How to Know in Advance if your BPH Surgery or Procedure Will Work!
Posted , 14 users are following.
It used to be pretty much just TURP, but now there are lots of way to fix BPH, which more coming on board each day. A partial list includes: Green Light, HOLEP, Urolift, REZUM, iTind, PAE and FLA.
But if you read the literature, or spend time here, what you will find is that all of these procedures can produce great results or not so great results. And that is often with the same doctor.
So, in broad strokes, in many cases it's not the procedure or the doctor that determines whether a surgery or procedure will work, but the condition of your bladder/urinary system going into the procedure.
Unfortunately, many doctors operate first and then make excuses when the operation or procedure fails. "Well, the operation WAS a success, but you really can't expect much with such a weak bladder".
Very nice piece of information to know, after the fact!!!
The more knowlegeable and ethical doctors will test the system first to get a better idea of outcome before the surgery or procedure. So far, urodyamic testing is the gold standard here, with video urodynamics the best of the best. Still, urodynamics has limitations, and is not the genie in the bottle.
Recently, a few of us in the self cathing group, were playing around with a way to use our catheters to open up the urethra in the way a stent might. The idea was to simulate with the catheter what a prostate reduction surgery often does, ie take the pressure off of the urethra. Problem is that a catheter is not really a stent because the catheter itself becomes part of the obstruction.
This lead me to think, what we really needed was a trial by stent. In other words, simulate a prostate reduction surgery or procedure with a temporary stent to see if indeed its worth doing the surgery or procedure.
Turns out, this has been thought of before. Problem is, as with many good idea, not much progress or effort has been put it into the idea since 2011.
From the 2011 paper:
"An interesting application of the biodegradable stent is to simulate the situation after the TURP in patients with a combination of severe BOO and severe overactive bladder. "
The cynic in me says not to expect too much in the way of more progress and funding in this area. First, these projects need funding and most of the funding these days is coming more from the equiptment and procedure manufacturers (think Urolift and REZUM) and not from stent manufacturers for a diagnostic use. And second, a trial by stent would be added time and work for the urologist, when in fact many are really chomping at the bits to either cut, slice, dice, burn, melt or lazer away your prostate.
However, on an individual basis, this doesn't mean someone motivated to find out before a surgery, if that surgery will actually work, couldn't hook up with a creative and enlightened urologist and do the trial by stent on their own. Not to say that may be easy, and in fact, if one does find such a urologist, please private message me their name!
I will post links to the only two studies I could find on this in my next message. They probably won't show up for a day or two until they come out of moderation.
Jim
3 likes, 138 replies
paul44935 jimjames
Posted
Hi Jim,
Here's a link (https://bphnews.com/2017/05/03/model-does-good-job-of-predicting-who-needs-enlarged-prostate-surgery) to an app that's been developed as a predictive aid as to who requires surgery, for what it's worth.
By the way, I am keenly interested as to what you attribute your decreased need to CIC yourself. You have written of bladder rehabilitation but surely there must be some link to the status of your initial circumstance. If nothing has changed there then wouldn't the earlier voiding problem continue. Nice if it's a matter of remission. I believe I have read of this for some BPH clients (hah!). Best, Paul
P.S. Wouldn't it be wonderfully validating for us if there were a urologist doing CIC on himself in the discussion group? I dream.
jimjames paul44935
Posted
Thanks Paul for the link. I couldn't find the app in either the Apple or Android app store, but maybe it hasn't been registered yet.
In any event, a quick read shows that the parameters you enter are: Mandatory: age, Qmax, PVR and optionally TPV and BOOI. The first two should be part of a typical urologist's exam for bph. TVP (total prostate volume) is often tested through imaging although the very inaccurate DRE (digital rectal exam) is often used. BOOI requires urodynamic testing.
First, given the number of bad diagnosis for bph/luts by urologists I've seen here, any help like this is welcome. That said, TVP and BOOI are optional, so a diagnosis and treatment plan made without those variables is questionable.
Also, any program is only as good as the bias of the programmers. So, if the bias for example, is that a flaccid bladder cannot be rehabilitated, then the app potential will suggest surgery when in fact an option like CIC exists.
So overall, this app, will probably do a better job than the average urologist, especially if all parameters are entered which requires urodynamics -- a test many urologists do not offer either as part of a bph diagnosis or surgical recommendation. That said, the parameters are limited. No cystoscopy info as one example.
My understanding is that computer based diagnosis are going to become more and more common, especially as nurses and PA's start taking more MD functions that MD functions. Whether the app is better than the doctor will depend on the condition, the sophistication of the app, and how well doctors currently make a particular diagnosis. Unfortunately, the bar of the latter is often not set very high.
Jim
jimjames paul44935
Posted
My initial circumstance/diagnosis was BPH/LUTS due to an obstructive prostate. The obstructive prostate remains as I have not had any prostate reducing surgery or procedures.
What has changed is that my intially flaccid bladder has been rehabilitated to an extent primarily through CIC.
Think of it as an engine and a load. The engine being the bladder and the load being the urine in the bladder. CIC has strenghtened the engine so the load I could not pull (push really) in the past, I can in the present.
That is not to say that everyone can rehab a flaccid bladder with the same results as all of our bladders and prostates are not the same.
Jim
paul44935 jimjames
Posted
Thanks, Jim. It still remains unclear as to why circumstances improve when the initial cause remains the same. Of course, one's first responses (that can extend over a long period of time until one gets something of a handle on things) can lead to an increasingly weakened "engine". Also not only is everyone different but oneself is also subject to so many variables including possibilities of remission here and there. That CIC can retune the engine so that it can handle the initial cause of the problem in an improved if not entirely satisfactory manner is intriguing. In my case it is still too early to say other than that that the issue has become more tolerable. Cheers, Paul
jimjames paul44935
Posted
The misconception is that urethral blockage by the prostate is the sole cause of LUTS. In many cases the bladder is capable of emptying even with a blockage if the bladder is not stretched.
So a typical scenario is that the prostatic blockage over time (could be many years) stretches the bladder. Before the bladder reaches a dysfunctional point the patient may have no LUTS symptons or in the mild and moderate range. But as the bladder stretches and weakens the symptons can become severe, even resulting in acute retention.
By rehabbing the bladder you are not fixing the cause but are in a way rolling back the clock. The other culprit in bladder stretching can be years of "holding it in". I sometimes think that caused my stretching as much as the prostatic obstruction. Today, I try and go when nature calls. Should have done that a long time ago.
Jim
paul44935 jimjames
Posted
paul44935 jimjames
Posted
jimjames paul44935
Posted
I'd say after 6 months I started seeing a lot of improvement. The next year was up and down with periods of improvement and regression. After two years I was off the catheter for long periods of time with low PVRs. Now 3 years later I've essentially stopped CIC and my only issue is difficult or painful initiation maybe one time out of five natural voids. This is usually associated with a very full bladder and usually after lying down or a period of inactivity.
I have found, however, that if I walk around or exercise (lately do deep knee bends) for a few minutes before such a void, I can avoid these episodes. Very occasionally, no more than once every week or two, I have to supplement the walking around with a sitting void in a semi recline position that seems to take some pressure off the obstruction.
But other than that, my system works probably better than it has since I was a teenager. No urgencies, no dribbling, no frequent trips to the toilet. No significant retention. On the average I still get up once during the night but for my age this is pretty normal regardless of BPH. And, no, I do not "pee like a horse" but I stopped doing that around age 25. Anyway, the important thing is not the force of the void but how empty you can get your bladder.
So, at this point, bph/luts has become so such a minor issue that I am reluctant to try even some of the newer, less invasive procedures to get rid of my aforementioned issues, as I compare the small upside to the potential downsides from any of these procedures. In other words, if it's sort of working, don't try and fix it!
Things could change in the future and my catheters are ready albeit collecting dust. If they do, I would have to evaluate going back to a regular cath schedule against available surgical options or procedures, but self cathing had become so easy for me that it would probably have to be an option better than what currently exits.
Jim
paul44935 jimjames
Posted
By the way, my CICing is going well. No need to get up in the night after more than three years of sometimes having to stagger out of bed every twenty minutes. All credit to you.
frank74205 jimjames
Posted
Frank
jimjames frank74205
Posted
Jim
frank74205 jimjames
Posted
maybe they would look into this further.What do think?
frank,
jimjames frank74205
Posted
Frank,
See my second post in this thread for links to study data suggesting the feasibility of this approach. There are many reasons good ideas don't move forward but the big one is money. Right now most Uro's and the equiptment manufacturer's seem focused on newer procedures that of course happen to turn a tidy profit. Maybe some doctor or institution will pick up the ball on this but I'm not holding my breath.
Jim
jimjames
Posted
PS It's the same way that self cathing isn't promoted much by uro's or if so, just as a throwaway. Doesn't really fit into their approach of "well, the meds aren't working" so let's operate. Yet, you, I, and others know the value of CIC, a lot more than most of the doctors we see. If the doc's got $10 for every time we cathed, I'm sure more of them would recommend it!
Jim
Jim
frank74205 jimjames
Posted
JIm ,AS an expert on cic ,which you are,do you think as one approaches the older years it would be harder to cic?This is what my URO said?
whats your opinion?
thanks 'jim,
frank
frank74205 jimjames
Posted
Jim ,I am going for another urodynamics test June 2nd. If i can pee during the test,i guess this means my bladder is not the problem? Then it must be an obstructing enlarged prostate causing my retention. So if i had the Uro Lift, it's possible that i could get out of complete retention?
If i cannot pee during urodynamics ,then its my bladder,Uro lift will not get me out od retention?
Am i right on this?
Thanks forever Jim for all your thoughts.
frank
Thanks for evever for all your thoughts.
Frank
jimjames frank74205
Posted
It's a bit more complicated. Urodynamics will measure among other things your bladder pressure. If the pressure is adequate then there is hope for normal voiding after a prostate reduction surgery. If not, then less hope. Being able to pee during the test suggests the bladder is working better than if you can't pee, but even if you can't pee there is hope if your bladder pressure is good.
Jim