Failing Urolift after brachytherapy and radiation. Any thing else possible besides TURP?

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As stated, Urolift slowly failing with reducing stream. Cancer treatment last fall and winter with retention after brachytherapy in August so self-catherization from August until February which was very life limiting. Alpha blockers are out because of heart issues and low BP. Anybody else in a similar situation? Is there a possible less invasive procedure than TURP that might work? 70 years old and already had multiple surgeries requiring general anesthesia so would prefer to avoid negative cognitive consequences of lenghty anesthesia. Anyone else had similar problem that was resolved?

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  • Posted

    Had a bipolar TURP in April and was offered either general or spinal. Went for general. Have had spinal before with no issues. You said "avoid negative cognitive consequences of lenghty anesthesia". I had no issues whatsoever with my general. I am 73. My TURP was very easy, pain free, and so far effective. Only issue was the Foley catheter in for 3 days after. I was in and out of the hospital in 4.5 hours. Previous to this operation I had a PAE in 2017 with only sedative, and HD Brachytherapy in 2014 - two treatment session and each with a spinal.

    Tom

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  • Posted

    Good luck, I'm also looking for the next best procedure. I had Urolift and then had 2 out of 6 clips removed because they were protruding into my bladder. I had good flow after that for about a month then slowly went back to pre-urolift. So full TURP will be the next thing unless I can find some better next procedure.

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  • Posted

    I had FLA for PCa/BPH with Dr.K in Houston, about 6 weeks ago, I am peeing at average flow of 13.7ml/sec after FLA, it was about 5 before, very happy with this outcome, no side effects except retro

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    • Posted

      very simple, you just measure how many seconds it takes to fill up whatever container you are using, and volume of urine in this container, divide the volume by seconds to get ml/sec, I take few measurements and get average, first grade exercise

      from Google:

      Normal Results

      Normal values vary depending on age and sex. In men, urine flow declines with age. Women have less change with age.

      Ages 4 to 7 -- The average flow rate for both males and females is 10 mL/sec.

      Ages 8 to 13 -- The average flow rate for males is 12 mL/sec. The average flow rate for females is 15 mL/sec.

      Ages 14 to 45 -- The average flow rate for males is 21 mL/sec. The average flow rate for females is 18 mL/sec.

      Ages 46 to 65 -- The average flow rate for males is 12 mL/sec. The average flow rate for females is 18 mL/sec.

      Ages 66 to 80 -- The average flow rate for males is 9 mL/sec. The average flow rate for females is 18 mL/sec.

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    • Posted

      That is what I have been doing. I have a plastic beaker that has ml markings on the side. Before my TURP I was at 3ml/sec with 1 Flomax, then 5ml/sec with 2 Flomax. After the TURP I went to 7ml/sec, and I am now only taking 1 Flomax every other day, and am still at about 7ml/second. I can't seem to get the flow higher despite the channel being "wide open", so says my urologist. So, any restriction in flow has to be coming from the bladder.

      There is another way of measuring flow and that is to take the peak reading. There is a Uflow meter device sold on Amazon, costs about $10, and some on this forum use it. I am not sure if this measures peak flow or average flow. The way we are doing it is average flow. After reading a number of articles about measuring urine flow I am still not clear about the correct way to measure the flow - is it total ml/total seconds, or peak flow rate? I saw the stats you sent on one web page but, again, I am not sure if this is average flow per total time voiding, or peak flow.

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    • Posted

      the stats I quoted shows averages, the same with my measurements, as they are averages over 20-30 sec it takes me to void, in my case from 6 measurements, so if you measure over the shorter time like the first 10 sec while voiding and take average from few measurements you could call it a peak flow, in my case I am around 17ml/sec, I void between 200-520ml, depending on how much I drink and how long I wait, I still take Alfusosin, but likely at some point will stop it

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    • Posted

      normally not, but I had 15 ablations, 5 for PCa, 10 for BPH, so was extensive, I was aware any side effect can happen and I read about some of them, as I was seating in front of Dr.K and reading/signing a consent form with a long list of potential complications, some of them are up to 5% of treated patients, I had every opportunity to ask and he mentioned some cases for BPH that were a failure for some unknown reasons, but I didn't ask specifically about RE, I am happy don't have any other issues, no incontinence, no ED, and very strong urine stream, the only minor complication was my second Foley, after 11 days of Foley post FLA, after removal I got UTI, and was unable to urinate, had to go to ER and had another Foley for 14 days, after the second Foley removal, my stream got v.strong right away, I had RE in the past when I was on Flomax, before I switched to Alfuzosin to get red of RE, it worked in about 75%, so I am familiar with this side effect, I am sexually active and don't consider this as a big issue, especially when other critical issues were addressed successfully so far

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  • Posted

    I agree that FLA provides an advantage in treatment with ability to engineer and design the accurate and precise tissue removal for best and longest results. The key to success is selecting the doctor capable and caring enough to do the job completely. Good luck with your next chapter in an ongoing battle.

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  • Posted

    I agree that FLA provides an advantage in treatment with ability to engineer and design the accurate and precise tissue removal for best and longest results. The key to success is selecting the doctor capable and caring enough to do the job completely. Good luck with your next chapter in an ongoing battle.

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  • Posted

    I agree that FLA provides an advantage in treatment with ability to engineer and design the accurate and precise tissue removal for best and longest results. The key to success is selecting the doctor capable and caring enough to do the job completely. Good luck with your next chapter in an ongoing battle.

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  • Posted

    I had a failed Urolift, 5 clips. My next step was PAE - which does not require removal of the clips. I had to do the procedure in two steps - the right side was embolized through the wrist; the left side through the femoral. You are awake through the procedure, as the IR occasionally talks to you. The second procedure was July 15, and I have been slowly improving. The jury is still out as to my ultimate outcome, but it seems to be going well. No sexual side effect.

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