Enlarged Prostate Gland - Reports to request in 2nd opinion before surgery

I know all of these posts are at least 2 months old and the problems have probably been solved by now one way or another but there is another solution, an alternative to Green Light laser and TURP that has come on the scene with great promise. It's called Urolift and there's a wealth of information about it on the web but not many reviews from actual post-procedure patients. So far I have heard from three patients who recently had the procedure done and all three relate very positve results in just a few days with no side effects at all.

I'm convinced that the procedure is in my near future if my prostate upon examination is less than either 80 grams or 100 grams, depending and if I have no medial lobe of the prostate which apparently is rare. I'm tending strongly toward the procedure but I surely would like to hear a few more reviews, pro or con. Any more Urolift patients out there? Thousands of BPH sufferers need to know how you are faring. 

Hi Ron,

From what I have read about the urolift I would not have been a candidate. My prostate was too large and I do have a large median lobe that still protrudes into the bladder. The reason why it was not recommended for larger prostates is that additional staples would have to be used and more than 6 staples (three per side) can work against each other. I haven't heard of any reports from anyone having had this procedure. I personally wouldn't want to be an early adopter. Several years back the innovation of the prostatic stent was hailed as a good procedure for bph. It sounded good, (a stent to keep the urethra open within the prostate area) but it had disasterous results as the stent became impacted into the tissue and had to be surgically removed. I could see something similar happening with the urolift staples that are used to pin back the prostate to make a wider path for the urine to pass through.

Hi Bob,

I, too, have been diagnosed with BPH (at age 71) and advised to have TURP, but do not like the risks of death/complications associated with it. It had already occurred to me that a stent should solve the problem since my urinary tract is currently being kept open by a catheter, but yours was the first mention of its existence that I came accross. Could you please tell me more about the prostatic stent to which your submission refers? Did the impaction occur in all the procedures,or just some, and how long after insertion did it take before causing a problem?  What problem did the impaction cause? Where was the innovation made and by whom?

I think the originators and suppliers of prostatic stents is Urolome. They are part of American Medical Systems who also make the Greenlight Laser systems. Stents can be temporary or permanent. The temporary ones can be biodegradable. If you look up Prostatic Stents on Wiki they have a good article on them. I have read of the permanent stents becoming impacted in the prostate and needing to be surgically removed. I think a major risk is that with a permanent stent in place a person needing to have an emergency procedure with a cystoscope

like I did, wouldn't be able to have it until the stent were removed. I have heard of stents moving and causing complete retention until they were rmoved. I imagine you couldn't be cathed if this happened until the stent were removed.

Hi Bob,

Thankyou for your prompt and complete reply to my query. I am new to this, having been diagnosed only last week and having only started with symptoms at the end of March 2014 - which were originally diagnosed as UTI for which I was given two courses of antibiotics (the first did not solve the problem). I then had about 3 weeks without symptoms followed by a return of frequent desire to urinate accompanied by need to pass bowel movement or wind. Generally micturation was sparse but I was managing a reasonable flow once or twice a day.  I went back to GP who prescribed a further dose of antibiotics but felt my abdomen and sent me to A&E hospital for intervention for acute retention. I was catheterised and immediately drained of about 900ml. The doctor thought I was somewhat dehydrated so I agreed to drink a litre of water before going home, and have since tried to increase my daily fluid intake.

.

This retention did not worry me since I have always been able to have a (nowadays occasional) 4 hour drinking session whilst only needing to urinate once or twice during the evening. Furthermore, since giving up smoking about 15 years ago, I regularly had no fluid (or food) intake between breakfast and 5pm and did not need to urinate during that time.

On return to the hospital to see the urologist (intern?) I was advised to keep the catheter until after a scan and appointment with a specialist because otherwise there was a danger that my kidneys might be damaged by urine retention of which I was unaware. I was told my prostate, BP and blood test results had all been within normal limits (including kidney function) and that there had been no sign of infection on first admission to A&E. The scan showed healthy kidneys but stones embedded in the bladder wall and some (old) scarring. My only concern was to get rid of the catheter which initially made even walking difficult and is preventing me from wearing my shorts when running and sunbathing. I have now got to the stage where it no longer seriously interferes with my running and vigorous excercise/dance sessions (but sex is out of the question although, surprisingly,.ejaculation is normal!).

The specialist examined my prostate and anounced that it was enlarged - which was normal for someone of my age. He was going to prescribe alpha blockers until he examined the scan and announced that the stones indicated that the problem had been going on for some time. ( If that were so, why had it not already affected my kidneys?). He recommended TURP and simultaneous removal of stones through endoscopy.

I have been fit and healthy all my life and have seen what invasive surgical procedures can do to other people. I immediately began investigating the alternatives: lithotripsy can break up the stones with ultrasound - without an endoscope I understand - I now needed a  non invasive solution to the enlarged prostate. The temporary biodegradable stents that you describe would appear to be the best solution (in the event of complete retention, emergency catheterisation could be performed by entering the bladder from between the navel and the pubic bone - and cytoscopy could surely be performed the same way). My only reservation is your description (elsewhere) of the flap of tissue above the confluence of the vas deferens and the urethra which  prevents reverse ejaculation into the bladder.  Could this be compromised by an inexpertly fitted stent or its subsequent movement?

I think I will start initally on the Saw Palmetto and other medical alternatives before demanding a trial without catheter. Again, many thanks for your help.

Mike

 

Mike, there is new and minimally-invasive procedure that may be the best solution for you called UROLIFT. Don't be surprised if your urologist has not heard of it. Mine had not either but he was very intrigued and is now preparing to do the procedure himself.

I've taken all the bph meds for at least ten years. The Docs don't tell you but they will destroy your sex life completely. I used Saw Palmetto and other non-prescripition herbs and concoctions but they had no effect at all that I could tell.  

The prescription meds for bph do work to relieve your symptoms so it's really easy to just accept that solution. It's not so easy when the side effects kick in. The meds are really just a very slow but very certain castration. The first effect is retrograge (dry) ejaculation. That is not reversible. The next effect is to reduce your libido and finally erectile disfunction. There was never a word from my urologist that this would be the inevitable result. I refused to do the turp procedure because of the possible very negative and very possible results and if you read these posts you'll see that it my not work anyway. 

When I read about urolift this March I researched it thoroughly, found that it was approved by the FDA only in Sept 2013, and only a handful of Urologists are doing it.  I contacted one of these Docs, had the cystoscope examination to determine if the prostate had a third lobe which disqualifies the urolift procedure and an ultrasound to measure the size of the prostate.  I was very depressed to find that not only does my prostate have a third (central) lobe but is larger than the 100mg limit. Either of these conditions will disqualify a patient for urolift.  Very depressing as only turp will work for me and I may be in dire straits for the rest of my life as a result.

I urge you to look on youtube at several demonstrations of urolift. It's a wonder solution that will last at least for years and you get to keep your sexual desire and ability.  The uroloft procedure is being done in a number of European locations, mainly England and in the US as well. Chances are excellent that you will find a urolift Doc in most large cities. In Texas it is being done in Dallas, San Antonio, Houston and probably other places as well.

Do yourself a big favor and at least see if your prostate is a candidate for urolift and let us know here what you find. These posts and other internet sites such as Youtube are an excellent source of real world experiences. Good luck and welcome to the BPH sufferers community!       

  

Mike, here's a link: Good luck!  

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Patient Moderator Note: I have removed an URL (a link) from this reply as it was unsuitable for inclusion within these forums. If any user is interested in this removed information they should contact the author via the Private Messaging system requesting such. Thank you for your cooperation.

Hi Mike,

I only got temporary results from Saw Palmetto and over the counter prostate supplements. Like you said, I experienced good and bad voids. The only thing that actually allowed me to go when I was quite restricted was Jack Daniels Whiskey. If I woke up in the middle of the night feeling like I needed to go and couldn't, I'd drink a whiskey and walk around the kitchen for 10 minutes and then I'd be able to go.

900ml is a lot to retain. I'm surprised you didn't feel it. That can be a problem as you can damage your kidneys. A relative of mine has no sensation of needing to urinate and caths every 6 hours around the clock. He had a turp but it only lasted a few years, then was told his bladder had lost elasticity and could no longer contract, so he chose to cath on schedule.

When I went to the emergency in full retention in the middle of the night they removed 1400 ml and I was begging for a cath. After that I bought some hydrophilic (packed in sterile water and pre-lubricated) caths and learned to cath myself. 

Having been down this road for more than three years now, I found flomax (or the generic tamsulosin) to give good relief. For me though it stopped working after a few months.  It's very difficult in these cases to pinpoint the actual problem.

If I were you I'd have the stones removed with a cystoscope in surgery and start taking the flomax or tamsulosin and see if that works.

In three years I've had the TUMT (microwave procedure to open the prostate), a Greenlight XPS laser to remove 70g. of a 120 g. prostate, a cystoscope procedure to remove a membrane blocking the urethra, 

tried self cathing every 2 eeks to "keep the channel open", and emergency cysto surgery to cauterize three bleederrs causing a hematuria, remove bladder stones, and resection (widen) the bladder neck. When I had the Greenlight Laser my uro said he uncover a lot of of pus in my prostate that were never seen or diagnosed with tests as chronic prostatitis. So all contributed to my symptoms, and just widening the prostate alone with the laser turp only lasted 6 months for me.

Regarding the retro, my uro preserved a flap of tissue above the valve that releases semen into the prostate to direct the semen down and out instead of back into the bladder. Most uros don't practice this. Even though he did the laser turp and then the cysto resection and cauterization and bladder stone removal, he said he would try to spare me from retro, and he did, but he said he couldn't guarantee it. Whether the stent would interfere ewith ejaculation is something i don't know. Certainly if it got impacted and had to be removed surgically, it's a possibility the surgeon wouldn't be looking to spare you from retro.

 

Hi Ron,

I had read your posts and fully intend to investgate urolift as you suggest. The Moderator has removed your link and suggests a 'private messaging system' (which he does not explain how to use), but I am sure I shall be able to find the nformation. In case you were in any doubt, I live in Greater London, England, so your locations in US may not be cost effective for me.  Thankyou for your kind concern and information, anyway.

Mike

Hi Bob,

Thankyou for your further detailed advice. Do you know if the Hydrophyllic Catheter lubrication includes lidocaine or similar anaesthetic and if they are available in UK or by mail order?  I am still at the stage of investigation and 'watch and wait' and may yet get a second opinion from another urologist before committing to anything drastic. any input and advice is welcome, however, and gratefully received.

Kind regards, Mike

I believe that the procedure has been performed in London longer than in the US or anywhere else as your medical system approved it quicker than ours. It was invented in California about ten years or so ago and is making its way around Europe, Australia and the Far East so that sounds true to form for us. I don't know why the moderator has a problem with a link to you tube but you'll find a wealth of information. You'll notice that a lot of the posts are from me. I really pushed it hard trying to get input from urolift patients and thinking wrongly that it would work for me  I did get some replies. Every single reference and post is favorable. It will replace TURP, currently the gold standard,  for those who qualify, because it is hardly invasive at all, very little pain and almost no blood, no effect on your sexual desire or abilty, they just staple the lobes of the prostate one side to the other compressing the center of the lobes away from the urethra into a narower profile allowing urine to flow and the bladder to empty. What could be simpler than that? Almost all patients go home the same day or next in some cases and have no symptoms from the procedure, after a week or so. It has proven to be effective for several years which TURP may not be.    

I knew you were a Limy as you cannot conceal the accent no matter how hard you try.  My forbears immigrated from County York before the Revolution so I feel an affinity to Merry Ole England.

Best of luck in your endeavor and stay away from those damn meds if there is any way possible. 

Hi Patient Moderator. I used a link to youtube to provide information about the urolift procedure. I am a bph patient who doesn't qualify for urolift but if I did I would have had the procedure two months ago and I would be free of bph symptoms now instead of in a state of foreboding and dread as I am faced with TURP as my only solution and I will be faced with whatever outcome it provides for the rest of my life. I am sincerely doing my best to make BPH sufferers aware of a revolutionary new non-invasive procedure. Nothing like this has ever been seen before. This site's reason for being, as I understand it, is to do exactly what I am trying to do, get out the word to other patients to provide real-world experiences from those who are not as inflicted by BPH as i am. Where did I go wrong, just no links allowed? Ron  

Bob, somewhere on this site, or some others possibly, I saw a refence to a procedure whereby a vein specialist, not a urologist, stops the flow of a vein that supplies the prostate thus starving and shrinking it and relieving BPH symtoms. Maybe I'm getting desperate but I am looking for any solution to avoid TURP. If you are aware of where I might recover that information please let me know. I saw it when I was researching urolift and haven't been able to find it again.

You are a wealth of information and I am sure that there are at least hundreds, probably thousands of lurkers who don't reply but who benefit from your experience.  Just know that there are many who appreciate your posts. .  

Mike,

The best cath and best price I have found is "28416 Coloplast® Speedicath® Male Straight Intermittent Catheter 16Fr, 14" L, Pre-Lubricated, Hydrophilic Coated, Sterile" which I buy for $1.57 each in foil packets on line from bestbuycatheters dot com in the US. I'm sure they must sell these in the UK if you can't get them from the US. The hydrophillic cath becomes super slick when exposed to air. They are packed in sterile water and when they are exposed to air they are very slick (and have a handle to make it easy to hold on to). There is no lubricant per say, but they are slicker than caths with gel lubricant. I use the size 14FR rather than the slimmer 12FR because I found the 12FR tends to flex and not push past the slight resistence offered by the prostate and then again by the bladder neck. The 14FR is rigid enough to not flex inside me. I was surprised to find these caths go in all the way to the hilt (a good 13" to 14") before they pass the bladder neck. There's a lot more plumbing inside then I would have expected. There are videos and web pages that explain how to insert the cath if you look for them. I use 1 liter disposable urinals with cc and oz markings (they are 50 cents each in boxes of 50 online) at night so I don't have to find the bathroom in the dark, and when I was cathing I let the urine flow into the urinal so I could measure my PVR. It's good to double void before you cath so you get an accurate measure of PVR (post void residual). Any PVR under 200ml was considered OK by my uro.

Hi Ron,

It was on another thread and you are referring to PAE or prostatic Artery Embolization. There's a specialized form of this procedure being practiced in Cyprus (was formerly in Israel) called the Gat Goren Method. However I commented on the other thread that PAE has been found not to be viable on middle lobes. That is also true of the Gat Goren method according to Drs. Gat and Goren.  

The question I have is that if the Urolift procedure is not viable for large prostates, and if the prostate continues to grow at the rate of 5% a year, wouldn't it be just a stop gap method?

Regards,

Bob 

Ok, no links.

Yes, that's it. PAE. So, the third lobe strikes again. Yes, urolift probably is a stopgap procedure, just as laser turp, button turp and any other method is often limited in efficacy over time. What urolift is though is a way to relieve symptoms completely in 30 minutes with almost no blood or pain or side-effects. There have been no reported instances of retrograde ejaculation, no adverse effect on sexual ability or libido. It is such a new procedure that scientific studies have been conducted for only two years. But the very encouraging results indicate that the procedure is just as effective after two years as it was at six months. That certainly indicates that it will still be effective for more years, maybe many years. There are many reports of failure of TURP after a few months or a few years or it doesn't relieve symptoms at all, doesn't even allow the patient to discontinue the bph meds, etc.

True, some TURP patients have a couple of months of discomfort, minimal side effects and then many years without a problem.  I'm sure that occurs most often with younger patients with smaller prostates.

When I saw a urologist, experienced with urolift, and he advised me, after the cystoscope and ultrasound indicated that my prostate was 114 mg and with a third lobe, that my long-term urologist, in the TURP procedure, would have to remove the third lobe as it would just drop down into the cavity created by TURP on the other lobes.

Medical knowledge marches on. If urolift is a stopgap measure it will buy the patient some time until more methods are discovered, and not to be forgotten,  it allows the patient to get off of the life-destroying meds that cause reverse ejaculation, loss of libido, erectile disfunction etc. To many of us that is no small stopgap measure.    

Ron,

I have to agree that all the procedures are stop gap measures as the prostate continues to grow. I think what may cause a lot of the failures though is that other things besides an overgrown prostate are often part of the equation. Then when the procedure doesn't give lasting relief, the other factors start to be addressed. It seems most uros follow the standard playbook...antibiotics, flomax, turp, bladder neck resection, removal of stones if there, diverticulum, strictures, then repeat the whole cycle. What's often struck me is that millions of women have the same LUTS symptoms as men, often unable to find any cause or treatment, and yet they don't have a prostate! The early reports (up to 2 years) on the urolift look very promising for those with smaller prostates and no median lobe.  It's a shame we haven't found a single person who has shared their urolift story online, but as neither of us is eligible for it, it's not immediately relevant to our own future with this condition.  Best of luck.

Bob

One other thing I noted Ron was that on a two year follow up in Australia, there were consistent improvemments at 2 weeks that lasted for two years. However, there was no positive impact on PVR (post void residual), and I recall reading that a significant PVR was another disqualifier (along with a prostate over 80g. or a significant median lobe) for having the urolift. So fo those lucky enough to have the right type of minimal bph, the urolift looks like a good bet.

After 3 weeks I have finally had a letter from my urologist informing me that my prostate is 'rectally 35cc or so' and benign. Altho' Bob generally refers to ccs, I noticed that you refer to grams. Are they the same, or do they have a convertion factor? Am I right in thinking that, even allowing for my fairly low stature and weight, this can hardly be described as 'enlarged'. He still recommends TURP because I have stones in the bladder, but has thankfully agreed to a second opinion to be sought.

The first time I met an American (from Dixieland) , at the age of about 8, his first words to me were: 'Don't call me a Yank and I won't call you a limey.' I had no intention of calling him by anything other than his name, and can never be offended by whatever anyone calls me. Consequently, your last post to me brought back fond memories of the last time I heard the term. I, and my forebears, are native to Yorkshire, too.

I'm glad that you took no offense at my calling you a 'Limey".

My urologist says that, in describing the size of a prostate, cc's and mg are about the same.  Apparantly your prostate size is normal. That being the case the meds that shrink the prostate should be of no benefit to lucky you.  As I have said before, Flomax, Jalyn, etc etc etc have very undesireable side effects and I wish I had found some way years ago to avoid them entirely.

I don't know how my current self-medicating is working but I am really enjoying it. My sex life has come back, no doubt assisted by 10ml of testosterone every 14 days that I inject myself and half a viagra pill every nite at bed-time.

Not to be minimized; I have been walking four miles vigorously every other day without fail for a couple of months now. Yesterday we discovered a steep hill about a mile long, walked down it and back stopping to catch our breath twice. My legs and butt are like rocks. I know all of this heavy blood flow in my legs, butt and lower abdomen are having a beneficial effect. I wonder if old guys like me but more gym nuts than I have been are less likely to be bothered by bph?   I know I'm really searching for an answer to what has happened.

A few months ago I was up several times, maybe five or six sometimes,  every night, I knew where every bathroom in our county was located. I wet my pants pretty often and wore black or Navy pants every day so it wouldn't show. Traveling in a group was out of the question. My sex life was almost a thing of the past. I took Jalyn every night to reduce the urges and a sleep aid to help me avoid some of the urges to go. I know that I'm retaining quite a lot of urine and plan this next week to find out how much. I am wary of kidney damage if the bladder is under too much pressure but I'm not feeling much pressure, just that when I urinate I know I'm retaining. We'll see how it develops in the short run.      

I refused to have a TURP many years ago when my postate was 35 gr and waited for PVP (green light laser) to reach the UK for my by then 75 gr prostate. I had it in 1995 and it was sucessful and problem free but my flow was not as good as I had expected.

Over time my prostate re-grew to 150gr. Again I refused TURP and had the newer Thulium Laser prcedure lsast year. The recovery time and improvement was slower partly because I was still passing blood the next day and they sent me home with a cather and told me to come back in a month.

During that time I got an infection caused by the catheter and had to go on three different antibiotics to clear it up. At my follow up with the surgeon he said that he had only wanted me to wear the catheter for two weeks and that his instructions had not been followed by the nursing team.

Years ago my father in law in his 80's went into retenion and was found to have a massive prostate. Due to his poor health they did not want to do a TURP so fitted a permanent stent.  After a few months it had to be surgically removed as it became clogged up. He then needed to have a catheter fitted.

Urine contains many dissolved substances (solutes) - waste chemicals

that your body needs to eliminate.  These solutes can form crystals,

solid forms of a particular substance, in the urine if the urine pH is

increasingly acidic or basic the concentration of dissolved substances

is increased; and the urine temperature promotes their formation

Well, good news for the urologists and bad news for BPH sufferers. My uro said "the prostte grows like a weed". I have read on line that the prostate grows 5% a year, so that seems to ensure that if I live long enough I'll need several more procedures in my lifetime (I'm 67). My prostate was supposedly (according to my uro) reduced from 120g to 70g with the GL. Starting at 70 grit's probably over 80g. already. 

Everything I heard about the permanent stent was that it was a disaster and almost sure to block up and get impacted in the urethra, requiring surgical removal. Now I believe they are using biodegradable ones, but I don't know how effective they are.

The stones are a new issue fror me. I've had gout and acidic urine but it's the first time I had stones, and from what my uro said there were a bunch of them about the size of bb's. Readin the side effects of the Micardis HCT I was taking for BP, confirmed it can increase uric acid.

I stopped taking it after my last surgery. This whole subject of BPH seems to be a mystery shrouded in an enigma.

I was warned in 1983 that my prostate was slightly enlarged and to keep an eye on it:-) In 1994 I went to a new GP and mentioned some symptoms. He did a DRE and referred me to a urologist. They were concerned about my flow and retention and told me that my 35 grm prostate needed a TURP as a matter of some urgency.

Research soon told me that was not a good option. I started on tincture of Saw Palmetto and it seemed to help my symptoms but did not slow the growth down. I made contact with an American urologist who had written a book on the Prostate. He told me of microwave surgery that I considered going abroad for. He also told me of cyro surgey and laser surgery.

I decided to wait for PVP laser surgery. it took a long time to arrive in the UK.

I lived in Scotland at that time and contacted a Newcastle hospital in 2003  when I heard that they were doing it. They agreed to see me if I could get my local area health authority to refer me and pay the cost of any future surgery.

That was a bit of a battle and it was 2004 before I was seen at Newcastle who agreed to operate. it was done in 2005 by when my prostate was 75grm.

I thought that was done and dusted until it started to grow again and by now living in England and it was by then 130grm..   Again ran into old fashioned urologists who only beleived in TURP. I managed to be referred to another area where I saw one of the original PVP surgeons. While my prostate was large he felt that my symptoms were liveable with.

After a a couple of years and a delay because I was having heart valve surgery I found out that a Surgeon (nor a urologist) had been doing Thulium Laser surgery at my local hospital all that time withouthis urology brothers letting on. Got an appointment with him and had the procedure last May. He later offered me Avodart to prevent it growing again. I asked at my age will it have time to?? Possibly not he replied.