The Urolift procedure; patient views and questions

For me, it was at the 4-6 mark where I knew I was going to be happy.  I'm at 7 weeks today and I still feel it a little, but confident it will go away completely eventually.  It's so slow I probably won't even realize when it completely disappears.  

As I pass week 4 I am hoping to catch you up!

Good morning J. You had this din the UK.  Was this a trail.  Did your doctor tell you about any side effects with the new 4D Urolift.  I have been looking for information on it and there is very little.  But it gives me a concern and I did find a few doctors that have some concern the way they do it.  The first one is holding the bladder neck open with 2 clips.  There is a increased risk of retro ejaculation.  And the second is delivering the clips in a posterior direction, I worry the neurovascular bundles may be injured, increasing the risk of erectile dysfunction.  I had my Urolift almost 3 years ago. No side effects.  I would never have the new one.  I hope all goes well for you  Lets us know  Ken

I appreciate your study of this issue.  Six months since my Urolift and I, also, have been fortunate to have good results.  But, though in my heart, I am hoping that the newer treatments for BPH are better, my head is telling me "Not so fast..."   Thanks for looking out for us.

Thank you Mark.  I have been looking up all the procedures.  I try to get all the information I can.  The new 4D Urolift can't find any trials or information.  The only thing I found was that one Dr. Chin doing it but the way he is it may cause more problems.  They should stay the way it was. Improve the clips.  I did read that they are having good results with median lobes and Urolift.  Take care  Ken  

Not a trial. In fact I am not sure if the 4D pattern is something that the manufacturers have approved, or it’s just a modified technique that some surgeons are adopting on their own initiative. I can’t find anything that suggests there has been formal trials or even a paper about the technique comparing results.  But surgeons are a bit of a law unto themselves wherever you are in the world. I think the 4D pattern is within the allowed range of positioning, just not following the suggested positioning in the Urotract manual. So give it is a minor up that can be reversed, some of them have put the devices where they seem to have more effect in retracting the urethral wall and bladder neck. I’m still improving slowly and will let the forum know how it goes. Well into week 5 now. Sort of wondering if the better opening results around the bladder neck means it takes a bit longer for the body to adjust to the change.

I think that is wrong.  They are going against the manual.  Most men have this procedure done because they do not want retro ejaculation.  If they hold the bladder neck with a clip you will end up with retro which goes against the procedure.  I hope you improve.  If my doctor would have told me that I would have said no.  The urolift is only to pull apart the prostate not mess you up.  I think I'm going to write the company and talk with my doctor.  They should know what is going on   Take care  Ken    

The artifacts (especially with a 3T MRI) are common knowledge.  They are indicated on the Urolift website. Perhaps a multi-parametric MRI should be done before the Urolift followed by a fusion guided biopsy of any suspicious lesions (Pi-Rad score of 3 or greater).

The MRI obscuration is 1.6mm around each inner and outer clip, my uro who does Urolift specifically mentioned it as a drawback.  I didn't have urolift.  Outer clip can never be removed (well, not without a full prostatectomy !), nor suture; removal can only be of innermost clips.  If have 8 clips, pretty much everything is then obscured I believe so if PSA high, can't use MRI to show no need for biopsy (dodgy MRI outcome like dodgy PSA, is unreliable, a good MRI outcome however is reliable and allows you to avoid biopsy entirely; however dodgy MRI outcome can at least help target a biopsy into the right area of harmless inflammation...).  Urolift doesn't damage prostate tissue or reduce volume of prostate muscle or nerves (unless suture goes thro' a nerve inside prostate or on outside of capsule, or unless outermost tab pressing on bundle of nerves on outside of capsule, stuffs them up - no idea if this is possible, or if outermost tab is in fact that far out..).  So if modified urolift ended up stuffing up the operation of the ejaculatory blocking sphincter, interesting to contemplate whether that would flatten or reduce the quality of orgasm, or not; depends whether that phenomenon, an outcome for some with TURP/HOLEP/PVP-Greenlight, is as a result of the prostate muscle working less hard as less back pressure if can just easily pump semen up into bladder thus triggering fewer nerves, or whether the damage to orgasm, where it occurs, is due to some prostate nerves being cut out entirely by TURP/HOLEP/GL (or some remaining ones, thermally damaged).  There is NOTHING in the one article of research I found (see 2 of my earlier posts for the search term to find it with) on impairment of orgasm by those 3 procedures, that comprised speculation of WHY the impairment (reduction in sensation) occurs i.e. which of the above might be true, so one can only speculate whether holding the bladder neck open alone, would cause such impairment. Men often write that Tamsulosin has caused RE, but none of them men ever write about whether or not there was any change in quality of orgasm; that data would help, since if there were no change in quality of orgasm? for most/any of the men with Flomax-related RE, then one could pretty confidently say that pinning the bladder neck open with modified Urolift, albeit leading to RE, would likewise not flatten or otherwise damage the orgasm, and one could then conclude that the effect must be due to fewer nerves/muscles left, and not due to the thing having to contract less hard due to less back-pressure. 

These doctor are wrong.  They are not doing the Urolift the way the manual states.  If you pin the bladder neck back you will end up with retro.  That is why most men have the Urolift done because they do not what to loose it.  I for one would not have had it done if that is what they would have told me.  I wrote a long letter yesterday to the company about the Doctors in the UK and a Dr. Peter Chin in Australia.  I hope they get in trouble  Ken 

Your uro' blamed it all on the Tamsu including libido ?  I thought it was Finasteride that was associated with low libido, although Tamsu' can lower blood pressure which I suppose could slightly weaken erections (???).  I asked for Finasteride and my uro' said you don't want that at age 49, mentioning also the development of man-boobs as well as libido effects.  He said try tamsu, I declined as there is a family history of cataracts and I know the operation can be harder if you EVER even once took tamsu, as it binds even more strongly, much more so, to the A1 receptor in the iris, than in the prostate.  Nonetheless, it is interesting that Tamsu gave decreased ejaculatory sensation?, if we assume that's not due to the finasteride then .... at least for you, it had that effect.  Which may mean (if it generalised well) that it is the RE that causes decreased ejaculatory sensation?, presumably because of the reduced need of prostate muscle to "pump" as the flow is easier up into the bladder - so that (if this conclusion were correct), the decreased ejaculatory sensation? that some report after TURP/Holep/PVP-Greenlight, would not be due in this hypothesis to there being less prostate tissue left, or due to nerve damage, but due to the RE as the primary cause.  Someone ought to study this properly, hard to do I'm sure especially as it is a bit subjective ....

We need some data from other men that take Flomax (Tamsu), particularly in absence of finasteride or surgery.  Many have posted here that Tamsulosin caused them RE, I do not recall any postings on whether or not that came with decreased ejaculatory sensation​. 

I had the urolift procedure about a year ago. I had blood clots for about a week and had to g to emergency three times.

?  I may have some slight improvement. I get up at night about three times but I take tamsulson  in the evening. It helps a lot. I'm 78. My urologist thinks my declining libido is age not tams. related.. o  

I think your urologist is pulling your leg. Research it yourself by looking up side effects of Tams on the web.

Neal

Hi, Evidilos,

Would you be kind enough to tell some more about exactly why you had to go to the ER three times? Was it *just* the blood clots blocking your flow? What did the ER people do for you? I'm 72 and seriously considering having the Urolift procedure within the next several months. Would you do it again? Thanks in advance for your help.

Hey Robert going on 3 years for me.  That is the only procedure I would consider.  I healed fast and no side effects  Have a great day  ken

Hi Ken, Glad your feeling good again.

frank.

Ken:

Did the ever figure out what was causing your recent issues?

George

Hey Frank.  Doing ok but they never figured out why it happen.  Bladder just stopped.  Everything looked good on the inside.  Who knows.  How are you doing  Ken

No they never did.  I just stopped 32 hours ( 500 CC ) and then 17 hours ( 800 CC )  still don't know.  After the scope he said all looked good.  I hope I never have to go through having a catheter again for a while.  The 7 hurt like crap.  I still say it hurt because my bladder was inflamed but they said nothing.  I have to go see my urologist when he want don't know  Ken

George & Frank.  I don't know if this has anything to do with the problem.  But even since I have come out of the hospital my libido has been very low.  I have no feeling to do anything.  I don't wake up with anything anymore and porn I fine boring.  The last time I had any feeling or reaction down there was in the hospital with the catheter in.  I hope it goes away  Have to talk with my doctor.  I do do Testosterone Gel every morning.  Has anyone had this problem after being in the hospital  Thank you  Ken

Set's put it this way: I don't remember ever having a high libido after a hospital stay.  I think you'll be fine Ken, just give it some time.  Unless you just started taking a medication that you have never taken before, there is no reason for you to all of a sudden permanently develop a low libido.

George 

Thanks George.  The only thing they put me on was Flomax for 9 nine while I was in the hospital.  I stopped that as soon as I came home.  I guess I want to but not getting any coperation Just have to wait  Ken

Hi Ken, I wish i had the answer for your libido problem. Glad to hear your doing better.I can't figure out why i feel cold most of the days. Idon't have a UTI , no fever . Can you get a Uti without a fever?my  GP says to wear more clothes.Not a good answer. I hope it has nothing to do with CIC? I don't know?

Take care Ken.

 

Thanks Frank.  I'm not going to worry about it.  It will come back in time..  It's not like I have them lined up waiting.  I did not get the chills until a week later no fever.  I think I had the UTI before I had the scope done that is why the catheterization ( 7 Time's ) way so pain full. I hope I never go through that again.   I don't think it has anything to do with the CIC it's just something that happen some times. This is the first one i had in years. Still don't know why I stopped peeing or where the infection came from.  If you think you have a UTI go to the doctor and have it taking care of please  Ken      

I agree with George, after what you've just been through this is no surprise and I bet you it self-resolves within 6 to 8 weeks, max.  For now, put it to back of your mind.  I abstained for 10 days after prostate biopsy (and had worrying pain in penis at first attempt, at day 10, causing abandonment of coition; then fine at day 13).  After holep I abstained entirely for a whopping 7 weeks or so, which wouldn't normally have been anything like possible, yet was in those circ's.  Your body and mind are still affected by that trauma, even if that isn't directly evident to you.  I have never heard of testosterone gel, but have read vaguely of testosterone ?supplements becoming more fashionable for younger men. 

My acute LUTS symptoms (following on from years of milder symptoms, but very distinct far more extreme and very sudden) that preceded my Holep were deemed to have been due to acute bacterial prostatitis, but it didn't manifest in either a fever, or even in anything that showed up in a urine sample.  I believe from googling this is not uncommon, for it to be confined in the prostate, not show up in pee, and generally hard to diagnose (they're not much into, ahem, taking other fluids, or quick prostate massage prior to pee sample - maybe those rarely-used techniques would make it show up..no doubt the latter, and perhaps the former, would alarm some patients).   It's a beggar getting them to give you antibiotics for what might appear to be acute prostatitis if it's not showing up in urine, my GP (state doctor) and uro' didn't give me antibiotics for (I presume) this reason - though I did later get antibiotics ?as an incidental to be being scoped and then to the biopsy and finally as an incidental to the holep.  So in short "can you get a Uti without a fever" - well, I think so.  If you've been treated to prevent LUTS, via urolift or other options, then an infection in the prostate wouldn't even show up, I guess, as LUTS, my uro' said post-holep that would be the case for me (it wouldn't show up if contained within that organ). 

Yes  I am just going to take it easy.  Not going to worry about it.  The only pill they gave me was flomax I stopped that the day i came home.  Waiting for my doctor to e-mail me to see if he want me to come and see him.  Time will tell  I hope it never happens again  Thank you  Ken

I have been using it for the last 2 years.  My doctor told be to try it.  But have not use it in the last few weeks.  Did not have it in the hospital and they are not going to give it to you.  Like I said I will just take my time.  I am just trying to figure out why it happen.  No one can tell me. When my doctor did the scope in the hospital he said all was fine.  But there has to be some reason why.  I do have cyst in my kidney don't know if that has something to do with it.  But I guess life goes on.  There are men on here that have more problem then I do.  Why should I complain.  God bless you all  Ken