How median lobes work

Posted , 10 users are following.

I have a prominent median lobe. A few months ago I had PAE. My flow increased significantly, but suddenly it stopped. I used a catheter two times, and the flow increased again. The same situation ( the reduced flow, and after catheter improvement)

has been repeating itself on a regular basis about every 2 weeks or so. My URO does not know why. However, he told me that a median lobe could be compared to a valve and it is moving. So what I think is going on is that it moves to the side and opens the bladder after I am using a catheter, allowing the flow to increase. Then it moves back, and the the flow is reducing. I have read on this forum that some men had temporary improvement in the flow after a cystoscopy or using a catheter. Maybe somebody has a similar situation? Could you please share your experience?

Thanks.

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  • Posted

    I had a large median lobe too. I'd say my flow def got better after cysto and catheter. I believe for the reasons you stated... it gets pushed to the side or whatever.

    I had rezum and it seems to be getting better. No relapses almost 1 month out. You can search my posts here for how that went for me. Wasn't an easy procedure or recovery but I'm hoping it helps long term

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  • Posted

    Alex,

    .

    I had a median lobe obstruction that was resulted in total blockage which was corrected with a Rezum. One study that I read best described the urethra as a garden hose with enlarged lateral lobes as stepping on the hose and an enlarged median lobe as bending and kinking the garden hose.

    .

    From my experience with the garden hose when washing the car, I got it. When the hose is kinked behind a tire, the water stops. When the urethra is kinked below the bladder outlet by an enlarged median lobe, the pee stops. Growth of the median lobe can go further to stop the flow than growth of the lateral lobe.

    .

    Steve

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    • Posted

      thank you Steve!

      I am 79 years old, and another surgery in my age is probably not a very good idea.

      As I mentioned above my urination improves a lot after i am using a cat and stays Ok for a few days..

      However, I often get Uti,

      so, I wonder if it is possible to move that median lobe that bending and kinking the garden hose , my urethra, out of the way from outside by massaging bladder, or doing something with penis.

      what do you think?

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    • Posted

      Alex,

      .

      That is a question for your urologist to answer. I really doubt that massaging the bladder will do anything to move your median lobe out of the way. If you are 79 and worried about surgery, then Rezum is a minimally invasive outpatient procedure where you are not put under. It worked to clear my median lobe obstruction and I am peeing normally now after 10 months of catheters.

      .

      Steve

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  • Posted

    I posted a while back that after a cystoscopy and dilation that my urologist did "while he was in there" about my LUTS improving significantly. A rigid cystoscope is likely to cause some near-term dilation and that could explain your improved flow.

    Regarding the median lobe obstruction, one of my urologists said when the topic came up that an overgrown ML can act as a ball valve and shut off flow through the bladder neck. I'm not sure he chose the best valve analogy, but basically what I think he was saying was that the ML can grow upwards towards the bladder and push the bladder neck up into the bladder.

    I think the answer in your case is the simplest one - when you catheterize, you must push back some of the ML tissue for it to make its way into the bladder. When the catheter is removed, that tissue doesn't "spring back" into its prior configuration immediately, leaving a better but temporary channel for your bladder to empty through.

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    • Posted

      one of my urologists said when the topic came up that an overgrown ML can act as a ball valve and shut off flow through the bladder neck.

      I think that's a good analogy. Prior to my TURP, I had a large median lobe protruding into my bladder (per my uro's cystoscopy observation). I found that if I waited too long to empty my bladder, my flow was very slow and it took a long time to void. If I voided before I really needed to go, my flow was ok. One of the things I am please about post-TURP, is that I know I can hold it if I need to and will be able to void normally once I find a bathroom. No more 3-4 minutes to empty my bladder.

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    • Posted

      Those are exactly the symptoms I have if I get too full and/or wait too long. It locks up and only after laying down horizontally and relaxing for a few minutes can I start any sort of stream. The last couple of times I've had to do a uroflow test at the uro's office that's what happened and I knew it would. I'd tank up on water for an hour prior to my appointment and if I mistimed it the uroflow test was pointless. I don't have much trouble at all most of the time if I can get to a urinal before it gets to that point.

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  • Posted

    i saw my picture and the visual of a ball valve is dead on! it grows up the neck then flops over exactly like a ball valve over time.. to me, thats why you don't notice it until its too late and one day you're like WTF?!? it happens slowly over years.

    all the urine comes down from the kidneys and pushes down on the ball valve (ML).. you try to contract and its impossible so your flow is like 5-10% normal. i feel blessed i never got to full retention since i stupidly listened and did "watchful waiting" for almost 20 years.

    that said i wouldn't have risked all the side affects 20 years ago

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  • Posted

    Alex, I also had PAE done in 2016, and FLA in 2017. Neither resulted in a huge improvement in flow. But I only get up one-two times per night now.

    After the FLA I developed RE which I had never had before.

    About 3 weeks ago I went to a new urologist and insisted on a cystoscope, He confirmed that not quite enough tissue was removed from the median lobe during the FLA. He recommended a Rezum procedure, which I am still considering.

    I did not notice a huge improvement in my flow afterwards, but it was somewhat better.

    However much to my pleasant surprise the RE was completely gone it was the first normal ejaculation in more than a year. Unfortunately it was a very short lived and things went back to the new normal of little to no ejaculation in only a few days.

    So a scope can definitely give some short term relief. But its a cruel tease lol.

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  • Posted

    I have a large median lobe problem, and believe the ball valve analogy is correct. My symptoms can be all over the map; one day I feel totally normal, and the next day my urinary flow is obstructed all day and night. Most nights I get up only once to urinate, while some nights it might be 4 times (even though I drink the same amount of liquid each day.)

    When I'm obstructed, walking for 5-10 minutes almost always helps clear it. Laying down and sitting down seems to make the problem worse (the opposite of another comment on this thread...)

    I've taken data on my own condition to try to link any lifestyle factor with bad days vs good days, but the only one that seems significant is the amount of walking and overall movement during the day. To me, all of this supports the ball valve theory. Not enough movement in the day, and the ball valve closes. More movement helps keep it open.

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