My disappointing Urologist visit.
Posted , 19 users are following.
Last year, I went to see a urologist for the first time after a kidney scan revealed that I was retaining urine. At the uro office, a catheter was used by a nurse to measure the retention and it was 250ml.
My uro walked in, and he immediately offered TURP, no exam, no test. I told him I'll think about it. He gave me a DRE, told me he felt a nodule, and suggested biopsy. Again, I told him I'll think about it. He told me to come back every 3 months. I left, and never came back.
This year, arming with an incredible amount of knowledge 
accumulated from this forum mainly, I went to see another uro, from the same medical group. This time I know what to ask for: my prostate nodule, more information on my prostate, especially my prostate size, whether or not it has a median lobe, and an MRI.
Nodule: After performing DRE, he said that he can not be sure that there was a nodule, maybe it's just felt a little tighter than normal. (Maybe it just went away, I hope ) . After looking through my PSA history, he said that if he were I, he would not worry about it. Which I consider a good news.
MRI: I then asked for an order for a 3T MRI, for my BPH as well as cancer diagnosis. His answer was not how it works. You can only get an MRI if you go to Cancer Center and only there, they will decide whether or not to give you a biopsy or a MRI-assisted biopsy. I told him my friends told me you can have an MRI without a biopsy. He said "your friends don't know what they are talking about."
Prostate size: He then offered me a Urolift. He already knew I don't like TURP because of too much bleeding. I told him I'd like to know my prostate size. He said the only way is through a prostate scan. I asked if I can have one. He said you can have one when I do the Urolift.
Median lobe: I asked if I have a median lobe. His answer is you can find out only by having a camera in your bladder, and you can only have it if you have a Urolift.
Overall, it was a dissappointing visit. It seems like I can not get the information to make informed decisions on selecting a good procedure, without subjecting myself in one of the procedures first.
Is it similar to what happened to you ?
Hank
1 like, 97 replies
keith42667 hank1953
Posted
The main thing that was similar to me was that I left my first appointment without much information except for a DVD re: GL and also a little brochure about same. After this first meeting, my preop appointment (thats what they called it) was in two weeks and the surgery in three weeks. If I hadn't discovered this forum, I probably would have gone through with it. I couldn't get a urine sample out for the Urologist so I had to cath there while the doctor and nurse waited. They said I didn't have any UTI and in fact it was very clear. They also gave me a already opened box of Magic 14fr to take home with me no charge. As these two weeks went on I got more comfortable with cathing and I wanted to think about this for awhile. I went in for the preop appointment in two weeks. My Urologist wasn't there but his PA (a female) was there. I told her I wanted to hold off on everything for now; I told her about my learning to CIC and she seemed ok with that. She also told me that my PSA level was "going in the right directions now" as well as another alert we got with my last blood test during hep c treatment: my creatine level had spiked. But with the CIC that was also heading down. I haven't had my 12 week SVR for being clear of the hep c virus just yet. Its been about 10 weeks since I finished treatment. I was clear (undetected) at 4 weeks and 8 weeks so I'm expecting good news about that. I guess I will try and contact my Urologist office again one of these days to see about a follow-up. I have still never had a cystosco;y or a urodynamics test or anything but an ultrasound on my bladder and the glove test twice. Yes, I do have an enlarged prostate and apparent BPH. In fact, they seem to be so sure thats what it is that they never have done any other tests. Perhaps they were going to do that in the preop but, like I said, that was only a week before the scheduled surgery. Seemed to me like the GL was in my immediate future if I had just accepted it. I realize there is a good chance it would have turned out alright, especially if retro ejaculation wasn't that important to me. But now I still have all my options open I think.
richp21 keith42667
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hank1953 keith42667
Posted
We have similar experiences I guess. After I came home, from the exit printout, I found out that they already scheduled me from a procedure (probably Urolift) 2 weeks later. I canceled it. My symptoms are not too bad right now and I know CIC so I am not rushing into anything. Hank
glenn54030 hank1953
Posted
I am glad I didn't read this forum before I decided on green light surgery or I probably would have decided against it. Most of those writing are those with bad experiences. The thousands and thousands of men who have had good results do not bother to write. I am 4 weeks post op and not completely healed. I was told preop that it would take 6 months or longer for total (whatever that means) healing. Depending on how much I drink before bed I get up 2 to 4 times. Retention is getting better but has a way to go. I no longer wear a pad.
hank1953 glenn54030
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Hank
derek76 glenn54030
Posted
After my first PVP I was out and about without a care on the third day. On day two I had a two hour train journey home and about another hour to get home from the station without the need to pee.On the old prostate news group where the first ever PVP patient posted around 2001 hundreds followed and all had good results. The difference ? perhaps then the ones doing the procedures were leaders in their field. The UK hospital where I had mine were conducting trials and I was one of the first forty patients done by their team of four urologists. At that time Laserscope made the equipment and one of their representatives used to attend most procedures.
derek76 hank1953
Posted
Part of the problem now is that you have too many choices. In 1994 apart from a prostatectomy, it was TURP or TUMP. I wanted neither and knew that laser procedures were being developed and decided to wait it out. Now I would have too many confusing options. PAE sounded a good method but we are getting a lot of poor outcomes from members. I don't understand urolift as the prostate must keep on growing within its straightjacket.
GL PVP or HoLep still seem the best options
hank1953 derek76
Posted
Right now FLA is my best choice except it's short on history and insurance would not cover it. But I need to know my anatomy before I can make a decision. Hank
zdzislaw glenn54030
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Please do confirm this in a couple of months. I had a nice post op period and total retention after 6 months. Doing CIC. My uro wasn't even
surprised ...
hank1953 zdzislaw
Posted
WOW ! toby52 also had a discussion on this forum about GL, with similar result: good recovery, total retention after 6 months due to stricture. Let's hope Glenn have better result. Hank
glenn77 hank1953
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derek76 glenn77
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What is his procedure of choice now?
When my prostate regrew in 2013 I spoke with the Uro who did my GL PVP in 2004. He Said:
" As far as the laser options are concerned, there have been 2 major upgrades to the Greenlight laser from the machine I used for your surgery. We have had one of the latest machines here as part of a study which has allowed us to look at it and the consultants involved have been keen for us to continue with this latest machine. Generally however in the department the view has been that we should adopt the HoLEP procedure and so that is the direction in which we are moving currently.
For yourself both laser options should be OK. The key will be that the team looking after you have the laser that they are happy with."
hank1953 glenn77
Posted
"He became convinced that it is so problematic that he will no longer perform or teach GL."
Very good Glenn. You might have saved someone a lot of pain and misery from posting this. Hank
arlington hank1953
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hank1953 arlington
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arlington hank1953
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No, but he didn't dissuade me from trying the PAE (although he correctly predicted it wouldn't help). Probably because of my enlarged median lobe - which has a must lower success rate.