If you're contemplating seeing doc for bph surgery
Posted , 11 users are following.
I'm writing this for anyone who is currently in the situation I was in 8 or 9 months ago, to provide info I hope will be helpful.
Back then, I had been on bph medication for years and now the symptoms were becoming unmanageable. I read online about minimally invasive surgery options that are relatively new and didn't exist back the last time I looked into it, and I asked my GP for a referral to a urologist.
The urologist discussed two options, Urolift and Rezum, both minimally invasive surgeries (depending on your situation, you may be presented with different options). The diagnostic tests that were required to determine eligibility were:
- Transrectal ultrasound - this determines the volume of the prostate. It is quick and painless
- Urodynamics - this determines the bladder's ability to hold urine and empty steadily and completely. It worked like this: sensors were placed on the skin near the urethra and in the rectum. A catheter was inserted to empty the bladder of urine. Sterile water was pumped slowly into the bladder until relatively full. Then asked to urinate into a receptacle that determines void rate and degree of emptying. This test was unpleasant but they wouldn't do the surgery without it
- Cystoscopy - this lets the physician see first hand the degree of constriction and determine if there is a median lobe. You're going to look at the cystoscope and ask "You're putting that where?" but they won't do the surgery without and I guess it's over pretty quickly
The tests determined I was eligible for either Urolift or Rezum and I chose Rezum for reasons discussed in another post. My surgery was delayed for about 5 months due to elective surgeries being prohibited due to the covid-19 pandemic, and I finally had the surgery in the doctor's office about 2 weeks ago. You only know the full results about three months post-surgery
0 likes, 16 replies
raffie mark06334
Edited
Thanks for putting the diagnostic test steps out there.
Guys deserve to know ahead of time what they are getting themselves into.
They should also know many of these diagnostic tests are run by female healthcare workers so if you don't want opposite gender caregivers doing your intimate testing, you will need to call ahead & set up an all-male team. This takes time to do. Some places won't accommodate your request.
lee56659 mark06334
Edited
For my urodynamics test, I was told to show up with a full bladder. Then, with no one in the room, I voided into a device that measured the time from when I started until I finished and measured the amount. My urologist described my flow as "p**s poor. I guess that's urology humor. I could have told him that without the test. I had a cystoscopy but not an ultrasound. I wasn't a candidate for urolift due to a large median lobe so I opted for the TURP and it was the best thing I ever did for my BPH.
russ_777 lee56659
Posted
Lee, if that's all you did for that test it was a uroflow test, not a urodynamics test. A uroflow test is the first step in a urodynamics test based on what you have in your bladder when you arrive. After that the "fun" starts. Like raffie and mark said, the urodynamics test involves the nurse/technician placing a lot of sensors "where the sun doesn't shine" including pressure transducers that are on the end of catheters in you rectum and bladder. When my urologist asked me if I would consider doing the test he said about half of their patients cancel their appointment for the urodynamics test because they "chicken out." Can't say I blame them, I knew it was going to be awkward based on his description but I understood that it is an excellent diagnostic tool that really tells the urologist what's going on, so I didn't hesitate.
I guess it depends on the individual but the aspect of having a female nurse doing the test didn't bother me. I knew her as she had done some abdominal ultrasounds on me in the office and knew her to be professional, competent and caring. The curveball was that when I arrived she asked if I minded if an intern observed the test. I said no without thinking about it and a young female nurse intern stood a few feet in front of the chair you sit in for the test while naked from the waist down, for the entire hour and saw it all. At least she learned something. The only painful part for me was when she put the catheter in my bladder as it passed through my prostate. The key thing about the test is it proves whether the poor flow is due to prostatic obstruction or a weak bladder....or both. In my case I had a peak flow rate of 5 ml/sec which is very low but had high pressures in my bladder and emptied completely. It also proved that I didn't have stress incontinence which I already knew.
lee56659 russ_777
Edited
Nothing beyond the uroflow test was suggested. I guess based on that, my PVR and the cystoscopy, he didn't feel anything else was needed. By that point, I was ready for the TURP and glad I did it.
When I was treated for bladder cancer with immunotherapy, I had a female NP instill the solution into my bladder thru my urethra every week for 6 weeks. One time she had a young female intern watch (with my permission). Didn't bother me at all.
DaveCanPee mark06334
Posted
Hello, Mark:
Interesting post, but limited in some ways. In other words, for any man with an enlarged prostate (i.e. BPH), what does "eligibility" really mean? Your Uro gave you two options for "your" condition. What other "new or existing" options could have been offered by other highly skilled (and trained) Uros besides bands to squeeze your prostate and water vapor to zap away your mass? Perhaps this is hard to address when we get hung up on terms like "minimally invasive." Terms that put the fear of God in most. Perhaps we should talk about the natural (and Uro guided) steps that most men go through:
If we are BPH sufferers, we generally have a "mass" pushing up into our bladded and squeezing our urethra down to the diameter of a cocktail straw. While we are offered "all" kinds of remedies, we should never take our eyes off these most important items as we search solutions:
In other words, regardless of what we are "eligible" for, we should always ask if these important items are going to be disturbed. Preservation of these should be important in our decision making process.
Dave
mark06334 DaveCanPee
Posted
Dave,
Thanks for your comment. You asked: "What does eligibility really mean?" It has a specific meaning. Each of the interventions you listed--medications, "minimally invasive" surgeries and traditional surgeries, is appropriate for certain patients, and inappropriate for others.
For example, if you have liver disease or are taking certain anti-fungal medications, you might not be eligible to take some of the medications commonly used to treat the symptoms of BPH. If your prostate is >80 cc, if you have a median lobe, if you are allergic to nickel or titanium or stainless steel, if can't tolerate general anesthesia, you may not be eligible for certain of the surgeries. The diagnostic tests I described and the patient's medical history are used by the urologist to determine eligibility.
If you want to lay out the natural (and Uro guided) steps that most men go through, you might want to begin with "watch and wait", as that's where most men begin. But as you can see from what's been posted to this forum, many readers are well beyond that stage, they're considering surgical solutions, and my post was intended to give them an inkling of what they can expect when they visit their urologist, because I was unfamiliar with the diagnostic tests required and my guess is that the same is true for most men
Mark
DaveCanPee mark06334
Posted
Hi Mark,
Thanks for the response and clarification. I would also add "MRI" to your eligibility steps. In my case, this was the #1 step my Uro did (and the only one). Then he brought me to the computer and showed me the 269g mass that was pushing up into my bladder and squeezing my urethra to a closed position, causing full retention. Then he said I can get that our for you and give you back the "garden hose" you had when you were a young man. I said "perfect!" It has now been 2-years since my procedure and the garden hose works great.
I agree there are other medical conditions that could hamper a man from being "eligible" for the best solution to their BPH problem. This is unfortunate and complicates things, regardless of eligibility steps. As is said here many times, we all share BPH, but at the same time, we are all different in our BPH situation.
Dave
cartoonman mark06334
Edited
I wish you the best of luck, Mark!
My BPH shut down my ability to pee in August of 2014.I declined my uro-doc's insistence that I allow him to do a TURP. And started CIC. And I started reading. I had the Urolift done in December of 2015, without incident. It worked great... for about three months. Then... back to zero.
More reading, more decisions. In March, just as Covid was taking off, I had the HoLEP procedure. "Textbook perfect!" said the doc. And yes! QUick healing, almost no pain, Foley removed after 4 days... and now I am back to peeing like a teenager. I'm thankful every day over this!
If JimJames is still active and reads this, please private message me! I was booted off for unknown reasons a couple of years back, now I'm back!
~Jean
DaveCanPee cartoonman
Posted
Hi Jean,
Your post/reply reminds me of removing the mass. That is a great thought for the BPH sufferers. "IF" the mass (i.e. enlargement) is the problem, then the fix is removing it. Not squeezing it with bands, or shrinking it with beads, or roto-rooter the middle, etc., but rather removal. Good point!
Dave
russ_777 DaveCanPee
Posted
This seems like a very narrow view of treating BPH. Decades of successful treatment by other means say otherwise.
DaveCanPee russ_777
Posted
Hi Russ - I question "decades" of treatment that only treats the symptoms and does not fix the problem. "IF" the problem is an enlarged prostate, then the large prostate is in fact the problem. Medicine has keyed on our fears (and manhood) and has come up with baby-steps that we readily gravitate towards because they are less invasive, but not one of them removes the mass. Shrinking is not removing. Squeezing is not removing. Trimming is not removing. If my view is narrow, then so be it. What I can say is that I no longer have BPH because I fixed the problem.
I appreciate your reply. This really helps others to see the varied and complex views.
Dave
russ_777 DaveCanPee
Posted
I agree with you when we're talking about urolift, or PAE and Rezum for very large prostates. Might even add TURP , Green Light and Aquablation for very large glands (200+gms) because they have limitations in the diameter of void they can create. TURP and GLL because of the amount of heat they dissipate is directly proportional to the amount of tissue removed, and Aquablation because the water jet is limited to roughly an inch in ablating depth. But with less than 100 gms or so any of those ablative, vaporizing or resective methods can remove the transition zone entirely (if that's what the surgeon wants to do)....and that's what causes BPH. They can also deal with the central zone which is what includes the median lobe that causes issues for some of us. But bottom line is any of those can create a cavernous void in moderately sized prostates.
Where I differ with you is I don't see how it matters how you get to the endpoint if the amount of tissue removed is similar at the end of the procedure for most prostates. Gone is gone.
DaveCanPee russ_777
Posted
Hi Russ,
To me the "matter" part of this boils down to how much is removed and what method is used to remove it, AND, whether or not any of these four things are disturbed during the removal process:
My procedure preserved all of these. Can we say that for all the procedures you listed?
Dave
russ_777 DaveCanPee
Posted
Urethra - Not all versions of prostatectomies preserve the prostatic urethra.Some procedures that can preserve it are rezum, PAE, FLA, and of course Urolift. Probably some others I'm unfamiliar with. I'm not sure how much that matters though because over time the epithelial cells that line the urethra regenerate to reconstruct the epithelium. See, for example, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736348/
Bladder neck - If you have a protruding median lobe it's difficult to avoid the bladder neck regardless of which procedure is used. I believe the suprapubic robotic simple prostatectomy has the best chance since the approach is from above from the inside of the bladder.
Sphincters - The internal sphincter is usually affected similar to BN. A surgeon has to make a bad mistake to damage the external sphincter. That's why the proximal end of the veru is always an important surgical landmark.
Nerve bundles - A non-nerve sparing radical prostatectomy is the only procedure that intentionally affects nerve bundles around the prostate. Monopolar TURP can affect some of the nerves but who does monopolar TURPs anymore?
All procedures have their strengths and weaknesses and most are not used under some circumstances. Then you have questions regarding cost, coverage, physical location, availability, recovery time, and so on. We should be thankful that there are businesses out there willing and able to take the risks of developing so many new technologies not knowing whether they'll be approved by the FDA or covered by most insurance carriers.
TKM cartoonman
Posted
Jean,
I remember your name from a couple years ago. The last time I saw a post from Jim James was about April of 2020. He may have still been active but I have not been on much myself because of being "booted off" like yourself. I can still get on and read posts but do not get notification emails.
I got a notification that says my email "was blocked by the mail servers".
Good to hear about your Holep, I may eventually go for that myself, in the meantime I'm still using catheters 2&1/2 years now..
Thomas