Simple Robotic Prostatectomy

I was walking within 24 hours after surgery. This was also the same day I was released from the hospital. At home I walked multiple times every day as I was recovering. I never took anything stronger than Tylenol and Motrin (I am anti-narcotics). I returned to work within 10-days (could have went back sooner, but I took advantage of PTO and stayed home where I was most comfortable). Back in the gym (cardio & weights) at 6-weeks.

Dave,

I am so glad that SRP worked so well for you. It was really your only option, besides full open surgery. You have forgotten to mention to us that underwent serious spinal (or intravenous) anesthesia for that surgery. Most likely were operated in up-side-down position to remove the pressure from the bladder on your prostate during at least 2-hr surgery. Also you were very lucky yo have an artful surgeon, who was well trained in SRP technique with sparing all the corresponding nerves and sphincters responsible for the erection and ejaculation. You were operated by an artist. Most URO surgeons offering SRP will just cut-off your prostate. You seemingly are in a good physical shape and relatively young for a BPH patient. At age 60 I didn't no that I have BPH. Most of the BPH patients, who are ripe for the surgery are in their late 60th or early 70th and typically in much worse shape. So their results can differ dramatically from yours. I would say, youe case belongs to these 10% of very lucky ones. I have two friends who underwent SRP surgery in their mid 60th due to BPH complicated by an early PC and spikes in their PSA. They both(now 72 YO) were successes but both told me,if you can avoid it, avoid. Their stream is excellent (as race horse according to them), but one has RE and another admitted that his sex life was over after SRP.

So, not everybody is so lucky. That's why I have chosen PAE for me as a first step. Maybe in the future it will be SRP with a well qualified surgeon. My father is 101 -year old, suffers from BPH since age 60 but resited any surgery. He have taken Avodart in his 80th (didn't experience any loss of libido and erections) and still can pee, albeit with difficulties and almost every hour. He is in a good mental shape so far and claims that BPH is not his worst problem.He has no signs of PC and definitely is not a candidate for any of discussed procedures. URO prescribes him antibiotics for frequent LUT infections. Everybody is different and there is no "one size fits all" in urology.

I am really glad that it worked for you so well. Ther many cancer survivors who went through SRP and lead an active professional and sexual life. It depends often on how rich you are and what access do you have to the best medical care. Unfortunately US medical system gives it only to a few privileged patients.

Best of luck to every participant of this discussion.

Gene

Hello Gene:

Thank you for the response. You are right, one size does not fit all. My anesthesia was intravenous and I was under for 4-hrs, and yes, I was stood on my head the whole time. I also agree that I was lucky to find a surgeon that was skillful and confident in the SRP procedure. This was a concern as I researched the procedure and questioned him before it was done. Sparing nerve bundles was at the top of my list. I told my doctor that I wanted that garden hose he promised and I wanted to continue having sex (I believe I said I wanted a garden hose and a love stick). He laughed and came through for me.

As for my health, you are also right. At 61 years old, I have always been healthy and take no medications to manage my life. I am sure good DNA comes into play. Blood pressure has always been good, even when body weight goes up. Have always been a gym rat and back in the day, competed as a powerlifter. I still train with weights and do cardio. I am a true believer in muscle groups supporting our skeletal structure.

I read a lot about prostate procedures and remember seeing that if you were sexually active before procedure that you were a candidate for continuation after surgery. Not sure how accurate this is, especially if certain nerves are damaged, removed, etc., but I have always been active sexually. I can also add that sex/erotic behavior comes first from the brain. Kind of hard to explain this, but the brain is very powerful and our thoughts can take us to many places.

On being rich, that would not be me. However, I am resourceful. I have two health insurances (fortunate) and I seeked out the right provider and forced a referral. In other words, I fended for myself. I learned years ago in the military that nobody watches out for you better than you. I took control and made certain things happen and got myself in to see the doctor I ended up using. I also researched alternatives and tried my best to understand what was happening to me. I had one urologist that tried to teach me self-catheterization and that was a complete failure and traumatic (made myself bleed). To me, this was treating a symptom, not fixing my problem. I am aggressive in problem fixing and anti in band-aid treatments for symptoms. I hope I never have to see another catheter for the rest of my life.

Gene, thanks for sharing. Kudos to your dad for living to 101. That DNA might rub off on you.

Dave

Congrats again for ur remarkably short and complicationless recovery. It seems that it could be more of an exception than a norm.

Obviously. I have had neither simple robotic prostatectomy nor HoLEP. But I also hope readers know that HoLEP is an excellent option for large prostates and is indeed a minimum invasive surgery compared to STP. Since I am not qualified nor creditable to voice an opinion, I could only cite published literature given below.

Source:

ncbi?nlm?nih?gov/pmc/articles/PMC4446381/#!po=15.0000

(In the above, replace the sign ? by a period I.e. a dot) free access.

title： HoLEP: the gold standard for the surgical management of BPH in the 21st Century

authors: John Michalak, David Tzou, and Joel Funk

Only one section of the above paper related to open prostatectomy is given below.

“HoLEP and OP

Since the origin of HoLEP in the early 1990s, it has revolutionized the surgical treatment of men with large prostates. Men with adenomas deemed too large to resect endoscopically are often advised to undergo open prostatectomy-a surgery associated with high transfusion rates, lengthy catheterization times, and hospital stays averaging as many as 5.4-10 days [9,14].

Contrary to TURP, HoLEP is a size-independent procedure. The consequence of this is that HoLEP will eventually make OP all but a historical operation for even the largest of prostates. HoLEP has been used to successfully enucleate adenomas as large as 800 g [5]. Numerous well-designed studies have demonstrated that HoLEP outcomes, catheterization time, and hospital length of stay are independent of pre-operative TRUS volume. Lingeman, et al [1] retrospectively reviewed 507 patients who were stratified into three groups based on preoperative TRUS measurement - < 75 g, 75-125 g and > 125 g. They found no significant difference in hospital stay, catheterization time, post-operative AUA-SS, and post-operative Q max among the three groups. Similarly, Kuntz, et al [11] prospectively followed 389 patients who were stratified into three subgroups (< 40 g, 40-79 g, and > 80 g). They found no differences in catheter time, hospital stay, complication rate, or post-operative symptom score across the cohorts. Furthermore, the blood transfusion rate was zero in all three subgroups.

HoLEP and OP outcomes have been directly compared in multiple, well-designed, RCTs. Kuntz [9] demonstrated that HoLEP could be used to resect adenomas greater than 100 grams with similar efficacy as OP, but with radically decreased hospitalization stay, catheterization times, blood loss, and transfusion rates (see Table 1). Naspro, et al [14] performed a similar randomized, prospective study comparing HoLEP to OP in 80 patients with prostates > 70 g at 2 years of follow up. They found almost equivocal functional outcomes but a lower transfusion rate (4% vs 17.9%), decreased catheterization time (1.5 vs 4.1 days), and shorter hospital LOS (2.7 vs 5.4 days) in patients who underwent HoLEP vs OP, respectively. Moody and Lingeman, et al [15] retrospectively compared HoLEP to OP in prostates greater than 100 gm and found that patients who underwent HoLEP benefitted from a minimal change in postoperative hemoglobin (1.3 vs 2.9 gm/dl), a shorter length of stay (2.1 vs 6.1 days) and greater amount of adenoma resected (151 vs 106 gm). Furthermore, efficiency and efficacy of the operation were not compromised; procedure duration and AUS-SS improvement between the two cohorts were equivalent.

Table 2 demonstrates the staggering reduction in LOS, catheter time, and transfusion rate that HoLEP patients enjoy.”

....................................TABLE 2................................

.................................................Kuntz (2008) Naspro (2006)

....................................................HoLEP/Open......HoLEP/Open

Length of stay (d) 2.9/10 2.7/5.4

Catheter time (d) 1.3/8.1 1.5/4.1

Tissue removed (g) 93.7/96.4 59.3/87.9

Procedure time (min) 135.9/90 .6 72 .1 /58 .3

Transfusion rate (%)0/13 .3 4/17.9

Hemoglobin loss (gm/dL) 1.9/2.8 2.1/3.1

Prostate size (g)> 100/> 100 > 70/> 70

Change in Qmax +20.6/+20.7 +11.4/+11.8

Change in AUASS/IPSS-19/-18 -12.2/-13.5

Thanks for sharing, dl. From the description from Dave, the SOP was a major surgery, way more invasive than most BPH procedures. HolEp seems to be a better choice? Perhaps Dave had a good reason to go with OP. Hank

hello Hank,

hope all is well!

from all the papers that i have read, for large prostates, holep is the more preferred choice that prostatectomy, which dave probably would not agree.

the question is do we want our stomach and bladder or prostate cut open to remove the adenoma or let a laser enter thru the penis like in cystoscopy? I had watched several open prostatectomy on youtube and they were bloody and were major operations.

the holep enucleation way of removing the adenoma is very similar to the open prostatectomy, very complete, thus they have about the same functional outcomes, such as Qmax and PVR. other than that holep seems to be better in all other categories.

did u ask me about insurance for holep? sorry, i lost ur post so couldn't reply.

medicare and BCBS will pay for holep, i suspect all other insurances will pay for it as well, as holep is one of the most studied surgeries and has been around since 1998.

dl0808,

you are right, HoLEP is doing the same as open or SRP surgery, but is less bloody due to coagulation with Holmium laser. I'm not sure, though, taht it''s covered ny Medicare or more precise, if very few doctors, who perform HoLEP will accept Medicare. I was looking for one in San Diego and LA and was not able to find one. My primary HMO offered only TURP or SRP without preservation of surrounding nerves.

There terrible complications after HoLEP, which are well reflected on this site, albeit they are not so frequent as after TURP or green laser.

Results of operating on a huge prostate are rarely predictable. That what pushed me towards PAE as apart of a clinical study. BTW, what do you know about Medicare coverage of PAE?

The argument almost scholastic. According to my search in Southern CA, very few doctors offer HoLEP covered by Medicare. Maybe things are different in SF or NY. Out of pocket cost of HoLEP is around $20,000, from what I learned on this site.

Gene I am sorry that it coming to that. Insurance company and going to pay for your surgery but not to better your life or even let you have one. ( Saving the nerves ) To me it's just hard to believe we have come to this...God help us Ken

Hello Hank:

To be honest, HoLEP was never on the table for me to consider, and I am not sure I would have went there. What I read about Simple Robotic Prostatectomy seemed to be the way to go, although to some it still sounds like major surgery, or more invasive. My thoughts were I did not want anything messing with my urethra, my sphincters, or my nerve bundles. What I did want was this great mass taken out so I could pee freely and without any difficulties, while at the same time, allow me to maintain sexual activity. Luckily, I seemed to have found it.

Dave

I'm glad all the guys I'm reading about in this forum have had great success from the various procedures. I however did not have a positive outcome. I had UroLift at age 52 (I'm now 54, 2 years post surgery) and suffer from ED, I can't achieve erections at all and have spent thousands of dollars trying every pill on the market, as well as generic ED meds and even penis injections, all of which have produced zero results. After much effort spent communicating with the company that makes the UroLift device, as well as talking to my urologist who performed my surgery, I am left with an apology and the statement that "UroLift isn't for everyone."

I was a vibrant man with a very healthy sex life prior to the UroLift surgery. but my prostate was so enlarged I could not pee without self cathing. I was in tremendous pain almost constantly from the inability to void my bladder. I was assured repeatedly that the surgery would not affect my sexual function. I'm approaching the 2 year mark since having the surgery and I am a shell of a man, angry and frustrated and have nothing but constant regrets that I ever agreed to have the UroLift surgery.

I just needed to share, it doesn't really change anything to vent, but venting is all I have now.

All the best to all who have had success with their various procedures. I only wish I had had a similar outcome.

Den

Hello Den:

Vent as you need to. Always welcomed.

Before my SRP, I briefly reviewed the Urolift and asked my previous urologist about it. I was quickly told my prostate was too big.

Can the Urolift bands be removed and other alternatives consider? Just wondering. I feel for you and with all the ways to treat/correct our prostate issues, we seem to never know the "right" one for us. We also struggle understanding our own anatomy and what each part does (nerve bundles, urethra, sphincters, etc.), let alone what procedure threatens those parts in us.

You just made me think about how the Urolift is performed and how the metal bands are applied. When I first saw it on the Internet, I thought that sounds simple, never realizing how the bands could interfere with nerve bundles (which are on the outside of our prostate capsules) and the cuts that happens in our urethra.

Hang in there and do not give up on solutions. I know it is easier said than done, but as I shared in an earlier post, nobody watches out for us than ourselves.

Dave

Dave, good arguments you have. Glad it worked out well. Thanks for sharing. Hank

Den, did Urolift at least solve your urinating problem ? Also, wasn't self cathing sufficient enough so that you were still in constant pain ? Hank

good suggestion. i had considered and had done research on urolift . i understand that one of the features of urolift is that the implants can be removed by cutting the sutures. after cutting , the internal metal tabs in the urethra can be removed by a special tool whereas the external metal tabs each with the suture attached remained in the body.

with the old set of implants all removed, a new set of implants by a different and more experienced urologist. perhaps, this time, the nerve bundle might be avoided. other type of surgeries may have much higher chance of RE. i would stick with urolift if preserving ejaculation is the objective.

Ken, the resident urolift expert, is a good person to comment on this.

hello gene,

u are right that if the doctor does not accept medicare, then having medicare covered holep will not help the patient much. but for holep, most patients are focused on finding a very experienced doctor to ensure success. they don't seem to mind travelling great distance. i seldom see posts discuss insurance coverage.

i agree that the result for larger prostate is unpredictable. thus readers with large prostate should not expect they would get the same OP result as dave. for very large prostate such as the one dave had at 343cc, holep and open prostatectomy are the only options. it would be helpful to understand the complications from each procedure. those readers who are interested in OP may want to do some research before deciding. But i have no interested in OP.

one bothersome complication from holep is transient incontinence, typically is about 17%. but some surgeons use a technique called bladderneck preservation. with this technique, the TUI post hoelp is reduced to less than 2%. there is also a new holep technique called no touch en bloc low power holep. it has lower complication rate. i learned all these from a forum called steadyhealth which has far more info on holep than the patient info forum.

these holep techniques are not generally known to patients who are trying to decide on a bph surgery. the variety of techniques available to bph patients cause endless confusion, me including.

i don't know anything about insurance coverage for PAE.

in the eastcoast, holep could cost as high as $30,000 if pay put of pocket.

Hi Dave,

I appreciate the kind words and the encouragement to not give up on solutions, At this point, I have resigned myself to the hand fate has dealt me. I was stupid to have the surgery, It just goes to prove that we shouldn't believe everything we are told by doctors.

Some have suggested I have the UroLift removed but I feel more surgery could add to the damage already done as opposed to "fixing" my problem. And to be totally honest, at this point I do not trust anything any urologist says.

Thanks again, glad you are doing well.

Den

DL I was not going to say anything but being you put my name in it I will say something. I have talk with Den before when he first came on. What he is not telling you is that he was on JALYN from 2010. ( Dutasteride & Tamsulosin ) The main side effects of it is impotence. I have talk with the company and my Urologist My doctor said that he has never giving that pill to any of his patients because of the side effects. Neotract over the last 8 years have had no man have impotence or retro. The only way that could happen is by the pill or if the doctor did something wrong. And if he did he is not going to tell you. What I feel what happen being that he was younger when he started the Jalyn when your younger you have no problem with erection and when you get older some men do have a problem and I think the Jalyn just caught up with him I hope there is something they can do for him to help him. But only time will tell. That is why I say when a doctor give you a pill to take. Look up and get the information on it and see what the side effects are. I would not have taking that pill. Men please do your research. Ken

Hi DL:

When the EOB was sent to my insurance provider after my SRP, the bill was $117,000. Granted, this is probably at multiple times the allowable, but expensive nonetheless. Thank goodness I had a primary and a secondary. Nothing out of my pocket. Very fortunate.

Dave

Hi Kenneth,

Unfortunately, My second green light procedure left me impotent. A !% chance. My Dr. gave me viagara which caused a horrific hangover. Next I tried Cialis , which seemed a bit better,but not total . He never discussed the issue with me.I think if i had been given better instruction,it might have worked.

I have still been able to achieve orgasm with the help f a vibrator. I asked the Dr here at Mayo if I should be able to continue this activity and he assured me that I would.It is no perfect but it is better than nothing.

Bes.

Tom

incredibly high cost, four times the cost of holep! so cost and durability of the procedure definitely are factors to evaluate a procedure.

hospital stay is expensive. do u remember how many days u had to stay in hospital? it might be helpful to know the breakdown.

just curious what ur primary and secondary insurance were at time of surgery. did u need preauthorization from each?

this is important clarification for readers who are considering urolift.

urolift still is the champion in preserving ejaculation.

i am puzzled, when Den was off his medication should all he side effects including impotence disappear overtime or the side effects will stay forever?

Hi DL:

I was rolled into the OR at 7:00 AM. The actual procedure started at 8:00 AM and finished at 2:00 PM. I was released from the hospital 24-hrs later.

I did not need any pre-auths. I had already been referred to the facility by my previous urologist and the troubles I had been having. My primary insurance is a health insurance provided in my State. My secondary insurance is TRICARE.

Worth noting that the facility I used was a cancer center. A family member had a great cancer experience with the facility and I was determined to get in there to see an oncology doctor in urology, whether I had cancer or not. Plus, I was already convinced the SRP was for me, and the facility had doctors who could perform the task. I got in and the rest was history.

In closing, the EOBs have all passed through and the final allowables paid were no where near the billed amoun, but then again, that is how inflated our system is. I have no idea the quote for a patient pay SRP with no insurance.

Dave

I am so sorry for that. There are still doctor that tell there patients very little or all will be the same. Yes you can have a orgasm without a erection. At least it's something. Don't give up there could be something out there. I was reading something this morning that some procedure take up to a year for some men to have a erection. Maybe there is hope. All the best Ken

You would think it would but being on it for so long I think it is a side effect that will stay forever. He was on it for over 10 years. I wonder if there would be something that he can take to counter act the meds. I have to go through some things but I think he was still taking it before the Urolift. Ken

hello dave,

thanks. for comparison, holep, the one i know, also has an overnight hospital stay for 23 hrs.

there is a differnce though. u seemed just picked a doctor, but holep patients are very picky. they often want to pick surgeons who had done thousands of holep.

also similarly , $30K is the billing rate not the actual payment for doing holep.

u brought up an important issue.

do u mean the drug he has been taking for so long has damaged the organ or tissues responsible for erection and ejaculation? the drug keeps the urethra open but is slowly and unknowingly eroding those sexual functions to a point that they will not return to normal even after the drug Is withdrawn?

is this a known fact? if yes, this drug is dangerous! Is there a time period exceeding which the sexual function will be damaged for good?

Hi DL:

The term I have heard for this is "Chemical Castration."

Dave

Let me look at it again and i will get back to you????

I just got done reading 4 or 5 papers on Jalyn is a very bad drug with about 40 side effects. It stops the body from making testosterone. It causing a lot of issues with your sex life. The libido and not wanting to have sex at all. Some doctor do not even know what the side effects of this drug is when they give it to you. It does not say anything about continued use but if you take this for over 10 year you must have done some damage to your body. He also was on a pill for depression. I would have to look it up . That's why I tell men Check out the pills before you take anything please Ken

Yes. I also read that they are trying to pass that procedure off as a cure for prostate cancer. Ken

since taking drugs is the first line of defense for bph, i believe that almost all patients when they see their urologist for the first time, they will be asked to try a drug first before the urologist will discuss surgical correction. I myself was asked to take flowmax then Myrbetriq for several months. When they didn't work, only then my uro would let me bring up the topic of surgery. likewise the insurance company would need proof that drugs didn't work before I could prove that surgery was a medical necessity before it would approve surgery.

But i was never been warned that bph drug could have such detrimental effect on sexual functions, equivalent to chemical castration.

So u are right, before a patient take any drug prescribed by his uro, he should check the side effects carefully and monitor the side effects regularly.

DL,

Didn't I write in my summary rebuttal that Doctors who prescribe 5-alpha-reductase inhibitors together with the manufactures should be sued for billions in one big class action suit. They destroyed life of millions of men around the world. So far I see only two safe options UroLift for small prostates and PAE on another pole for large prostates. Everything else bears 30% risk of ED or incontinence. SRP is teh only option for super-large prostates. It shouldn't be allowed to grow beyond 120g in the first place. Anything else is direct malpractice of the attending URO/PCP.

I think that Den, who disn't disclose his years of taking Avodart can try a pump and Testosterone injections supplemented by everyday 5 mg Cyalis. Works miracles on ED.

T^her is always a hope. I'm glad that Urolift is exonerated. There is a lot of misinformation on this blog due to illiteracy, albeit non-intended. Male sexual health should be taught in schools and colleges equally with other sex education because, contrary to women's sexual health, which could be preserved or not. almost every men older than 60 suffers from similar and usually swoped under the rug even from their sexual partners LUTS and related ED problems. Most insurances in US, including Medicare won't even cover anything related to sexual health, rather than counseling under the psychiatric coverage. It's ridiculous and should be eventually addressed by US congress.

It's the Physician's lobby, who enjoy charging exorbitant fees in so called "male clinics" who created that situation, which maybe inadvertently makes BPH treatment in US substandard even by standards of countries like Portugal and Brazil.

I found the activity on that site related to the Prostate health and treatment options almost quadrupled over last few days. I find it very beneficial for everybody, will credit the most educated and active participants and hope that some actions can be taken to improve future medical care of BPH.

Gene

It's used for Prostate Cancer surgery since invention.

DL,

It's not chemical castration, which is used in terminal cases of PC and with sexual predators. In case of "chemical castration" doctors try to minimize the Testosterone in blood to the possible minimal level. in case of prescribing Avodart and other 5-alpha reductase inhibitors DHT is suppressed. DHT is responsible for libido and erections, while testosterone for the secondary sex features: muscles , voice, beard. Testosterone amount stays the same. For young male with levels of testosterone 3-4 time greater than for some aging me, the reduction ion conversion to DHT still leaves enough of it. When T drops with age impotence and drop in libido ensues. Then comes depression and hopelessness. There is very dew mysteries in these effects.

I commented a while ago that Avodart should be prescribed to me in their 80th.

According to recent studies it has a very long lasting effect on libido and erections. By itself it doesn't damage anything, except shrinks the prostate pretty much like PAE but uses a different mechanism of DHT deprivation, although a part of PAE too, but in case PAE, DHT is reduced only in prostate, not in blood or brain. According to teh recent research in some males Avodart can cause permanent loss of libido and correspondingly erection. They are related strongly. Probably injection of T and supratheraputic doses of T may fix the damage. I doubt that anybod does this research. It's supressed by Pharma who markets Avodart and Propecia for hair grows in young balding man.

I personally know a 30-yrea old professional bodybuilder who ijects huge amounts of testosterone weekly, takes Avodart and Propecia to prevent receding hair and confided to me tat he has enormous libido.

Another proof that everything is personal and age dependent.

I just want to clear up a few things since I have talked to a few of you on this forum. I was never on Avodart. I was precribed Jalyn and Rapaflo in 2010. I had the UroLift procedure in December 2016. I am 54 years old. Prior to surgery I had zero problems achieving erections. My ED started post surgery. One month post surgery my urologist said I could discontinue taking the Rapaflo but he wanted me to continue taking the Jalyn because it will slow the prostates enlargement. I have tried pumps, Viagra, Levitra, Cialis, and Tri-Mix injections and none of those things have produced any improvement.

I am also now on Buspar and Zoloft for my anxiety and depression (both of these prescribed within the last 6 months - I was NOT on any anti-depressant prior to surgery),

I have spoken with NeoTract who makes the UroLift device, I have talked to my urologist who performed the surgery and I have been told that they are sorry I am experiencing ED and depression and anxiety and they hope I find a solution to my problem. And the rep for NeoTract simply said, "UroLift isn't for everyone."

So essentially no one wants to take any responsibility or admit that something went wrong, but SOMETHING did go wrong. I know I will never know the truth of what caused these issues. If I could turn the clock back I definitely would have never had the surgery.

I am seeing my urologist this morning for a routine check up and I am going to control my tongue because I tend to get quite angry at his nonchalant attitude. And at his assurance that my surgery was a success.

It was a success in the fact that I now can pee with minimal straining, but I would take straining to pee over what I deal with now in a heartbeat.

This forum is a way for me to vent my frustration. And I thought maybe someone else somewhere has had a similar experience with UroLift, but it seems everyone has had great success with their procedures. I guess I drew the short straw.

Den

sorry that urolift has been causing u to suffer so much for so long.

u are well informed and have consulted experts on urolift. i am just an ignorant layperson and i also know nothing about the drugs u have been taking.

just wondering:

if ED happened right after urolift

if u have positive identified ED was caused by urolift, and

if u ever considered or has ur urologist ever suggested having all the implants removed?

Yes that is true. When I first went to my urologist he gave me Flomax and Rapaflo. I hated them both. That is when he told me about the Urolift. It was only out 3 months and I was the 20th man he did.

When a doctor ask you to take a pill. First ask him if he know anything about the drug. If he does then look it up and see for your self. And if you feel you do not what to take that because of any of the side effects. Don't. Call the doctor and ask for something else.

That is your right. You can't be forced to take anything you don't want. And you can't be force into having any surgery you don't agree with. Good luck to you all ken

hello gene and ken,

your and Ken's knowledge on BPH drugs and their side effects are astounding and broad. it would be most helpful to readers if one of both of u have time to tell them what these drugs are and their side effects and danger for taking them long term.

all these drugs are meant to be taken long terms like years. a search on internet showed that they could reduce the amount of ejaculate or even dry orgasm but did not answer the question that if all the side effect would disappear after the patient stop taking the drug. there seem to be littleevidence that these drugs would cause permanent damage to sexual functions.

if anyone is interest, Below is from Johns Hopkins. Note sexual dysfunction is not emphasized or mentioned .

Medication

Drug treatment of BPH is a new development, and data is still being gathered on the benefits and possible adverse effects of longterm therapy. Currently, two types of drugs-5-alpha-reductase inhibitors and alpha-adrenergic blockers-are used to treat BPH. Preliminary research suggests that these drugs improve symptoms in 30 to 60% of men taking them, but it is not yet possible to predict who will respond to medical therapy, or which drug will be better for an individual patient.

5-alpha-reductase inhibitors

Finasteride (Proscar) blocks the conversion of testosterone to dihydrotestosterone, the major male sex hormone found within cells of the prostate. In some men, finasteride can relieve BPH symptoms, increase urinary flow rate, and actually shrink the size of the prostate, though it must be used indefinitely to prevent recurrence of symptoms. It may take as long as six months, however, to achieve maximum benefits from finasteride.

In a study of its safety and effectiveness two-thirds of the men taking the drug experienced

At least a 20% decrease

In prostate size

(Only about half had achieved this level of reduction by the one-year mark)

One-third of patients had improved urinary flow

And two-thirds felt some relief of symptoms

One study published last year suggests that finasteride may be best suited for men with relatively large prostate glands. An analysis of six studies found that finasteride only improved BPH symptoms in men with an initial prostate volume of over 40 cc (cubic centimeters); finasteride did not reduce symptoms in men with smaller glands. Since finasteride shrinks the prostate, men with smaller glands are probably less likely to respond to the drug because the urinary symptoms result from causes other than physical obstruction (for example, smooth muscle constriction). A recent study showed that over a 4-year period of observation, treatment with finasteride reduced the risk of developing urinary retention or requiring surgical treatment by 50%.

Finasteride causes relatively few side effects. Impotence occurs in 3 to 4% of men taking the drug. Finasteride may also decrease the size of the ejaculate. Another adverse effect is gynecomastia (breast enlargement). About 80% of those who stopped taking the drug had a partial or full remission of their breast enlargement. A study from England found gynecomastia in 0.4% of patients taking the drug. Because it is not clear that the gynecomastia is caused by the drug or increases the risk of breast cancer, men taking the drug are being carefully monitored until these issues are resolved.

Finasteride can lower PSA levels by about 50%, but is not thought to limit the utility of PSA as a screening test for prostate cancer. The fall in PSA levels, and any adverse effects on sexual function, disappear when finasteride is stopped.

To get the benefits of finasteride for BPH without compromising the detection of early prostate cancer, men should have a PSA test before starting treatment with finasteride; subsequent PSA values can then be compared to this baseline value. If a man is already on finasteride and no baseline PSA level was obtained, the results of a current PSA test should be multiplied by two to estimate the true PSA level. A fall in PSA of less than 50% after a year of finasteride treatment suggests either that the drug is not being taken or that prostate cancer might be present. Any increase in PSA levels while taking finasteride also raises the possibility of prostate cancer.

Alpha-adrenergic blockers

These drugs, originally used to treat high blood pressure, reduce the tension of smooth muscles in blood vessel walls and also relax smooth muscle tissue within the prostate. As a result, daily use of an alpha-adrenergic bloeftv drug may increase urinary flow and relieve symptoms of urinary freurgency, and nocturia. A number of alpha-l-adrenergic drugs-doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin),and tamsulosin (selective alpha I-A receptor blocker- FLOMAX) for example-have been used for this purpose. One recent study found that 10 mg of terazosin daily produced a 30% reduction of BPH symptoms in about two-thirds of the men taking the drug. Lower daily doses of terazosin (2 and 5 mg) did not produce as much benefit as the 10 mg dose. Thus, the authors of this report recommended that physicians gradually increase the dose to 10 mg unless troublesome side effects occur. Possible side effects of alpha-adrenergic blockers are: orthostatic hypotension (dizziness upon standing, due to a fall in blood pressure), fatigue, and headaches. In this study, orthostatic hypotension was the most frequent side effect. The authors noted that this problem can be mitigated by taking the daily dose of the drug in the evening. In another study of over 2,000 BPH patients, a maximum of 10 mg of terazosin reduced average AUA Symptom Index scores from 20 to 12.4 over one year, compared to a drop from 20 to 16.3 in patients taking a placebo.

An advantage of alpha blockers, compared to finasteride, is that they work almost immediately; they have the additional benefit of treating hypertension when it is present in BPH patients. However, whether terazosin is superior to finasteride may depend more on the size of the prostate. When the two drugs were compared in a study published in The New England journal of Medicine, terazosin appeared to produce greater improvement of BPH symptoms and urinary flow rate than finasteride. But this difference may have been due to the larger number of men in the study with small prostates, who would be more likely to have BPH symptoms from smooth muscle constriction, rather than from physical obstruction by excess glandular tissue. Doxazosin was evaluated in three different clinical studies involving 337 men with BPH. Patients took either a placebo or 4 to 12 mg of doxazosin a day. The active drug- reduced urinary symptoms by 40% more than the placebo, and increased the urinary peak flow by an average of 2.2 ml/s (compared to 0.9 ml/s in the placebo patients).

Despite the previously held belief that doxazosin was only effective for mild or moderate BPH, patients with severe symptoms experienced the greatest improvement. Side effects-including dizziness, fatigue, hypotension (low blood pressure), headache, and insomnia-led to withdrawal from the study by 10% of those on the active drug, and 4% of those taking the placebo. In men treated for hypertension, the doses of other antihypertensive drugs may need to be adjusted to account for the blood-pressure-lowering effects of an alpha-adrenergic blocker. These drugs may also induce angina in men with coronary heart disease. A doctor will be able to determine which individuals are good candidates for their use.

Good afternoon Gene. I agree with you 100%. Some of these drugs that they give us are very bad for us. They do more damage they good. There are some doctors that are good and care about men and there problems. But they there are doctor that will not tell you everything and I know there are men on here that have heard this.

1.All will be the same.

2.You don't need it

3.That rarely happens

Well some of us still enjoy sex all the same pleasures and we want nothing to change. Sometimes we feeling like just because we are older we need to be put out to pasture like a old horse.

We must all way look for a doctor that will listen to our concerns and not this 5 or 10 minutes rush you in and out where you have nothing answered. Remember a doctor can suggest you to do or take something but it is up to you to say no or yes. Take care and god bless Ken

Den,

It's the same thing as Avodart + flomax. Has side effects of both, kills your libido and casuses RE.

Rapaflo is just as tronger version of flomax.Did you rry testosterone injection + cialis? It should work on you after 3-4 monthh

Thanks dl for John Hopkins study. Good post! Hank

Good Afternoon Gene.

Very good post on the drugs that men end up taken. That is why I all way tell anyone that whatever pill you are giving look it up for yourself because not all doctor know all the side effects of every pill they give out. And for your own good it best.

As you say they do not mention anything that regards to sex. Now we have to look at this a couple of ways. It all depends on how good your doctor is. Most doctors are only concerned with getting you to pee better. That is the main thing.

When you go in for a surgery there are a lot of time they do not tell you of the sexual side effect they kind of say a few things and they over look it or tell you all will be the same. And you talk about retro. They tell you that you don't need it. That is not there choice. That is your because you are the one that will have to deal with any side effects... And they if something happen they give you another pill .

Some will explain it all and answer all your questions and when you need to get a hold of them They are there for you. I can get a hold of my doctor anytime. I can send him a email and he will get back to me either the same day or the next.

What you are asking I will have to think about it. That will be a lot of typing. Maybe I can cut it short and look at the pill that are giving out the most. We will see.

I can tel you of one pill that I have taking and did not care for. Flomax ( Tamsulosin ) It may work to help you pee it will relax the muscles in the prostate and the bladder. That would be great but there are 55 possible side effects.

This is just some of the things they tell you about your sex life. Decreased sex drive. Loss in sexual ability and retro ejaculation. There are more about sex but it's the same. Forget about it. I was on it before I had my Urolift done. I took it for 2 weeks the first orgasm I had I could not believe it.

The built up was there but when the orgasm it. I felt nothing. ZIP. It was like I did nothing. And with no ejaculation. I felt short changed and in complete. I called my doctor and told him and that is when he told me about the Urolift. That was 3 1/2 years ago and I am very happy I had it done.

Now with the built up in you symptom. Let me say this. Last year when I was in the hospital. They put me on Flomax again because I shut down. My doctor ask me to please take it for now. I said okay but when I am out of here I'm done

Turned out to be a inflamed bladder.I was on Flomax for 9 day's I did not take it anymore when I came home. Well it took me almost 3 weeks to get my ejaculation back. Now can you picture a man that has taking this med or 2 to 3 years. How long will it take to go back to normal or will it be permanent. We never now. That is why you have to do your research on any pill that a doctor give you

I hate to get off this subject but I was reading this the other day. Men that have there prostate removed or have any procedure that they do not save the nerves. Do you know that it can take 2 to 3 years for a man to get his erection back and that is with help. I do not know if all doctors tell there patients everything. I know some men have good results but it can happen

Well that is all for now. Take care all and remember do your researchKen

Hi Gene,

Yes, I've tried everything and have had minimal to zero results.

I had an appointment with my urologist today. He is simply perplexed. He has me scheduled for a CT pelvic scan next Monday to see if that shows anything that could be causing my problems. If that doesn't work, he wants to refer me to a specialist. He mentioned the Mayo Clinic if I'm willing to travel. That will all depend on the cost for me.

Thanks for your suggestions,

Den

DL,

I don't understand all the drug terminology very well either. But you guys on here seem pretty well informed and I appreciate the words of encouragement and advice.

Yes the ED occurred right after the surgery.

No, my urologist has not identified a cause.

Yes I have considered having it removed, but I'll still be left with the metal clips that cannot be removed from the outer wall of my prostate, so I am not putting myself through another surgery that could mess things up even more than they are.

I saw my urologist today and he has me scheduled for a pelvic CT scan next Monday. If that doesn't identify any problems, he wants to refer me to a specialist, perhaps at the Mayo Clinic.

Den

Hi Den,

I fully appreciate your desperation. I doubt that CT scan will show anything relevant,. I don't even knwo why he prescribed it. Just another dose of X-ray irradiation. Not small BTW. I never heard of teh case when everything fails. Did you try a private "male clinic" and talking to real good sexopatholgist ? I have serious doubts tha UroLift could damage your prostate nerve bundles to syuch extent . The pins pit through the lobes are very small, and the site heals itself. I would still blame the combination of your 5-alpha-reductase inhibitors + flomax+UroLift trauma.

Did you try vacuum pumps with elastic rings? They suck but work on practically everybody. I use an elastic ring sometimes. It can produce an erection and keeps you last longer. Many young norma males use it. Bought at CVS. The last resort is a pump implanted into the scrotum with release button. It my be expensive though,$6000-7000) and sometimes they get infected after a few years. Works for everybody who lost both, libido and erections. Just curies, is your libido still there? If it's not present, you will never get spontaneous erection at your age.

I wish you best of luck.

Gene

hello den,

i had spoken to urolift rep in CA about tabs that are left behind. she said they would not interfere with any body function (except on MRI images).

if they really bother u and u want them out, i believe they could be retrieved by simple open prostatectomy. but the problem could be u will have hard time to convince ur insurance it is a medical necessity.

just curious if CT sees if any implants is pressing on a nerve?

DL I sent Den a PM seeing if he could have another doctor do a ridge scope on him to see where the clips were put in and to see if there is any scare tissue from where one may have been put in wrong and then taking out Ken

what is a ridge scope and how it could see urolift implant metal tabs located on the capsule of the prostate?

Sorry DL I spelled it wrong. Rigid cystoscopy they would be able to tell if there in the right place and any scare tissue Ken

Do you mean scar tissue?

I'm sorry. I spelled it wrong. It looked good to me. I should be in bed not reading. Having a stress test tomorrow. There trying to find out if my blockage is worse or my A-Fib is failing. It will be 2 years November 28. Have a good night and I will take to you later. Ken

ken,

in den's situation, are u sure scar will cause erectile dysfunction? i have not read it in any literature. but i am not well read like Gene and u.

i thought the nerve bundle is on the external surface and not on the interior surface of the prostate. scope can only examine the inside of the urethra. thus if an implant is clamping on any nerve, the scope will not be able to tell.

look at it another way, turp or holep hollows out the entire interior of the prostate and they give the patients RE but not ED. it seems that what commends the erection has nothing to do with the urethra surface, thus looking at the interior metal tabs of the implants is likely not able to diagnose the source of ED.

u are the expert of urolift, not sure if u agree. perhaps den knows more what he and his uro are looking form either using MRI or scope.

make sense or i am talking nonsense?

DL

What I am saying is. There is a certain way the clip go in. I'm saying that if the doctor goes in they can tell if the clips are in the right place but they also should be able to see if the doctor went to high there would be scar tissue. The nerves are at the top of the prostate. Don't know if they can reach them through there or not. May have to look that up. Ken

DL Could not sleep. Had to look it up. You can't get to the nerve bundle from the inside of the prostate. Good Night...Ken

Nerve bundles (I believe there might be two) are on the outside of the prostate capsules. That is why mine were never touched/disturbed with the SRP. These are one of the precious parts we need to protect, and consider, when looking at all these intermediary steps/mouse traps. In other words, hands off. Do not touch!

Dave