Final decision time - Aquablation or wait?
Posted , 7 users are following.
I want to say thanks to those that are still on this board who have informed my process in going through my BPH journey. Along the way different tests revealed sometimes conflicting things but with my insurance now covering aquablation and a date set, I need to make a final decision. Here's the summary situation:
52 years old, 70 to 75cc / ml prostate, with IPP (intravesical prostathetic protrusion) (median lobe pushing up against bladder), forming a ball valve (confirmed by good cysto), bladder seems to be working based on urocuff testing (less invasive urodynamic testing), bladder trebeculation just starting in some areas
perhaps due to IPP, flomax and alpha blockers don't seem to help much with my issues, in fact may make my urgency worse with drip feeling; stopped taking all alpha blockers and supplements for now and still not going toward retention
i'm not retaining or getting close to it anymore as I was 6 months ago when I flared to have a near constant urge to pee, probably physical therapy work has improved the state of my pelvic floor to where I'm squeezing out a bit more volume on each void (70 to 90ml)
resolved symptoms: occasional burning, start/stop, dribbling
biggest complaints now: high frequency (sometimes near constant feeling to go), nocturia (wake up every 2 hours so 3-4X a night), hesitation to start (20sec to 1min), weak flow but not a thin stream, urethral irritation because i can push urine out past the tight prosthetic urethra after going
seem to be getting urge to go as my bladder is filling; likely voiding to close to nothing or nothing; on recent PVR, got down to 37ml after filling bladder with 18oz of water
Unclear if Aquablation will resolve my frequency but it may. IPSS has gone from high 20's (28) to 16 at last form
I am psychologically ready to do the procedure in the hope I'll sleep better, improve my anxiety and go to the restroom less often. Don't want RE and considered PAE but now believe it is too non-specific in how it acts for my median lobe/obstructed urethra AND the urologists have scared me with the complications they say they see from PAE.
Anyone have thoughts if my conclusion is reasonable or if I should try to wait it out somehow with more pelvic floor work and maybe attacking this as an OAB problem (take myrbetriq or something).
2 urologists say, you have an obstruction, get it out of the way first; another one claimed still early BPH
0 likes, 6 replies
not_too_shabby cali-mike1970
Posted
I'm in a similar situation as you, and I am only 48. I have done a lot of research and I think aquablation is the best procedure available now. I am going to have it done next year once my new insurance starts and I can go to a doctor that offers it. If you have aquablation available to you, I would do it. I ended up in the emergency room about 6 months ago to have my bladder drained, ruining a vacation. There is a podcast called "Prostate Health Podcast" by Garrett Pohlman. I would listen to episode 74 about bladder health. You don't want your bladder wall to thicken as that will likely be irreversible and any procedure done afterwards will have less benefit. I think I have already done some damage, but my current provider doesn't offer aquablation, and I did not want to do a TURP or Urolift.
cali-mike1970 not_too_shabby
Posted
Yep, found that health podcast and really got me over the fear that RE is an inevitability with resection procedures. Actually saw Dr. Pohlman in person and he is excellent, and recommended the aquablation for my anatomy even over his epTURP. He is a big believer in sparing the bladder even for mid-aged males, and I find my local doctor in the West Coast seems to be as well.
Seems like uro's fall on one or other side of that fence. A uro in Texas I visited recently who I used to see 20 years ago told me to 'hold up' and the story of a doctor he just operated on who carried 400ml of fluid around for many many years (residual PVR) and it didn't bother him, sleeping and what not, and eventually his creatine went up and finally operated on him and things are fine. bladder works fine no issues. says for some people waking up 4 to 5 times is no big deal for others once is too much. he was sort of advocating for me to not go to the conclusion that a procedure now is the only answer.
There are no guarantees in any of this (I may still have frequency afterwards), hopefully no worse, it may come back in 5 years, etc etc; but at the very least I can attack my frequency / OAB if I indeed have it more aggressively after this. Right now I have a bad pipe and maybe a dysfunction on top of that (or maybe it's all related). The thing that bothers me the most is the constant frequency, so I'm willing to try to take the next step to fix it or find a way to manage it that gives me at least 10 (hopefully 15) more years of non BPH thinking times in life --still want to travel, try to build a business, etc. Don't want to be stuck in this mode much longer.
michael55618 cali-mike1970
Posted
Hi, I know you have read some of my other posts. It sounds like your situation is somewhat similar to mine. I am 56 and had a 70 cc prostate.
It sounds like you have done all the right things in terms of research and seeing multiple doctors. What clinched it for me was that my doctor told me it was not a matter of "if", but rather "when" I would have a procedure. At that point, I just decided to get it over with, in large part to get it out of my head. But also because if I waited another 5 years, then I would be in my 60s and the procedure and the recovery would presumably be more difficult, not only because I was older but because my bladder was in worse shape. Of course, my willingness was also based on the fact that Aquablation has no risk of incontinence or impotency.
The only other reason I could think of to wait would be if there were a better procedure coming on the market. But I liked the fact that Aquablation has been FDA-approved for 5-years.
compiler michael55618
Posted
michael, the OP IPSS score has gone from high 20's (28) to 16 at last form. His main problem seems waking up every 2 hours so 3-4X a night and large prostate size 70 to 75cc. It affects his quality of life. The OP eventfully needs the surgery. Can you share how your nocturia has improved since the aquablation? You ever reported “continue to need to pee once per night.” How many times did you wake up before the procedure? Do you still have the weak stream after the aquablation? Have you done the ultrasound post-void residual urine volume test after the aquablation?
michael55618 compiler
Posted
Before surgery my nocturia was a little unpredictable. The average night I probably had to get up twice. But if I had salty food or drank alcohol it could be up to four times. But on the other hand, I had gotten pretty good about limiting fluid intake. If I drank no water after supper, and emptied my bladder before going to bed, I might only have to go once.
My nocturia has improved a lot. I should add that I no longer limit fluid intake in the evening. So, I have fewer headaches. Sometimes I don't bother to use the toilet before bed. I still have to get up to pee once. I don't think my prostate is to blame - it is my bladder or brain. Last night was a perfect example. I went to bed and woke up after 6 hours. I had zero urgency to pee, yet I could not go back to sleep. After lying awake for 10 minutes I reluctantly made the trip to the bathroom, then returned to bed and went right back asleep.
I would not call my stream weak. The word I use is adequate. My urologist told me that I would chip the back of the toilet so he built high expectations that have not been met.
I've had 3 ultrasounds. Two showed post-void residual volume below 75 cc, one was just above that. So, I am happy about my ability to empty my bladder.
cali-mike1970
Posted
Thanks all, really appreciate the input. My GP has an ultrasound device in his office and today we did a pseudo before after PVR test. I was at 178ml before and 78ml residual after (consistent with my 90ml consistent output), with some slight urge to go even after finishing. About 30 min later I probably was able to get more out since I stopped drinking fluids at that point. If the aquablation gets me voiding closer to zero then I could see how my frequency could instantly go to 1.5 hours off the bat. that's alot of optimism but the whole thing just reminded me that I'm willing to take a chance to get rid of this partial emptying and feeling like urine is left in the bladder and having to go again in 20 or 30 min to get more of out.
My reasoning is similar in that I'm eventually going to need a procedure, so might as well get it done sooner to preserve the bladder and get it out of my mind. Praying things don't get any worse. I'll post my updates after the procedure --have good holidays.