Tulsa Procedure and FLA for BPH

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Hey Jim -

Just registered to the board, but found it and read it thoroughly when I first had a traumatic event in Oct 2020. I am 64 and in otherwise good health, but suffered BPH for many years. Took Flomax for years never sure it did any good.

Finally had my PCP send me to his Urologist for a checkup. Went to pee before entering the office, and when I got there they asked for a urine sample... duoh. So I squeezed out what I could, then went in and the nurse did a bladder scan. I think she said s**t or Jeezus, and her eyes lit up. I said what's the matter, and she said your bladder is at 99% capacity.

The doc came in, and immediately said we have to catheter you.... he took out 2.5 liters.

After this traumatic event, and learning I was now entering the world of CIC, I found this site and took comfort in the many helpful posts, including yours.

I am now an old pro at CIC. I stumbled upon Cure Ultra M14C 14FR pre-lubed catheters, and couldn't be happier with them.

I lost about 8 pounds (of mostly urine), now have a flat belly, sleep through the night, no incontinence, never have to run to the bathroom, sex life is good... CIC has been all positive.

BUT - I keep wondering if I want to do this the rest of my life, or try a surgery/procedure at some point. Just don't know what to do. The Urologist is pushing a bi-polar TURP, and says he does them all the time with great results. But then I read some of the war stories here, and don't want to deal with all the potential side effects and issues... so hard to decide what if anything to do.

The doc says that based on my large median lobe, I would not be eligible for other treatments.

Now that I am registered on this board, would like to more actively post and learn more.

Your comments always welcome.

Your story is a lot like mine except 8 years ago. CIC turned my life around without any of the risks associated with procedures and surgeries. After awhile it became as routine and painless as brushing my teeth.

Like yourself, I also have explored other options. For awhile I took Daily Cialis which helped reduce my cath frequency some, but then I started getting side effects from it so stopped.

I also at one time was able to rehab my bladder enough to the point where I stopped CIC for months. Now, I cath sometimes and sometimes don't. Depends on the volume in my bladder.

I have looked at all the options. So far nothing has jumped out at me. I think it all comes down to what you're looking for. If you're just looking for an alternative to CIC there are any number of procedures including the TURP you mention.

For me, preserving my ejaculation is a deal breaker, at least for now. So that doesn't leave too many options unless you want to roll the dice. Some procedures have more of an incidence of retro than others, but they all seem to have at least 10%. I think the TURP you are talking about has about 100% retro. Not for me, now.

I started this thread because I heard about Tulsa. But from what I understand, Tulsa also has a high incidence of retro. Another procedure mentioned here is FLA.

It's only done by a few doctors and the results are mixed. Durability is a question. Data is relatively sparse. Retro seems to be about 10% which is similar to Rezum.

Your criteria may be different. Many men don't care about retro at all. If that's the case, you should take your time and look into all the options.

You say your doc said your large median lobe limits you to just one procedure. Not sure if that is true or not. I believe HOLEP works for larger median lobes and maybe some of the other less invasive procedures as well, but not sure.

Like I said, I'm like you except 8 years ago. And like yourself, open to options other than CIC where I will be less dependent on a catheter but so far haven't found anything that calls to me.

But who knows. Maybe something new will come along that better meets my criteria. Or maybe, as my age advances, I will start to lose the dexterity required for CIC. If that started to happen, I would re-evaluate my criteria, go for one of the current procedures and swap being more independent for a chance of retro.

Can't tell you what to do. I would like to say you're relatively young and something really great should coming down the pike in the next 5-10 years. But that's what I thought 8 years ago and still haven't seen it. But I have my criteria and perhaps a bit picky. Meanwhile it's CIC which has served me well to this point.

Jim

Thanks Jim. Your thoughts reflect what I feel right now.

One thing that spurred my interest in considering other options was the cost of my catheters.

I am still working, and my company used to offer an HMO. I paid nothing for my catheters for a year and a half. Then they got rid of the HMO option starting in 2022, and under PPO, the catheters are costing me about $3,500 a year due to deductibles. Ouch.

I turn 65 in October, but since I am still working I am using private insurance. What do catheters cost under Medicare with a BCBS supplemental policy?

Anyway, I think you and others mentioned "Sperling" a few times.

I did find this doc, so he must be who you are talking about. I am intrigued by this FLA procedure, and he even mentions having a large median lobe as an issue that this treatment specializes in. He also goes in through the rectum, not urethra (if I'm not mistaken).

I'm in Chicago, but would be open to flying to NJ or FL to do this if my insurance would cover. Or maybe there are docs in Chicago that perform this same procedure. Thoughts on this?

Hello y'all. I've also been infrequently visiting this site. Glad to see there is still some support here and great to see Jim.

I'm still doing catheters. Probably use 3 - 5 per day. I've been blessed by not having much trouble with UTIs. I think part of it is that I have used the drop in method for a long time now. I hang the catheter on my cabinet over the toilet, use my left hand to raise penis to correct position and widen the opening a little and insert the end of the catheter. I have to be careful to lower penis all the way hanging before pusing catheter all the way in. I have gotten some blood by not doing this carefully. Thankfully, my urethra has so far always recovered. I still like the fact that I am completely voiding.

I haven't done a log for awhile. I know I should drink more water and less black coffee but I'm not having any real problems. No doubt that my bladder now has more feeling and I am definitely using that feeling of needing to pee more than watching the clock as I had to do in the beginning. The only thing that kind of worries me is that at this point, I can't get out a drop before cathing. A couple of years ago I could usually get out just a small amount first. This could be because I am regularly totally emptying so when I get urgent calls to pee, there really isn't all that much in my bladder. Sometimes my urgent feelings still go away for a time but usually come back. Sometimes there's close to 500 ml I think but haven't actually measured. More often is probably around 300 to 350 ml.

I've been doing this for around 5 years I think. The Urologist I was seeing has recently retired. My PSA numbers are too high but they aren't increasing and my general MD doesn't seem worried about it but is keeping an eye on me. Actually, he is my doctor's former PA who I guess is now a doctor. Anyway, he's the one that gave me my annual medicare exam.