Facing "Prostate Shaving"

Have you considered asking to be referred to another Area Health Authourity that may have shorter waiting times as you are entitled to do.

There is a system Choose and Book in some areas. Otherwise you can google waiting times for different procedures in different areas. I've forgotten how to 

Thanks for that tip Derek. I'll look into it; or maybe go private (fortunately I have a bit of savings that I can draw on).

Someone I know lived in an area where they did not at that time (2005) do GL Laser and were violently opposed to anything but what what they called the Gold Standard TURP. He was prepared to sell his car in order to stop having to self catheterise several times a day.

Err.. Snap! I can identify with that. Self-catheterisation was one of the options which I declined.

As far as I can tell, GL Laser has the edge on TURP, but only just. So I'd go with the latter if the GL Laser was not available.

Also search Thulium Laser and HoLep laser as alternatives. The hospital who did my GL laser in 2005 have on a split decision gone over to HoLep. Any laser one is less bloody and should have recovery in days rather than weeks.

I don't know about the more powerfull second generation GL Lasers. The original ones used a laser rod that cost about £3K. On bigger prostates they often had to use a second rod. 

Thanks for that thought Dudley

The first thing to consider is what are your present symptoms and what procedure do you hope will help them. From experience I can say the prostate needs medication and/or a procedure if you regularly go into retention and/or if it is painful to urinate and only small amounts come out/ and/or if your PVR post void residual is measured at more than 150ml. Procedures can usually open the path that urine takes through the prostate if that path is blocked by an overgrown prostate. I think procedures are less successful with everyone in reducing the amount of times up at night to urinate. The reason is that often this night time frequency may be caused by other reasons than a blocked prostate.

My PSA was about 4.1 about 2 years ago, and now it's 8.  Had a biopsy done (second time) and came up negative again.  I was told that shaving the prostate would probably help me.  I retain probably about 1 L of urine.  Having problems with incontinence, and self-catheterisation many times does not work to empty the bladder.  I've had one successful attempt out of 6 trys recently.  Earlier use was more successful.  At 63, I despise having to use depends.

Are you saying you void a liter of urine when you go on your own? PVR is the amount of urine you cath out after you go by yourself. It's the amount of urine left in your bladder after a normal pee is completed. I don't think it could be a liter unless you are completely in retention. It can be measured by going on your own, then draining the cath into a urinal with ml markings, or it can be measured with an ultrasound. Anything over 250ml. needs to be addressed with a procedure or you will lose the elasticity of your bladder.

I also don't understand how you can not empty by cathing. I found that the size 12FR cath were too flexible and wouldn't go past the prostte and bladder mouth, but the size 14FR were more rigid and made it to the bladder mouth. Once yo pass the resistence of the prostate and then past the resistence of the bladder mouth and go into the bladder about another half inch, your entire bladder should empty unless you have a diverticulum (pouch) in your bladder, which is possible if you hold a liter of urine in your bladder. Some diverticulum can be 800ml or more, a pouch in the bladder.

You don't say what "prostate shaving" technique has been offered to you. There are several like the Greenlight laser, the holmium laser, the thulium laser and the standard turp.

If it was me I would first have a sonogram to measure the size of the prostate and also determine the capacity of the bladder and look for any diverticulum, and also measure your PVR. The way that is done is you drink a liter or so of water an hour and a half or more before the sonogram and they take pictures of your bladder and prostate. Then you are asked to void completely in the bathroom on your own. Then they take more pictures so they can measure how much liquid was in your bladder before and after the void.

My psa was about 5 at your age and now at 69 is close to 8. I had two greenlight lasers and a turp in 3-1/2 years which included a resection of my bladder neck and removal of bladder stones. I'm still having problems because my prostate grows back each time and is now 203g. It was over 300g. before my last tuerp which was 8 months ago. I'm presently taking avodart to try to stop the growth and shrink the prostate. For me, three prostate shaves didn't last long.

P.S. If you do have a diverticulum in your bladder that can only be removed with bladder surgery.

300g, that was masive. It must have been the size of a grapefruit.

I had a GL in 2006 when mine was 75g. and I was retaining up to 650 ml. By May 2013 it had regrown to 131g. when I had thulium laser. It was 50g. when checked in January of this year when I complaimed of a variable flow but I do not have any retention.

The formula is L x W x H x0.52. I'm not sure how accurate that is but it's an approximation. Just before my first GL laser in May 2102 it was 7.2 x 8.8 x 9.2 cm x0.52 = 303 g.  After the GL in May 2012 and a second GL in Dec 2013 it was measured again in Oct. 2014 as 6.6 x 11.4 x 8cm x 0.52 + 313g.  I then had a standard torp in April 2015 and 6 months later in Oct, 2015 it was 9.1 x 4.2 x 10.2cm x 0.52 = 203g.  Your prostate about tripled in size (assuming the 200g GL reduced the 75g. prostate to 45g.) in the 7 years from 2006 to 2013. Mine seems to be doubling in size every couple of years. I can't see getting another surgery every couple of years. I still don't feel like I have fully recovered from the April surgery, where I needed 6 pints of blood transfusions for a massive clotting hematuria. (I had a similar hematuria requiring 8 pints of transfused blood in Dec 2013). I really can't rely on my urologists strategy of waiting for the next problem and cutting off more prostate. This time I'm tracking my pvr and prostate size with a sonogram every 6 months. If Avodart can stop the regrowth, I'll probably be on it for life.

 

P.S. Derek. I recalculated the growth rate on both our prostates. It seems mine is growing at a little more than 20% a year and yours between 15% and 18% a year depending on how much was removed by your procedures.

Thanks so much for your reply... going on my own I void between 100 to 250 ml.  When I was using a catheter, I was eliminating 1L.  I was using a catheter successfully, I think the box they gave me were 12FR.  I had just a few that "didn't work".  But now I have used about 7 of a new box (14FR) and only one was successful emptying my bladder.  The other times urine would dribble out or spit in short bursts.  The cath was full when I removed it.  As far as the type of shaving..the Doc wasn't specific.  He did say that I would be in the hospital over night and have a cath for about a week until everything healed up.  What I would like to achieve would be to be able to go when I need to and not have the problem with nightime incontinence.  Currently I wear depends at night and they are soaked when I get up in the morning.  I was almost considering just having the blame thing removed, but didn't know it that would make things worse.  I'm still learning about this and the procedures.  Oh, yes...  I have been taking flomax for about 2-3 years now.  Initially that was helpful and I knew it if I forgot to take it in the morning.  Now it's not that much of an effect if I miss.

Based on what you say it sounds like something is blocking the cath in your bladder, unless you really are emptying and sometimes just don't have much urine. You have used the cath successfully in the past so you know how far in it goes to reach the bladder. (Mine would go in right to the hilt, the whole 14 inches to get inside the bladder). If somethin is blocking the cath, it could be a diverticulum or even the median lobe protruding into the bladder, or even a bladder stone that moves around. There is no way for you to know without getting the sonogram I described above to take a picture of the bladder and the prostate both with a full bladder and after you void. I think once you know your bladder capacity and post void residual, and they have determined if your bladder has any blockage, and the size of your prostate, you and the urologist will have some idea of how to proceed. About a year after my first greenlight laser, I had a membrane grow across my prostate opening that needed to be removed with a cystoscope tool. After that I cathed about once or twice a month to be sure everything stayed open. A year later i had uncontrolled bleeding and when my uro operated he found he had to widen my bladder mouth and remove bladder stones. So although he thought the laser would fix everything, it really didn't. It sounds like your incontinence may be caused by your bladder overfilling. A liter is an enormous amount for the bladder to hold.