HEMATOMA (GROIN BRUISING) AFTER A PAE

Thanks nealpros

Hi Neal

Any improvement since your second PAE?

 

Neal,

   Thanks for your post. I'm scheduled for PAE a week from Monday. Will print out your post and take it with me!

Rich

Hi Neil,

I have good news, and bad news on that front.

First, the bad news. No, I had no positive effect from the second PAE. I am probably responsible for the lack of positive results. I believed from reading the posts being written at that time, late last year, that the PAE was effective for everyone, and that the few cases where is wasn't effective resulted from poor technique on the part of the doctor doing the PAE. This, in fact, may well be the case in some cases, but there is more to it than that.

JimJames, and others have recently pointed out the importance of a complete urological workup before a PAE, or any other treatment. I did not have such a workup, thus the failure of the PAEs. There can be many causes of urological symptoms, such as other obstructions, stones, infections in bladder or urethra, shrunken or atonal bladder, etc. that have nothing in the world to do with your prostate. Having a PAE to shrink your prostate will, in those cases, have no more positive effect on your urological symptoms than trimming your toe nails.

JimJames has kindly guided me through the process of self cathing with interesting results. Using self cathing, I have determined that my post void residual (PVR) averages about 138. That's not normal, about 60 is, but it is not too bad. Also, and most importantly, after self cathing, my symptoms of frequency, and urgency, have NOT gone away temporarily, as they would be expected to do if I couldn't effectively mostly empty my bladder. If I self cath just before going to bed, I still get up about 4-6 times per night. Many men are able to self cath before bedtime and sleep the night through.0 That looks to me like I DON'T only have a problem with my prostate. (It appears slightly enlarged on DRE and ultrasound).

So now, I am suspecting my bladder. I approached my local urologist, and he put me on Myrbetrig 3 days ago. The early results have been a chest cold, (this drug can make it more likely for you to get one), and DECREASED GETTING UP AT NIGHT E.G. ONLY TWICE LAST NIGHT. I haven't gotten up that few times in years. I realize that this is very early in the process. Even the prescribing information says that it can take 60 days to be effective. So, we'll see what happens, and I will report more about what is happening as time goes on.

Neal

Hi Neal - thanks for this update. It contains a lot of improtant info.

First I disagree that the failed PAEs are partly your fault. It is up to the IR who does the PAE to properly screen you and determine where your problem lies (enlarged prostate or atonic bladder). Most of us do not have that knowledge beforehand. I think PAEs are way oversold by the IRs as being a panacea for all things peeing-related when they are not. There are a lot of failed PAES because they were not the appropriate treatment as you discuss here. In my case even though the prostate was reduced 100gm it was not near the urethra so my IPSS stayed at 26. It is just a random shot and if there is some bladder muscle weakness then chances of a good result are even less.

Jimjames also taught me CIC which has saved my life. I CIC every 6 hours but my PVRs are still way high especially at night. So I may have to increase to 6 times a day. But my NVs are also ok, being between 100 and 200ml, but the CVs are 300 to 500ml. I cath at 11pm but am always awakened from a dead sleep at 3 or 4am and then take out 500 to 600ml. But I almost can never get back to sleep after that!

Next week I will see about getting the Gat/Goren procedure done but if that doesn't work then it is CIC or a simple prostatectomy for me. I have decided not to try FLA for a variety of reasons.

When you have a chance to write, what type of catheter are you using and have you had any problems with UTIs. Also have you had any urodynamics testing done yet?

Glad to hear you are on top of it now. This forum is a life saver.

Neil

Forgot to ask you how your NVs are?

Also forgot to mention that my continence nurse said that PVRs in the range of 100ml are quite acceptable for men over 60 and nothing to worry about so from what you say it seems your bladder is functioning well.

Have you done a creatinine test to check on your kidneys? Mine has gone up 50% over the past year from low normal to mid normal which shows my kidneys are under stress.

Neil