FOCUSED LASER ABLATION

Thats funny John. Prayers for a continued speedy recovery

That's great news John! I plan to call you in a week or so to see how it's going.

I had similar things happen with PAE but not consistent, maybe I need to hold it more often. My flow not improved dramatically but still better than before and not as blocked up. 3 months post PAE now.

Sure Mike, give me a call anytime. I noticed today that sitting that long at my desk, was noticeable and started to get uncomfortable. I dont think sitting helps us big Prostate guys. We will see. I may start standing up at my desk for a couple of weeks as I heal up. So far I am pleased with my situation. If anyone needs my number just ask and I will pm it to you.

Mike, Give me a call. 

John

John

well you are sitting putting pressure on an area that had surgery so it makes sense, I will call as soon as I get a chance - wishing you a speedy recovery.

Michael

Twenty days post op and set some new achievements just the last few days. This week my volumes have increased dramatically. I went from 75-100 range to now I am going 250 to 500 each trip. Flow is really good. I am enamored with the flow as I have not seen this in years and it is hard to believe it. 

My nighttime trips have gone from eight a night down to two a night and last night was a FIRST! I did not get up to pee all night until 6:16 am. I am pleased but also know that I can expect some relapses over the next month or two. WHY? It is just what sometimes happens “ebbs and flows” with any procedure is the natural recovery rate

Dr. Kara man ian told me that the period I am in now is called “reforming”. He said it is where the prostate is taking on a new shape as the laser voided area are clearing out the tissue and collapsing inward to form a smaller and new shaped prostate footprint. Those of you that ask for and received my MRI before and after pictures can look at those and see where this might happen. Dr. K says it will just get better over the next 60 days. He is still encouraging me to ejaculate but I am not ready just yet. I can still feel the swelling and I don't want to deal with a disappointment right now as I am so happy. I will wait until next week. He says it will be fine. I know that the recovery protocol for TURP surgery is to wait 2 months to ejaculate in that procedure. He assure me that all the sexual equipment is there and in good shape. I know the erection part is fine and I was experiencing that since day 3 post op. 

Dr. K once again told me that they usually do not take out as much tissue as they did with my prostate and the recovery is easier. I did not tell him but I did not think my recovery was that difficult??? I think I was surprised that the retention  I was having from the large prostate pushing up into my bladder was relieved so well from the tissue removal. Emptying the bladder feels so good as it had been a longtime since I had felt that relieve.

They removed the protruding bladder tissue, they removed a suspicious spot that was in active surveillance for the prior year and a half and the removed three channels along and on three sides of the urethra to free up the stricture that was pinching my flow down to nothing with the BPH.

I am very pleased wtih him.

That is up to you Joe.  Wait to enjoy the rest of your life.  Men today need to take charge of there body and don't let doctors just go in and cut away and say it will help.  Your doctor is very good.  He told you exacly what he was going to do and he told you you will not loose anything in you sexual function.  I think he want you do have a ejaculation because it want to prove it to you that he saved it for you with this procedure.  He want you to be happy  To many man are being talked into surgery that take up to a year to heal and somethime they don't work.  It all depends on the doctor and how much he cares.  And if he has a IM THE DOCTOR AND I KNOW BEST  attitude God help you.  There are many of these new procedure that will do the same things as the old standard ones and some doctord don't want to learn anynew ones.  Life is to short to give up anything Take care Joe  Ken  

GREAT NEWS JOHN

Thanks John for the continuing updates...

So great that you are constantly improving.

Cheers

Morning John

Just wondering now that it has been 2 months, have you had any PSA tests, Volume retention by ultrasound, and or the current size of your prostate? I know you have been doing great, but do you have any data that quantitatively collaborates how you feel? Or is it too close to your procedure and that data will come, at say 6 months? Has your sleep time increased and your fatigue factor improved from improved deep sleep? How is your handicap? Is it Dropping? Your doing Great, this procedure is proving itself out to be a no-brainer as a Frontline cure for FLA for BPH. Time will tell how permanent it will be. I have not studied any other procedure that has given these type results and almost immediatly with virtually No downsides. Dr K should have No Problem with his Clinical Trail results to publish his report. I am sure that the AMA and the Insurance industry will want more testing and down the road results before there will be an approval. From what I see about PAE C/T there studies are out there for over 5 years with high success rates and it is still not approved by insurance

Mike

Sadly I doubt FLA  will be covered by insurance anytime soon. Probably over 5 years

No but I did ask Doctor Karamanian about that and he said that in 2 more months my total recovery will be over and I should then schedule both of those test. 

first, I do not feel any retention. I do have to work on holding my pee sometimes as i conditioned myself to peeing early when I did have retention BUT the great news is I can now fight off the urge without peeing my pants which is what I use to do. A lot of my urgnecy is nervousness caused and from stress. My Dad now has to have a heart value replaced. It has not been a good 6 six months except for the focal Laser Ablation treatment results. In late August my Mom died. In September my wife broke her kneecap while visting Dr. Isaacson. In November my dad had a heart ablation. December I had to do something as I was getting block and dove into FLA. And now my dad has to get a new heart valve soon. 

My hadicap has now gone up as I have not played enough for 2 months or worked out enough, my distance has really slipped but I noticed that it is slowly started coming back. I told my wife that I was considering buying her a new callaway Epic Drivier  for her Valentines Day gift and she does not play golf!! IT was not a good look she then gave me.

MY sleep, well I do not wake up to pee anymore, but I do wake up with concerns of stressful problems at work and my Dad's issues. Then after I am awake for a while, I think about it until I do need to pee. This is usually only once a night as compared to 8 times a night to pee before the FLA. The fun part is I am occasionally still measure the volume at that time and it was 500 cc last night the one time i got up. It is a lot of fun to pee that much. Also, I no longer pee on the golf course. I am sure the squirrels in those trees miss me. No, i do not think that there is any other procedure with this good of results but everyone is different. The common logic of FLA is easy to compare and understand. I also have logic as to why and how long this should last. The lack of insurance approval is due to the urology pressure that is being applied. Believe me Mike this was worth 5 times the money I paid. Just glad I did not have to do that. My retirement would suffer. It is good to hear from you again. 

Hi Mike,

The short answer is that the urologists don't make any money from FLA. It's done by interventional radiologists. There are many more urologists than interventional radiologists. The urologists therefore have more money to lobby the FDA to control the funding for the necessary research to get the needed approvals. In this as in so many things, FOLLOW THE MONEY.

Neal

That's actually completely unfounded and untrue.

Urologists take part in plenty of trials regardless of who they "make money from". I refer plenty of patients to interventionalists, radiation oncologists, medical oncologists, etc... depending on what the patient needs.

Statements such as the above are completely wrong and are dangerous to make.

I think the underlying point is that if a urologist feels a patient requires a prostate reduction surgery or procedure, they will tend to recommend one of the procedures that they or their office does. This holds true in terms of references outside the field of urology, but within urology as well.

Three years ago, my urologist at a large teaching hospital recommended TURP, as that all his hospital did then. A year later, another urolgogist recommended Button Turp, because that is what he did. Same year, a third urologist recommend either Green Light or Urolift, again because those were the two procedures he did. In none of the cases did any of the urologists ever discuss an option outside of what they currently offered.

When I did bring up other options myself (a procedure the doctor didn't do), I invariably found myself more knowlegeable about that procdure that the doctor. 

This is not a criticism, but what I see as a reality often in medicine as a whole. It's OK for me, because I tend to do my own research and "shop around". 

From your postings here, and from the very fact that you do post here, I have a feeling that you are atypical and are curious about alternative procedures than most urologists. But what Neal is talking about does seem very typical. 

Jim

Doctors will discuss options, including alternatives to therapy;

Greenlight, Button Turp, TURP, etc... are all similar variations of a similar procedure (and are relatively new.) Urolift is also very new in the grand scheme of things.

A lot of the other things mentioned aren't well known about, because very few patients have had them done. I think if there is more information about them available (including data), we will be able to advise about them as well.

Another thing is certainly cost; my patient population generally has issues paying $50 for a co-pay or a few hundred dollars for a deductible. Much more than that just wouldn't be financially possible for them (or for the majority of the population.)

HI Jim, So glad yoor comment was in my email. Somehow my emails all got deleted ,i could not get back into this web site.

I have always appreiciated your wisdom and knowledge. I have a question?

I am seeing another urologist. He checked my urodynamics prevous test and said there was activity,so i don't have to do another urodynamics test. 

He wants to do a cystoscopy test. This urorolgist does Uro Lift.

I am still in complete urine retention.If he  tells me Uro Lift Could have  possible chance of getting me out of retention,my question is this? Would you consider having this done? And what are some of the questions i should ask him?

Thanks,very much my friend Jim>

frank,

Urolift is not a great procedure for frank urinary retention.

My group has not had much success with it. It may improve the flow a little in that case, but it is unlikely to get you out of retention.

My group has the busiest Urolift surgeon in the world, and does not recommend it for retention.

Hi Frank,

Good to see you back, we were wondering where you had gone. Not sure what you mean "there was acivity". Are you talking about adequate detrussor pressure? 

As to next steps, what does your current urologist have to say? I believe his last opinion was that urolift probably wouldn't help much, and I assume he was looking at the same data from your urodynamic test. 

Jimm

May be there is some activity in the bladder and CIC help.  My urologist told Frank that he did not know if it would help him but he has had good result on men that have retention.  Also he told him that if it did not work the urolift would open his prostate up so he could do CIC easyier.  Ken

Can you answere this for me.  If a man come to you with a proble amd you do testing and find a little larger prostate.  An he has voice to you his concernd on retro ejaculaton and does not want it.  Why would you tell him about the the ones that cause retro.  Why not said I know your concerns and these are the treatment that cause the lease problem.  It me your pushiny the big ticket items.  Ken

Also On Frank.  I think the urolift is a much safer procedure for him then a turp that his other doctor wanted to do.  Also told him it would not work but wanted to do it anyway.  I agree with Jim.  Some doctor will push only what they know.  Boy I glad my doctor is not like that.....Ken 

I don't think I understand your question.

Some treatments have a higher rate of retrograde ejaculation than other. Orgasm should be largely unchanged. I counsel patients regarding all options and allow him to make an informed decision.

I do not know what you mean by "big ticket items" (??)

It's great we have an actual Urologist contributing to this forum ! thanks !

In my experience, I have to agree with other posts.  The two urologists that I have seen in the Pittsburgh area do Greenlight Laser.  They think this is the answer to everything.  This is what they know how to do so this is what they push.  There is no intelligent conversation about other options.  When I told them both that I had called the parent company behind Greenlight and was told that there is a 30% chance of retrograde ejaculation, they both stopped in their tracks.  The side-effects were being minimized.  

It depends largely on technique and extent of the ablation

I appreciate you taking the time to input on this site.  I have found it very hard to find a urologist to openly discuss the many options available.  And with interventional radiologists coming into play, we have more options.  We have direct injections into the prostate done in the office using several routes in Phase III trials.  It appears the goal someday is the make BPH treatment done in-office with little downtime, without sexual side-effects, and without general anesthesia in acceptable cases.

The treatment of the disease has certainly evolved over the past 2 decades- it is very different than when I first started training.

We currently treat many men in our office with some of our minimally invasive procedures with minimal side effects and downtime.

I expect things to continue to improve!

Hi Camster,

Private urologists and teaching hospitals can get invested, both in terms of training and machinery, in a certain procedure. The trend does seem toward less invasive, more in office treatment, but it's unrealistic to expect a single doctor to offer up all the options in this fast changing landscape. Especially with the very new procedures and/or those offered outside of their speciality such as with IRs. That's why it's up to us, using online resources such as here, to do the research, and "shop around".

As I mentioned in another thread, it's both the best of times and the worst of times for men looking for solutions. It's the best of times in terms of finally having newer, less invasive choices, but it's the worst of times in that more choices can make the decisions even harder.

For that reason, it's also the best of times to get treated if you find the right match, but also the best of times to "watch and wait" because the trend seems to only promise newer and better procedures just around the corner.

Jim

Hello JerseyUroGr,

There's an interesting new thread on prostatitis here:

https://patient.info/forums/discuss/finally-found-the-cause-of-my-prostatitis-597557?page=0&utm_source=forum&utm_campaign=comment-notification&utm_medium=email#2740996

In the thread, a new type of lab culture called Next Generation Sequencing (NGS) is discussed. From the website that offers this type of testing: " offers Urologists Next-Gen Sequencing, a superior diagnostic tool over culture and PCR detection methods."

According to MicoGen, these new types of tests can detect bacteria often missed by the more conventional labs. A theory that has been around for some time which could explain why antibiotics can often be  helpful for prostatitis even when bacteria is not detected. 

Wondering if you are familiar with and could comment on the usefulness of this new type of testing.

Thanks.

Jim

 

Thanks!  Well done explanation.  

Not a professional opinion on my part, but there is the theory out there that even BPH can be caused by a host of bacterial and non-bacterial pathogens.  The inflammation by these causes swelling.  These pathogens are hard to detect and can reveal a negative urine culture.  

Camster,

I have no doubt that prostatitis has many times been misdiagnosed as bph/luts and/or the two often coexist making diagnosis and treatment more problematic. It does seem that there's a rush to reduce prostate size even though studies suggest that the correlation between BPH and LUTS is not always a direct one.

Jim 

This thread has gotten way off topic and here we find our friendly neighborhood urologist wading in to the conversation pushing urological procedures being done by his urology group being blatantly advertised by his username. Not a mention of FLA and zero moderation. Unreal!

I have no problem with a urologist chiming in with professional insights that we as lay people are not aware of.  On another thread on PAE, there was a doctor who I am familiar with chimed in as well giving factual information. 

Noted. I actually thought I was asking the doc the question regarding more sensitive tests for prostatitis (he never responded) in the "Rezum" forum that he started and seemed to ask questions in. But as you said, he's posting in both forums now. 

Jim

OT posts were heavily moderated on this guy's thread; 93 rather interesting and challenging discussions wiped out, yet not here. 

I don't understand what your problem is Ross - a real Urologist commenting, correcting false assumptions and sharing some of his experience and knowledge. What's wrong with that? He doesn't do FLA, what's wrong with him sharing what he knows about what he DOES do? I find it interesting. Any discussion regarding FLA is going to enevitably be compared to other procedures isn't it? I don't understand the 93 discussions comment, are you saying 93 of his comments OT were moderated in a different discussion?

I also found the deleted posts interesting and the discussion for the most part challenging. I tried to find the deleted posts in my browser cache, to copy to another thread, but my tech skills aren't that great. If you, or anyone else, have a cache copy, copying them into a new thread would be great. 

Jim

Jim,

I don't have them either. I just find the moderating on this forum shockingly lame! TBH I have no problem with people going OT but do have a problem with the inconsistent moderating that wiped out 93 posts that many people found interesting, as if they were catering to the urologist who's getting free marketing rather than the tough questions being tabled by the patients.

This is an open forum.  A urologist has the right to contribute.  If he can share a clinical inside look at solutions, I'm for it.  I welcome clinicians to express their experience here.  We can only read so many studies.  Field experience brings a real world inside look.  

which thread has the 93 deleted posts?

That is very ture.  I wish more doctor would show a interest in this fourm.  And he is just giving us his views on the procedures.  like all of us on here.  We are just trying to help Men have to stick together  Ken

If the Urologist is avoiding tough questions, well in today's world with law suits you can't blame him can you? In general I find physicians are reluctant to comment on anything another physician does.

I wouldn't say he avoided them I am just saying that the moderators have double standards by having wiped out a very long and interesting thread citing an off topic rationale. Perhaps I am too cynical with my concerns that a Dr using his practice name as his username and only discussing procedures that are done by or are going to be offered by his practice .

OK I hear you Ross re double standards. It doesn't bother me re New Jersey Urologist, even if it was a form of advertising why not? I think it's amazing an actual Urologist takes the time to contribute and share what his practise offers, what kinds of results they are getting.

Mike,

I also think it's great the doc stoppped by to answer questions. The more points of view the better.

The caution, however, is the inherent issue of "the appeal (or argument) to authority", which more or less is defined as the fallacious argument because an authority thinks something, it must therefore be true. I don't have to state the obvious, but if we all were comfortable with the answers we got from our own doctors (the authorities), then there would be no reason for this forum.

Also, while I'm sure this doctor and many try to stay as up to date as possible, remember that their focus and knowlege base is mostly on FDA approved, trial tested and insurance approved procedures, which is fine.

Beyond that, we have to do our own digging. I'm sure I'm not the first here who had to present new trial results to their doctors who knew nothing about this procedure or that.

Jim

I think that is a bit disingenuous regarding tough questions; most of it was little more than a bash fest- the first post in that chain alone accused me (and all urologists) of being "money hungry" and doing the wrong thing for patients; I was vilified by someone who knew absolutely nothing about me other than I was a doctor who knows about procedures. How can that possibly be objective?

I'm not here to have arguments, I am here to answer questions regarding prostate issues for those who have them and may not have ready access to a doctor.

It was over in the Rezum thread that the doctor started. Somewhere in there you will find the moderator's remarks, and a marker for the 93 deleted posts. 

Jim

I am happy to discuss/answer any questions regarding established or in-the-pipeline procedures in urology, whether or not I personally perform them.

Correct; I can only comment on procedures that are established or have some peer-reviewed research behind them; I practice what is called "evidence based medicine".

Great points, but I don't want to scare off other Urologists from contributing. Sometimes I think this group can actually be dangerous. Let's say some new great surgery comes out, Mr X announces he now feels like he is 18, sleeps through the night, has no side effects, etc. It's just one person, you may not have heard about the other 9 who had side effects, get up 6 times a night etc. but based on one person's report you believe that rather than your Urologist.  A urologist monitoring might be able to warn, or even if not he or she is seeing hundreds of patients a month so what he is telling us should mean something. Our own doctors recommended TURP, Green Light or whatever, so we joined the forum to find out what else is out there not wanting painful invasive surgery with side effects. So when a Urologist who knows about Rezum and Urolift can share I think it's great.

It was not a criticism. But today's anecdotal stories (patient experience) and experimental procedures can often turn into tomorrow's "evidence".

Dr. Peter Kramer had an interesting take on that in a NY Times story titled, "Why Doctors Need Stories". In it he said, ' ...Because so little evidence stands on its own, incorporating research results into clinical practice requires discernment. Thoughtful doctors consider data, accompanying narrative, plausibility and, yes, clinical anecdote in their decision making.."

So while it may be irresponsible to base medical decisions on anecdotes alone, to ignore them completely in lieu of study data (often contradicted later) is also short sighted.

Jim

Hi Mike,

As you know, I'm the last person who makes decisions based on anecdotal stories But on the other hand, these stories (like your story with FLA)  can be very useful as a starting point for further examination. We are in agreement that having a doctor's input is a good thing. I was just pointing out that many of are here because our own doctor's input wasn't as good as it should have been. You know the saying, "measure twice, cut once". Well, for us it's measure (explore) many times before cutting once. 

Jim

Jim

All good points Jim.

Your thoughts on the in-the-pipeline 3T MRI guided Focal Laser Ablation? (my apologies if your have already stated this).

There hasn't been any research/peer-reviewed data regarding its use for benign prostate disease. I do not know of any FDA-level studies for it that are either running or are in review for the future.

Clinical trials gov identifier NCT03131544.  He is still recruiting participants.  No study results have been published 

I reported some time ago in one of these forums (I think this one, but I cannot find the post anymore - it seems to have disappeared) that my UK Urologist was adamant that the claims for MRI guided FLA for BPH were had to be based on the resurrection of old an old laser technology, and implied that they were actually bogus.

​What I got in reply was a load in invective by someone telling me how self serving Urologists are and that my Urologist was clearly only interested in making money ...

​It seems to me that this anger against Urologists mainly comes from American based contributers here. 

I found it by searching your posts. It is in this thread:

https://patient.info/forums/discuss/fla-568029?page=0#2585798

 

Hi Mike,

Was it this thread here?

https://patient.info/forums/discuss/focal-laser-ablation-594069?page=0#2711604

I didn't see anything about urologists only in it for the money but I will tell you that I have heard first hand some fairly uninformed opinions from urologists on procedures performed by IRs. It could be the other way around as well, for all I know.

Jim

 

I'm sure it goes both ways.

I refer a lot of patients to interventional radiologists, medical oncologists, radiation oncologists, nephrologists, etc...

I would hope they would do the same if it's in the best interests of a patient.

Thanks!

​For some reason when I try to search for my posts, one a couple come up, and the rest are invisible!

Looks like Motoman found the correct thread. I think it's fair to say I have more respect for urologists than John does, but it's also fair to say that doctor's on a whole tend to be more knowlegeable and recommend procedures that they personally do, as opposed to ones they don't. Especially when things cut across specialities such as IR and urology.

Jim

Right.

​What I would really like to know though, is whether this MRI guided FLA for BPH which is getting such attention in this thread is actually a myth (as my Urologist suggested)

I think most us on this thread have been numbed by the statement by urologists that TURP is the gold standard.  Meanwhile, the potential side-effects on the other side of the equation are hardly mentioned.  So there probably is some distrust here for a certain segment of urologists.  

You can easily research FLA for PCa and come up with a number of hits. It may not be mainstream, but it's no myth and has its advocates for focal treatment of cancer leisons. FLA for BPH is newer and there is less out there, but there is some anedoctal data here if you look over the FLA threads. 

Jim

that's funny I must be dreaming then because I had it done - I guess I flew on a mythical United flight to Houston from the legendary Mile High city.

I would imagine that there is distrust of any physician (or any profession.)

Up until relatively recently, TURP was all that was available. It is still a great procedure for many patients.

Thankfully, urology is a very technology-savvy field, and there are a lot of new techniques we can offer patients.

Me too mike.  I guess I also paid a mythical 14k for it.

In that case I may have completely imagined mine as the results have been unreal!

I hope I don't wake up tomorrow with a catheter bag attached to my bed and realize this has all been a dream. Not as bad as waking up as a "bug" a la Kafka I suppose. Sorry REALLY getting off topic now...lol

Jim, This urologist said after looking at the tracings on my urodynamic test that i have activity.Now he wants to do a cystoscopy.I don't know where he's going wtih this? I think he wants to find out if my enlarged prostate is the reason for retention?I assume that because my bladder has activity then this is not the reason for retention?What do you think 

Jim? My other urologist doesn't answer my email? It's been several weeks,all i wanted to know is, if my retention was caused by my bladder or the enlarged prostate. I never got an answer.

frank

Frank;

A cystoscopy would be the next test to have; it will allow your urologist to better evaluate your urethra, bladder, and prostate anatomy.

It will allow him to make sure that you don't have a different cause for your urination (such as a narrowing or stricture) as well as anything in your bladder that shouldn't be there.

It will also allow him to better determine the extent of blockage and possibly determine which procedure may be helpful for you.

Hi Frank,

Sometimes doctors don't answer emails for a number of reasons. I would call his office and make an appointment to discuss what the second uro said. If you could get them together for a consult even better. It seems that you're getting two different interpretations from the same urodynamic test. 

The first reading, if I remember correctly, is that you "failed" meaning that you probably did not have enough detrusor pressure for a successful prostate reduction procedure like TURP or Urolift. I think they said 50-50 with TURP and little chance with Urolift? 

As to your question, it sounds like you definitely have an obstrution that is causing your current symptons. The question really is if your bladder is functional enough to perform well after the obstruction is removed by TURP, Urolift or something else. 

Jim

Hi, Thanks for your response to uro lift? I have an enlarged prostate,my urodynamic test said i have activity,however i could nor void during the test. Is there a procedure you could recommend that what get me out of urine retention?  I'm almost 88years old.

thanks.

frank

I agree with the doc that you should have a cystoscopy if you haven't had one already, but I thought your first doctor gave you one? In the end, it may come down to which doctor's opinion you trust, because it sounds like your regular urologist is recommending against Urolift, and this second doctor is qualifying you for it. You might also want to get a third read on your urodynamic test because that is the most direct measure of your bladder function.

Jim

The other question, Frank, is how well are you tolerating CIC? Is it a real PITA? Are you getting a lot of UTIs and discomfort? Is it affecting your lifestyle significantly? Because if CIC is going well, another option is just to continue on with it for now. Newer, promising procedures like aquablation are coming online which may offer you more. But waiting or doing something now is really a personal decision, with no right or wrong answer.

Jim

Thank GOD  I'm not say another thing on this subject  Ken 

Hi, Thanks for your reply. I had a cystoscopy it shows an enlarged prostate, about 4cm long with obstructing lateral lobes.Bladder normal,No tumor,stone diverticulim or glomerulation. Why was i told i would have a 50 or 60 % chance of getting out of retention after GL procedure?I'm doing CIC now in October  it will be  1 year. What is your opinion on this problem?Do you think i could get out of retention?

Thank You so much.

frank,

Jim ,I dont know what you mean by PITA,i assume this means pain in the ass?Well i'm doing quite well with CIC ,NO UTIs so far, it will be 1 year in October. How many years have you done or are still doing CIC?I don;t have a problem with CIC.JIm what is aquablation?

thanks,my friend JIm.

frank

Yes, PITA=pain in the ass  

Look, if you're doing OK with CIC, no rush as I see it making a surgical decision.  Aquablation is a new procedure but hasn't gotten FDA approval yet. It might be good for you, it might not, I was just using it as an example of newer procedures coming out. If you still have confidence in your original uro, I'd make an appointment with him and discuss what has been going on with the new doc. And, if you haven't had a cystoscopy, discuss that with him as well. Meanwhile, CIC will protect both your bladder and  kidneys as well as an surgery, so don't worry that you're doing any harm to yourself. Some people do CIC for their whole life. In my case, I did it for around 3 years. 

Jim

How come you can say azz.  And my post was delated forsay ing HE-L  GO figure  Ken

You say that Urolift is not a great procedure for frank (?) urinary retention.

​Surely Urolift is the only Urologist procedure that has virtually no side effects for this very condition!  Otherwise we are most likely to get retrograde ejaculation. 

​I have had (two) Urolift operations and am now (eventually) doing well.

​I am indeed looking for a procedure such as acquablation (or FLA) that gives me greater benefit and perhaps a more permanent solution, but I hope that Urolift has bought me the time until one comes available in the mainstream.

​I am pleased to say that I am sexually fully functional (thanks to Urolift)!

My center had done hundreds of urolift procedures. For frank urinary retention, our results haven't been great, but of course it can be attempted as long as expectations are in check

And inal lyou  caseyo uh ave not had it help in retention.  I talked with my urologist.  He told me he would never do a TURP on a 85 year old men knowing that there is only a 50% chance that it maywork .  Franks first doctor told him that.  Why do it if it not going to work.  Put him through major surgery.  My doctor has had some good result with patients that have been in retention but he also said that if it did not work CIC would be easier for Frank because it would open up the prostate.  Ken 

In certain cases, urolift can be attempted in men with retention, particularly if they are not a candidate for something else.

You lose very little by trying it

I talked to Dr. Karamanian.  You are correct.  He is currently running a clinical trial and recruiting.  

Worked ok for me! :-)

?I don't know the term 'frank' urinary retention.  What does it mean please

Hi, Thanks for the info on Uro lift. My question ,if it does not take me out of retention,would there be another problem getting these implants out if i needed another procedure?Wouldn't the implants cause another proplem?

Dr,if you were me at almost 88years old ,what would you do?Does CIC get harder to do  as we get older?

Thank you so much,

frank,

thanks 

frank

This is true Camster and if I am not mistaken, Trustme was part of that trial.

There are several doctors doing FLA from The Netherlands and across the USA now (yes JUG - there are way more than the 2 you have repeatedly stated)  so I'd like to see more action in this regard.

Also Dr K told me that 2 of his patients have had insurance agree to pay and possibly a third for MRI guided FLA for BPH. Really great news. I have sent the codes to my insurance carrier, we'll see...

Meanwhile, yesterday was 5 weeks and 4 days since my FLA and I can only describe going to the bathroom now as normal.

So here's a little evidence for you from "unevidenced medicine":

Full strong constant stream

Can start my stream within seconds

Fully emptying

Going 7 - 8 times a day (I'd like to improve my frequency)

Full sexual function

My IPSS score is currently 2 ( I get up once a night)

I'm told it's early days, but I would be happy TBH with where I am.

Ross

Frank: "...Does CIC get harder to do  as we get older?"

-----------------------

If you're not experiencing difficulties now, I would not let your advancing age be the sole determinant in whether you continue CIC versus get a procedure.

CIC does not require a great amount of dexterity and with practice has been successful with children as young as 7, as well as when studied in the elderly population. CIC is also the go-to means of voiding in the SCI (spinal chord injury) population where it has been used even by quadrapalegics who have no use of their hands. Should CIC become too difficult down the road, the options would still exist either to get assistance from an aide of helper, or to then choose the best prostate reducing procedure from what is then available. 

This is not to say that I'm recommending you don't get a procedure, but again, I would not let your age dictate that choice. 

Jim

They want to give me another cystoscope those are brutal I would rather wrestle a bear. If you are willing to pay will they put you under to perform cyst. Please let me no thanks

Really happy you are doing well.  You found a procedure match and great doctor.  I found Dr. Karamanian to be very generous with his time.  He spent considerable time on the phone with me.  I found him to be someone who genuinely wants to heal others.  

Thanks Camster. It's all true about Dr K but I do wonder from reading these threads if people think we are going overboard about him. But I have never met a more genuinely honest and concerned Dr with a passion for his specialty and his patient's outcomes.

I also hope more insurance companies follow suit and start covering this remarkable procedure.

Good Morning JIM and FRANK.  I have talk to my urologist for Frank he ask me.  He said that he has had good results with patients that have been in retension not saying it would work.  But a Urolift would make it eaaier for him because it would open the prostate up.  My doctor will not put a patient in risk and to major surgery.  Like his other doctor wanted  to do..  I wish Frank luck want ever he will decide    Ken

I can just say over the phone that he was passionate about healing others. He wasn't a salesman.  I also hope more insurance companies would help with the cost.  It's a big outlay for most patients. 

Hi Ken,

Is Frank seeing your urologist? I wasn't clear on that. Frank says he isn't having any technical problems with CIC, so I don't think getting Urolift solely to open up the urethra for CIC is needed.

The other question is if Frank has a large median lobe, because I hear Urolift isn't the best choice in that case.

And lastly, should Frank have Urolift, and later down the road decide to have say, Rezum or aquablation, or something new, would that be a problem? Not clear at all from their website, but my understanding is that Urolift is not 100% reversible and that part of the implant mechanism still remains in place even if the implants are removed. If that is correct, would what is left over impede a future procedure?

Jim

 

It truly is a big outlay, I entirely agree. I was in a desperate place having gone into AUR twice in the first week of May. I really hit a wall and needed to do something drastic.

So happy I found this Dr, this procedure and was able to pay for it because when you look at all the options out there, I can't honestly think of any other procedure I would subject myself to - evidenced based or not. For me it just made so much sense.

No Frank is in Chicago and I am in Orlando.  When Frank first came on he told me about the doctor wanting to do a turp on him and he wanted to have a urolift I told him I had one done.  And he asked me to ask my doctor what he throught.  what I worte was what my doctor say.  THat he has had good result with urolift on patients with retention but it is not guaranted but it would make it easier with CIC.  Ken 

One of the things I like about FLA for BPH is that appears to have a very good safety profile from studies with FLA for PCa. So, while I still think it's too early to make a call on functional results, other than of course the $$$, there doesn't seem much of a downside risk as opposed to many of the other procedures. 

Jim

Urolift has a great side effect profile- probably the best I've seen.

However, every individual is unique; for extremely large glands with a median lobe and retention, it may not be the best procedure.

It's hard to find a procedure with a super upside and little downside.  For you, it preserved all your sexual function.  No damage to the urethra.  It focused on the impingement areas.  Everything seems rational.  These new emerging procedures take time to be evidence-based.   For instance, PAE has been going since 2011 in the US and is still gathering evidence.  These things start somewhere with pioneering doctors before they become mainstream.  

Frank:

The Urolift implants can be removed, but often don't need to be even if you ended up having a different procedure.

As far as CIC getting harder, well, it's really a factor of dexterity; if you can perform the motion still, it shouldn't be much harder.

Would Urolift negate or make more difficult potential future procedures such as Rezum, Aquablation, Button Turp, iTind, etc? It's unclear from their web site, but my understanding is that part of the holding mechanism is permanent even if the implants are removed. 

Jim

There might be some people wondering how my FLA went. To add to the evidence of Ross, I can't say my experience is not as spectacular but I would still say it was a success.

My situation was different, I've had BPH symptoms for maybe 15 years if not longer. Probably some bladder issues since I always went to the bathroom frequently even in my 20s.

Prior to FLA I went into retention, my Urologist warned me not to wait too long because I could damage my bladder or at least create problems. I also had kidney issues which could have been really dangerous had I not done something really quickly, that's why I had the Foley on from the time in retention to the procedure (1 week) and then another 6 weeks to protect kidneys.

Now it's been 4.5 months since FLA - I only just feel like I am getting close to "normal" My residual after peeing is around 100ml. I just started holding my urges so I can wait 2 hours without too much problem and natural voids higher if I wait. I think it's still improving, probably this is all to do with the bladder in my case.

All the same things as Ross, except not fully emptying, and I still rely on Flomax so that is my only disappointment - I will try to stop it again at the 6 month point.

All this time after surgery I was doing CIC, Jim helped me with that. I stopped CIC about a week ago. Seems like I might not need to do it any more, I will do a check once in a while to make sure I don't have too much post void residual, or to see if it's getting lower than 100.

Michael

My take as an MD with a background;

Phase I (small- 10 patients) single-center trial; these are generally done to test safety, which is a great first step.

Relatively few exclusion criteria, which is good (other than retention, which would be an expected exclusion in a Phase I BPH trial.)

If someone doesn't want to try a standard treatment, this would be something to look into, as these generally are/should be fully paid for (you may still need to pay for airfare if you are not local to the center of the trial.)

The implants can be removed; if another treatment is performed, they can be removed at the same time, or may fall out if a significant ablation is performed.

Hi Mike,

How would you compare your symptons today to your symptons prior to going into retention? Better, the same, not as good? Trying to get a bench mark here. I am glad you feel FLA was a success, and from what we have discussed I'm optimistic that your symptons will get even better as your bladder readjusts. 

Jim

one other thing to add I forgot to mention - I still get up a few times at night, but it doesn't bother me that much since I can pee easily now and go back to sleep quickly. Some nights better than others, I like drinking tea after dinner so that probably doesn't help - or alcohol sometimes.

Jim/Mike

Mike, It makes me genuinely so happy to hear that your bladder function is steadily improving. It appears that FLA has allowed you to work on your bladder function  by dealing with the BPH and I am sure that Jim has been a wonderful help too in helping your bladder rehabilitate.

I also can't thank Jim enough for the personal help he gave me when I was in total retention last month. With his hands on help I was able to self cath my way out of trouble until I had the Foley and the FLA

Mike, I wish you continuing success and hope that the improvements continue unabated.

Ross

Jim,

Before FLA and retention every time I tried to urinate I had to push hard, it hurt a lot at times, sometimes I would stand at the urinal for over a minute trying to get the stream going. Sometimes I gave up trying to urinate and tried again later. waking up at night was worse since by the time I managed to urinate I was upset and more awake. I was tired during the day and depressed - only recently I feel more like my old self, but at 62 soon this has taken a lot out of me of course, plus I had TWO failed PAE's in the 9 months prior to FLA.

Generally speaking I am happier now and more optimistic things will improve even more so I can get off meds. Worst case scenario is I've bought my self some time in case a future even better solution comes along in case I ever decide I need more relief.

Michael

Ross thanks for your kinds words, obviously I'm happy for you too and Jim has been a great support.

Ross and Mike,

Ross, thanks for the nice words. As Mike transitions from bladder rehab (CIC) to bladder retraining (timed voiding) things should only get better, as long as bladder volumes are properly monitored. 

Mike -- I've been sleeping through the night lately, but the last two nights I had a beer and got up once. That's normal. Also, in your case, once your bladder retrains itself a bit, it will hold more which should translate into fewer bathroom trips. And then there's the whole nocturia thing, that it sometimes impossible to control as we get older. In many cases, nocturia can be totally unrelated to bph/luts and therefore should not be looked at as a shortcoming of any surgery or surgery.

Jim

Mike,

It definitely sounds it helped with your obstruction and you certainly seem to be in a better place now than you were after your failed PAE's. And yes, worst case, you bought yourself some time with minimal downside risk.

Jim

Frank,

I thought you had the same urologist as "kenneth1955", but Ken told me that isn't the case. How did you find your urolift doc? How many urolifts has he done? Does his office offer any other prostate procedures, or do they just do urolift? Also, if you want to share his name with us.

Jim

Every man has a right to have any procedure he want to have. The doctor only can suggest one.   And with the Urolift there are no side effect if the doctor does it right.  And its worth a try and it alot better that having your prostate cut out.  When the TURP don't work  What is the doctor going to say.  ****  Whoop's Sorry  ***    Ken

According to my Urologist who I think is the foremost Urolift surgeon in the UK, Urolift does not prevent any future procedure.   He says that the implant just get swept away - 'no problem'

Hi Mike and JerseyDoc,

It does appear that Urolift has a relatively low side effect profile, however I still think the idea of "nothing to lose" (not necessarily your words) needs some examining. So in the case of Frank, for example, where he may not be a good candidate, the risk/reward ratio is different than for someone who is a good candidate.

I went through part of the Urolift thread (link at the bottom of this post) and found at least one anecdotal report where "michael72708" claims that the urolift clips became embedded in his urethra after his prostate shrank from a subsequent PAE.

In the same thread, "paul96555" states in part: "....The innermost metal tabs can be removed, but not the sutures through the prostate or the outermost metal tabs that are outside the prostate – the sutures and outer tabs get left behind.  I heard of one case on one of these boards, where the outermost metal tabs had “grown in” as the prostate grew larger after the urolift (outer tab is set distance from inner tab, distance between them = length of suture...) and the subsequent HOLEP operation was messed up when the sliced inner piece of prostate tissue was caught with a tab (that used to be outside the prostate) in it."

I have no way of knowing whether michael's problems were directly related to the urolift or not, nor do I know if Paul's explanation of the metal tabs outside the prostate is correct, but thought I'd bring it up for discussion.

Here is a link to the urolift thread in question:

https://patient.info/forums/discuss/the-urolift-procedure-patient-views-and-questions-300828

Jim

Jim. This urologist is at U.I.C, his name is Dr Erwin Kocjancic. He does Uro Lift. I wish i knew of someone else on this forum that had this done by this DR.Any ideas how i could find out?

Thanks JIm

frank,

 

Jim This is the answere i got from my urologist> I don't know whats causing your retention, You have an enlarged prostate,and a dysfuntionable bladder.Thats it.

Were do i go from here?

frank,

Was it Dr Kocjancic who told you that your bladder was dysfuctional?

Jim

JIm<Thanks,your the best!

frank,

Hi Frank,

I'm trying to figure this out. It sounds like you're getting two different interpretations of your urodynamic report. I think what you're saying is that your regular urologist says your bladder is "dysfunctional" but Dr. Kocjanic, the urolift doctor, says "it has life".  If this is correct, then you need to sort it out somehow. Either get a third opinion from a voiding specialist, or go with the doctor you have confidence in. The other option is to just stick to what you're doing, CIC, for now at least. 

Jim

Jim, Dr, Kocjancic says there is activity in my bladder,now he wants to do a cystocopy to see why i can't have a natural void.What is a voiding specialist like you mentioned?I can't see where having another cystocopy would hurt anything,maybe he will find an answer to why i can't NV.My regular urologist said not to consider  a pacemaker in my bladder. The nurse at U.I.C. said urologist have different opinions.

This should not be the case.Why  should it be that way?

What do you thimk Jim

frank

JIm, My regular urologist told me that i have a dysfuctional bladder.

The first Urologist i went to who said i should have Turp procedure.Now i also emailed him . His latest answer is I have 3 choices. #1 live with a foley bladder, #2 do CIC, #3. have the prostate tissue ablated.Then he says a lot of men have the surgery and are able to have NV.

I have my doubts  about this statement?

MY hope is maybe i can get luckly one of these days and a have a NV.

Do you think I'm reaching for the stars JIm?

frank

 

When did you have your last cystoscopy? Try and get hold of your cystoscopy report and recent urodynamic report and post them here. Maybe the helpful doc from NJ will take a look and suggest if further testing is warranted. If not, you may want to get a third consult elewhere because it seems your two urologists differ in opinion. Like the nurse said, it's not that uncommon.

Jim

A lot depends on bladder function, that's why I suggested you post the actual urodynamic report, as well as the report from your cystoscopy, assumin you have had a fairly recent one. "Measure twice, cut once". In other words do your best to figure out the problem before trying to solve it.

Jim

Frank please do what Jim is telling you.  Also stay away from that first doctor All he want to do is the Turp on you and he told you the first time that it may not work and you would have to do CIC.  Why have the sugery just for him to do it..  Ken 

Jim

?Actually this may be quite relevant to me - thank you for pointing it out.

?I have from time to time some symptoms which have been put down to prostatitis.  These symptoms come and go, and seemed often to be provoked by exercise.  Recently they have intermittently become worse.

?(I documented a snapshot here https://patient.info/forums/discuss/prostatitis-or-something-else-how-do-i-get-a-diagnosis--563044)

?I wonder if one (or more) of the outer tabs is somehow snagging such that it gets pulled when I exercise (even walking sometime does it), and this in turn pulls on the inner tag giving me prostatitus type symptoms.

?I have 9 Urolift tags inserted after two operations.  I documented my initial experiences here https://patient.info/forums/discuss/urolift-my-experience-75gm-prostate-7-tags-454757?.  (I must update this as I had a repeat operation).

?I know this is not the best forum to ask, but has anyone heard of such prostatitus type symptoms after Urolift?

Mike, I see that you had Urolift, maybe twice with 8 staples in place and mentioned FLA.

I am deciding between PAE, FLA, or Urolift. My first question when inquiring about FLA with Dr. K was if trying Urolift first would make me not a candidate for FLA, he stated that it would due to the presence of the staples.

Rick

Hi Rick

​Yes I have had (two!) Urolifts.  The first had 7 tags.  After the second one, I ended up with 9, one removed and 3 added.

​I did consider PAE but went with Urolift as it was newly accepted by our National Health Service.  (Actually I paid privately for the second Urolift)

​FLA does not exist in the UK and as far as I can see from all these threads is done only by a couple of people.

​My Urologist has reckoned that Urolift would not prohibit and subsequent treatment, so that was also a factor in choosing it.  I am beginning to wonder whether he is right, especially after what you say.

​My Urologist is keen on Acquablation being the solution to replace TURP and preserve all sexual function.  So that is where I may go at some point.

Mike

Good morning.   Mike.  A man can get prostatitis at any age.  Not just because he had any procedure.  I had the urololift done 2 1/2 years ago.  I get pain in the groin area testicle most of the time on the right and my penis gos numb.  I have never felt any of the 4 implants that I had put in.  There was only one time that when I was having my stricture checked witha  scope that the doctor found one of timplants let lose.  When he tryed to fix it that hurt.   Had to have it redone.  WHAT happen was that my prostate got smaller.and he put a new one in and had to tighten the other 3.  ido  go to the gym but nerver had a prpoblem.  Take care  Ken

@richard My first question when inquiring about FLA with Dr. K was if trying Urolift first would make me not a candidate for FLA, he stated that it would due to the presence of the staples

----------------------

We have been told the staples are removable but it' still unclear if the whole mechanism is removable. Did Dr. K. say that you were a permanent non candidate or that you would be a canidate if the staples were removed? If he was unclear, you might want to go over it again with him, assuming you're still interested in FLA.

Jim

@mikemh I wonder if one (or more) of the outer tabs is somehow snagging such that it gets pulled when I exercise (even walking sometime does it), and this in turn pulls on the inner tag giving me prostatitus type symptoms.

--------------------------

Hi Mike, 

Maybe there is some way to check out your theory, either with imaging and/or cystoscopy? Urolift is relatively new so all the side effects may still not be documented.

Jim

@Kenneth Frank please do what Jim is telling you.  Also stay away from that first doctor All he want to do is the Turp on you

------------------------------------------

Hi Ken and Frank,

If I understand things correctly, Frank's first doctor told him that he'd have 50-50 chance of success with TURP and 5% with Urolift. This sounds consistent with a failed urodynamic report. I don't think he was suggesting either, and apparently was quite OK with Frank continuing on with CIC, but maybe Frank will verify. 

His Urolift doc apparently has read the same report a little differently. What I told Frank is that he should try and get the diagnosis straightened out before making any final decisions. 

Jim

He should have it check out.  frank is doing great with CIC ( with your help )  I just don't want you to have something major done that is not goingt o help and cause him more problem.  HAS I said before my doctor will not do major surgery on a man of his age that why he will do the urolift  that may help but if it don't it will make CC easier for him the prostate will be open  I wish him luck  Ken 

Yes I wish there were some way but I think my urologist said that the tabs don't show up with imaging.  Cystoscopy would only see the ones in the urethra.  Maybe someone knows better.

Mike The doctor can tell if there off with a cystoscopy.  That is how he found one of mine was off. It let loose  That was last year  Ken

Hi, Jim and Ken, I want to-say exaxtly what happenend. I have seen 3 urologists. The first one did a cystoscopy,thats all. His comment was i should make arrangements at the hospital for procedure Turp. I decided against this and went to  another urologist. He read my cystoscopy and agreed with the first URO. Later on i was the one who sugessted having a urodynamics test,he agreed .His final diagnose was he does not know what is causing my urine retention. I have a dysfuction bladder and a enlarged prostate. I asked him what he would do if he were me? He said would continue doing CIC.  He also said if i haveTurp or GL i would have 50 to 60 % chance of getting out of retention. I decided to keep doing CIC, Thanks to JIM.Now my 3rd and final Uro does Uro LIft. He read my urodynamic test and said there is activity,he wants to do a cystocopy.

This is where am at .The Urologist on this forum, said Uro Lift will not work for urine retention. I must  also say my 2nd Uro also said the same,Uro Lift will not work with urine retention.So i still don't know if i should persue this 3rd Uro and get this cystoscopy.

Always interested in your opinion.

thanks

frank

Hi Frank, Has your 3rd Uro looked at the cystoscopy report done by the first uro? Do you have a copy of that report and a copy of your urodynamic report? If not, I would get your own copy of both reports. 

Jim

Frank, also what might help you with any decision is to make a short list of: (A) What you like about CIC; and (B) What you don't like about CIC.

Jim

Frank  First of all and I have said this before i think of you as a father and if you were mine what would tell you.  Will if CIC is working for you and you don't mind doing it.  And you don't know if any procedure will work why have it done.  You are the main concern what you think.  I wish you well and may God bless    ken    

Jim, Ihave copies of cystoscopy and urodynamic tests. My 2nd Uro also said not to do pacer in bladder. I don't know as of now where  my 3rd Uro is  going with this. Do you have any idea?

Thanks  Jim

frank

Jim, Yes my 3dr Uro has a copy of the cystocopy done by my 1st Uro.and also urodynamics test results.He said the tracings on the urodynmaics test show activity,so he wants to do a cystoscopy.Can you figure where he's going with this?

Thanks  Jim

frank

Jim and Ken, This is not quite right. The 2nd Uro said i would have 50 Or 60 % chance of getting out of retentiion with surgery.He also said Uro Lift will not work with urine retention.He is saying i should continue with CIC.

Hard to figure  why the different opinion on these procedures?

thanks

frank,

Hi Frank,

Your third uro wants the cystoscopy to see if in his opinion you qualify for a Urolift. Apparently, he wants to take a look himself, rather than rely on the previous cystoscopy report. 

From the feedback you've gotten, two of the uro's you've seen, and one uro online here (JerseyDoc) don't think your chances are very good with Urolift. This doc apparently thinks they are good enough at least to go ahead with the cystoscopy.

Some questions I would have moving forward are: (1) How many Urolifts has this doctor done; (2) Does he offer other procdures (TURP, GL, etc) or just Urolift?. 

At a certain point it will depend on how much faith you have in this particular doctor versus the advice you have been given before. 

Regardless of the cystoscopy, the function of your bladder is paramount, that's why your urodyamic report is so important. If it were me, I'd probably get another evaluation of that report from a voiding specialist. You could also post a copy of the report here and maybe the JerseyDoc will comment. 

I also suggested you make a short list of: (A) What you like about CIC; and (B) What you don't like. This may also help in your decision, because the devil you know is sometimes better than the devil you don't know. 

Jim

 

Frank Do you trust this doctor with the surgery or is he just trying to get you on the table.  50% or 60% are not good odds. especially if your going to have to do CIC anyway.  Have the cystoscopy and then see whats up. What get me is the doctor wants to put you through major surgery and not the urolift.  But they do the same thing.  Make a tunnel    Ken

Hi Ken,I have an appoint in August,I'm going to have the cystoscopy done,then see what he says. I'm doing CIC It's ok,the hard part is getting up at night.and doing this 6 times a day.My kidneys must be over working,i don't know,but i sure wish it was like 4 or 5 times a day that wouldn't be to bad.

frank,

JIm, Your advice is always super. I din't know what you mean by a voiding specialist?How do i find one of  these specialists?Jim how do i post a copy of urodynamaics results to Jersey Doc?

Thanks  again JIm

frank

Hi Frank, A "voiding specialist" is a urologist who takes a special

interest in voiding issues. They can be found at larger, teaching hospitals but also in private practice. The point was that two urologists looked at the same urodynamic report and apparently came to different opinions. A third opinion therefore might be helpful. It's not that unusual for doctors to come to different conclusions looking at the same data. This happened to me with a biopsy years ago, and I ended up having the slides read by four pathologists until a reasonable consensus was reached. 

If there is a summary portion of your urodynamic report, maybe you could just copy it right here to one of the posts.

Jim

Im glad your going to have it done. AT  night have you throught about wearing a condom catheter at night a few time during the week.  This way you would not have to get up.  Just do CIC during the day  Good luck ken

Jim,This is the  Urodynamics report ,i wanted to send this to the URO on this form. I don't know how to do this?

frank,

 

Frank, I don't see any report. Did you post it here?

Hello,Kindly tell me your observation on my Urodynamics test.The patient performed self cateterization.

Test was done without flourscopy.A uroflow could not be completed prior to study. A post void residual was obtained which demonstrated significant volume remaining in the bladder.After placement of urodynamics catheter ,an additional 325 ml was drained. The urodynamics study demonstrated a bladder capacity of approx 625 ml.There was generally safe bladder pressures until approx 165 ml of filling.At this volume there was the onset of significant detrusor pressure with pressures approaching 70-80 cm/h20. There was no associated leak.Pressures were safe again until 370ml.Throughout the remainder ,his detrussor pressures were significantly elevated.His presurres were consistently above 60cm/h20. Despite the increased detrussor pressures there was no voluuntary detrussor activity associated with a void.The study is consistantwith an increased bladder capacity and increased detrussor activity with poor bladder compliance.Despite sigificant detrusser pressure ,there was no leak or evidence of a voluntary void. There was no detrusor -sphincter dyssnergia.

Thank you so very much for this observation.

frank

Hi Frank,

The report posted OK now and hopefully the Jersey Doc will see it and give his professional opinion. 

My unprofessional take is that the report was better than I expected based on what your 2nd urologist told you. Your bladder does seem to have "some life" as your third urologist said. Again, more "life" than I would have guessed.

You appear to have adequate detrussor pressure as well as no nerve damage, which is consistent with your symptons being caused by an obstructing prostate. 

So, in my unprofessional opinion, the odds your second urologist gave you for a successful procedural outcome-- 50-50 with TURP and 5% with Urolift, appear to be on the conservative side, and hopefully you can expect better pending your cystoscopy.

So if you have confidence in the Urolift doctor, I would go ahead with the cystoscopy and then re-evaluate going forward based on what he tells you. 

After the cystoscopy, some questions I would ask him are: (1) How many urolifts has he done; (2) Does he offer other procedures such as TURP, GL, etc. (3) What does he think the odds are he can get a successful outcome in your case. 

Last thing, you mentioned that getting up a night was a major issue with you. Keep in mind, that even if you have a successful procedure or surgery, you still may have to get up once or twice during the evening for reasons other than your prostate. The difference would be that if the procedure was successful, you wouldn't need to use CIC for those nightly voids. 

Jim

Hi JimJames- This is a bit off-topic, but as you seem to be one of the foremost experts on Self-Cathing in this forum I'd like to ask you a question. First of all, I am new to the world of self-cathing. Here's my question:

Using the speedicath, is it possible to use the speedicath, finish, put the used speedicath back into the packet, and then reuse it 1-2 hours later, then toss the twice used cath? Would there be too much risk of a UTI this way? Have you ever done this sort of thing to save money..?

Thanks

Hi Jay,

I answered your question over in one of the self cathing threads. Link here. Let me know if you find it, this site is not the easiest to navigate.

https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874?page=4&order=Oldest

Jim

 

Ross

How are things going? John said that you had quite the problem and scare when you passed a bladder stone? That must have been fun. That was nothing to do with your FLA, but still strange. That must have hurt. Hopefully you are ok now peeing with ease and having sex like not for a long time. Did you talk to Dr K about your problem? I am sure that if you go back to one of the mri scans that were done either before or after that a scan of your bladder would show this stone. When they scan the prostate they do where the urethra goes through the prostate to the bladder. Was the stone worth anything? How big was it? You probably have it mounted in a ring?

Hope your having lots of sex and finding mens rooms is not your primary purpose when you go shopping?

Mike

Yikes, Sorry to hear that!

Stones don't show up on MRI. Would get an ultrasound or CT to determine if there are other stones.

Jersey

I was asking Ross about the details. He might have known about the stone prior to his procedure and passed it out after. Also, I don't know the breadth of his scan. They take hundreds

Of slice scans in high definition and may not scan much beyond the bladder neck. I would assume to get this far along through two procedures that his urologists saw it in an ultrasound and after having a PAE first that it should have found it the stone.

Mike

Hi Mike,

Long time no see. Yeah I knew I had a bladder stone going into the FLA from a CT Scan I had had last November. I was concerned with my recovery arounnd weeks 5 through 7 as I appeared to be all over the place in terms of the quality of my stream; some hesitation and weakness on occasiuon. I mentioned it to Dr K who thought it was a possibility that as I healed, I may end up passing the stone but was still confident that it was early days and that things would improve over the coming weeks.

On the day of week 7, I became symptomatically a basket case which culminated late that evening in a dribble and a complete stop followed by the sensation of enormous pressure for a couple of seconds. Then something shot out across the toilet and hit the wall LOL! A 6mm black rock! The torrent of urine that followed can only be described as a firehose and ever since it's been consistently an amazing torrent. No it didn't hurt one bit, I was overjoyed that there was a very good reason for my symptoms and had NOTHING to do with my FLA. Mounted on a ring? Too funny!

Mike I still go looking for the stall when needing the men's room for the sole purpose of enjoying the sound of my stream hitting the water as hard as it does! I know, pretty sad!

I truly hope you are still doing amazingly well and are enjoying your new found quality of life.

Ross

 

Hi,I had a urodynamics test,and a cysto .I could not do NV with urodynamics.Cysto showed enlarged prostate. I have been doing CIC 10 months i am in complete retention.I was told that i have activity in my bladder,and he can't figure why i am in retention?I would sincerely appreciate your opinion . Do you think i have a dysfunction bladder? At age almost 88,do you think Turp or Gl would be a proceedure i should consider? Also do you think Uro Lift would be another option? What do you think would be the best way for me to get out of retention?I know there would be a lot of blood loss and possible infection ,with this surgery?Do you think i'm to old for this surgery?

Thank you so very much for your opiniom.

frank

 

Jim ,Thanks for your reply. I will have this Uro do the cysto this is the uro that said i have activity and feels that it's the enlarged prostate causing the problem. Like you said i will ask the questions you presented.Do you think even after the proceedure i could still possibly also have to do cic?The fault i'm finding with cic is i get testicle pain after i i do this. But not always.

I believe this might be normal since there are so may nerves in this area.What do you hink?

Thanks 

frank

Frank,

A lot depends on how much activity was there per urodynamics, but given the fact you've been in complete retention for so long.

Your first doc I believe said your chance of success (and getting off of CIC) with an agressive procedure like TURP or GL was 50-50 and closer to 10% with a less agressive procedure like Urolift. This seems consistent to what Jersey Doc said earlier. Specifically, I think he said that Urolift would not be his first choice for someone in retention like yourself.

Then there's your current Urolift doc who it sounds like is giving you better odds. Have you asked him what he thinks your odds are?

As to tolerating an agressive procedure like TURP at your age, I believe Jersey Doc said some time back that he didn't see age per say as an issue, as long as you were medically cleared for anathesia. But this is just from memory. That said, TURP is a much more invasive than Urolift, and some men have more difficulty recovering than others. 

As to your testical pain, is it in one testicle or both? Is the testicle(s) swollen at all? I would mention this to your urologist and get checked for Epididymitis which is an inflammation of the testicle, sometimes caused by CIC, but something that can be treated.

Jim

In the  case of a large prostate (160 ) with contained but aggressive tumors (Gl 8) would you do GL laser before radiation or after if necessary.  Is Holmium laser more appropriate for large prostate?  All best!

A 160 g prostate is absolutely massive;

Way too large for a Greenlight laser procedure.

I would strongly recommend a conventional prostatectomy (or robotic assisted) if that is a possibility.

With a prostate that large, the chances of having voiding issues after radiation would be high.

Why is that the only option.  With all the procedure we have today there should be something else.  I have a friend that is 75.  10 years ago he was talked into prostatectomy by his doctor.  It took him almost 3 years to get back to some what normal.  He said that they had a great sex life for there age and he lost that.  Never got it back even with pills.  He told me if he had to do it again.  He would have never did it..  Robert think and research before you do anything...Ken   

Robert have you looked in to FLA9

Prostatectomy is a procedure that has been evolving over the past few decades.

The procedure today (by an experienced surgeon) is different than even a few years ago.

I would recommend seeing one of the top surgeons who can do it robotically in under an hour and had great results

But why not HoLEP instead?

That may be a possibility in experienced hands, but will not control the cancer to the extent as a radical prostatectomy

Makes sense. So  I guess one would have to analyze the efficacy of both procedures in terms of cancer against their respective side effect profiles, taking into account the specifics of the particular cancer, including growth projection, and the person's age,overall health, etc. 

Jim

Exactly. It's not a one-size-fits-all choice.

I recommend seeing your urologist, as well as possibly getting a second opinion to review your pathology, history, and options.

Many thanks for your words of wisdom. 

Dear JUGr

Many thanks for this. I am 83. Am told too old for RP by surgeon at NYH.  A friend was 79 and went for RP because Bob Hope did it and lived to 100.  But my friend had several miserable years though doc is widely regarded as a top practitioner. Would FLA be better than BlueGreen? Robt

I see where your coming from.  A doctors main concern is to get rid of the cancer and if any problems come up then to fix that.  But some men still want a active sex life.  Once you disconnect nerve and try to spare them.  A older man has a harder time to recover from that.  So in a way you can say you are saving his life but your killing him in other ways.  I am sorry but I think we still want it all....Thank you  Ken

Prostate Artery Embolization works fine for large prostates.  Would have to talk to a PAE doc regarding the aggressive tumors and radiation.