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New to all this. Where to start?

Posted , 14 users are following.

sasquatch
sasquatch

Good afternoon, all,

I am fairly new to this world.  I'm about 50.  I've been reading through this forum about all the different interventions available to treat BPH.  I had no idea there were so many options out there.  

The last couple of years, I've slowly experienced worsening symptoms.  I went from sleeping through the night up until a couple of years ago to waking up to use the bathroom once or twice a night a few times a week...and have had an uptick in that recently.  I am looking for a urologist so I can get a start can figure out a proper diagnosis.  Are there any specific questions I should ask from the start?  Is there a standard treatment hierarchy that most urologists go through?  Are most of the options like PAE, HoLEP, FLA, and others usually reserved for those who have tried several different medications first?  

Mainly...what advice would you give to someone who is just starting this journey?  What do you wish you knew when you first started?

Thanks so much.  

1 like, 43 replies

43 Replies

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  • lester19220
    lester19220 sasquatch

    Posted

    If you are in the USA most states have a physician profile website where you can research and check out a doctor. As for meds most will not work for everyone and beware of supplements and herbals. They are not regulated because they do nothing.
    • bob31550
      bob31550 lester19220

      Posted

      silver bullet??

      Just found something very, very interesting, in the big online bookstore.  There's a review of Dr. Thomas Levy's book, Curing the Incurables.  The top review is by the handle of skeptic turned believer, Brian.  He has numbered his "astounding" health changes, and his first item is that his prostate health has been restored.

  • glenn77
    glenn77 sasquatch

    Posted

    Here are a couple of things I would ask.   First of all, we know that you have nocturia (waking during the night and going to the toilet.).   Maybe you have BPH, but it could be primarily because of sleep disturbance waking you, and THEN you go to the toilet.   If your urologist is not aware of that possibility, consider a different urologist.   Moving beyond that possibility, if you actually do have BPH, find out the estimated size of your prostate.  And ask if you have median lobe enlargement, for that is a subset that is problematic, as the lobe can start pushing into the bladder.   Finally, if you are diagnosed with BPH, the doctor will probably want to prescribe a medication.   Carefully read up on the possible side effects of any prescription medications, and come here for input from someone who has been down that road.
  • kenneth1955
    kenneth1955 sasquatch

    Posted

    Well.   For a start I want to welcome you to this forum.  We have all gone through these problem.  Now with your getting up at night you may have to watch what you drink.  Do not drink anything after 7PM.  When you are looking for a Urologist you need to find one that care about you not rushing you into a surgery.  You will have to have a lot of test to make sure what is going on.  He may start you on pills first.  But try to stay away from Flomax & Rapaflo.  Some men do not like the side effects.  It can give you retro ejaculation.  Which the sperm goes backwards instead of out.  What every meds he give you before you start check out the side effects and tell the doctor you have a problem.  With all the procedure there are 9 out of the 10 top procedure cause retro ejaculation.  Urolift is the only one that does not cause retro.  Because it does no cutting of the prostate.  It is done with clips.  You are going to have to sit down and do your pros and cons of everything.  You will know if they are a good doctor when they listen you you and your concerns.  I wish you well.  Ken   

    • Truthmatters
      Truthmatters kenneth1955

      Posted

      "With all the procedure there are 9 out of the 10 top procedure cause retro ejaculation.  Urolift is the only one that does not cause retro."

      Are you including PAE in that? My experience, similar to almost everyone else, is that retro is not a side effect of the procedure.

    • kenneth1955
      kenneth1955 Truthmatters

      Posted

      Yes that is and good morning.  With PAE  you get a decrease in volume because your prostate get smaller  Ken
    • richp21
      richp21 kenneth1955

      Posted

      Hi Ken,

       “ PAE decrease in volume”

         Do you have a source for this?

         Thanks.

      Rich

    • TKM
      TKM kenneth1955

      Posted

      Kenneth,I don't think we know that a person would have more volume of semen with an enlarged prostate. I have never heard of any studies showing that. It is a deseased condition so I doubt that it would put out more volume and probably works less efficiently. This is a good question for Urologists or researchers, although I doubt there is much interest in studying it.

      Thomas

    • kenneth1955
      kenneth1955 richp21

      Posted

      It is in a lot of the article that you read about the prostate.  If the prostate is made smaller the volume of the ejaculation will decrease because 30 % of the fluid is made in the prostate.  Most of the time it is not much but it all depends on how small your prostate gets.   Have a great day  Ken
    • kenneth1955
      kenneth1955 richp21

      Posted

      Rich if you read a article on the prostate it will tell you that the Prostate makes up 30% of your ejaculation and the seminal vessel make up 70 %. of the ejaculation.  If you get rid of either your volume will be cut some.  You really can say because all men do not that the same ejaculation volume Ken
  • tom6446
    tom6446 sasquatch

    Posted

    I would ask for an ultrasound first before any other invasive test. It should tell you the approximate size of your prostate and check to see if you have a problem with retention. Very easy to do in the doctors office and could be done before all the other tests.
    • bob31550
      bob31550 tom6446

      Posted

      I am also a newbie. Was in ER several times and got ultrasound and CT scan but no one at this major hospital said that the bladder scanner (which was used twice on me) could "size" my prostate.

      The uro didn't mention this either.  Your post sounds very logical.  Could you, or others, expand on this subject and your experience with prostate sonograms?

  • TKM
    TKM sasquatch

    Posted

    Sasquatch,

    The first step is to find a Urologist, probably recommended by your GP, or a friend.   You will probably first try lifestyle changes, like not drinking liquids in the evening. Do not take cold medicines, like antihistamines, they can make BPH problems worse.

    If those don't help your Urologist may want you to try some drugs.  The first is usually an Alpha blocker like Flomax or Alfuzosin.  These are not bad . The side effects can be low blood pressure, dizziness, and retrograde ejaculation.  All the effects are temporary and go away within one day when you stop taking the drug.  For me the retro lasted about 8 hours so by timing when you take it, problems can be avoided.  Some people take Cialis, to increase flow, and of course it does not cause retro, and can be a benefit to sexual function because it is like Viagra. Cialis can be expensive and insurance may not cover it.

    A Urologist may suggest Avodart or Finisteride.   Be careful of these drugs because they can cause loss of libido and erectile disfunction which may last for years after you stop taking the drug.  The effects may even be permanent. 

    If the drugs don't help or lose their effect you can try Self Catheterization, CIC.  There are some good discussions on this web site about this.  If you don't want to CIC the next options are PAE, Urolift, or Rezum, in the order of least invasive to more invasive.  Before you do any of these procedures you should get tests from your Urologist like DRE, Flow rate, Cystoscopy, Trus to determine prostate size, and possibly a Urodynamics test for bladder function.

    Be aware that Urolift even though one of the least invasive procedures leaves metal clips in your prostate that cause distortions in MRI images and may interfere with the use of MRI for biopsy and FLA (Focal Laser Ablation) later.

    Hope this helps,

    Thomas

    • sasquatch
      sasquatch TKM

      Posted

      One other question about PAE, Urolift, Rezum, FLA, and other procedures.  If prostate cancer (I have some cancer history in family) is detected down the line, will any of them be an issue with treating the cancer?
    • TKM
      TKM sasquatch

      Posted

      According to the Urolift FAQs the metal clips that are used with Urolift cause distortion in MRI images up to 15mm around the clip. Also according to the FAQs the limit on MRI strength is 3 Tesla. Which is the strongest MRI as of 2018 anyway. I have not been able to get more details from NeoTract so far.

      According to Dr Karmaranian in Texas that would make an MRI biopsy or a FLA more difficult but not necessarily impossible. However he said he has never done FLA on a patient with Urolift so did not know for sure.

      Of course the old method of biopsy using 12 to 18 needles could still be done as far as I know.

      Thomas

    • kenneth1955
      kenneth1955 TKM

      Posted

      That is true to a point.  This is what is said on the back of my card.  ** The Urolift implants is MRI conditional.  It can be safely scanned in an MR system meeting the conditions on the back of this card **  I had 2 last year no problem.  I also talk with Dr. K.  And yes he did say that he has not done anyone that had a Urolift yet.  But he also said that he would be willing to try.  Ken
    • sasquatch
      sasquatch TKM

      Posted

      Thank you, Thomas.  There really are no free lunches with the treatments.  I guess the good news is that worst case, they could remove the clips if need be.

       

    • TKM
      TKM sasquatch

      Posted

      Sasquatch,   They can remove the clips in the urethra but not the clips on the outside of the prostate and not the sutures.   Thomas
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