Non-Invasive BPH Treatments I'm considering
Posted , 25 users are following.
Please forgive the length of this but if you take the time to read it, I'm sure you will be able to relate.
60 years old. Very fit, very active, very athletic. I weigh 5 pounds more today than I did as a senior in High School. I exercise, eat right, don't smoke, used to drink a glass of wine once every 3 days or so but can't even do that anymore without it causing urinary difficulties. I've been dealing with BPH symptoms seemingly since time began. I have not slept 8 hours a night for 30 years or more except for one night on February 23, 2010, from pure exhaustion, 3 days after my Mom died. I don't know what it feels like to not feel like I don't have to urinate. I have an enlarged prostate. Who doesn't. I have tried Saw palmetto, Beta Sitosterol, Urolxitrol, Tamsulosin, Half a tab of Cialis daily, I've tried prostate magic pills, blended mixtures of the world's best of the best. Swedish Flower, Rye Grass, this that, that, this. . .I still have BPH but the healthy food store owners are driving new cars thanks to me. I'm done with pills, pills and more pills. I'm done with side effects and lightheadedness, etc. I've become my grandparents with all the medications laying around. I hate it. I no longer know what it feels like to feel normal.
I have done endless research, I have been to multiple urologists, I have had ultrasounds, cystoscopies, rectal ultrasounds, uroflow tests, urodynamic tests, etc., etc. Urologists tell you, "Hey, we'll just go in and clean you out, remove some tissue and you'll be like new." The fact that they mention all of this so casually and nonchalantly is amazing to me. We are men. Men are visual, physical creatures. We are used to a sexual experience where there is a result of our gun going off. If you get a standard TURP, you will be shooting blanks forever. This is insane. Doctors act like this is no big deal, everything will feel the same. No you won't. It will NEVER be the same. You're BROKEN. You have lost a bodily function that if I am correct has (along with the help of a female partner) been creating the human race since a man first discovered his erection. Having a ream job TURP is like going to a rock concert and not being able to hear anything. They call the old fashioned TURP the ‘Gold Standard’? You have to be kidding me. It’s more like the kiss of sexual death to anybody that goes through it. It butchers you. I know men that have had to seek counseling they were so depressed after having a standard TURP.
I find it unimaginable and absolutely hard to believe that after endless decades of research, there is still not a reasonable and non life changing treatment for BPH, the most common problem that men face.
Anyway, after years of my research, waiting and waiting for something wonderful to come along that will revolutionize how we treat this miserable part of a man’s life, I find that I can not wait any longer. Constant UTIs (Urinary Tract Infections), long regimens of antibiotics, plus the daily Flomax, Cialis, etc. I’m sick of the whole thing. Now I have some thickening on my bladder wall and some trebeculations.
I am considering one of two or a possible combination of both to treat my BPH. One is the A PKTM TURP which uses lower-voltage energy to vaporize and cut away the portion of the prostate that is enlarged and causing your symptoms. The lower-voltage PKTM Technology, combined with the safety of operating in saline, results in a safer, faster and more effective procedure. This procedure is also known as a ‘Gyrus, bipolar procedure. No, not bipolar like my ex-wife, this is the good kind.
Basically it is an Electrovaporization of the prostate with the Gyrus device. The reason there tends to be less complications is that the surgeon can be more precise with what is removed and what is left alone. There is also a saline solution that is used throughout the procedure.
I’ve been told and I’ve learned through my research that there is a 10-15% chance for retrograde ejaculation with this procedure, recover time is much shorter, less bleeding and very little chance, if any for ED. Those are fairly good odds for a good outcome compared to Las Vegas where your chance for a bad outcome is about 99%. It's still a chance but if I don't do something soon, I will be facing worse problems with my bladder, kidneys, etc. I am still sexually active so would like to preserve that functionality.
If there is anyone out there that has had a Gyrus procedure, please reply to me with your comments.
The other procedure that everyone seems to be talking about is the UroLift. Obviously this procedure is the least invasive one there is with eseentially no tissure being removed but there is simply not enough data yet with such a new treatment option. The idea is great. Insert a device into the urethra, the insert and deposit some small anchors through and behind the prostate wall and tether some others on the inside urethra side and voila - you have an opening held open by stainless steel tabs and thread. Sounds pretty darn good. but. . . .I’m not sure anyone can convince me that you won’t be able to feel these foreign objects as you move around in (and around) such a sensitive gland. The other thing I don’t get from a mechanical standpoint. . . .there are anchors on both ends of a surgical thread, what’s to keep the inner anchors from pulling the outer ones inward, thus closing off the urethra? Am I missing something? Then there’s the issue of the prostate which will continue to grow and grow over time. How long will it take until it overwhelms the anchors or pulls through - or worse. Is there anyway to remove something that resembles a spring-wing wall molly bolt that has been (essentially) blindly placed through your prostate wall? The other question is that it is an implant situation so will the body reject it?
Hey. I am all for doing something to relieve my BPH and see what it’s like to maybe sleep through the night and see what it feels like to urinate without having to pack a suitcase for the bathroom trip(s) but there’s a reason that there is a dozen (or more) different procedures for BPH on the market right now. It’s because men are demanding better options. All the the procedures claim to be the best invention since canned peas but the reality is that whether you scrape it, burn it, electrocute it, laser it, vaporize it, bake it, auger it, pulverize it, ream it, etc., it still destroys what it is to be a man.
If anyone has had the UroLift (or the Gyrus procedure) please reply and help me make a more informed decision and also to get the word out to our fellow BPH sufferers out there. Maybe through our words and actions, we can some day create a vaccine or at least a completely non-invasive out patient solution. Thank you for taking the time to read my long call for help. I sincerely look forward to any thoughts you may have.
David
4 likes, 133 replies
hungupdown david92007
Posted
I had been waking up every two hours or less every night and was suffering RE, very uncomfortable, despite having been off meds for a year - they wern't helping and I wasn't happy with side effects - muscle weakness leading to knee injuries.
Within two weeks of PAE, I could sometimes sleep 7 hours and ejaculation began to return - in limited volumes. Now sleep through most nights, even after drinking in evening, and ejaculate volume continues to improve.
Prior to procedure my prostate volume was 163ml, and retained Urinevolume was 200ml. At one month checkup scan prostate volume had decreased to 136ml,, and retained volume was just 2.5ml.
Only adverse side effects were initial stiffness, lasting a week or two, and occasional blood in semen from weeks 3-4.
I'll be having a 6 month check and hope that the prostate volume will have further decreased.
The best thing about PAE seems the zero long term risk of side effects. So even where it isn't a success you won't ever be in a worse condition.
When looking at the alternatives I came across some scary reports on death from elelctro-turp. Some bubbles, always given off from the electrodes, will enter the blood stream via arteries that have been cut. This can be fatal!
I can't see any advantage of electrical cutting over laser cutting sufficient to justifying that risk.
Search "Fatal gas embolism during transurethral enucleation of the prostate"
mikemh hungupdown
Posted
I was interested in your statement that "The best thing about PAE seems the zero long term risk of side effects". What makes you say that? Surely there may be some consequences of stopping the blood supply to the organ? Do we know what the long term is?
I was considering PAE but went for Urolift. But the Urolift doesn't seem to be helping.... I wonder whether I could now get a PAE??
How are you doing now? All the best
Mike
RonTexan david92007
Posted
I've had RE for years and it doesn't bother me much at all. it's a small price to pay for complete urinary health otherwise.
You eliminated urolift and I feel the same way as the prostate will continue to grow and eventually another procedure will be necessary. Any and all of the turps, old turp, new turp, green light laser, and Holep will all cause retrograde ejaculation as the urethra is opened up to the bladder and this creates the path of least resistance.
But let me tell you what you should worry about; the inevitability of erectile dysfunction caused by the meds and supplements you rely on. Eventually the efficacy of these pills will end and then you're stuck with the necessity of surgery plus you probably are not even shooting blanks by then, your magazine is empty and the gun stores are closed.
The pills that shrink, smooth out, etc etc the prostate will give you ED almost as certain as castration eventually. I have read a few posters who claim that this is not true but there are far more that admit that this is the case. it may not be permanent though if one gets off the meds asap.
There's another concern also, if one delays a solution long enough there's danger of a large retention causing kidney damage due to a back up of urine into the kidneys. I had just about reached that point when I decided that I had waited long enough and suffered enough that I had to have a procedure done.
I researched for months, chose Holep at the Mayo Clinic in Phoenix as the most likely procedure and facility to assure a good outcome. I chose wisely and well and now four months post-op I have been urinary problem-free for all but the first seven days after surgery. I pee like a fire hose every 3-4 hours, taking about 10 seconds each time and getting a good thirty-minute warning that I need to go. You know, like it used to be as a teenager, literally. I'm 76 so my sex life is not like it was back then but it is improving steadily and it's ok if it doesn't improve more.
If i could go back 10 years or so, knowing what I know now, the first time my urologist prescribed a medication to relieve BPH symptoms I would say; No thanks, I'm going to the Phoenix Mayo Clinic for Holep, I want to be able to urinate normally, sleep thru the night, have no accidents because I couldn't get to a urinal quick enough, a permanent solution that will not destroy my sex life and will cause me to get more repeat blowjobs as well. And I want a painless, almost bloodless procedure that will allow me to get back to a very active lifesyle immediately. I also want to minimize the risk of error, of infection, of incompetence by using the best surgeons in the best facility with the best staffs and best equipment in existence today. That's what I would do and i wish i had done it ten years ago.
Jezzaman RonTexan
Posted
I have been reading with great interests all the posts here.
I am 53 and have been diagnosed with BPH after a severe case of AUR;
I was catheterized for 2 weeks prescribed Tamsulosin and then went for a TWOC. I could pee but not easily, but they let me home without catheter. Within 24 hours I felt very rough and my flow was decreasing rapidly. Long story short I spent 4 hours in increasing agony waiting to be recatheterized. Now seen Urologist at local Hospital and he is offering Green Light Laser. Do you know much about this treatment? Is it inferior to Holep in your opinion?
Many thanks for any info you have.
jimjames Jezzaman
Posted
I also ended up with about as close you can get to AUR without actually having it. After looking over my options, I decided I didn't like any of them at this point in time and therefore two years ago decided to go on a program of self-catherization (CIC).
CIC isn't promoted by most urologists for a number of reasons, and when presented I think many shy away because of the "ICK" factor
But it has worked very well for me, and the ICK factor disappears in a couple of weeks. If not for a long term solution, it's something to think about as a stop gap measure until you decide on which type of surgery you want.
Other than GLL and Holep, also consider some of the newer procedures such as PAE and Urolofit. There is also something called EP (ejaculation preserving) TURP but seems it's only available in Germany.
Jim
Jezzaman jimjames
Posted
THanks for the response.
In actual fact the Urologist I saw was very much about me making informed choices. He recommended CIC and is making an appointment for me to be trained in it. What is "ICK" factor?
Can you elaborate a little more on your experiences of Self CAthetersization, any tips would be most welcome. I see the advantage for me in that I can see for mysef how severe my condition now is bearing in mind that from the day I went into AUR exactly a month ago I have only tried without Catheter for 24 hours and then got a raging infection within that 24 hour period. So for all I know the second episode of AUR might be due to LUT or perhaps prostatitis. The infection seems to have cleared after a week on Trimethoprim but I do feel very uncomfortable sitting on a chair around the perineum area, so I wonder what that is? Could it be the catheter tube or Low grade infection?
As for treatment I am fully researching everything, The Urologist said i was free to get a referral to Addenbrookes, Cambridge where they have one of the best UR Depts in UK! I certainly dont like the idea of RE at all!
Jeremy
jimjames Jezzaman
Posted
As to my experiences with CIC, why don't you read some of my posts in this thread here:
https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874
In fact, if you have any detailed questions that might be a good thread to reply to so this thread doesn't turn into a CIC thread.
I also have more recently talked about CIC in this thread here:
ttp://[url=patient.info/forums/discuss/median-lobe-prostate-bladder-blockage-options--455396?page=0#1640681]patient.info/forums/discuss/median-lobe-prostate-bladder-blockage-options--455396?page=0#1640681[/url]
I will comment on your UTI situation, briefly. UTI's are pretty common with indwelling catheters. Less common with CIC, but they still happen, and they are more likely to happen during the initial period while your body gets used to the process and while you develop a better and more gentle technique. And "gentle" is the key word. No need to force anything, just go slow and gentle.
Sometimes urologists prescribe antibiotics prophalactively during the initial few weeks, sometimes they don't. I wish mine had as I had a bad UTI in the beginning.
Later on, and this is very important, you may end up with a positive urine culture but be asymptomatic. This is referred to as "colonization", as opposed to a UTI and it is not recommended that colonization be treated for those on CIC. A lot of doctors don't know this and will suggest antibiotics, but I'm pretty sure your urologist understands.
Jim
jimjames Jezzaman
Posted
Jim
Jezzaman jimjames
Posted
EP Turp sounds worth exploring but prohibitively expensive for me, and I doubt the UK NHS offer it!!
Now regarding your assertion that you have managed to "rehabiitate" your bladder over 2 years of CIC to the point that you only now need to Self C once a week and can void naturally most of the time. THis I cannot understand as surely the difficulties voiding naturally are caused by the BPH? and no amount of work on the bladder will change that? Or are you saying that but for the initial stretching of your bladder you might not have had any problems in the first place. It doesnt seem to add up to me, unless i am missinfg something? So whilst I am very pleased for you I think it sounds more like a "Divine Intervention" than anything else!
Interested to hear your response, and thanks for all the info on CIC which i will be trying very soon.
Jeremy
derek76 Jezzaman
Posted
There is an interesting recent article on retro if you Google. Ejaculatory dysfunction and the treatment of LUTS
jimjames Jezzaman
Posted
https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874
jimjames derek76
Posted
Jim
Jezzaman derek76
Posted
Jeremy
Jezzaman jimjames
Posted
Jeremy
derek76 Jezzaman
Posted
jimjames Jezzaman
Posted
Jim
Jezzaman jimjames
Posted
Any thoughts useful. My instincts are to take the GL PVP and be done with it.
Jeremy
jimjames Jezzaman
Posted
Jim
Jezzaman jimjames
Posted
I had an appt today the hospital for the CIC. Now bear in mind that ive had a Foley in since 28th July apart from 24 hours (mid August)when they took it out and I got a horrible UTI within 24 hours which brought on AUR (complete blockage).
So i was expecting the worst today. any how they toko out catheter at about 12 noon and said go home see how you get on; come back at 4pm (unless you cant pee at all!) and we will take it from there.
Well i went home and drank a large glass of Cranberry juice and then soon felt an urge to pee. All was ok I passed and it felt as though I had voided ok, not the fastest of streams but probably as good as before all this hell started with sudden AUR in July. I did drink some more and then quite quickly after felt an urge to pee which I olbliged asap,. I found if I let it go a while with the urge then it was harder to pee it out subsequently?
Dunno if that rings true with you?
anyhow back to hospital at 4pm; nurse did US scan and found 80ml which she said was a ok! Said lets give the Self cath a miss as risk of reinfection may not be worth it and she had refused me prophylactic Ab's point blank (its very political in UK at present!) I said no lets do it as i thinkn i must have that as an emergency option; no way am i ever going to put myself at the mercy of A&E with AUR if I can avoid it! Been there, got the badge, it was hell!
So thats me now, just gotta hope i dont get infection; any tips on that welcome!
So now do I postpone the GL on 6th OCtober? my instincts are crying out yes!!!
I am getting urges to pee now, and there was some blood after passing urine since the self cat this afternoon and stings a bit, is that normal?
Yours hopefully
Jeremy
jimjames Jezzaman
Posted
1. Did the nurse do the CIC in the hospital or did she just tell you what to do?
2. Have you done CIC since you got home?
3. What is th ename of the catheterthey give you? Does it have a coude (rounded) tip or a straight tip? What size FR is it?
What's probably going on is that you bladder had a nice rest with the Foley so it's not surprising that your PVR is about the same as before, in fact it might be even lower.
As far as the blood, stinging, etc., that all is normal when you start CIC and should go away within a couple of weeks. With me I also felt an urgency at times even though there was nothig to come out. That said, I was a "virgin" in that I had never had any sort of catheter in me, so I would imagine since you had a foley your body will adapt easier to CIC.
The basic guidelines on CIC is that if you cath 400cc or more, increase the frequency of your CICs. And if you cath 100cc or less, decrease the frequency. I've also seen it somewhat stricter where they use your total bladder volume instead of just the catherized volume. So in that case, if your total bladder volume (natural void volume plus catherized volume) is over 400cc, then increase frequency.
I don't know if she gave you any guidelines on how to start, but one starting point is to do CIC before bed time and then on awakening. You will also find it useful especially in the beginning to log both your natural void volumes and catherized volumes, and what time each occured. You should always try to naturally void right before CIC, but with me, sometimes I couldn't, so in that instance I would just record my catherized volume.
As far as UTI's, this is a risk, especially in the beginning. That's why I recommended phrophalaxis antibiotics but sometimes they are not cooperative because they go by the stupid guidelines without taking into consideration how you reacted before.
So, all you can do is to use as clean and gentle a technique as possible. Never force anything, and try an relax the muscles as it goes in. When you hit resistance at the prostate and sphincter muscles, very gently push through.
If you find after a couple of days that your PVR stays around 80, then instead of doing CIC 2x/day, you could do it just once before bed. If your still under 100cc at 1x/day, then you can try once every other day. Then once a week. If you're under 100cc at once a week then you really don't need to CiC but at least you have a valuable tool should you ever go into AUR again
Jim
jimjames Jezzaman
Posted
So my thinking is that given your PVR of 70ml, if this continues for awhile, that means you could keep the CIC for emergencies only, and go back to a Watch N' Wait strategy, of course depending on your other symptons.
To help make that decision, you might want to computer your International Prostate Sympton Score, not for recently but for what it was like when you were not in AUR.
Jim
jimjames
Posted
https://patient.info/forums/discuss/what-is-your-international-prostate-sympton-score--453484
Jim