guidance for helping my brother make a decision about procedures.

Posted , 7 users are following.

Hello All,

I am sorry that this is much the same as in previous posts, i'm sure, but would be grateful for some advice.

My brother has been diagnosed with BPH and is seeing the urologist tomorrow to discuss treatment. He had a cystoscopy some time ago which was very painful and caused him a lot of problems afterwards for some weeks but he didn't get any feedback from that.Hopefully there are notes with the new urologist.He has not had a scan so doesn't know the size of his prostate.

  1. He has no nocturia
  2. It is slow to start urinating
  3. He has a slow stream but not just dribbling.
  4. He has no discomfort passing water.
  5. He feels he is able to empty his bladder but without a scan he can't be sure.
  6. He often finds he has no feeling of passing water in spite of doing so.
  7. The other problem he has which has been suggested to him is related to his prostate, by person who advises him on supplements, as "it is all down there" is that he suffers from some bowel issues. Mainly flatulence and, more problematic, urgency meaning he sometimes only just makes it to the toilet. Is this a known effect of prostate problems?

He has been recommended the option of TURP, Urolift or Holep. I must confess that I don't feel, personally, that his symptoms warrant surgery but would be grateful of others' opinions.

Without a scan, can the urologist know which is the best procedure? I have read about certain sorts of enlargement affecting the best procedure but I don't understand about lobes or even if the urologist can know without the scan.

Are the other procedures such as PAE a better option if he can get it?

I have read that Urolift is a fairly temporary fix and only works for some types of BPH. Is this true.

Thank you very much for taking time to read this.

I will be very grateful for any advice anyone can give so that I can be helpful to him at his urology appointmen.

Thank you very much,

Richard.

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10 Replies

  • Posted

    From what you've said, I honestly think he is not a candidate for a surgery yet.

    He needs at least a PVR scan and an MRI before any decision on the further treatment is taken.

    BPH and urine retention do cause IBS symptoms, though no doctor was able to explain the link. It may be a sign that he is retaining a lot of urine, which needs to be checked.

    There is usually a medication stage before a surgery, which for some lucky ones keeps them going until they pass away for other reasons.

    If his urologist is only talking about surgery - it may be time to see another one.

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    • Posted

      Thank you for the reply.

      I did feel that surgery is a bit premature with the way he is at the moment. He is on Tamsulosin which he doesn't like and I will suggest he tries Cialis which I am on.

      That is interesting about urine retention causing IBS symptoms. We will ask the urologist tomorrow about that. I hope they will recommend an ultrasound scan to check for urine retention.

      I do think he is most concerned about the bowel issues.

      I felt that surgery is a bit premature at the moment.

      Hopefully this urologist will be a bit better than the last one who hasn't even reported the rusults of the cystocopy.

      Have you heard of the issue he has that he has no sensation of passing water and doesn't know until he looks down sometimes? I don't think I've heard of that. Once again, we will see what the urologist says.

      Thank you again.

      Richard.

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    • Posted

      i just had the urolift 2 weeks ago and havent been able to pee since Went to the doc today and he said my bladder is the problem and i will have to self cath for 8 more weeks I did have serious urinary retention problem and he says my bladder might not work right for awhile or maybe permanently so if your brother is retaining urine dont ignore. Also, the bowel problem can be caused by the prostate issue I took metamucil which does wonders for this. I suggest he try it.

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  • Posted

    Hey Richard

    I do not feel you needs a surgery yet either. What he needs to do is get a second opinion. He does need to have all the test before anything is talked about surgery. Some doctors like to rush a men before they look at all options.

    Maybe he has a BPH problem because he has a infections. Tell him to take a hot bath for 20 minutes this will help any inflammation in the groin area.

    Do not let any doctor talk him into any procedure that will cut away at the prostate. That is when the problems starts. I do not know if he is still sexual active but most of the procedure will cause problems with erections and ejaculation.

    Have him look into PAE or Urolift. They do no cutting and they do not cause sexual problem. I myself had a Urolift done almost 8 years ago. I am still open. No problems at all

    Just make sure he get all the test. Stay away from any surgery until he really needs it.

    God best to you for thinking of him....Ken

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  • Posted

    One thing comes to mind, your point #7.

    What you describe is called URGE INCONTINENCE and is not usually associated with prostate issues. *Consider it a separate issue altogether.

    There are several explanations for this condition.

    The long list of causes include:

    Diarrhea

    Constipation

    Muscle damage - Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly.

    Nerve damage - Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to incontinence.

    Hemorrhoids - When the veins in your rectum swell, causing hemorrhoids, this keeps your anus from closing completely, which can allow stool to leak out.

    Examination includes one or more of:

    • Digital rectal exam: to determine the strength of your sphincter muscles
    • Balloon expulsion test.
    • Anal manometry.
    • Anorectal ultrasound
    • As well as traditional
    • MRI to provide pictures of the sphincter
    • Colonoscopy - a tube is inserted to inspect the colon.
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  • Edited

    Firstly, his supplement friend may have the best of intentions but he should get a medical opinion or two on his bowel issues. Could be anything from a minor allergy to something very serious. He should see a gastroenterologist.

    Secondly, not sure why his cystoscopy would be so painful? Did the second urologist have a look see too? I can't imagine they wouldn't. When I had mine done the physician showed me while it was happening how my prostate tissue was in the way.

    Also, has he had a Urodynamic study? How big is his prostate? Is there blockage in the median lobe? These really are questions more for the Dr. There are some people offering great and important advice on this forum but no one has a license to practice medicine.

    I suggest you find out the above then research the alternatives. I had Urolift and it worked fine, Minimally invasive with no loss of sexual function. TURP & HOLEP are both more involved procedures with longer recovery times and risks of loss of sexual function.This is a pretty good straight forward resource to understand BPH https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

    Don't be afraid to get multiple opinions. I went to five urologists before I found one that made sense for me.

    Good luck.

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    • Posted

      Thank you all very much.

      All the information was very helpful in our trip to the new urologist.

      He was very calm and helpful, unlike his previous ones.

      He explained that he thought, given the relatively mild symptoms and the results of the ultrasound scan which showed a not excessively enlarged prostate and little urine retention, the surgery was not suitable yet. We did ask him about the bowel problems which he said was, as suggested above, unrelated.

      He also said that he thought a change from just Tamsulosin to a mixture of that and another drug that should reduce the size of the prostate after a few months. He explained very carefully that this could cause erectile disfunction but my brother was not worried about that.

      I'm not sure if we are allowed to mention the name of the urologist on this forum so will not give it but I do wish mine had been like this gentleman.

      His previous urologist had just told him that he had to have HOLEP and had booked him in without explaining any of the problems that he might have.

      He has booked James in for a review in 6 months.

      I am interested in what you say about being surprised about having pain with the cystoscopy. I had one which was also very painful indeed and also left me in pain for some time although not as long as my brother. Did you have any sedation or anaesthetic with yours?

      I will be chasing my brother about getting an appointment to see his GP about his bowel issues as, like you, I feel that relying on a non professional is not wise. The Urologist did suggest that my brother's neurological issues due to a broken neck in the past and restriction of his spinal chord may be partially responsible for his bowel problems but he should seek specialist assistance as it was not his area of expertise.

      A very satisfactory trip to Bedford hospital where all the staff we saw were very kind and helpful.

      Thanks again for all your helpful and detailed replies which were very helpful in guiding my brother.

      Thank you very much,

      Richard.

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    • Posted

      Very happy that you found a urologist that is not rushing him into a procedure like the other one.

      Good that he is trying him on medication. Good also that he told him about sexual problems and retro ejaculation. Not all men will react the same.

      What type of cytoscopy did you have. I have the flexible cytoscopy all the time to check on my stricture. It is a little uncomfortable but no pain. I fine it kind of neat after he is done checking he lest me loo inside sometimes. That is giving with lanacane in the penis.

      The other is a Rigid Cytoscopy is done in the hospital on a general. That one would be more painful because it is a bigger tube and it is made of steel

      Good luck to your brother....Ken

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  • Posted

    Kenneth's suggestion to medicate in place of operate is correct.

    If medication fails, one can change dosage or change medication.

    Surgery must be considered when all useful non surgical interventions

    are not beneficial.

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  • Posted

    Thanks again everyone for all the helpful coments and suggestions.

    He is very happy to try the different medication and see what improvement there is.

    Thank you very much.

    Richard.

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