Importance and necessity of Urodynamics Study

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I have a very enlarged prostate, 4x normal at 120 cc.  I'm on Flomax.  Considering a return to Finasteride.  My PVR is 55 cc.  I had two negative MP-MRIs this year (no lesions detected). I had an MRI guided biopsy in 2015 that was negative for cancer.  My Uro says a Urodynamics study is not 100% mandatory for my case.  However, would the Urodynamics give me enough information to determine if my bladder is being damaged? My Uro says my PVR is mild.  My bladder wall is mildly thickened and distended.  My concern with Urodynamics is this - and where I'm looking for help - Can a complication be the formation of scar tissue from the catheter?  I sometimes go 4-5 hours without peeing, and good nights (praise God) means getting up only once all night (there are a few bad nights here and there, of getting up 3-4 times).  I would hate to run the risk of getting a stricture from the procedure. The nurse told me the catheter is flexible and tiny.  I don't know if that means less chance of a stricture.  I had a very bad biopsy experience (I still have blood-discoloration in my semen) and that has impacted my quality of life. I would hate to run even a small risk of complication from a test I do not 100% need at this time. Any thoughts, advice, stories to share? Many thanks in advance.

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  • Posted

    My recommendation is to have your bladder scoped which is a very brief procedure.  Do not get more biopsy's but get a 3D MRI which will give you a report on likelihood of cancer.  If risk is low I would head straight away for a PAE.  I also had a prostate size of 120 and a PSA of 10.3.  After PAE my life is normal again and PSA down to 5.

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  • Posted

    Hi Michael,

    Your PVR is practically normal. What is it when you're off Flomax? What is your IPSS score, if you don't know you can google it.

    As to urodynamics, it's a functional test, and you seem to function pretty well, so not sure of the point. As to your fears of stricture, etc, the catheter they use for urodynamics is even smaller than a flexible cystoscope, so I wouldn't worry about strictures at all. Did they use a flex cystoscope with your biopsy or a rigid?

    Info re bladder damage, I guess you mean stretching and trabeculation, you can get from ultrasound studies.

    I'm a big fan of urodynamics but you need a reason for it. Not sure you have one.

    Jim

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  • Posted

    You are doing great. Unless you have side effects with the drugs and want to get off them, I would not risk having anything inserted into my urethra. Hank
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  • Posted

    Hi. My prostate was 140gm and the found by accident that my bladder was twice normal size due to retention and hence stretching. He said I needed a urodynamics test to confirm my bladder had enough power to make the HoLEP worthwhile. The dynamics test used a very small catheter inserted for about 30 minutes. My tests showed very strong bladder power (140 instead of a more normal 40?!) so no problem. I wouldn't worry at all about a stricture but as others have said you need a reason to have the test.

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  • Posted

    Hi Michael, I’m new to this site and prostrate procedures as a whole. I just had a biopsy done this morning. My Uro also did a csytoscope today and during that -watched the screen as he performed it and he explained as he went - I saw how restricted my uretha was and that having just went my bladder was still almost half full.  He filled my bladder and then I did a flow test.  I have tried Flomax but I can’t tolerate it so based on today he has recommended laser TURP.  I can barely go an hour and a half without urinating.  I will say I was quite nervous about all this today but the cystoscope at least to me was far better than the biopsy.  I really don’t have an answer for your question other than to say compared to my symptoms the test was a breeze. 

    Roy

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    • Posted

      Hi Roy,

      There are less invasive procedures available today than laser TURP. Self Catherization (CIC) is another option, one that I chose over TURP. If you're not aware, TURP has a very high incidence of retrograde (dry) ejaculation. For some that's a deal breaker, others not.

      Jim

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    • Posted

      Hi Jim, 

      I have read about the risks and I haven’t made up my mind yet. I’m 66 and also have Afib ( which for now is under control) I know I have to do something.  Medicines are out so ya it’s looking like some form of TURP or catherization. To be honest I’m not real thrilled with either option.  Thanks for the input I appreciate it. 

      Roy

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    • Posted

      Hey Hank,  I had a discussion with my uro about this this morning also.  I’ve taken Calais 5mg daily for 3 years.  It worked well until a few months ago. My reaction to Flomax was on day one 3 hours after taking it my Bp was 92/55 with a pulse of 127. The high pulse rate with afib is the problem, that can throw me out of Normal Sinus Rhythm very quickly.  It was at least 5 hours before my resting pulse went below 100. My cardiologist along with uro both agreed don’t take it anymore.  The uro’s statement was Cialis is very weak hence why you can tolerate it but why it’s becoming ineffective. It’s his take I most likely will react the same to any of the stronger meds. I really don’t want my heart back in it’s irregular heartbeat for me that means a heart procedure next time it occurs. So I’m extremely hesitant to take any more meds. I’m now up to two heart meds I can’t take Flomax and a bp med so I am not really inclined to experiment with any more BPH meds.  I think their a great option if you take them. Even with the meds I can’t take, I still have 4 prescription meds + 2 asthma inhalers. It sucks big time — aging isn’t for the weak.  Roy
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    • Posted

      Hi Roy, Cialis did nothing for me except better erections. If you have high BP and take med for it, some BPH meds can let you stop the BP med. Like the Doxazosin I am taking is often prescribed as BP med, for men as well as women. Hank
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    • Posted

      TURP is way too barbaric. Too much bleeding. Too much pain. Too long recovery time. Too many potential problems. If money is not a problem, I'd look into FLA. If my prostate is larger than 80mg, I'd look into PAE.

      You can ease into a low dose of alpha blocker that is not Cialis or Flomax. I've read that alfuzosin has the least side effects. It maybe good enough for you now. If your frequency is due to retention, CIC maybe your answer. In a way, you have to pick your poison. Hank

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  • Posted

    I have had so many tests, investigations and scans and conclusion is that I need to reduce the size of my prostrate  to allow a better form of flow and less retention. I have ruled out TURP due to invasive nature so going down a different route.
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    • Posted

      Having had one TURP already and now told that in 2 years it has all grown back in to the extent that I can't self catheterize as it won't go in and I am left with attending the hospital regularly and in emergency for Foley catheters which keep on blocking.  Anyone know how to stop the thing growing as it is the only thing in me that is at the age of 74. Still think my best option is removal of Prostate which would get rid of Prostatitis and infections plus nothing then left to block a catheter.

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  • Posted

    I was prescribed Alpha1s Flomaxtra then Prazosin 4mg a day 2006 to 2015 for BPH. Urologists had known since 1995 that increased dosage beyond 2 years  could be necessary but without a billion dollar pharmaceutical company benefit  no one bothered to do the research to let them prescribe it. There was a substantial financial benefit from 5ARIs Finasteride, Duodart, Avodart and the rest. 5ARI trials were inconclusive due to said "study design" but these drugs went to market anyway. Lots of names that seems to split the "side effects". I was prescribed Duodart March 2013> March 2014 and MRI detected 3+4 PCa and RP November 2015 at 72. 18 of 20 Biopsy hits were negative with the only 2 cancers MRI identified. Recovery  was difficult and incontinence goes on. The Australian supplier of Duodart has reported 5 suspected adverse PCa events for the drug without any details of how they isolated these 5 from other cancers of other users. Our Therapeutic Goods Administration still does not require Prostate Cancer to be listed as a "side effect" for this drug.Our Commonwealth Ombudsman says only side effects surfacing during trials need to be advised to people prescribed the drug. I made wrong choices at both BPH and PCa by not researching enough myself. There are too many options and considerations all made more difficult by government cost-cutting and insurance restrictions. Research and take the least quality of life intrusive option first. Barrie Heslop

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