reasons they recommend to urinate just prior to self cathing is because it cleans out the urethra and makes you less prone to UTI's. It also gives you a more accurate measurement of your true PVR than you would get at the doctor's office via bladder scan and therfore gives more guidance as to how many times a day you really need to cath.

      As to being more successful with your caths if you don't void first, that may have to do with the tightness of your bladder sphincter. It tends to tighten up right after the bladder is emptied but in your case we know it's not emptying completely. So maybe what is happening is that it's just partly tightening up after you urinate.

      What you might try then is to urinate first, then wait a couple of minutes, then self cath. This might give your bladder sphincter time to loosen up a little for the catheter and give you the benefits of a cleaner urethra and a better PVR measurement. 

      Jim

       

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    • Posted

      Hi Joe,

      Given your measured PVR via ultrasound is only 120ml, it also begs the question what is the reason you are self cathing. What exactly are your symptons other than frequent urination? Did you compute your IPSS score? You can figure it out in a few minutes here:

      http://patient.info/forums/discuss/what-is-your-international-prostate-sympton-score--453484

      In any event, as long as you are self cathing, you can get a better idea of your true PVR if you first urinate.

      Jim

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    • Posted

      Hi Ken,

      You addressed your last post to me but I assume you're not "done" because of anything I said? I've always thought that we were on a similar page as to seeking the less invasive treatment that will work. 

      I don't know who "yelled" at you over your opinion but I think it important we have strong voices on all sides of the issues here and hope you reconsider leaving so we can still have yours.

      Jim

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    • Posted

      The soce would be a 21. I'm not sure why/if I should be self cathing. I had a few drinks on Thanksgiving, 6 while I may have 4 a month,and wasn't up all night as usual.. But when I did awake my first urination produced a big blob of white goo, I emailed my PCP and told her I am stopping both the Finseteride and the self catherization...

      Seems I may have something that was not broke, or not broke enough to need fixing..

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    • Posted

      No Jim I have no problem with you. Some of the others on here complained to the moderator about a my opioion to Joe.  I did not know that he as had a problem for 2 years but I still say the urologist force his hand.  I feel a man should fight for his prostate not just give it up.  I have other things going on in my life to worry about this site.  This is for everyone to give there opinion  Just because i say something does not mean they are going to fellow me.  Spanding time with my family before having a heart ablation on monday.  That is more on my mind  You have helpped many man on here and you know alot.  Take care  may I will keep a eye on your stuff only.  All I want no matter what procedure a man picks get all the information you can and make sure you pick it not the doctor  Ken   
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    • Posted

      Joe,

      Some people with IPSS 21 have an operation. Some do nothing. Some something inbetween. It's really how things effect you individually.

      I think stopping Finseteride and even regular self cathing is a reasonable choice if you are OK with the quality of your life, however with an IPSS of 21 you should have at least active surveillance.

      Active surveillance would include checking your PVR from time to time, either at the doctor's office via bladderscan or via catheter at home. It also would include scheduled blood tests and periodic bladder and kidney ultrasounds to make sure no damage is being done.

      That said, voiding 15 times a day is a lot and if it increases your quality of life may reach a tipping point where you want to do something. Have you tried Flomax (tamsulosin) or better yet, Daily 5mg Cialis? Both might help you empty better and Daily Cialis has the benefit of no retro ejaculation. 

      Jim

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    • Posted

      Hi Ken,

      I did see one of your posts to Joe was deleted by the moderator. But whatever happened, I know your heart is in the right place and you have put a lot of time here into helping people.

      All the best with your heart ablation, Monday, and please let us know how that went. You definitely deserve some time off from here, but I hope that after a taking a break, you will reconsider and come back to help people.

      Better to put the fear of g*d in someone regarding TURP than to let them blindly follow a doctor and then regret the choice for the rest of their life. I certainly don't think that is always the case but even it happens 10% of the time it's enough for us to give them other options.

      Jim

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    • Posted

      Hi Ken

      I saw your replyies before they were deleated.

      I simply don't now why they were deleted unless the folks running this sight have an agenda.

      For me I will also sign off as I am seeking information not some ones opinion of the information I skould have,,

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    • Posted

      Thanks Jim  I will.  Still with family  I reated a house so we can all be together this week.  My kids and grandkids loved it.  Went in the pool every day  Take care  Ken
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    • Posted

      Yes that is true Just because I'm not a fan of it does not mean your going to follow me.  We just need all the information we can.  Over the last year I have been sending many letters to alot of the hospital and I have learn that there is a 20% decrease in Turp surgery Men are going with other procedures  Take care and heal well.  Ken

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