Prostate biopsy

also not informed of possibility of having mri first,nor given any aftercare advice,nor checked for pain/being able to wee.took all of 15 mins..

Rather undignified and a bit uncomfortable but was able to make love a few hours later then make a long train journey the following morning with no ill effects. Perhaps I was just lucky. Was done at the Royal Gwent hospital in Newport, Gwent.

Cheers Richard

I was bricking it before I went in had read all reviews on internet and spoke to lad at work who said it knacks as he had it not so long ago so I feared the worst now have to wait for the results another pain

Yes double standards and rather inconsiderate not to have been either warned or asked first. A bit off.

Cheers Richard

well,neither informed of all risks (false negatives-first biopsies average cancer pick up rates of 47\%-,requiring further biopsies,sepsis,duration of possible bleeding,potential-or actual!pain..) nor presence of third woman in room discussed(chaperone,should be 'offered and discussed),door opened halfway through procedure for another person to hand over  paperwork(urine test results,which should have been checked before proceeding),misinformed about possibility of mri first,and left to go home after 15 mins..gp neither informed of biopsy having been done,nor result 10 days after results appointment..gold standard?hardly..informed consent obtained?decidedly not..concern raised with health board?yes,maybe one way to get this looked at and changed..

So much depends on the professionalism of the whole team. Without a good team everything deteriorates. With a good team procedures work well, the team is better informed and so, as a result, is the patient. Clearly your NHS Trust is desperate for a good new team leader in their Urology department to take them all into real medicine. All your partner can do is get referred to a decent team from now on - I wouldn't stick with a department that treated me like that.

nor would we..yet,concerned about others potentially being exposed to the same

Here here - I agree fully bear63. If anyone wants details of with urology group I had under which NHS trust in SE England just PM me for details. I had a very professional group (though I believe all groups jut don't understand the importance of rapid,ideally pre and post op oxygenation of the penis and keeping going for 2 yrs plus if necessary in order to reduce the level of post RP ED).

What is oxygenation of the penis and how is it done?

Oxygenation is the brought about by large volumes of oxygenated blood entering the penis. This occurrs every night in a healthy male - nocturnal erections last 2 to 3 hrs and maintain the penis health.

RP, even in the hands of the most experienced surgeon, results in a degree of cavernosal nerve damage (neuropraxia). The main mechanism through which this is thought to occur is neuropraxia probably caused by:

a.     direct trauma during surgery,

b.     thermal damage due to electrocautery,

c.      cavernous nerve ischemia due to vascular injury (such as the accessory pudendal arteries), and local inflammatory effects associated with the procedure.

This results in total lack of noctutnal erections or any sort of erections and a chain of events that result is fibrisis leading to shrinkage of the penis and permanent damage to the system.

Neuropraxia is, fortunately, reversible (it may take a long time though) but the if permanent damage has occurred it will be too late.

It is really important therefore to maintain good levels of oxygen to the penis as soon as possible post-op. This can be managed with a comvination of several ways:

1. Taking Daily PDE5 inhibitors - one of the following (for up to 3 yrs post op until normal function returns)

Avanafil - 200mg

Tadalafil – 5mg

Sildenafil – 100mg

Sildenafil is the cheapest but in clinical trials Avanafil gave the best results followed by Tadalafil.

2. Twice daily use of a VED (Vacuum Erection Device) - for the frist 2 months post op and continuing once daily till normal erectile function returns.

3. If the PDE5 inhibitors have no effect at all in the beginning then 3 x weekly use of PGE1 injectopn into the penis (Caverject). This should only be needed for the first one to two months.

It is important to use a combination of drugs and VED in orfer to maximise the oxygenation and maintain the health of the penis while the nerves are repairing themselves. In post cases nerve repair will occurr over the first year but there is evidence that it may take up to three years. Don't give up on maintaining oxygenation before erectile function returns to the point where your nocturnal erections are routine again!

My apologies for such a long answer. If you are interested in the full physiological story I would be happy to PM you.

Many thanks for such a comprehensive posting. I had hormone treatment followed by RT and have had an almost zero PSA score in the eighteen months following.

I'm using Levitra10mg tablets with a reasonable level of success but do not want to be totally dependent on this for a good erection so I asked my GP to prescribe a pump which should be available for me any day.I think there is a lot of truth in use it or loose it but the medical world does not seem to be much concerned beyond carrying out the initial treatment IMO.

Cheers Richard

I could not agree with you more. There are so many papers published that there is no excuse for ignorance. Don't worry about being dependant - it is a key part of maintaining oxygen levels along with the pump. Your GP may need the urologist to recommend it and for you to have 'proper training' at a urology clinic before he/she writes a prescription for a VED.

If you google 'you tube Dr. John Mulhall - Erectile Dysfunction' you will find a really helpful talk by him. He also comments (I think in that video) on the total lack of knowledge of urologists in this area.

Thanks for that/  Yes my GP did refer me to the local ED clinic after I was really insistent and then at the clinic I had to be very firm because the guy there said no point in my having a pump if you were getting erections using the tablets.  Very dissappointing attitude from professionals who should be up to speed on all of this.  I will check out the you tube suggestion thanks.

Cheers  Richard

 

Many thanks for the lead.  I've now watch the long video and found it very interesting and suggest all here who have not seen it to do so.

Cheers Richard

Glad you found it helpful Richard. I also PMd you with a paper that includes a good flow diagramme.

Dear Romney

Thanks it was very useful, much appreciated..replied off list.

Cheers Richard