Going for urologist consultation on 100 cc enlarged prostate
Posted , 18 users are following.
I first noticed difficulty urinating 14 years ago when I was 37. At 50, two years ago, DRE suggested abnormality. DRE last year -the same thing:- '
"it does not feel right" Both years PSA is 4.8. GP referred to urologist at age 51 who prescribed Tamsulosin. To the end, I strain to urinate and carry pee bottle with me in the car and in my office. Last month cystoscopy reveals bladder stone and BPH. Prostate biopsy ultrasound measures my prostate to be 103 cc in volume. Ct scan ob abdomen/kidneys was normal except for large prostate. I was close to renal backup after these procedures so I am using a Foley Catheter. The 30 year 'veteran' urologist suggested TURP while tomorrow the Gleason score will be returned. Each man must decide carefully own his own but your comments are appreciated.
0 likes, 34 replies
spr chris04161
Posted
Hi Chris
I like you had an enlarged prostate from an early age. Now I am 62 and have had 5 biopsies and and MRI. My prostate was 190 gm two years ago.
I did research and decided not to get on medications that my Urologist(s) recommended as side effects were too great a risk in my opinion. I tried herbal and that helped (saw palmeto and beta sisterine and lycopene). Urination got really difficult- had to pee every 45 min to an hour- up 6+ times a night, urgency, etc . My IPSS score was 28.
On Dec 20th 2018, I had a PAE procedure done. The doctor could only plug one artery because the other seemed to be attached to penis blood supply. I had to have a foley for 5 days (mostly because of Christmas holiday). My PSA went up 10 fold after the procedure (which the doctor- Dr. Shaw in Texas who is an Interventional Radiologist, said was a good sign).
So it has been less than a month- now my IPSS score is 4. All my symptoms are much reduced to gone. I can go 3 hours + without peeing, sleep all night ( at most getting up twice at 12 and 3), urgency is reduced, sex life was unaffected.
I would highly recommend PAE- mine was covered by insurance- just paying the deductible. Urologist will say there is a danger - but I disagree the IR doctors are very careful and do not harm, whereas Uro want to cut and give meds the solve one issue and cause another.
Anyway that is my 2 cents worth.
good luck
arlington chris04161
Posted
Hi Chris,
I had the PAE and it didn't work for me - largely because I have an enlarged median lobe. Since I'm not yet comfortable w/ the risk/reward profile of other procedures, I've been self catheterizing (CIC) for 4 years. I think it's the best option. It allows you to go on your own to the extent that you can but then empty your bladder when you can't.
I was on the Foley for 2 months and my Dr. was trying to get me to CIC but I was hesitant. I learned how to do it in 10 minutes and it isn't nearly as bad as you might imagine. The more you do it the easier it becomes.
The one that works best for me is the speedicath male compact by coloplast.
Best of luck!
chris04161
Posted
Thanks for the replies to this post. Met with the 31 year URO veteran. 12-core Prostate biopsy was all negative except for a small 'ASAP'. I have a 12 mm stone in my bladder. He will use Light Amplification for the Stimulated Emission of Radiation ('LASER') to break it up since the urethra is only 9 mm wide. I asked about Rezum but he claims he needs a more sharp cutting tool (vis-a-vis bipolar current probe ) to remove a relative large amount of the median lobe. Button TURP is not as effective for large prostates. Since my overall health is 'good' and CT scan showed no other abnormalities and since 14 years trying to pee and frustration, TURP sounds like a 'relatively' good solution. HoLEP is not a efficient solution for the URO nor is Rezum. I will meet with a 25 year URO , his partner, 2 days before my surgery next week. Hard to reason why my small size 5'9, 160 lbs has such a large prostate at age 52. Thank God for no cancer...yet. Again thank you for your comments.
uncklefester chris04161
Posted
When you say* HoLEP is not a efficient solution for the URO nor is Rezum.* is that just another way of say he doesn't do those procedures? If not, how about findind a uro that does. Are you in the USA?
oldbuzzard chris04161
Posted
IMO you need another urologist. Anyone who would perform a TURP as a first line treatment for simple BPH is a quack. They can do Rezum on really big prostates and can spray the median lobe as much as necessary. They do Holep on really big prostates too. Not sure about button TURP, but I wouldn't be surprised if he's wrong on that too.
For heavens sake, find a doc who does a lot of Rezum and try that first. It will probably work. If it doesn't, look into something like holep or greenlight. Ignore the input on any procedure from docs that don't do them.
john98818 chris04161
Posted
if you're not a medical doctor, you can go crazy trying to figure out what surgical is best for you. we (the people on this forum and myself included) just don't have the education or background to weigh the risks and benefits, effectiveness, etc. find a good board certified urologist who is warm, listens, had a good reputation and has s record of good results that you form a relationship with and in the end that you trust and try to follow his or her recommendations. my mistake was i went to an our of town MD to have a procedure i heard about in this forum and experienced a poor result. i should have listened to my trusted urologist from the start. don't drive yourself crazy trying to diagnose yourself and coming up with your own treatment plan.
arlington john98818
Posted
It should be a collaboration - but , in the end, the patient's decision - guided by the educated opinions of the Doctors.
barney34567 chris04161
Posted
Oldbuzzard mentions "DO NOT let anyone who hasn't done hundreds of these do this. " This is very wise advice for any major surgery. I had a full blown radical prostatectomy and was treated by a guy who has done >500 operations. Volume of patients a doctor has treated does not assure success but minimises risk and complications, in my opinion.
chris04161
Posted
Feedback for those considering TURP. Each person has a unique experience but out of gratitude for those who commented I share my story as a 'young man' (52). Forgive the short-hand notation: Had TURP 24 January. Spinal anesthesia. URO removed bladder stone which was a consequence of enlarged prostate and BPH. I had been 'dribbling' since age 37. Prostate was pushing up into bladder and puddles of urine left over then calcified to 12 mm stone. Doc removed 35g of the 103 g prostate. Saline 'irrigation' of the bladder started the same day. Antibitoics and Oxycodone for pain. One night stay in hospital; went home with catheter. Catheter removed after 4 days. 24French Catheter removal was like a 5 second bee sting as the balloon slid against the prostate wound. Ouch! Worse than any other part of the TURP chapter. I now appreciate Bernoulli's equation as my FLOW is very strong. NO SEX for 4 weeks or whenever the wife allows it. My wife wears the pants in my house (but I pick out the pants!). Doc prescribed Fenasteride 5 mg/day but I will not take it until I evaluate sexual activity. Also, there is a 7% per re-surgery rate PER YEAR (empirical data) so in 10 years 70% or TURP patients have the surgery again. Back to work after 8 days but notice bleeding started back so take it easy! Godspeed.
DG64751 chris04161
Posted
I had HoLEP 5 days ago after a urolift that lasted all of 2 weeks (I had an enlarged median lobe that was blocking my bladder entrance). 5 Days in and all pain is gone and urine is clear. Yes, I had general anaesthesia but no more problems with frequency, urgency or retention. At 48, its given me my life back. Having said this, I am curious to know what investigations if any I should have expected to have before my Urolift. I have a feeling that I should have been offered the Holep instead initially.
compiler DG64751
Edited
The holep is indeed good but men may experience retrograde ejaculation. Do you…..?
DG64751 compiler
Posted
i will report back on that one soon.
cali-mike1970 DG64751
Posted
can i ask about your frequency (i'll also be making a post on this). since you clearly had BPH and no confounding diagnosis like CPPS --I think), what was your frequency like? When I started with a 4 month flare up that I am on, I would have frequency and when I would go I felt obstructed (hesitation, dribbling, start/stop, etc). Now, after 3 months of physical therapy and daily supplements like quercetin, saw palmetto, swedish flower pollen (which work as good or better than flomax for me), I have the urge to go to the bathroom every hour still but I feel like I have flow (not high pressure but def comes out) and don't feel retained. I measured my output and often it's 70 to 90ml, better than the 15 to 50ml I would get when this started. That's still not a normal hold of my bladder waiting until 250-300ml and then voiding with pressure to a low residual.
I'm just wondering if BPH frequeny can present where you are not getting retained but just this feeling to go all the time while your bladder is filling up. Like maybe the bladder is acting poorly after so many years of pushing against a backed up urethra. Curious.
compiler cali-mike1970
Posted
Testing the urine flow rate. According to your reporting voided urine 90 ml every one hour, you probably have the urinary frequency, urgency and retention due to the blockage. Do you know your prostate size?
cali-mike1970 compiler
Posted
yeah it's 70cm and i'm 52. the urocuff test does show obstruction and PVR of 100ml on no drugs and 50/60 when i was on flomax. looking into PAE first, then aquablation.
compiler cali-mike1970
Edited
The Urocuff should show the urine flow rate. The age of 52 post-void urine volumes > 50 to 100 mL is abnormal. Have you tried 5-alpha? Do you have median lobe? Ask your doctor and make sure PAE is suitable for the 70 cc prostate. If so, please share the results.
cali-mike1970 compiler
Posted
2 IR's say PAE is OK for median lobe. my uros say I don't have one but one of the IR said I did because there is some pushing up against the bladder wall. What is the best way for someone to tell if you have a median lobe? cysto? I've had one of those (Uro said no median lobe) and a T3 MRI (uro who saw that said none, but a FLA IR doc in Houston said yes). Haven't tried 5-alpha. I guess that would help determine if this is chronic prostatitis or BPH. My biggest symptom now is frequency (don't feel I'm retaining either, just going alot) and nocturia (now waking up every 2 hours vs 1 hour before). also have hesitation and start/stop but that has gotten better with pelvic floor and prostate supplements. that's why i'm starting to doubt bph boo.
compiler cali-mike1970
Posted
You do have BPH as you reported your prostate is 70 cc. You need to make sure the PAE treatment is suitable for the large prostate.
cali-mike1970 compiler
Posted
That's true. 70cc is nothing to sneeze at for a 52 year old. And the MRI showed hypertrophied nodules. Urocuff showed an extraordinarily weak 3 ml/sec and doc said my bladder is working fine but working overtime to get through the BOO. Said at the pressure it's creating it would shoot up to the roof without obstruction. they were willing to consider a procedure without further testing.