Retention - Bipolar Vaporization

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I just had every test done, Uro, cyst, kidneys, an it was an ultrasound that found the my bladder not voiding properly, My Urologist found a liter during the last visit and did the cystoscopy after using the catheter to drain the liter out. I have been self catherizing since them, 2 weeks now while I look for alternatives to the Bipolar Vaporization(I think this is a variation of TURP). I backed away from the Surgery that was scheduled this week as I feel there might be some better alternatives with less side effects. I did ask my doc about FLA and he pointed me to Urolift. The doc believes it's more of a damaged bladder as I don't void until I get to about 1100 ML so I'm not sure that these alternatives would work. He did detect some obstruction during the cystoscopy but he did say that he does not believe my prostate is very large. Am I wasting my time with the alternatives if it's my bladder? Very confused!

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  • Posted

    Have you had urodynamic testing? It tests bladder functionality and can help predict surgical outcomes. Without it, you and your doctor are just guessing. Ideally, you want video urodynamics. If your doc doesn't offer it, seek out the urology department at a large teaching hospital.

    How is self cathing going? I was in perhaps a worse position than yours (they drained 1.5 liters) four years ago and recommended TURP. Long story short, I decided to self cath instead. Now, four years later, my IPSS sympton score has gone from "severe" to "mild" and my retention from that 1.5 liter to often under 100. Self cathing helped rehab my bladder and in fact I now only have to self cath once or twice a week.

    Whatever you do, don't rush into anything without a lot of research. No magic bullets for everyone, regardless of what you may read. Every procedure carries some risks without any guaranteed outcome.

    Jim

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    • Posted

      Yes, I did the urodynamic test and I didn't think it went well since I could not void with 1100 ml pumped into me. Doc said there was some movement and that TURP would be the next step. He didn't think there was much of an obstruction but he felt the TURP could provide easier voiding from the bladder. Does that make sense?

      I didn't know self cathing can help rehab the bladder, that's very positive news. Thank you!

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    • Posted

      Tom,

      I couldn't void on my urodynamic test either. My take is that they pumped too much fluid into my bladder too fast. Nothing at all like a real life situation. I'm still very pro urodynamic testing, but a lot has to do with how the test is performed and how it's interpreted. Did they find "high pressure", that usually indicates enough bladder integrity if either the obstruction is removed or the bladder is further rehabbed. Speaking of bladder rehab, I have several self cath threads on that topic. Self cathing isn't for everyone, but if it doesn't bother you, it's a great way to at least buy time, and if you're lucky, even fix things up. My uro finally admitted that my results from self cathing were as good as he gets from TURP!

      Jim

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    • Posted

      I'm surprised they didn't pump fluid in until you started to void.  That's what they did during mine, which was done at a university teaching hospital.  There should have been some measurement of your bladder pressure.  Mine is low.  If you also have low bladder pressure, will a TURP do anything for you?  Sounds to me like you may need more information before taking the surgery plunge.

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    • Posted

      It never occurred to me but I wonder if it would be detrimental to do a urodynamics test where they pump that much in AFTER I've been doing CIC for several months.  If you can't release any and they pump in 1100 ml or something, might that not stretch out the bladder again and undo all they good I may have been doing for months?

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    • Posted

      I don't think a one time "stretch" would make much of a difference long term, but I would discuss the situation prior to the fill. If you know that you're not going to void after say 600ml, there is really no reason for them to keep filling, so agreeing on an end point volume in advance might be a good idea. I would also ask them to fill on the slow side which more closely approximates the real world. Whether you void or not during urodynamics, my understanding is that they still can measure bladder pressure which is the important thing.

      Jim

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    • Posted

      Prostate size alone isn't all that important - its how obstructed your urethra is. If its not that obstructed, surgery won't help much or at all. Often people with retention have bladder and prostate issues. If your doc suggested TURP with a bladder problem and not much obstruction you may want to find another doc.

      IF you don't mind doing it, I would self cath for awhile and see if things don't start to improve. If you confirm that there is more than a minor obstruction to your flow, I would look into the less invasive procedures (Urolift, Rezum, PAE, FLA) as they work almost as well with virtually no chance of debilitating side effects.

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  • Posted

    Given all of the tests that you have had, it seems that the doctors should be able to give you a more definitive diagnosis.  I had similar retainage issues, and I was retaining 1.5L of urine.  My bladder is distended, and neurogenic.  It is not creating enough pressure to empty it.  My prostate is also enlarged, but not to the extent that I should have this much difficulty voiding.  I have been self cathing for 7 months.  It has made a big difference in my quality of life.
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  • Posted

    Tom  It is a Turp which should not be use unless it is a last resort.  Being your doctor told you about the Urolift you are not there yest.  The urolift will open up your prostate and relax your bladder.  It make work for you and it will give you no side effects.  And it takes less time to heal.  Going on 3 years for me  Take care  Ken    
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  • Posted

    If  your problem is bladder related, it's hard to imagine why a TURP would help you.  My Uro told me I had bladder, sleep and prostate issues and said surgery and drugs probably wouldn't help much. It seems many guys on this site have had surgery with bad outcomes (also, lots good) so I think a lot of thought and research is necessary before making that decision.  

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    • Posted

      I wouldn’t put a lot of weight into the urodynamics test and the Doctors diagnosis. Lots of people here, myself included, failed that test. Couldn’t urinate after they put 1000 ml in my bladder. Told me I had a neurogenic Bladder, TURP might help me, etc. I had tons of tests after that, including MRI to see if nerve damage or MS was causing this. 

      I decided to try removing some of the obstruction the prostate was causing after self cathing for months. 

      I have had two different procedures done, Itind, and last year FLA. Both have given me relief, and my bladder seems to function fine, even though I was led to believe I might never pee normally again. 

      My advice would be do a lot of research. But don’t take that test as the answer, or the Doctors word. Because they just don’t know what’s going on down there.

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    • Posted

      I didn't think the MRI could tell if there's nerve damage. Are you saying that it can detect it? I was looking into a local 3T MRI to help me confirm a few things. But I am leaning towards the UROLIFT or FLA. Where did you have your FLA? And how long was the recover? I play a lot of softball and Golf once a week so I'm trying to understand how long I would be out for. Any additional information would be helpful. Thank you!

      Tom

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    • Posted

      The first MRI’s I had were to try to get to the bottom of my bladder supposedly not working properly, due to the failed urodynamics test. So I had an MRI of my lower back, because of problems there with L4-L5. They thought this could be causing nerve damage. Next, I was told I might have MS, so had MRI of my brain and neck I believe to rule that out. Then I was back to square one. So that was just several rabbit trails before I just got sick of it and came on this forum and found a lot of info. 

      I tried the Itind first, as it was not invasive, but wasn’t a long term solution, at least for me.

      I had a 3T MRI over a year ago, and had the FLA with Dr K in Houston a year ago. The recovery was pretty quick. I was skiing downhill on Black Diamond runs 10 days after the procedure (probably a little too aggressive too soon) Went on a two week motorcycle tour 5 weeks after the procedure. 

      FLA is expensive compared to Urolift and Rezum, but Dr K is a really good Doc. The follow up is outstanding.

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    • Posted

      Urodynamic testing will tell you if your bladder function has been compromised by nerve damage. It's a functional test. A 3TMRI is a functional test.

      Jim

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    • Posted

      I don’t think I understand that statement that a 3T MRI is a functional test. How is it a functional test? They image it.

      And my statement on Urodynamics is it might tell you if there is nerve damage, and it might not tell you...

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    • Posted

      Typo. Thanks for the correction. Urodynamics is a functional test. What I meant to say is "A 3TMRI is not a functional test". It's imaging, as you stated.

      Jim

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