Turp operation or laser ?or leave alone?

Robbie,

Propbably not what you are thinking of but I had good results with a 1 liter disposable bedside urianal which I keep in a basket lined with a disposable garbage bag, right by the head of my side of the bed.

I often go every two hours or so at night, sometimes less sometimes much more. But with a urinal every two hours doesn't hurt my sleep. For example if I go to bed at 12, I'll void twice before going to bed. If I then go every two hours I'll wake up at 2, 4, 6. That's three times. With the bedside urinal I get up in the dark, keep one eye closed standing next to the bed, pick up the urinal and open the cap and urinate with the other hand,  close it up, check the level against a night light (sometimes I have to empty it) put it back in the basket and go back to bed. There's no walking, opening lights, aiming for the bowl, etc. I'm done in 60 seconds or less. I keep my mind empty of thoughts, and I'm back to sleep in seconds.

Although I had a greenlight laser and a bladder neck resection, it only addressed my retention and difficulty passing urine. It didn't help my nocturia that much. Sometimes I'll go every 20 minutes all night long, and in that case sleep is interrupted by 20 or more voids in an 8 hour period. Some people report a big improvement in their nocturia after a procedure, but others, like me, don't. 

hi Bob,  oh my god ... going evey 20 min. all night long !!  must drive you crazy ... i've thought about the bedside urinal ... maybe i'll try it.  i never turn on lights to go to the bathrom at night ... and i sit down to pee .. because it's so slow to empty ... and it's more comfortable ...plus i never drip on the floor .. more sanitary !! 

Hi Rob,

I keep a journal. It happened 8 times in the last three weeks. Looking on the bright side, it didn't happen almowt 2/3 of the time. Luckily I'm retired, so if I don't get to sleep untial 8AM I can sleep to noon, and catch a nap later in the day. But compared to waking up in full retention every night, like I was before my Greenlight, I'd rather pee too much than not at all.

If you are very slow to empty (ie, a trickle rather than a stream) you might need a procedure, especially if you are retaining more than 250ml post void residual. But it may or may not help the nocturia. Some people (like me) have additional problems with the bladder neck, bladder, etc., which the widening of the prostate can help but not eliminate.

Best of luck.

Bob

definitely no fun !! 

Hi Robbie, you can probably search for my recent posts on the matter. I had meds, then greenlight (did almost nothing), then TURP (only worked for ~15 months), then doctors recommended another round of TURP or complete removal, then I searched the net and came across HoLEP which none of the 6 urologists I had seen ever mentioned because they don't do it so they have no financial incentive and experience base to discuss it. I went to Dr James Lingeman, had HoLEP, and have had zero problems ever since. Went to bed early last night, 9:30PM, got up at 7 this morning. I usually do not need to get up at night anymore to urinate.

So travel to the best HoLEP doctor you can find on the net. Lingeman is out of Indi and is the most experienced in the US (~3000 done). The woman at Mayo in Rochester was trained by Lingeman I believe and am told she has done many. Others can be found around the US. Just make sure they have done at least 30 HoLEP procedures and hopefully more. There is a learning curve. DO NOT let urologists who do not do HoLEP discourage you from looking into and getting it.

Robbie,  you must find out how large your prostate is.Any urologist can do an ultratrasound through your backside to determine size. If less than 80-100 mg urolift would give you an instant solution. I have corresponded or read posts of at least ten Urolift patients and there has not been on single regret for doing the procedure. I have read the results of clinical trials also, all results of urolift are positive. It's simple, quick and mostly painless but not many Docs do it because it has only been approved by the FDA since Sept 2013. Medicare may not pay for it yet either.

I can tell you where you can get it in the US this month for a total cost of $2500 out of pocket. The Doc will apply for insurance or Medicare reimbursement for you but you may not get it for a year.

Urolift will fix your problem for at least a few years, maybe a lot longer and allow you time to determine a permanent fix like Holep. You will not get Holep in less than several months.  If your prostate has a third lobe or is too large urolift cannot be done so you have to find out the size and whether it has a third lobe.

The prostate is examined with a cystoscope through the urethra. I've had both the cystoscope and the ultrasound, both are easy and painless.   Good luck and keep us posted!

hello Bill, wow .. that sounds fantastic. I haven't heard of HoLEP before !! But i'll research it now !!  A dreaded question for you ..any problems with ED ?  is your sex life ok ? 

from everything i've read TURP sounds akin to being butchered and much of the success depends on the Dr. doing the butcheing... i'm on medicare, no private insurance.. what's the cost of HoLep ?  thank you so much for sharing.

hi Ron,  I've had my prostrate checked by more than one Dr. and it only a little enlarged. So i may be a good candidate for Urolift !!  do you have any effets with your sex life .. that's the part i dread ..  yes, please sahre with me the info on the doctor who will do Urolift for $2500 .. I can afford that. 

Is it an outpatient procedure or a short saty in a hospital ? I've got to take care of this problem and try to get my life back ... thank you so much for sharing the info.

Ron,  I am also one of those who is procrastinating the surgery for the fear of side effects, RE being foremost. I am 49 and suffering for 4 years and want a relief because lack of sleep is affecting my work apart from discomfort and agony of retention specially in the middle of night though my daytime are not as bad.

 I am avoiding Dutastride as it may leave me with ED even though I know it gives me releif.   I am not sure if Dutastride can be discontinued after the size of the prostate reduces in few months and  sexual health is restored. Or it needs to be continued indefinitely. Some feedback will be helpful. 

I am forming an opinion the Greenlight might be a good option to avoid RE.  I am trying to find a doctor who can assure me of this.  Anypointers will help. 

I also followed up on Ron' advice and reached out to Dr. Kella for Urolift.   I am not sure if I am a candidate for this as my prostate is 85g and i have median lobe protruding my bladder. 

I am willing to travel to San Antonio from Delhi which is long flight but it will be disappointing to find after reaching there that I am not a candidate for this procedure.   However I would like to get a greenlight procedure done as second best option if Urolift is not viable in my case.   I would appreciate feedback from the participants who have spent equal or more amount of time researching the topic or have experienced some of the procedures. 

thanks 

Sanjeev

Don't waste your time on greenlight Sanjeev, you will probably be disppointed and have to go back shortly after for another procedure. Greenlight is not very effective once a prosate reaches the size of yours. Greenlight also radiates into good tissue which can cause future problems. Your size prostate should be great for HoLEP whcih is usually a 1 and done and fast and easy procedure. There are not many poeple in forum posts discrediting HoLEP but if you see any, I bet that in most cases they went to doctors just learning the procedure who did things wrong. So go to a doctor who has performed at least 30 HoLEP procedures minimum, and you'll be fine.

Hi Robbie, definitely check out HoLEP. I started having serious prostate problems when I was 47 and am now 58. HoLEP worked great for me. On sex drive impact, I cannot accurately advise on the impact. The reality is, my sex drive has definitely lessened. I feel like my testoserone level and thus (in my mind) drive is only about half of what it was. HOWEVER, the reason I cannot accurately advise on this sex drive topic is because while waiting for months to get the procedure, I had to have a cath in full time, I got an infection and didn't realize it till too late, and it essentially killed or fried one of my testicals. My drive today is ~50% of what it was, and nothing comes out (great for wife), all retrograde into my bladder, which is not that big of a deal for me. To date I have assumed that these side effects were all caused from the severe infection, but I really do not know for sure. I still have sex and can get an erection, my libido is just not like it used to be. I do not take drugs to help though.

I previously stated in one of the forums, a warning for anyone having to use a cath for an extended period of time. If you feel any pangs of discomfort, DO NOT assume it is the cath just poking a little and things are otherwise fine. Get into your urologist asap. You probably have an infection and need to get on a high dose antibiotic. I figured that out too late. It certainly didn't help that I was kite surfing with the cath in either!!

ho Bill ... kite surfing with the cath !!  well damn .. good for you .. that's "baallsy" !  hahah  testosterone definitley decreases with age.. i'm 71 and still enjoy sex ... but a lot less frequent than in my fifties !!  maybe some of your problems are because of the prior infection and testicle problem. very sorry to hear that. I'm searching for a Doc. with experience .. if anyone knows a good one in south florida - Sarasota area pleaseeeee let me know

I suspect you are not a candidate for Urolift because of the third lobe. The size is marginal also.  Look up the clinical trials for the Holeb method. The size and number of lobes does not matter for Holeb. (Holmium laser enucleation of the prostate). As I do not qualify for Urolift I am pursuing Holeb. It originated in New Zealand and is more common in your part of the world than here in the USA. Green light laser, turp, etc do not compare in results from the patient's point of view. The data is all available on Google. I think Retrograde ejaculation is just to be expected from any of the choices except Urolift. There are many posters who support this and most of them are past the child-producing age and don't care very much. The sensation of orgasm is degraded very little if any and is considered to be a small price to pay. If you continue on the meds you'll have RE plus ED. Get holeb if you can find a surgeon. You may have to wait montsh in India just as we do here. In my opinion, well worth the wait. Let us know what you do, you can help someone just as many of us try to do. 

There is a Holeb Dr at the Mayo Clinic in Florida. May be some others. They will advise you if Medicare and supplement will pay the full cost of Holeb. I think at Mayo it will not, so check it out. You know Mayo otherwise is among the best in the country. Good luck, and keep us advised as I will and many responders do.   

Robbie, I reply to so many, I hope I haven't already replied to you but here's the straight story on Urolift. If your prostate is no larger than 80-100mg depending on the urologist and if there is no third lobe that will simply fall down into the urethra when urolift pins the other lobes back then urolift is the least invasive, least painful,  most certtain procedure to avoid a bad outcome. If you meet he above criteria then find a uro who does urolift. I don't believe that I have heard of a bad outcome yet. The meds for BPH are even more certain to give you ED than turp and green light. Urolift is a great way to get immediate relief that will last for years, but you must meet the criteria and you may have to pay out of pocket as the procedure is brand new. But don't be afraid of it,  the urologist learning curve is not steep and the outcomes are wonderful, lasting at least for years. Good luck!! Keep us posted!  

hi Ron, no you hadn't replied ... and i really really appreciate your helpful insight !!  i've had my prostrate checked a few times sooo now i have to find out it's size and then go from there !! Urolift sounds like the way to go..

again...many thanks 

Robbie 

and Ron, if you could share the info on the Doc. who will do it for $2500 I'd very much appreciate it ...

thanks again ..

Google Dr Naveen Kella, San Antonio, Texas. He has a great staff and is a god urologist as well as a good man.  iIf you are coming from an inconvenient distance be sure to tell him and see if you can't do the whole thing: consultation, ultrasound, cystoscope etc to see if you are a good candidate and schedule the Urolift  in a few days so you can make one trip. Maybe not but it's worth a try. The San Antonio River Walk is beautiful, see the Alamo, Sea World, etc. Good luck and keep us posted.  

Hi Ron,  i will definitley look Dr Kella up in Google. I've been to San Antomio before...it's a very nice city !!  thank you again for all your help !

Robbie 

Thanks Ron. Holep is available here and there is not much of a wait except we need to mentally align to this. 

Thanks Bill.   I value the inputs.   

Sam, I can't get Holep until December and I'll travel about a thousand miles one way or another for the appointment but that's my intent. It's supposed to be a one-time fix for ten years or longer and much easier on the patient than turp or green light.  Guess I'll find out. Whatever procedure you have please keep us posted and best of luck to you. Ron

samdelhi, Dutasteride (Avodart) will not give you ED necessarily but it will definitively reduce your libido. I am 68, was on it for 3 years, could still get an erection but the desire for sex was way down (this would be the case with Finasteride also). Dutasteride prevents the conversion of Testosterone in you system (this is how it shrinks the prostate). Tamsulosin (Flomax) will not give you ED either (on the contrary, it acts a bit like Cialis as they are both alpha-blockers, Cialis much better of course). Tamsulosin will give you RE and it did to me.

It takes about 6 months of Dutasteride to shrink your prostate (shrinks about 30%). It takes about a year on Finasteride (Proscar) with less total shrinkage. If you stop Dutasteride your prostate will just grow back and will continue to grow. It takes about 2 months to flush the Dutasteride out of your system and about 4-6 months for the prostate to grow back. Dutasteride is a very long acting drug, long time to titrate up and long time to titrate down. Some people report that they never get their libido back. Dutasteride is only a temporary solution because once your prostate has shrunk the 30% it continues to grow from there. This just buys time which is good enough if one is elderly but not too good for a 49 year old.

I had a Plasma Button TURP in August (highly recommended as the new gold standard, see my post here to SD1959). I got off Dutasteride 1 month ago (Uro wanted me on it for a bit after surgery to minimize internal bleeding). My libido is coming back but it will not be the same as when I was 50. I had to stay off sex for 6 weeks and I now have some RE (not enough data yet). Some ejaculate has been noted but not as much as before. Most people with any kind of prostate-tissue-removal-surgery will get some degree of RE. Sex is still fun but not as intense on the climax (just like when I was on Flomax).

You will have to decide what is most important to you at your age. I needed to urinate first and foremost and going every 1-2 hours was no longer acceptable.

I would not fly all the way from Delhi to San Antonio to get a Urolift. If I had to go through that effort and cost I would choose the procedure that would last me the longest without the need to redo in a few years. If you do decide to fly to Texas I would recommend the Houston Medical Center.

Regarding your low immunity to getting colds, etc you need to start taking a good quality multiple vitamin and maybe even a little extra vitamin C.   I have been taking good vitamins and eating healthy for years and it truly does make a "difference". 

As an update to my recent posts, I had the HOlep done 10-31 at Mayo in Phoenix and it was a fantastic experience. Now 19 days post-op I am normal in about all respects, and my sex life is coming back. I have commented elsewhere in these threads about the details. In short; Holep is now the gold standard, no pain, very little blood and a life-time solution. It just works!  

Another update: I'm now 30 days post-op with HOlep on a huge prostate, with a third lobe protruding into the bladder, etc. Post surgery I had pink urine for seven days, some discomfort for eight days but no actual pain, no clots, no medication of any kind,  etc. I have had incontinence (due to the third lobe stretching the bladder neck) for three weeks, and a bit of leaking to-date but it's easily handled. I hold my urine for three hours or so depending upon fluid intake,  and a factor that amazes me is that after having an urge to go I can delay for twenty to thirty minutes before finding a bathroom. My stream is like a fire hose, I don't believe I had a stream that strong ever in my life. I find myself drinking a lot more fluids than I ever would before as it caused so much difficulty before. For example last night we had supper at a restaurant with live music and I drank five beers during two hours or so. I didn't go to the bathroom until we got home. Amazing. I haven't done that in thirty or forty years. I'm now certain that my sex life will be good, probably about like ten years ago and that's a relief.

There's certainly no guarantee that another patient's results will be as satisfactory as mine but I will make one claim without qualification, if a  prostate is too large for Urolift or even for TURP or Green Light and only a Simple Open Prostatectomy is recommended via an incision into the bladder or elsewhere then that Urologist is doing you a disservice. Holep works for any size prostate and with any number of lobes. That is a no-brainer and I would go so far as to say that HOlep should be done rather than Urolift, TUMT, TUVP, TURP, Green Light, or any other for the purpose of opening a channel through the prostate to enhance urine flow.

There are some caveats, of course, I have no diabetes, heart condition, high blood pressure, obesity, bladder or kidney stones, etc. I am in excellent health which is certainly a big plus factor but I'm also 76 years old.

There's also the availability of HOlep surgeons being a difficulty in some areas. There's only a dozen or so that I know of in the US, none in Texas. and they are booked up for months in advance. I really lucked out in finding a surgeon who would slot me into his schedule because my condition would not allow me to delay. I still had to fly to the Phoenix Mayo Clinic for the procedure.

Rest assured that if you need surgery your urologist will not even mention HOlep. If you ask about the procedure you will be told that  Holep is a discredited procedure and that TURP is the GOLD Standard and the only one most Urologists will recommend. The truth is that most Urologists have heard of HOlep and upon investigation found that the learning curve to become competent in the HOLep method is extremely steep. It requires very extensive training with a Holep mentor during dozens of HOlep surgeries before a surgeon can do one on his own. . To my knowledge no surgeons are doing HOlep unless thay are associated with a large regional University Hospital or Clinic like the Mayos. It is probably a matter of funding the environment for HOlep.

Speaking of funding, the procedure is expensive, probably prohibitive for many if paying out of pocket. Medicare and a Medicare supplement are funding mine but I may have some out of pocket cost as well. I'll know soon.  

Best of luck to all of you. Ron      

Another update: I'm now 30 days post-op with HOlep on a huge prostate, with a third lobe protruding into the bladder, etc. Post surgery I had pink urine for seven days, some discomfort for eight days but no actual pain, no clots, no medication of any kind,  etc. I have had incontinence (due to the third lobe stretching the bladder neck) for three weeks, and a bit of leaking to-date but it's easily handled. I hold my urine for three hours or so depending upon fluid intake,  and a factor that amazes me is that after having an urge to go I can delay for twenty to thirty minutes before finding a bathroom. My stream is like a fire hose, I don't believe I had a stream that strong ever in my life. I find myself drinking a lot more fluids than I ever would before as it caused so much difficulty before. For example last night we had supper at a restaurant with live music and I drank five beers during two hours or so. I didn't go to the bathroom until we got home. Amazing. I haven't done that in thirty or forty years. I'm now certain that my sex life will be good, probably about like ten years ago and that's a relief.

There's certainly no guarantee that another patient's results will be as satisfactory as mine but I will make one claim without qualification, if a  prostate is too large for Urolift or even for TURP or Green Light and only a Simple Open Prostatectomy is recommended via an incision into the bladder or elsewhere then that Urologist is doing you a disservice. Holep works for any size prostate and with any number of lobes. That is a no-brainer and I would go so far as to say that HOlep should be done rather than Urolift, TUMT, TUVP, TURP, Green Light, or any other for the purpose of opening a channel through the prostate to enhance urine flow.

There are some caveats, of course, I have no diabetes, heart condition, high blood pressure, obesity, bladder or kidney stones, etc. I am in excellent health which is certainly a big plus factor but I'm also 76 years old.

There's also the availability of HOlep surgeons being a difficulty in some areas. There's only a dozen or so that I know of in the US, none in Texas. and they are booked up for months in advance. I really lucked out in finding a surgeon who would slot me into his schedule because my condition would not allow me to delay. I still had to fly to the Phoenix Mayo Clinic for the procedure.

Rest assured that if you need surgery your urologist will not even mention HOlep. If you ask about the procedure you will be told that  Holep is a discredited procedure and that TURP is the GOLD Standard and the only one most Urologists will recommend. The truth is that most Urologists have heard of HOlep and upon investigation found that the learning curve to become competent in the HOLep method is extremely steep. It requires very extensive training with a Holep mentor during dozens of HOlep surgeries before a surgeon can do one on his own. . To my knowledge no surgeons are doing HOlep unless thay are associated with a large regional University Hospital or Clinic like the Mayos. It is probably a matter of funding the environment for HOlep.

Speaking of funding, the procedure is expensive, probably prohibitive for many if paying out of pocket. Medicare and a Medicare supplement are funding mine but I may have some out of pocket cost as well. I'll know soon.  

Best of luck to all of you. Ron      

Hi Ron, It seems like you hit the lottery with your holep. Considering how large your prostate was, that is a remarkably quick recovery.

Do you know what the holep cost? With medicare, it's irrelevant to us, but others out of country may want to know. My Greenlight was $6500 and covered by medicare. But my emergency surgery for hematuria and stones was $68,000. Luckily medicare and my suplemental paid all $800 or so.

Another question, have you experienced the retro yet, and does it effect the orgasm experience. Some people say yes, others say no.

Best regards and continued recovery.

Bob

typo ... should have read Medicare and my supplemental paid all but $800 or so of the $68,000 hospital bill.

Hi Ron;  Do you have an "opinion" on the "button turp" vs what you had which is the "Holep".  There are so many procedures that seem "kinda similar" to me which makes it confusing.  Regardless of the procedure it seems that for a month afterwards there is alot of "inconvenience" and "pain".  The thing that scares me the most is when people talk about "self catherization".  Just the thought of that scares the BeeJesus out of me. 

Hi Bob,

You mentioned that your greenlight laser "...addressed my retention and difficulty passing urine", yet you also mention that you're getting up every two hours (or more) to urinate.

I was under the impression that the reason many of us have to get up frequently at night to urinate is because we don't completely empty our bladder and therefore only a little comes out each time.

I'm therefore curious since you void into a urinal, about how much urine comes out per void and if therefore if there really is no retention.

In my case, I also had to get up every two hours to urinate but the problem was retention. Once I started a self-catherization program, I was able to fully empty my bladder. Since then, I either can sleep through the entire night without having to go to the bathroom, or sometimes get up just once, depending on what my fluid intake was that day, as well as what proportion of that fluid was taken in the evening.

-- Jim

 

You said, "he thing that scares me the most is when people talk about "self catherization".  Just the thought of that scares the BeeJesus out of me. 

--------------------------------------

Hi Chuck,

I have been self-catherizing for over a year now, but I certainly understand your feelings. I almost fainted after my first self-catherization, and the first few weeks were difficult. There is no discounting the initial "ick" factor!

That said, it's amazing how the mind and body adjusts to these things. If I tell you that today self-catherization is no more traumatic (or painful)  than brushing my teeth I would not be exagerating. The whole thing takes about five minutes with most of the time getting out the supplies and prepping, etc..  The actual time cathing is approximately the same amount of time it would take to pee with a full stream.

I'm not saying self catherization is for everyone, but it might be a good strategy for some, as it gives you the ability to fully empty your bladder any time you want. It also gives you time to wait for a future procedure or operation that might be better than those now being offered, which is why I stayed with it.

In my case, I chose self-catherization over the Turp procedure that was recommended by my urologist. I declined Turp because of the probability of retrograde ejaculation and other potential sexual issues.

I'm still looking at other procedures that would offer permanent relief for my BPH without the sexual side effects, but because the self-catherization works, there is no rush. It therefore gives me time to sit back and wait.

Hopefully, I won't have to self-cath for the rest of my life, but if I do, I won't have too much of a problem. Because I can empty my bladder fully, whenever I want, I usually sleep through the entire night without going to the bathroom unless I have had a lot of fluids late, and in that case I might get up once to cath.

-- Jim

 

Hi Bob. I'll know this week how the medicare reimbusement works and I'll report here once all facts are in. I think medicare and the supplement policy will cover "almost" all of the costs, but let's see how it goes. I've had the retro thing for several years, thanks to the BPH Meds. All of the surgical methods except urolift are about 90% certain to produce retro so I'll never get the ejaculation recovery, I'm certain. I don't believe that it affects the orgasm experience much at all especially since I'm doing somewhat better sexually than before HOlep already. I understand that it takes months to overcome all of the effects of the meds, especially reduction in libido so I anticipate increases there as well.  But I'll tell you this, if nothing improves beyond today I'll continue to be amazed and very satisfied at the improvement in my life. Simply unbelievable.     

Most patients have excellent results with button Turp. Some don't, more don't than with Holep. From what guys say on these threads any other method such as the "non-button" turp, tump, tuvp, green light laser, etc are all discredited methods replaced mainly by button turp or HOlep (if you can make HOlep happen).  If it is possible for you to get HOlep by any means possible to swing it I would certainly do so. My absolute preferrence would be Dr Humphreys at the Mayo in Phoenix but I would willingly have any of the HOlep surgeons operate on me. No other method is going to compare with HOlep (especially with very large prostates like mine) and that fact is borne out by studies documented on the web. Look them up.

Here's the main thing to me; if the quality of your life is declining because of an enlarged prostate choose the best surgical method by a surgeon practicing at one of the huge University hospitals or preferably one of the Mayo Clinics and get it done ASAP. If you are on the meds you can get off of them before they effectively castrate you. 

Urolift is a stop-gap method that works for many patients, apparently not as large a proportion as I originally thought as there have been several documented cases in these forums where urolift did not work.

I did the self-cathing thing and at first the cath was too large so I got a really thin one and I only used it once. It was unbelievable how much urine I was retaining and how long I could go after emptying completely. Many guys do it and leave the thing in for thirty days or so with a bag strapped to their leg.  If you get into full retention you will self-cath willingly and thankfully, believe me. Don't be afraid of it, you can do it. The one I used was brown in color with a tip that turned up slightly to help in passing the prostate. It had a small button where you held the cath to indicate the position of the upturned point. It was also very lubricated. Turned out I didn't have to use it but i knew I could if I had to.    

I can tell you these things; if your prostate has grown large it will get bigger. The meds work very well until they don't, then you are in a world of hurt. My experience with HOlep was nothing to dread, I had no pain, and no symptoms, no matter how minor, after eight days. Many patients report excellent results with button turp. But again, I would go to a big university medical center, or the Mayo Clinics, to have that procedure done also. Just do not wait, get it done ASAP, a larger prostate will complicate matters. Watchful waiting is not the way to go if your prostate is growing daily. That's the best advice I can give and I believe the hundreds of patients on these threads will bear me out. Best of luck to you and let us know what you decide.    

Thank You Ron.  I will keep you posted as to what I do.  Since my PAE was only 2 1/2 months ago I will probably wait the 6 months and see how Iam doing.  Iam basing this on the Doctors comments that it takes anywhere from 30 days to 6 months to get good results.  Take Care and have a very happy and merry Christmas.

Hi JimJames,

I guess it's more complicated than that. I just happen to have kept a journal the last 2-1/2 months as lately this has been a real bummer for me.

On nights when I get up more frequently than once an hour, I'm basically up the whole night, and then get 2-4 hours sleep from 8AM to 10AM on, when my urine production has finally slowed . On the plus side, I'm retired and don't have to work. On the minus side it pretty much makes me a zombie the whole day. On nights when I get up less than once an hour, I can generally get back to sleep right away and accumulate 8-9 hours total.

I had a hard fall on my butt in the middle of September and I have been having this problem of excessive night urination and accompanying insomnia ever since.

To answer your question, I generally void anywhere from 150ml to 300ml per void. The average is about 200ml per void. On nights I don't sleep, I void about 10-12 times which never really lets me get to sleep. My total output the last month on those nights ranged from 1.6L to 2.75Liters.

On nights I sleep I get up from 1 to 6 times (the average is just over 4 times) and my total output is anywhere from 250ml to 1.4 Liters. If I've produced a very large amount the night before, I will generally produce less than half a liter the following night.

Last month I had an ultrasound to measure my PVR and they measured 41cc of urine before voiding and 7cc PVR after voiding. So I'm not retaining anything.

The strange thing is I don't void much during the day although I drink water and seltzer and coffee. I always double or triple void before bed so I am pretty sure I'm totally empty. It seems that within an hour of lieing down in bed I start producing urine. 

Getting back to the greenlight. Before the I was not only producing very small amounts when I urinated , but regularly woke up around 3AM feeling I was bursting and unabe to void at all until I had some whiskey and walked around the kitchen for 10 minutes or so. It's like I would completely lock up, with accompanying pain in both kidneys. So to that extent the GL worked as I haven't had full retention since.  The GL only removed a portion of the median lobe which was and is protruding into my bladder. To  that extent, before undergoing another greenlight I would seek out a holep doctor  or possibly a simple prostatectomy as that seems to do a better job of removing most or all of the three lobes.

But whatever causes my kidneys to go into high gear at night when I lie down in bed is a mystery. About the only way I can slow it down is to get up and try to sleep in a chair, which usually doesn't let me sleep, but slows down the urine production and my need to void so if I do get back to bed I can sleep and only get up less than once an hour. SO far that seems to be the border between getting back to sleep quickly after each void and staying up all night.

uring urodynamics testing, prior to the greenlight, I also found out my volume at which I felt an intense desire to urinate was about 350ml., so I don't have a lot of capacity to begin with.

Hope this answers your questions. I've had this sort of nocturia causing insomnia in the past and it went away after a few months. No changes in diet or lifestyle seemed to have any effect.

Bob

It sounds to me that you really need to get something done sooner rather than later.  You probably need to investigate either a "Holep" recommended by Ron Texan or a "button turp" which  also gets excellent results.  I had a PAE back on Sept. 10th but would not recommend it.   Best of luck to you.

Would be nice to know what that something is. My issues are not being caused by a restricted passage for urine. I have no post void residual. I have already had more than half of the prostate removed with the Greenlight. Then 18 months later I had stones removed and the bladder neck widened with a bladder neck resection. 

Bob

You said: Would be nice to know what that something is. My issues are not being caused by a restricted passage for urine. I have no post void residual. I have already had more than half of the prostate removed with the Greenlight. Then 18 months later I had stones removed and the bladder neck widened with a bladder neck resection. 

---------------------------

Hi Bob,

Certainly no expert, but seems like you've done surgically about all you can do, at least for now. What does your doctor say? Does he suggest more time may help? If he's not forthcoming, sometimes a second opinion makes sense.

More than nocturia, given your urine output, sounds like you have noctural polyuria (large amounts of night time urine), that even a larger bladder and/or larger per bladder void would be hard to hold without at least several trips to the toilet at night.

I also had noctural polyuria, but not as pronounced as you have. Tried different suggested non-surgical strategies including compression stockings, fluid intake managment, testing for both diabetes and diabetes insipidous, checking for edema, and using diuretics earlier in the day to promote daytime and late afternoon urination as opposed to just night time urination. There are also other drugs that can be prescribed which I didn't take. And, of course, I self-cathed, so I was sure my bladder was completely empty.

I also read that some people like yourself may have low PVR during the day, but a larger PVR at night. Don't know how you would test nightime PVR without cathing, but I suppose if your per void night time output was less than your usual per void daytime output, that might be a clue. I

For me, fluid managment was a big help. Not just drinking less before bedtime, but taking in less fluid overall. The "8 glasses of water a day" thing has been debunked by many doctors lately, and many of us drink far more fluid than we actually need.

Currently, my fluid intake is no more than a couple of cups of coffee a day and maybe a beer with dinner. Sometimes 1 or two glasses of water a day, at most. This may not seem like a lot, but I am not dehydrated based on not only how I feel, but also based on urinalysis and blood work.  I simply drink by "thirst" which has been challenged by mostly the designer bottled water industry for years, but now drinking by thirst is again becoming more recognized by doctors as the best barometer of how much fluid we need.  What also might have made it easier for me is that I have also switched to very low fat, more plant based diet, with no more than maybe 12 ounces of lean meat per week. Less meat tends to make me less thirsty, perhaps because I get more water out of my food -- fruits, vegetables, cooked grains, beans, etc., -- than I would if I ate more meat instead, and my theory is that this food-based water is handled by my body more efficiently than drinking it, and tends not to "run through" as quickly.  I also am on a low sodium diet, which also may help with fluid.

Hopefully, you just need more greenlight recovery time to get back to more normal, but if not you might try some of these other strategies, assuming you have not already have.

Jim

 

Hi JimJames,

Thanks for your reply. Glad to see someone else has battled this condition of nocturnal polyuria.  My urologist hasn't been any help on this front. He offered a patch to calm down my bladder which dried me up and left me with a mouth full of cotton, no sense of taste and crashed my blood pressure down to 45/80. That's the last med I took for it.

My blood sugar is a little high at about 105, but not enough to cause this. I have a one inch cubed cyst on my kidney, maybe it has something to do with it. Maybe my Circadian rhythms are off due to some pituitary prolem. It's all speculation on my part, but nothing I'd want to address with meds or surgery.

At 68 I know you shouldn't look for trouble. I nearly died in hospital a year ago. 18 months after my greenlight, and after a year of cathing once or twice a month to prevent reoccurrence of scar tissue,  I started hemorrrhaging thick fresh blood from my prostate and bladder. They had me on a three way irrigating cath for three days for to stop the hematuria, but they never checked my hemoglobin. When they did it was down from 15 to 6. The irrigating cath was just washing my blood away. I needed emergency surgery for the hematuria, and removal of stones and a bladder neck resection and needed 8 pints of whole blood to get my hemoglobin up to 13.

The older I get the more I see that most doctors, even pretty good ones just use the cookbook, and if you fall outside of the norm you have to figure it out on your own.

It seems the really good doctors who really knew their stuff came out of the 1930's depression era. They were masters of medecine and scientists who also knew how to fix things as simply as possible with shortcuts that worked. I had a doctor like that and my kids had a pediatrician like that who was my doctor's good friend. Both of them died about 20 years ago. Doctors these days are cook book doctors who may know surgery and can follow the cookbook, and that's it.

Back to your case, what was your frequency and output at night at it's worst? Are you better with managing your liquids now? What is your frequency and output now? Is it consistent? Mine is all over the place. One night I'll get up once and void a couple of hundred cc's, another night I'll be up 15 times and void close to 3 liters. Yet my input is constant, 2 or 3 mugs of coffee, and probably a quart of seltzer and water combined, so maybe 3 liters a day altogether. I also just drink when I'm thirsty or need a coffee boost. My output during the day is every 3 or 4 hours and fairly normal, quantities although it seems like 

my night frequency is greater and often (but not always) the volume is greater. Lieing flat in bed seems to get my kidneys started. Then it's a crap shoot, to see if the frequency exceeds once per hour, which I can get back to sleep with, or every 20-30 minutes which keeps me up all night.

A couple of years ago I followed the interstitial cystitis diet for about a year and lost 20 lbs. I found no correlation with food and my condition, which was proved when I went off the diet and ate my normal diet including hot and spicy foods.

Bob

Bob

Bob,

You hit the nail on the regarding doctors. 

Carlos

I agree that you don't need 8 glasses of water daily.  I drink 2 large cups of coffee about 6am daily.  Then between 11 and 3 PM I drink about another 16 oz of water and then about  6 oz of water at 5:30pm with my supper.  Have never had a dehydration problem.  Also at bedtime which is 9pm for me I drink 4 oz of "tart cherry juice" which acts as a "sedative" to help you fall asleep.  I works for me.  I sleep from 9pm until about 12:30.  Then get up again around 2am and 4am.  I get up around 5:30 to 5:45 daily as I have animals that need to be fed.  If I don't get up by then they get me up!!!!  

Hi Bob,

Sorry your doc hasn't been much help. Maybe time get some second opinions or try stuff on your own. I hear you on "cookbook" doctoring. Really hard to get a doc to sit down and really tackle a problem on an individual basis.

I would think that compression stockings are something you might try on your own, and I doubt your doc would have any problem trying diuretics to try and get more urine flowing during the day. In fact, if you're on bp meds, the diuretics could possibly substitute for what you're taking.

To answer your question, at "my worst" my total 24 urine output was close to 3 liters with probably more than half between 5pm and 5am. I was also drinking more fluids than I am now. A funny thing about taking in a lot of fluids. I read that "thirst" is not only a sympton of dehydration, but also a sympton of over-hydration!  In the latter case, you end up drinking even more making the problem worse.

I haven't done an intake/void diary for awhile, but I started one yesterday.  My total intake was a couple of cups of coffee (small and large), and about 16 oz of water. So approx 40 oz of fluid, or around 1100 cc's. My total 24 hour urine output was 1400cc. I voided about 300 cc around midnight and another 300cc at 5am. I would not call this  complete night's sleep without voiding, but often I can now go 6-8 at night without voiding, but sometimes not. Many variables, including fluid intake.

Another thing I've read is that sometimes sleep issues mask for prostate issues. In other words, many people wake up during the night for reasons other than having to urinate (sleep apnea is the more dramatic one) and once they're awake they then feel the need to urinate and so go to the bathroom. Had they slept more soundly, they probably wouldn't have needed to urinate as the bladder tends to hold more at night than during the day. I think that is what happened to me last night when I woke up at 5am. I don't think I really needed to urinate, but I was up so I did. On the occasions where I have slept through the night without having to go to the bathroom -- fluid intake being equal -- those tended to be nights I slept soundly. Perhaps I went to bed very relaxed, or maybe a beer combined with the daily cialis I occasionally take made me sleep sounder.

I am going to keep an intake/void diary for at least a few days more and let you know if anything different develops.

- Jim

Carlos,

How is your recovery coming? Sounds like you had a rough one from your turp, like I did with the Greenlight.

Hi JimJames,

Thanks for the reply. I've been keeping pretty good rcords for the last two and a half months, and it boils down to 7 to 8 nights amonth of nocturnal polyuria that keeps me up most or all of the night, and nocturnal olyuria the rest of the month that I can get up and get back to sleep with. Last night was one of the former. I was up about a dozen times from 2AM when I went to bed to 5:30 AM when I got to sleep, and 3 more times from 5:30AM to 12:15 AM which I got back to sleep with in a few minutes. I passed about 2 liters altogether. If this doesn't ease off by the New Year I'll see my urologist again, but I have zero confidence that any doctor could diagnose or help this, without side effects that are worse than the condition I have now. I'm glad you were able to find a solution that is working for you.  I read an article a few months ago that said there were more than a million people, men and women, who have LUTS (Lower Urinary Tract Symptoms) including urgency, frequency, and pain, for which no medical cause can be detected, and for which no treatment is available, other than learning to live with it, or having it get better on it's own.

Regards,

Bob

Thanks for asking Bob. 11 weeks after my TURP, 1 week ago I had another procedure where they fill your bladder with water to try and reset it. I'm having to pee when my bladder is only a 1/3 full. Doctor also saw a lot of inflammation. Thinks I have IC. Anyhow now I'm in pain again from that procedure. I go back to the doctor in 2 weeks to discuss treatment. 

Carlos

Hi Carlos,

I thought I had IC because my Mom had it.  I hope you don't have it. There is an IC forum. If you google

ic-network forum

you can read up on other people's (mostly women, but some men) experiences. The bad news is there's no cure for IC, and treatments can take years. Most people flare up occasionally and then are better for a while regardless of treatments.

I was on the IC diet for a year, lost 20 lbs., but saw no improvement in my symptoms. I became totally paranoid about what I ate for a while. Finally, when I went off the diet I found no change in my symptoms again. Reading all the stories, I saw very few lasting success stories, although many people stop posting when their problems either do or don't go away, so it's hard to tell.

How often are you going during the day and at night? It took several months after my Greenlight laser for my daytime voids to slow down to let me go shopping for 1-1/2 hrs without needing a bathroom. Now (2-1/2 years later) I can easily go for 2-3 hours or more during the day. I still go every 1-2 hours most nights except those nights when I flare up and go much more frequently. Something about lying in my bed seems to wake up my bladder.

Bob

Chuck, I will second what JimJames and others say about self-cathing, but I'll go only so far as to say that you should learn how to do it, get the equipment and be prepared for the time that you are in full retention and pain and the only other choice is sitting in the waiting room of an emergency ward for hours until your number is called.

Self-cathing has got to be better than that and that's why I bought the catheters, looked up the procedure on youtube, tried to see if i could do it, FOUND THAT I COULD NOT GET IT TO GO and had to find a thinner catheter. That one worked ok, still very reluctantly but I knew that in a dire emergency I could relieve myself rather than go to the emergency room in pain.  Since prostates continue to grow I really recommend that anyone with an enlarged prostate learn how to do this and actually practice it a time or two. 

JimJames,

Just as a follow up thanks for mentioning the term nocturnal polyuria. I looked it up and that's what I have. I'm pretty sure on bad nights I produce more than 2/3 of my 24 hour urine output during the 8 hours I'm trying to sleep. That led me to some NIH trials on nocturnal polyuria which said that desmopressin taken before bed,  activates ADH in the pituitary gland at night, which serves to decrease urine production and concentrate it as well. It seems that desmopressin is the favored treatment for nocturnal polyuria. So I'm going to do a bit more research and if it looks good, will make an appointment with my urologist to try it.

Thanks for your input.

Bob

Bob,

http://www.medscape.com/viewarticle/731730_7

This above linked Medscape article not only talks about desmopressin,  but also touches on iother non surgicsl strategies including compression stockings and diuretics to help with your novturnal polyuria. You may find one or combination of these works best for you.  If you haven't already, you may have to register with Medscape in order to read the article but registration is free. 

Jim

I found a good Medscape article on different non-surgical strategies to treat nocturnal polyuria, lincluding  desmopressin, but it apparently my post ended up in moderator review because I included a link to the article.Hopefully you'll get it soon.

Bob,

I'm up at least 3 to 4 times a night. Mornings I go about every 30 minutes probably because of the 2 cups of coffee I drink. Afternoons an evening I can last 1 to 2 hours but that is when my pain starts. It's either my bladder or prostate or both.

Carlos

Hi Chuck, I hope you are doing well.  I was going to quit posting here - after all I have already reported my good results with a Button TURP in August.  However after reading the misinformation now being posted by some I felt best to come back for the sake of those considering surgery.  While the posters mean well, no doubt, there is erroneous information being dished out which is ill advised for those assessing treatments.

I have read many of RonTexan’s posts today and while I would rather not start a turf war on this I find it necessary to offer a different perspective.  First of all I am delighted and very pleased that he had his HoLEP and that it turned out well.  I wish him nothing but the best as he suffered a lot through the years (partially his fault for not acting sooner).  He deserves continued success and I hope and pray that he never needs surgery again.  He made a good choice by going to the Mayo Clinic and choosing HoLEP instead of open prostatectomy as he had let his prostate get way out of hand by his own procrastination.

Notwithstanding RonTexan’s good intentions, he is posting a lot of information that is misleading to others considering treatment for BPH.  There is so much of this that I frankly do not know where to start.  First of all, anyone with BPH should download the American Urological Association BPH Symptom Score Index Questionnaire, more commonly known as the IPSS Score (for International Prostate Symptom Score).  If one scores 7 or less, doing nothing is likely the best choice, if one scores between 8 and 20, drugs are indeed the recommended action and for many that is all that is needed for the rest of their lives (not for RonTexan or me).  If one scores 20 or more they should consider surgery and they should not delay like RonTexan did.  The first line of medication for BPH is Flomax (Tamsulosin).  There are other brands as well – all work about the same.  Flomax is an alpha-blocker like many blood pressure medications and simply relaxes the muscles around your prostate allowing easier urination.  This may be all that is needed for some.  Flomax goes to work in a manner of days and if discontinued its effects go away also in a manner of days.  So there is no harm in trying it.  I could not keep taking it as it gave me headaches (it does not for most).  The second line of medications is Avodart (Dutasteride).  There is an older med called Proscar (Finasteride) but it does not work as well as Avodart.  That is it - there are no other BPH drugs on the market other than over the counter remedies that hardly work at all.  RonTexan took Jaylin but Jaylin is nothing more than Flomax and Avodart combined into one pill instead of two.  GSK markets Jaylin to maintain patent protection as Flomax is now generic and Avodart will be so in early 2015, i.e., GSK makes more money out of Jaylin.  Jaylin works exactly the same as taking one Avodart and one Flomax.  Avodart works by reducing the conversion of Testosterone in your body and over time reduces the size of the prostate.  Clinical data indicates that it takes about 6 months for Avodart to shrink the prostate.  Again, Flomax starts to work quickly but it does not shrink your prostate, just relaxes the muscles.  The best treatment is to take both but one can save money by taking two pills instead of one Jaylin.  The data also show that the maximum shrinkage obtainable with Avodart is about 30%.  So do the math, someone with a prostate in the very large range, let’s say 120g, would end up with a prostate about 84g after Avodart, still very large and likely to still cause bad BPH.  RonTexan reported that his prostate was 114g after years on Avodart (Jaylin in his case, all the same).  If so that means that without Avodart his prostate would have been 30% larger or about 160g, huge indeed.  Avodart by virtue of the fact that it reduces Testosterone conversion also reduces you libido.  There is no way around it.  Take Avodart, shrink your prostate by 30% and reduce your libido.  Avodart is indeed reversible but it takes about 4-6 months to flush it out of your system.  Some people report that their libido does not come back as strong but do the math again – if one starts taking Avodart and stops 10 years later one cannot compare the two libido situations 10 years apart.  Even without Avodart your libido would be less at 76 compared with 66.  In my own case I tried Flomax for about 2 years, quit due to headaches, was on Avodart for about 2 years also and then decided to have surgery.  RonTexan was afraid to have surgery so he just kept taking his Jaylin over and over until he was desperate and his prostate was about to come out of his gut.  RonTexan just like anyone who takes Avodart lost some or most of his libido.  Like I mentioned, anyone 76 years of age would have lost some of his libido anyway, whether on Avodart or not.  RonTexan did not like this (I would not either, who likes getting old?) so in order to counter the lower libido he gave himself testosterone injections.  This was absurd.  On one side he was taking Avodart to reduce his testosterone so his prostate would shrink and then since he did not like the lower libido he was giving himself testosterone by injection to increase his libido back and thus enlarging his again prostate as a result.  Talk about counterproductive!

Now to surgery…  According to the American Urological Association, I quote: “Transurethral resection is the most common surgery for BPH. In the United States, approximately 150,000 people have TURPs performed each year.”  It is a fact that nearly all of these 150,000 people do not suffer lasting complications from TURP (the ordinary old rot-rooter type).  Nearly all do well and nearly all do not post on boards so like the silent majority you just don’t hear about them.  My father had a regular TURP when he was in his early 70s with no complications (some incontinence for about 2 weeks, less than RonTexan who is still having leakage after a month).  My father died this year at age 98 and he never needed anything else for BPH.  He also did not post on any board.  RonTexan had his HoLEP at the Mayo Clinic.  If you go to Google and enter “Mayo Clinic TURP” you will get a page stating the following, I quote: “TURP is one of the most effective options for treating urinary symptoms caused by BPH. To determine whether TURP or another treatment is the right choice for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.”  Contrary to what RonTexan says, TURP is still a great procedure done hundreds of times each day in the US alone.  However, the conventional TURP is now being replaced by what is called a Button TURP which contrary to its name is very different.  The proper name is PBVP for Plasma Button Vaporization of the Prostate.  A Button causes less trauma and bleeding and has a faster recovery, but removes as much tissue as a regular TURP.  The amount of prostate tissue left behind and genetics determine how fast the prostate will grow again.  RonTexan reported that his HoLEP removed 85%, i.e., left behind 15% which regardless of what his surgeon told him will continue to grow.  This may be irrelevant to him as he is 76 years old already and may not need another procedure.  I had a Button TURP in August.  In contrast to RonTexan I did not let my prostate get out of hand and grow to humongous proportions before I took action.  I scored 21 on the IPSS test prior to surgery, I score 5 now, would be hard to do much better as many 30 year olds will score about 5 also.  In contrast to RonTexan I did not have any incontinence, not for one day or one hour, and I did not have to fly to Arizona and fly back in diapers.  I had my surgery at St. Luke’s Hospital in The Woodlands, Texas, 5 minutes from my house.  St. Luke’s is a highly regarded organization and my surgeon, Dr. Steven Sukin, is also highly regarded.  I asked Dr. Sukin about incontinence prior to surgery and he “guaranteed” (his word) that I would have none.  He is in his 40s and he said that in the years he has been doing TURPs and now Button TURPs he has yet to have anyone with incontinence.  He said that the reason some get incontinence is that the surgeon is not careful enough regarding the movement of the probe (moved back and forth during surgery), that if the surgeon moves the probe into the sphincter muscle area one would have some degree of incontinence and it could last a while depending on the extent of the damage (or forever if the damage is bad enough).  Again he guaranteed that this would not happen to me (had not happened to any of his patients) and sure enough it did not.  I also had a third lobe protruding into my bladder and thus enlarging my bladder opening.  However the main sphincter control muscle is below the prostate, not by the bladder and I had no incontinence at all.  My prostate was not as large as RonTexan who postponed surgery too long but my prostate was large nonetheless and I had no complications.  Dr. Sukin reported to me that he removed all of the third lobe and 80-90% of my prostate.  As such my surgery should last 10-15 years.  I am 68 years old and doing very well today but if (a big if) I have to have another Button in 10-15 years it is no big deal, this one was a piece of cake.  I have absolutely no issues whatsoever and can urinate like I did when I was young.  I do have some degree of retrograde which does not impact my pleasure during an orgasm.  I have partial retrograde, some comes out, some does not.  According to the American Urological Association 73% of men who undergo a regular TURP will have retrograde (i.e., 27% will not).  I don’t care but I suspect that my partial retro will diminish some with time (it is a non-issue to me, no kids desired at this age and orgasms are good as-is).

If you look into these boards you will see that RonTexan has gone all over the place with his recommendations.  I know that he means well but he just spouts whatever comes to mind at the time and his advice is not consistent.   For months he recommended Urolift to everyone as the best and greatest except that Urolift does not work that well and he now acknowledges this.  Now he is spouting HoLEP to all.  The fact is that HoLEP is a risky procedure with a long learning curve and often with bad results.  HoLEP is only recommended for those with extremely large prostates as an alternative to open prostatectomy.  In contrast to a Button TURP, HoLEP can cause a lot of damage if not done properly.  The moderator of this website does not allow links to competing sites so Google “steadyhealth” and look for the thread “Prostate Surgery, HoLEP or Green Light laser?” and then go to page 8 and look for posts from “daduff001”.  There is a HoLEP horror story to top all and yes HoLEP is being done by many surgeons outside of Mayo or Indianapolis, sometimes with disastrous results.  But like I said, if one is looking for horror stories you can find them regarding any and all surgeries including Button TURPs.  A quack can go in there with a Button and burn a hole in your urethra or destroy your sphincter muscles just like the “experienced” Captains of the Exxon Valdez or the Costa Concordia ran their ships to the ground.  The key is to analyze the chance of success and the risk of complications for any procedure and then act accordingly.  I am going on a cruise next month and the fact that the Concordia killed  32 passengers is not keeping me from it.  RonTexan out of fear of potential complications let his prostate grow to the point that complications were likely from all but the best at Mayo even then he is having some incontinence today.  He could have easily had a TURP 10 years ago.  The odds are that it would have gone well and he would have saved himself 10 years of misery as a result.  I am saying this not to pick on him, but to assure those of you who are considering surgery know that there are many choices available today.

Like I said I have picked on RonTexan a lot today but I felt that I needed to repost for the benefit of others.  On a previous post in which he was adamant about waiting for 6 months to get an appointment in Indianapolis I asked if he had considered other alternatives as flying to Indi and having to fly back in diapers and discomfort seemed questionable to me.  He did not like my post and replied that he would not listen to me anymore in a rather unpleasant way, I quote him: “At any rate, I have quit listening (visualize my fingers turning off the CS volume control ........CLICK).”  So I hope that he did quit listening and does not see this post.  Nonetheless as I said in the beginning and also in the post that he took offense to I wish him the best now and then, BPH is no fun and I hope his trying days are over for good.  I am glad that he went to Mayo and I am very glad that he had good results.

For others that may be considering surgery I would like to suggest that they research Button TURP and research the hospital and their doctor thoroughly prior to surgery.  There can be complications with any procedure but obviously the experience of the surgeon is very important.  Don’t let the small percentage of horror stories out there keep you from seeking relief.  If you do, it would be like not flying because some planes crash.

Cheers and good luck to all…

CS123

Thanks for the article JimJames. Desmopressin seems to have the most effect of any approach, with the best results.

Bob

Hi Carlos,

That's not too bad at your stage of recovery except for the pain. The only pain I had was while and immediately after urinating. That was constant for about 9 weeks after the Greenlight, but then subsided. I never had any independent bladder/prostate pain. Hope things improve for you.

Bob

CS123,

I would just add the caveat that the model of the enlarged prostate causing LUTS (frequency, urgency, painful urination, retention) is not the whole story for some. SO tunneling a large hole through the prostate, or removing a large amount of it, doesn't solve everyone's problems. It's literally a crap shoot. I also figured the odds were in my favor but needed additional surgeries to remove scar tissue, resection my bladder neck and remove stones. I agree that most procedures and most doctors get good results for most patients. But these forums attract stories from those who didn't get the advertised quick recovery that the urologists all promise.

I also had a large prostate and had 70g. of a 120+g. prostate removed. But fear of surgery is also justified. Ask Dick Clark and Joan Rivers.

Bob

Bob, I agree that any time one goes under there is a risk  Don't know what happened to Dick Clark but what happened to Joan Rivers was clearly malpractice.  I also understand the issue with stones but why did you need to have your bladder resectioned and do you know why you developed scar tissue?  I know it can happen but I have not done any research on the odds.  I do feel that for a high percentage a TURP and now specially a Button would go well but like I said in my original post if a Joan Rivers type doctor is doing the probing he can cause a lot of damage.

Hi CS123,

From the wiki article on Dick Clark:

"

On April 18, 2012, Clark died of a heart attack following surgery to fix an enlarged prostate, a transurethral resection of the prostate, at Saint John's Health Center and the Pacific Urology Institute in Santa Monica, California."

Scar tissue is the result of removing the prostatic urethra during a turp or laser procedure. It basically has to grow back on it's own. It doesn't always make a neat tube when it's growing back. The bladder neck resection was because I developed three bleeders on my prostate and bladder neck causing a gross hematuria. The bleeders could have been from self cathing to keep the channel clear of new scar tissue, or from weakening of veins uring the greenlight, or for no reason at all. It was never determined, and often is not.

The odds are good. There's about 2,000 posts on the topix Complications from Greenlight surgery mostly from people who had complications. But more than a half million people have had the greenlight. But I think good results are much more likely if you go in with a smaller prostate. But there are people on that forum who said they went in to avoid future problems (like you did) and it was the worst mistake of their life. That's why I say it's a crap shoot. I went into the procedure with the odds in my favor and full of hope, but it was a long road just to get where I am. I didn't fit the model of LUTS caused strictly by and cured by a turp or laser procedure. My cousin's husband also had a turp that failed after three or four years and he is back to self cathing 4 times a day. So that's two people in one family. Both my aunt and father-in-law died of hospital infections while hospitalized for a low on the head (my aunt) and a broken leg (my father-in-law). My mother died when they tried to put a feeding tube into her and she had a heart attack.

I nearly bled to death on the three way irrigating cath a year ago. The last hospital stay in 2004, the guy in the bed next to me had his feeding tube inserted wrong and had a bolus of food in his throat all night. When I left, he was in a coma.

You can talk about the odds but hospital infections and prescribed medication side effects kill 200,000 Americans a year, more than all the wars since WWI combined, more than all the homicides and accidents in a single year. So what are the odds?

oops typo, I meant to say hospital infections and prescribed medication side effects kill 200,000 Americans a year, more than all the wars since WWII (not since WWI) combined.

Hi CS123,

I promise I'll get off my soapbox after this post, but the question of "what are the odds" made me think and do some googling.

Here's an interesting eye opener.

"In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.

Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.

That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second."

Now I also read that this number of deaths in hospitals is only 1.4% of the number of actual 34 million hospitalizations per year. But then I asked myself, would I want to go to a ballgame or concert in an arena with 50,000 people , when 700 of them would be executed at the end of the game or concert? Because 700 is 1.4% of the 50,000. ... Rant officially over.

Bob

I understand what you are saying and I don't disagree in concept.  I have an answer for your last paragraph and I have a comment regarding Dick Clark.  As we know Clark had a stroke and had been in bad shape for a while.  He had diabetes and coronary artery desease so the odds were against him.  Maybe the prostate surgery caused the heart attack, maybe not.  He was 82 and the typical life expectancy of a male is 83.  Any surgery at age 82 is risky, that is one reason not to wait for BPH surgery until one cannot or should not have it.  Regarding your last sentence, that is easy for me to answer.  I would not go to the concert because listening to Renee Fleming singing Tosca is not essential to my life so why risk it - on the other hand I have to urinate and I don't consider the alternatives like catherization or getting up a bunch of times at night at all acceptable. So I am willing to have surgery even though there is a small chance of dying under anesthesia.  The 1.4% figure you quote is apples and oranges,  Some of the people that go to the hospital are there because they are very ill, I was not and my risk of dying at age 68 due to anesthesia or infection were lower than the 1.4%.  Regardless, I go for quality of life, not necessarily lenght of life, that is just me.  Given the choice of 10 good years or 20 poor ones I will choose the 10 without hesitation and my wife knows this in case I am in a coma.  

Hi CS123,

I don't disagree with anything you have said. I guess I was just pointing out that since it's the 3rd leading cause of death in the US, opting for a hospital stay and treatment for bph could cause enough fear to cause a reasonable person to avoid treatment until there was no choice. I did. Ron did. I suspect many others do too. I don't think it's negligence to do so. I think it's weighing one's fear against one's discomfort. 

Bob

 

oops again. I guess I should have said opting for a hospital stay and treatment for bph or any other non life threatening condition, 

Remember those statistics I posted don't include death by natural causes or inevitable death in a hospital. They only include cases where the actions or failure to act caused the death, in other words, malpractice.

Bob

CS123 said: The first line of medication for BPH is Flomax (Tamsulosin).  There are other brands as well – all work about the same.  Flomax is an alpha-blocker like many blood pressure medications and simply relaxes the muscles around your prostate allowing easier urination.  This may be all that is for some.  Flomax goes to work in a manner of days and if discontinued its effects go away also in a manner of days.  So there is no harm in trying it.  I could not keep taking it as it gave me headaches (it does not for most).  The second line of medications is Avodart (Dutasteride).  There is an older med called Proscar (Finasteride) but it does not work as well as Avodart.  That is it - there are no other BPH drugs on the market other than over the counter remedies that hardly work at all.

------------

Hello CS,

Just wanted to add that here in the U.S.A. there is one other BPH drug on the market worth considering, and that is Daily Cialis, which recently received FDA approval for BPH. Studies have shown significant symptomatic improvement over a placebo. I meant to start a new-topic on Daily Cialis, and probably will soon, but thought this might be a good time and place to jump in.

I have tried both Flomax and Daily Cialis, and Daily Cialis worked better for me, at least initially. I say, “at least initially”, because both of the drugs lost a little mojo over time, but I still give the edge to Daily Cialis.

The advantages of Daily Cialis over some of the other BPH drugs are: (1) No retrograde ejaculation; and (2) No negative sexual side effects. In fact, there is a positive sexual side effect, similar to that of regular Cialis and Viagra. The negatives are: (1) Some non-sexual side effects that I found similar to Flomax; and (2) The cost ($100/month in the U.S.) which probably will not be covered by most insurance.

I still take Daily Cialis on an intermittent basis to give my system a little boost from time to time. I stopped taking it daily, because while it helped with my BPH symptons, it didn’t help enough that I could completely discontinue CIC (clean intermittent self-catherization), which is how I have been managing my BPH for over a year. Daily Cialis is easy enough to try and you should find out within a few days if it’s helping or not.

As to CIC, it does not appear to be a very popular approach to BPH -- except in the SCI (spinal chord injury) community, where many of our surgical options would not help. There are lots of reasons it’s not being promoted which is probably a post in and of itself, but I’ll just say it works for me as a non-drug, non-surgical approach, and it might work for some others as well.

I started CIC as part of a bladder rehabilitation program (flaccid bladder from retention) prior to Button Turp. By the time my bladder was ready for Turp, I was doing so well with CIC that I decided to hold off on the operation. Other than needing an assist from the catheters (whole process takes about five minutes), my urinary systems performs like it did in my 20’s.  No retention. No urgency. No leakage. And no more getting up at night every two hours to go to the bathroom like before.  Depending on fluid management, I either sleep through the night, or sometimes get up once.

My plan is to continue CIC until either: (1) I convince myself that one of the current options is better; or (2) Some new and better medical or surgical procedure is developed. Other than the normal risks of surgery (and the devil you know versus the devil you don’t) , my main problem with most current procedures is retrograde ejaculation. I’m sure I can live with it if I have to, but right now I have an option where I don’t have to.

I realize that CIC isn’t for everyone, but I am convinced that there are a lot of people where it would be a good fit – either long term or temporarily -- who aren’t being directed that way by their doctors.

As to the risks of waiting for surgery, I’m still relatively young in my 60’s, and my prostate isn’t overly large and does not appear to be growing in size. YMMV.

-- Jim

 

 

 

 

Hi Jim;   Have you had a surgery or procedure???  I can't tell by your post.  I have never tried daily cialis for this symptom.   How many times prior to use of it were you getting up nightly and how many times after you started using it???  I would "assume" that daily cialis does not shrink the prostate???   Hope to hear more details from you.  Take Care.  

Hi jimjames, thank you for your good reply. I am sure it will help the readers. You are correct of course about Daily Cialis and other alpha-blockers besides Flomax. I tried Rapaflo for instance and there is Uroxatral and others. They all are alphas and some may work better than others for various individuals. Rapaflo gave me slightly better results than Flomax but also stronger headaches, but also at a higher cost as it is not generic.  So for those that want to try an alpha, while Flomax is the best known and now cheap, there are others that are very similar but may work better.

Regarding CIC I realize that this is a very personal decision and each person should decide what is best for them. But I am left wondering why you go through the trouble, what do you do when you are out of the house or travelling, etc. when you can have a Button Turp and be over the hassle for years. Yes there is risk in anesthesia but for a healthy person in their 60s it is minimal - according to the NIH the risk is 1-4 deaths per 10,000 anaesthesias. While there are horror stories like Joan Rivers, it seems rather safe to me. Also isn't there some risk of infection with CIC? Good topic for futher discussion. I think you should indeed start a post, thanks.

Never had surgery. The plan was to have a Turp but to self-catherize prior to the Turp to rehab my bladder. The self-catherization worked so well I decided to put off any operation for now. As to "how many times prior...was I getting up at night" before using daily Cialis, that is not relevant since I self-catherize and for the most part never get up at night. The benefits I saw from daily cialis was larger voids which meant I had to catherize less. And no, daily cialis does not shrink the prostate. I believe the exact mechanism is unknown but I guess it sort of relaxes it similar to flomax. You really should give it a try. Nothing to lose. Probably best not to take with something like Flomax at the same time so definitely run it by a doctor first. I noticed a difference in a couple of days but they say wait a week. 

CS says: ut I am left wondering why you go through the trouble, what do you do when you are out of the house or travelling, etc. when you can have a Button Turp and be over the hassle for years. 

-----------------------------

You sound like my urologist but he's coming around to my way of thinking at least for me!

I'm not going to say there isn't any "hassle" involved, but it's not really that bad. Takes about five minutes (versus maybe two minutes to do it the regular way), and at this point is about as uncomfortable as brushing my teeth. 

"Traveling" is a good question, and I haven't taken a long distance trip yet, but when the time comes I will either pack up my supplies, or have them forwarded to my destination, whichever makes more sense. 

Right now, I'm cathing in the early morning and then late afternoon or evening. So most of the time I only cath at home, but easy enough to carry one or two catheters with me if I'll be out late. 

The horror stories are not the reason I've chosen to self cath. It's simply that for now I prefer self cathing to retrograde ejaculation which is the probable outcome of Turp or similar procedures.  My thinking may change in time, but perhaps in time newer and better procedures may emerge. The self cathing buys me time to wait. 

But equiptment "hassle" aside, I'll match my quality of life bph scores with anyone whether they've had a TURP, Holep, Greenlight, etc. I void completely every time I cath, meaning no rention or kidney issues, I have no leakage or urgency ever, and I sleep through the night like in my twenties. And I don't have to take any drugs. 

'

I'll finish up by saying that the reality of self cathing is significantly different from the perception. No one could ever have gotten me to self cath were it not for the fact that I was almost in acute retention when I arrived at my urologists. The choice then was either to self cath while waiting for a Turp, or to do a Foley for six weeks. The "ick" factor was just too great. 

Well, that was then, and now no one including my urologoist has been able to get me to stop self cathing because I still see more upside than downside, at least for now. 

Makes sense. As I said it is an individual's choice to make. You seem pleased and that is what counts. If you feel otherwise later you can always change your mind. Best...

Makes sense. As I said it is an individual's choice to make. You seem pleased and that is what counts. If you feel otherwise later you can always change your mind. Best...

Can't edit posts here, so I'll just do this as an add on. 

-------------------

So, assume for discussion sake that you have a bad case of BPH with running to the bathroom all night, daytime frequency and urgency, and maybe even some kidney issues. And now someone tells you that you can get rid of ALL THOSE SYMPTONS without surgery and without drugs. And it would only take you five minutes maybe 2-4 times a day.

Well, that doesn't sound too bad does it? Well, that's in essence what self cathing is really all about. Unfortunately, the associations with "self cathing" can kind of blind people to the potential benefits. 

 

That last post was not a response but a continuation. Changing the subject a little, is anyone else having difficulty navigating this site? I'm having the hardest time following the continuity of threads as dates do not seem sequential ,whether you set it up for most recent or oldest posts.  Maybe it's just me or my computer but I've never run into this before in a discussion group. I find myself searching for keywords in order to find posts. Crazy. 

Hi JimJames,

My cousin's husband who was aprofessor at a medical school self cathed for years. Finally he got a turp which failed after a few years because he had lost elasticity in his bladder and went back to self cathing every 6 hours. In his case he has to do it on a schedule because he has no sensation of having a full bladder. That is also what led him to stretch his bladder and with no bladder elasticity, hve to start cathing again.

I self cathed every 2 to 4 weeks for a year to prevent the recurrence of scar tissue. Unfortunately I got a gross hematuria, which may or may not have been caused by the cathing. When I cathed I always got blood and tissue in the cath, so it's possible I did some injury during that year, but it was never conclusively decided what the cause of the heaturia was.

I tried the free coupon for a 30 day supply of 5mg Cialis (Daily Cialis) and it didn't work out for me. The cons for me were it didn't work as well as the flomax and I got short tempered (possibly from unsatisfied libido). I reverted to using it just before sex taking one or two. But when I went to renew it I found that neither my drug plan nor medicare would reimburse it for any reason. The Walgreens price for 30 5mg pills was $330, or $330 for 8 20mg pills. OK, extra foreplay costs nothing and gets the same result so that was the end of cialis for me.

Bob

Hi Bob,

I don't think you meant to infer that self-cathing may have been the cause of loss of elasticity of your cousin's bladder, but it could have been read that way.

In fact, it's the opposite. Self cathing is a treatment for a flaccid (loss of elasticity) bladder. Doctor's often prescribe it (or six weeks with a Foley Catheter) prior to TURP so that the patient will have a better result after the bladder gets a chance to decompress and regain some elasticity.

Self-cathing on a schedule is pretty normal but the schedule is tailored to how much you output which you can easily measure exactly, especially in the beginning. So, even if you have no bladder sensation, you're protected from over expanding yhour bladder. So let's say  you have over 400cc when you self catheter, then you increase the number of times you do it a day. That way your bladder will never get stretched, Some people can get away with Cathing only once or twice a day, some people Cath six times a day. Again, it's all dependent on how much comes out each time which is partly dependent on how much you normally void.

As far as blood is concerned, there is a learning curve for self cathing, and it's easier for some than others. I had a very bad time for the first four months until I made some changes in equiptment and technique, and since then it's been smooth sailing.

Come to think of it, maybe I'm only paying $100 for a months worth of Cialis because my Medicare supplement pays the rest. I consider it worth the cost, especially since I probably only use it now maybe 10 days a month or less.

But I forgot about that free 30-day trial. That's how I started. So if anyone wants to try it for 30-days, i think you just go to the Cialis web site and they contact your doc, etc., and now you have a free month's supply.

Jim

 

It is not just you, I have the same problem with the order of post in this website and I am a computer person. Most sites like you said place the last post on the thread at the end, here they are all over the page. Maybe the moderator can chime in and help.

Well, I was hoping for an easy fix, but I guess it's not just me on this. Like yourself, I'm pretty computer literate and have never seen a discussion group with posts thrown around in what almost appears a random order. It's easy enough to find a post with you get a notification, but if you simply log onto the site, just try and find it! Again, I've been using key word searches to try and find individual posts. I will write the moderator on this and hopefully anyone else having problems will do as well.

JimJames,

No, I didn't mean to imply cathing caused loss of bladder elasticity. I think what happened to my cousin's husband was that he stopped cathing after the turp for about 3 years, but didn't sense when his bladder was full so he overstretched his bladder and it lost all elasticity. His uro told him it was like a deflated ball. At that point all he could do was to go back to cathing.

I have Cigna Medicare supplemental. Signa doesn't pay anything when medicare refuses to pay, and medicare (maybe to appease puritanical types) doesn't pay for cialis for any reason. At least that is what I understand.

That makes a lot more sense.  I'm a bit surprised his urologist didn't track his retention a bit more carefully after the TURP.

I have Medicare with AARP secondary and the AARP Rx plan. I guess it's the RX plan that kicks in but at any rate the out-of-pocket is about $100.

Back to your cousin's husband. Do you know if he had urodynamics done prior to the TURP? If not,  it's possible he was never a good TURP candidate to begin with as you need a certain amount of bladder elasticity (as well as detrussor pressure) for a TURP result that allows you to stop self cathing.  If he didn't have the elasticity and/or enough pressure then it's not surprising his bladder ended up like a deflated ball after he stopped cathing even with the TURP,  but again his urologist should've seen this coming if not before the operation, certainly after with monitoring. So how is he doing now with the self cathing?

Well he's about 8 or 9 years older than I am, spent his whole life as a professor of the urogenitoury tract at a medical school.  He still does some consulting although he's semi-retired.He had the utmost confidence in his urologist. I don't know how bad off he was or what he was advised except that they agreed the turp was necessary. I know it only lasted 3 or 4 years and he went back to cathing. I guess he's fine with it now, it's probably been a decade.

Bob

Hi all,

I have removed the argumentative posts in this thread. Posts are user's own opinions and it is anyone's right to disagree with another's point of view politely. We do not have time to get involved with individual disputes. However if users start name calling and posting offensive comments we will delete posts and deactivate accounts. You can use the "Report" link to draw these to our attention.

Re using the site and confusion of where posts appear - there is an FAQ section linked at the bottom of every page in the forums which goes to

http://patient.uservoice.com/knowledgebase/topics/59133-discussion-forums

The first and third links on that page explain the ordering etc but if anyone needs any help send me a private message and I can advise further. 

Regards,

Alan

 

You said "...I have removed the argumentative posts in this thread,,,"

_______________________

Hello Alan,

Your reply to me, above, could suggest that I have been making 

"argumentative" postings. Hopefully, you were addressing this either to others, or to the group as a whole. Could you please clarify. Thanks.

-- Jim

Hi Jim,

It was to the group as a whole. I replied to your post as it was the initial one mentioning problems navigating the site.

Sorry for any confusion.

Regards,

Alan

Thanks for the clarification, Alan. 

As to site navigation issues, opinions, etc, I did read the links you provided (thanks) and they did clarify some things,

but (and not to be argumentative ) I'm not convinced that the legitmate problem your software update tried to fix hasn't created a bigger one in terms of site navigation.

Would you prefer follow-up comments on thread navigation to be via private message, or is it appropriate to start a thread on site topics like this ?

Thanks for your help.

Jim

Hi Jim,

There is a Chatroom group here

https://patient.info/forums/discuss/browse/chatroom-3315 where you can post site feedback/suggestions.

Regards,

Alan

Ron, I would be interested to know where the Urolift can be done for $2500.  I am just starting to research this.  

I agree with you Bob.  I worked in a hospital for 13 years.  Hospital infections happen because of poor sterilzing and simple handwashing. Med effects kill many each year.  I don't blame anyone for being prudent in their choices - the medical center they choose, the type of anesthesia, their risk tolerance.  And many people don't even know when a medical error has been made.  For legal reasons, no one claims responsibility.  

Hello CS123,

I just read your long post above and this is what I have been looking for. Someone that has had a Button Plasma Vaporization of the prostrate.  You may have seen some of my post and I may have missed some of yours.  But, I am a 58 year old pilot that has been fighting with BPH and a getting worse retension for the past year and an half. I had been working with another Urologist and I thought I would get a second opion from another Urologist.  So, I have made a change to a new Doctor. It has finely come to the point that my current foley catheter will come out next week when my new Urologist (Dr. William Shappley in Memphis) does a Button on my prostrate and bladder opening. He had to put me to sleep a week ago to get this one in and at the same time took a good look with the cystoscope at my prostrate and bladder.  He found I had extra tissue at he opening of my bladder and as my BPH has been getting worse the tissue at the opening of my bladder is cutting off my urine being able to exit my baldder.  Then each time the catheter is taken out my urethra collapes and the flap of extra tissue cuts off my bladder, stopping me up. Thank you for your post. I will report back on this board as to what happens.  

Jon

Camster, that number was quoted to me in April-May or so last year after Urolift had been approved by the FDA but not yet by medicare, private insurance, etc. So, that doctor, Naveen Kella in San Antonio was performing the procedure for cash out of pocket of $2500, total cost. Since Medicare and private Insurance approved urolift for reimbursement just a coiple of months ago I'm sure that that figure will no longer apply. Dr Kella is a renowned surgeon and a good man, you can contact him through his web site.  

Thanks Ron for your response.  I have an enlarged median lobe so I may not be a candidate for Urolift.  I emailed a urologist about this for confirmation.  I received a response today from Dr. Martin Pisco in Lisbon, Portugal who originated prostatic artery embolization.  I have a rectal ultrasound scheduled for April 1.  He wants to see it.  Again, thanks for taking the time to respond.  It is appreciated.  

Hi Camster, I posted a longer response regarding PAE and median lobes that is waiting to be moderated because I mentioned a website that had a long standing discussion on PAE. The main point was that I read comments on that site that PAE doesn't work on an enlarged median lobe.

I can't wait to see the response.  And I would love to see the website discussing PAE and enlarged median lobe.  I will even ask the question to Dr. Pisco at some point and see what he says.  Thanks Bob.  

These are hard decisions.  Trying to correct BPH while still finding something that works without disrupting sexual function.

Hi Camster,

I'm guessing the post should be approved. If not just google Gat Goren Method healingwell

The forum has a 6 part thread on the Gat Goren method of PAE, with about a half dozen posters who have had the procedure and other PAE procedures with varying degrees of success. The median lobe is not a disqualifier but for some may slow down or reduce the progress of the procedure.

The decision is a hard one for sure. I think most people who have had any of the procedures spent a lot of time researching and thinking about their decision. Unfortunately you can never know for certain how it will work for you  until you actually have it done. And you won't know the longer term success until time passes. In my case I didn't have the procedures done until I absolutely had to, so that relieved me of any second guessing, I really had no choice.

Camster, Holep works for a prostate of any size or configuration. Mine was 114mg with a prominent third lobe protruding into the bladder. I was told that turp would not work for me and the only solution was an open prostatectomy, with months to recover. I chose Holep instead and my results have been repeated in these forums. The longer and larger that third lobe grows the more problems it will cause. My Holep was no more trouble to me than urolift would be to patients with smaller prostates. I recommend it without reservation.

Keep us updated, thousands of patients will read your posts.

Good luck, Ron 

Hello Ron ... we communicated a coule months back .. I contacted a Uro in San Antonio that does (did) the Urolift proedure ... I had all the tests done .. sent them to him... ans was prepared to travel to San Anton... then i sent him an email right afte the holiday ... and no reply .. i called his office and he closed his practice !!  can you recommend anothe Uro ?  I'd appreciate any help you can provide ...

Robbie

On the Healingwell forum onthe thread Gat Goren, PAE, LUTS, Part 6, there were two posters who had the Urolift. Here is what one of the posters posted today:

"I am in a very similar position to you. Started with a Urolift which led to urethral swelling, urinary retention, kidney function damage (mild hydronephrosis), acute urinary retention and now a nonfunctioning bladder. I'm currently cathing 3x daily. Needless to say I'm devastated that I did the Urolift."

Hi Robbie.Well, that's a bummer. I researched it a bit and it appears that a sr member of the firm may have misappropriated company funds and made it no longer viable. I guess Dr Kella is temporarily indisposed. Too bad, he's a nice person, I believe. He was probably the most experienced in Texas last year but there are a lot of urologiststs doing urolift now. 

Here's my take on Urolift after studying it for almost a year; if it works for you it can help you avoid the more-invasive techniques such as Turp, PAE  and Holep among others. It may help you avoid retrograde ejaculation which is the result of the Meds, Turp and Holep. But it frequently doesn't work at all and even if it does it's a temporary fix, buying you a few years at best. Then a more invasive procedure will be necessary in order to surgically open up a path and probably resulting in retrograde ejaculation.

You probably know that I had Holep a few months back and it was probably less invasive than Urolift. I already had RE so that was nothing new.

I don't know where to find another Urolift surgeon but I'm sure there are lots of them around nowadays. Just be sure to use one who has done at least a couple of dozen procedures. If you can swing the financial burdon of Holep I would do it and accept the RE. It's just not that bad. Good luck and let us know the next chapter of your story.

Hi Ron... yes, very strange about Dr Kella... soooo you had a Holep done ... and your sex life is normal again ??  i'm sure the retrogarde ej. is something i can handle ...i have medicare as my only insurance.. does it cover or do you know .. The Holep is only a temporary fix ?  Ooooh no .. i didn't know that, thanks for the info ..

also .. i've been talking reading about Robotics and found a group in Florida that practices Robotics .. it seems to be minimally invasve and much more precise .. do you know anything on Robotics ?

I hope all is procedding well in your recovery ..

Robbie

No, you misunderstood what I said. UROLIFT is a temporary fix not Holep. The Urolift surgeon simply uses stitches to pull the prostate lobes back away from the urethra so urine can flow normally. I believe it usually works although you read some posts where it did not. The prostate tissue is not removed and continues to grow, eventually the urethra will become blocked again. Every patient and surgeon are different so there's no absolutes, urolift may work beautifully for years and it may not work at all apparently. 

Holep is a totally different procedure, the surgeon removes almost all of the prostate tissue from inside without touching the capsule where the nerves are.  In my case 85% was removed and my flow is better or as good as in my teenage years. I had only a bit of pink urine for 7 days, no pain AT ALL. Don't ask me how the Holep surgeon accomplishes this with no pain but i can tell you that I had none at all.

As far as cost is concerned, I have medicare plus a medicare supplemental policy. These two paid all but about $650 which i paid out of pocket.

I had the surgery done by Dr Humphreys at the Mayo clinic in Phoenix and I recommend this solution without any reservation at all. Just unbelievable. Why men continue to subject themselves to the barbarism of TURP, Green Light laser procedures, etc  is beyond me. All of that pain, bleeding, poor results, procedures to fix the previous procedure is not necessary if my example with Dr Humphreys is typical of his results and I believe it is.

Good luck and keep us posted. 

 

Hi Ron ...ooops i guess i did misunderstand you ... The Holep is pemanent ...we hope... good to hear.  Do you know anything about Robotics ?  I wondering if anyone has had this type of procedure and can provide feedback to us ?? 

the cost of your Holep sounds very affordable and the fact that medicare paid a good deal of it is great news... i have the same Medicare coverage. I live in Panama .. and i went to a very good hospital here to have tests doen by a Uro ... he quoted me $5-6K for a TURP !!!  Unbelievable .. in Panama no less ..

Robbie  

Well, I'm no medical professional but I believe that robotics refers to the surgeon controlling the operating tools, scalpel, laser, water irrigation, suction, etc attached to a robotic arm which he manuevers like with a video game joystick while watching on a TV monitor.  I don't know the method my surgeon used; Manual or robot but I believe he could have performed a Holep procedure either way. I know the turp procedure can be done both ways and I believe the robotic method is the more up to date method. If I'm way off here someone correct me.

I wonder about living in Panama, what takes you to Panama and what is  daily life there like?   

hi Ron.. i'd lived in Florida for many years and i'd been in a bad accident. some guy rearended me while i was on my scooter .. Ugh.  had to have a couple of surgeries ... and decided that i wasn't getting any younger and didn't want the expense of a house and taxes, and hurricane isnsurance.... and blah blah anymore ... so ...decided to hear south.  Panama is a good country .. very safe for the most part .. and tied to the $. many foreign companies are located here .. and i teach English.  the city is not cheap anymore .. but the countryside is and it's really beautiful. I'm in the city for now .. and quite busy teaching .. there are many beautiful beaches here .. and beautiful mountains (small) where the climate is cool ... .. anyhow... all for now

Robbie 

Robbie, some things i have learned in the past, almost a year, of researching the prostate surgery thing; that, in the opinion of most healthcare professionals, and in my opinion as well, in weighing the likelihood of a succesful outcome, nothing compares to the professionalism of a surgeons support staff, his equipment, his experience and competence, etc.  

In other words, although I believe that the Holep method is by far the best method to remove tissue from the prostate, that the best surgeon with the best support staff and equipment and experience can perform a button turp procedure with a good outcome as well. That's also, I believe, probably true of a urolift and green-light laser procedure.

But when I say the best surgeon, staff, etc all of the above I mean that all of those factors are found in only a very few institutions in the US; the Mayo Clinics, Johns Hopkins, some university-funded teaching Hospitals, etc.

A major reason that I feel this way is because of the deaths and injury from infections, errors in medication and errors in surgery and anesthesiology that are  occuring in epidemic numbers and increasing dramatically in the US today.

My experience at the Mayo Clinic in Phoenix bore this out dramatically. The staff's attention to detail, cleanliness, and competence were in evidence everywhere, checking and double-checking constantly.

I wasn't really surprised at their competence but their examination of my  personality and mental state was done by two interviews by Doctors other than the surgeon. I thought a lot about the reason for this and I concluded that they just wanted to know if I was a nutcase of some kind who would lie about my past medical history, my drug history, or be bent on a lawsuit agenda of some sort. I can't blame them in the slightest, there's just so much about a patient that they may need to know and have no means to discover.  Just another example of the Mayo's thoroughness.

I feel so strongly about the entire surgical environment that you subject youself to in a surgical procedure that I will say, without qualification, that will not have any procedure done unless it's done in one of the dozen or so best Hospitals in America.

So, how would you know which they are? Easy, ask if the surgical staff performs the Holep procedure. If they do then they will have one of the best surgical environments in America as these few are the only ones who have a Holep surgeon on their staff.

These things I have learned in the past year. 

I completely agree !!  it all depends on the experience of the Dr, the staff, the equipment and the surgical enviornment !!! 

Great insights.

HOLEP gives retrograde ejaculate.  

Hello Ron

I have just read your comments on Holep verus GL Laser . i thought the only difference between the two was that tissue was removed to be examined with Holep but both are essentially the same? Hve I got that badly wrong?

I am booked in for GLL in a few weeks so am now concerned,

regards

Jeremy

Jeremy there is still time to call your doctor and change your mind.  Both will burn away you prostate and yes you will get dry orgasm.  I would look into something elso because once you have it done there is no turning back  Ken