Post MRI -- Now What? And Update

Posted , 12 users are following.

Hi Everyone:

First, thanks for all the helpful advice last time around. Thanks to you guys I avoided the needle biopsy and opted for an MRI. My PSA is 4.3 and 4.5. Last Uro wanted to do a Turp so I got a new Uro. She is the one who wanted to do the needle biopsy without any imaging.

The MRI was negative with no lesions suspicious for prostate cancer. It did show:

  1. Prostate size volume 49.4 cc;
  2. area of diffuse increase perfusion suggestive of prostatitis;
  3. transition zone findings enlarged with nodules consistent with benign prostatic hyperplasia;
  4. Bladder is thickened and trabeculated, likely related chronic bladder outlet obstruction;
  5. Left ignuinal hernia
  6. Small bilateral hydroceles are noted.

So what's next? What procedure should I consider? Would self Catheterizing help restore bladder function? Help me sleep longer at night as I'm getting up nearly every hour now.

Is 49 cc particularly large? Is this large enough to warrant PAE? Should I get a cytoscopy now to determine where the blockage is?

Thanks again everyone for the advice.

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15 Replies

  • Posted

    Congratulations on the new and more accurate diagnosis. You're off to a good start to taking charge of your BPH situation.

    If you've been reading very much on this site, you'll see that there are several good options. Your next step should be, IMHO, to see more than one urologist to see if you're a candidate for the procedure that he/she does. Some have had good results from the PAE procedure also. I mention it separately because urologists don't do the PAE procedure. It's done by an interventional radiologist.

    Also in my opinion, and in the experienced opinions of others on this site, you should definitely learn to self-cath. It's a good way to start on your way to improve your bladder function over time.

    I'll be providing a one year update soon on my Rezum procedure. For me it was a painless way to address the BPH symptoms, but using CIC (self-catheterization) for about 3 or weeks after the procedure was one of the keys to making it a true 'walk in the park'. YMMV....

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    • Posted

      Thanks Ken.

      Will CIC help me sleep longer at night?

      I want to CIC but I know this doctor will be hesitant. I'll insist on it, however, and say I need relief to get more sleep as I'm miserable.

      One issue, I just read an excellent post that PAE is good but only for very large prostates and his was like 135.

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    • Posted

      Catheterizating helped me a lot at night. I usually had to cath once during the night but it was such a relief to completely empty my bladder that I was able to fall back asleep.

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    • Posted

      It is great relief. Even during the day I feel much more relaxed. I used to think a lot of my jitteriness (if thats a word), nervousness, was from the urinary retention that I didn't feel as an urge to pee anymore. My bladder had become too damaged to signal that to me. Doing CIC was a pretty easy skill to learn for me and the prelubricated catheters make it so easy.

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    • Posted

      Ken,

      After over two years of self-cathing and lots of research, I'm thinking seriously about Rezum. I have a 93 gram prostate and have just about total retention. Can you tell me how everything worked out for you, the size of your prostate, number of steam injections, whether you ended up with retrograde ejaculation? Also, who did the procedure, and where, and what kind of anesthesia you had? And the big question, how well can you pee?

      Thanks in advance for any help. Very best wishes,

      Fred

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    • Posted

      Light,

      I'm 66 years old, in good health, and had a 68g prostate. Prior to the procedure in January 2018, I was self cathing several times a day. My research also pointed me to Rezum as the best option for me. I used the physician locator on the Rezum site and ended up having Dr. Kevin McVary do the procedure. At that time, he was in Springfield, Illinois, but is now at Loyola near Chicago.

      I had an enlarged median lobe that was pushing up into my bladder. My original uro had offered me a bipolar TURP about a year earlier because that's the only procedure that he did. At least my original uro was honest about it. I recall him telling me that "you'll never ejaculate again". That was the statement that convinced me to continue to cath and research the options.

      I asked for the twilight anesthesia and Dr. McVary was fine with that. I got the impression that he always, or almost always used twilight for Rezum. I also asked to self cath after the procedure rather than a Foley and he readily agreed to that also. I woke up from the procedure (10 steam shots) completely painfree. I self cathed once at the medical center before I left, and once more at a gas station on the long ride home. I was using FR16 Coloplast catheters and there was only a bit of discomfort that first day. No real pain.

      I self cathed for about three weeks although I probably could have stopped at the 2 week mark. I had some blood in my urine for a couple of days afterwards. I tested the semen for blood about three days after the procedure (I'm a guy..) but I never did have any blood in semen. And I had no retrograde ejaculation or any effect on erections. No incontinence at all either. I did have some minor urgency for a few days after the procedure, but ibuprofen took care of that.

      I'm closing in on a year since the procedure and my flow is still good. I did have to go back at about the 3 month mark because my flow was suddenly reduced. It turned out that there was some tissue that partially blocked the flow. Dr. McVary said that it was an unusual thing that he had only seen once before (lucky me).

      I'm very satisfied at this point. I am a strong advocate of self cathing afterwards though. I know of several guys who had Foleys and weren't fond of that experience.

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    • Posted

      Ken,

      What is your PVR? Do you still have to cath?

      I'm 2 weeks post Rezum and my flow is still worse than before, which I guess is expected. I see the doc on Monday to get my PVR checked. I think its worse also .

      Tim

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  • Posted

    Hi again Motto - your MRI results are great and congratulations on not letting your uro do a blind trus needle biopsy on you. I answered in your other posting that a cystoscopy is in order now for you. Also some urodynamics testing might be helpful to understand the strength of your bladder muscles.

    But in the meantime while all this is being figured out you still need to pee and to sleep. By far the best solution is to learn CIC which will give you back control of your bladder instead of the other way around. This will also give your bladder muscles a rest so they can strengthen too. If you decide to do learn CIC there are many of us here who can help you. But if your current uro trashed CIC and wants to do "gold standard" procedures then it is time to get another uro. As you can see you are learning the right questions to ask as you interview prospective new uros. Most of here have gone through at least 6 and many of us have given up on uros altogether .

    How old are you and what country do you live in? Take care.

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    • Posted

      I'm 56 and live in the U.S. Midwest.

      I think the new Uro might come around. She initially refused to do an MRI saying she doesn't do them "first passs" but requires a biopsy first to eliminate prostate cancer. She then scheduled the biopsy and cyto and told me I could do one or both but when I got there and refused the biopsy she refused the cyto claiming some BS about risk of infection for any future biopsy but she did order the MRI.

      Thanks to you guys, I pressed her on the fact that a high PSA alone did not seem to warrant a biopsy. I don't think I brought up CIC yet but will on the next visit. Weirdly, I think having my wife present makes her more reasonable? We'll see.

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  • Posted

    i agree with everything Howard has said . Get all the tests done inc urodynamics and cystocopy to fully rule out anything nasty .

    CiC IS daunting to begin with but is so so easy ,no pain , no discomfort and takes less than a minute .Empties you out so you can sleep etc . and great to have in an emergency . Im 53 and have had urinary problems for three years , acute retention etc etc . For me having the option of CiC means i can have a drink with the lads and carry on as usual without worrying i'll be up all night or end up in hospital with acute retention . In the UK we call it a " Get out of jail free card "

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  • Posted

    I would at this point choose to send a copy of my MRI to Dr. Karamanian via his web site using the upload button after I insert the cd into my PC.

    I would call and ask them to evaluate my situation and tell me what they believe would be a good option. Yes they preform FLA procedures but they do not think it is for everyone.

    With your prostate being on 49 cc, they may suggest something else. That is not a very large prostate.

    Only when they can see a tissue composite in MRI that would justify removing it for flow or Bladder clearing of the median lobe. They do not charge for this evaluation but they thoroughly read YOUR condition and actually see the problem or not. They do not charge you anything to do this. You are still making your own decision but you are a lot more informed from an Interventional Radiologist that specialize in nothing but prostate conditions. Very honest very truthful very informative very cost effective for more information. If you need contact information I will PM it if you ask.

    Good Luck.

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  • Posted

    Hi Motto:

    Are you taking any BPH drugs such as finasteride/dutasteride and/or flomax, alfuzosin, etc?

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    • Posted

      I did take Flomax then doubled the dose but did not tolerate it well. It seemed to make me incontinent at night or made it worse.

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  • Posted

    Motto, self-cathing is the way to go. I wish, I did that before my three surgeries over 14 years. My prostate, was 141 grams {very large}. I"ve been doing self-cathing for 28 months now. My opinion, do the self-cathing, and see what happens. This way, you will do the least invasive, and that may solve your problem. If not, then you may want to try other means to find a solution, to your urinary problem.

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