UFOLIFT Up Date
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Good Morning All
I was not going to say anything but I feel that you guy's need to know what is going on. This is about the Urolift and adding procedure to it at the same time.
I have been thinking about this for a couple of days. Like I said I was not going to say anything but I would not like any other men to go through what these other men are going through.
I have not heard about any of these procedure being done in the US. It is being done in the UK and Australia by a couple of doctors.
What these doctors are doing is wrong. The Urolift is a procedure that stands alone. I have all ready sent two letter's to the company and they told me they sent them to the internal team.
There are 2 ways of doing what these doctors are doing. One is after they put the clips on the prostate they do a laser lesser bladder neck incision. This one may be better but the patient is not informed of the added healing time. There is one guy on here now that had it done. The healing time for the Urolift is 2 to 4 weeks. With the lesser incision it will be 12 weeks or more. The patient was not told anything else of the risk or side effects. The doctor also had a additude when the patient ask if he could do the Urolift only for now
With adding the BNI the Urolift was not giving a chance to work on it's own. It would have taking the pressure of the bladder neck and he would have been able to pee but we will never know.
A year ago I was informed that a doctor was doing a 4D Urolift in the UK. I found out what it was and I wrote the company. At that time they said that they would handle it and got back to me saying that it was up to the doctor and patient as long as the doctor tells the patient of any side effect or problem. So in a way they are not doing nothing.
About a week later I got a PM message from a man in the UK that had it done. This is what he told me. I was just going in to have the procedure when the surgeon stop me. He said that he just saw a video on a new pattern for placing the clips by a Australia doctor. All he told me was that I was going to be his first solo patient.. I did not think it would matter( Did not do research ) so I listen to him he was a consultant in the first Urolift trails. There was no mention of the possibility of retro, higher risk of incontinence or any other side effects. It was just suppose to make it better.
When I woke up from the surgery I was in a lot of pain. The doctor was surprised. He never told me what he did. Never saw me after surgery. Every movement hurt. I was able to see him 4 weeks later.
At 3 month's still leaking and pain. Even when I stand I leak. After looking this up. This is not the recovery profile of a Urolift procedure this is more on the order of a TURP or a Holep. The clips are put in to high and put on the bladder neck to keep it open. I never had a bladder neck problem my prostate was small just a little tight.
This is also what the patient told me. The company should be watching it's back and start putting it patients first and stop these doctors from trying to make a name for them self. And stop them from using there patients has guinea pigs
I talk with my doctor and he said that they could cut the strings to relax the bladder neck. When he ask his doctor he told him that can't be done that the only way to fix it was to do a TURP. He told him no and got up and walked out of the office.
It is over a year and I got a e-mail from him at the start of the week that he is seeing 2 new Urologist to see if they can help him. He is still wearing pads for the leaking. Still in pain. He is not the only one. There are about 10 men that had this done. He also heard that the doctor in Australia is having some problems with the patients he has done.
Now my main concern is that these doctor are doing this and there is no data on the procedures at all. They do not know the healing time or side effects or if it really does help. They are doing this without any research or trails. With all the procedure we have today they were all in trails for 1 or 2 years so we would have the information on them. If this is not stopped we will have no procedure to save a man ejaculation which some of us still are concerned about. Urolift is the only procedure that save a man sex life and ejaculation 100 %.
Again I am sorry that this is so long but it has to be said.Take care allKen
0 likes, 17 replies
dl0808 kenneth1955
Posted
hello ken, i did some research. results are given below.
Below gives the cause for bladder neck obstruction as given by Mayo Clinic and I also present a paper in 2005 that discuss the etiology, diagnosis and treatment for BNO.
As u will see the major cause for BNO is BPH. Diagnosis for BNO is different than BPH because it has to prove that the obstruction comes from the bladder neck. Just like BPH, the first line of treatment is drug and the second line of treatment is surgery. the surgery is a single incision or a double incisions at the bladder neck towards the verumontanum. Details are given in the paper. This is the only paper that I could find.
From Mayo Clinic:
My doctor says I might have bladder outlet obstruction. What does that mean?
Answer From Erik P. Castle, M.D.
Bladder outlet obstruction in men is a blockage that slows or stops urine flow out of the bladder. Bladder outlet obstruction can cause urine to back up in your system, leading to difficulty urinating and other uncomfortable urinary symptoms.
Possible causes of bladder outlet obstruction might include:
Enlarged prostate, also known as benign prostatic hyperplasia (BPH) — this is the most common cause of bladder outlet obstruction in men
Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery
Use of certain medications, including antihistamines, decongestants or drugs to treat overactive bladder
Bladder stones
Prostate cancer
Prompt diagnosis and treatment of bladder outlet obstruction is important to prevent serious problems caused by urine backing up into your system.
If you can't pass urine, emergency treatment includes insertion of a tube (catheter) through the tip of your penis and into your bladder. This tube helps urine drain from your bladder. If your condition doesn't require urgent care, your doctor might order tests to determine the underlying cause of your bladder outlet obstruction. Tests include imaging the bladder with sound waves (ultrasound) and viewing the bladder with a camera (cystoscopy). Treatment might include medications or surgery.
by Victor W Nitti, MD
Abstract
Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Although the true prevalence of PBNO is difficult to ascertain, studies in both men and women with voiding dysfunction demonstrate a marked prevalence of the condition. Symptoms caused by PBNO include storage symptoms (frequency, urgency, urge incontinence, nocturia) and voiding symptoms (decreased force of stream, hesitancy, incomplete emptying). There are multiple theories as to the etiology of PBNO, including muscular and neurologic dysfunction and fibrosis. The diagnosis of PBNO can be made precisely with videourodynamics, urodynamic testing with simultaneous pressure-flow measurement, and visualization of the bladder neck during voiding. Treatments vary from watchful waiting to medical therapy to surgery, depending on the severity of symptoms, urodynamic findings, and response to therapy. This article reviews the current state of the art with respect to the prevalence, etiology, diagnosis, and treatment of PBNO.
Etiology
The precise cause of PBNO has not been clearly elucidated. Theories as to the etiology of the condition are varied. Initial theories focused on structural changes at the bladder neck, such as a fibrous narrowing or hyperplasia, as initially proposed by Marion.1 Leadbetter and Leadbetter6 proposed that there is a fault of dissolution of mesenchyme at the bladder neck or inclusion of abnormal amounts of nonmuscular connective tissue, resulting in hypertrophic smooth muscle, fibrous contractures, and inflammatory changes. Similarly, Turner-Warwick and colleagues2 described inefficient bladder neck opening resulting from abnormal morphologic arrangement of the detrusor/trigonal musculature.
A neurologic etiology for PBNO in the form of sympathetic nervous system dysfunction has also been suggested.7 Crowe and colleagues8 demonstrated an increase in the density of neuropeptide Y-immunoreactive nerves, part of the sympathetic contractile system of the bladder neck, in bladder neck tissue obtained from men with bladder neck dyssynergia.
Some cases of apparent bladder neck dysfunction may actually be the result of abnormalities of the striated urethral sphincter. It is widely accepted that the first event in volitional micturition is relaxation of the external striated sphincter.9–11 The recent work of Yalla and Resnick11 showed that, as the external sphincter relaxes (and pressure drops), the pressure in the bladder and at the bladder neck increases. However, the rate of increased pressure in the bladder is greater than that at the bladder neck. When vesical pressure exceeds vesical neck pressure, which occurs “within a few seconds,” voiding ensues. The authors also found that, in certain patients, the periurethral striated muscle can extend functionally to the bladder neck. In such patients, the pressure changes during the initiation of voiding may be slightly altered. In another study, Yalla and colleagues12 demonstrated that such extension of the functional external sphincter to the bladder neck occurred in 48% of men.
Diagnosis
PBNO is a videourodynamic diagnosis, the hallmark of which is relative high-pressure, low-flow voiding with radiographic evidence of obstruction at the bladder neck with relaxation of the striated sphincter and no evidence of distal obstruction. In men, what constitutes high pressure and low flow in PBNO has not been universally defined. In various series on PBNO, detrusor pressure at maximum flow ranges from 20 cm H2O to 70 cm H2O with maximum flow rates (Qmax) of less than 15 mL/s.3,15,17 Nomograms used to classify obstruction in men with BPH do not necessarily apply to PBNO.
Nitti and colleagues14 recently categorized PBNO into 3 distinct types: classic high-pressure, low-flow voiding (Figure 1); normal-pressure, low-flow voiding, with narrowing at the bladder neck (Figure 2); and delayed opening of the bladder neck. All 3 classifications represent vesical neck dysfunction causing obstruction. Alternatively, PBNO has been diagnosed by micturitional urethral pressure profile, in which a pressure drop between detrusor pressure and bladder neck pressure is seen.21
In women, the pressure/flow criteria for PBNO are even less defined. According to the videourodynamic criteria proposed by Nitti and colleagues,16 a detrusor contraction of any magnitude associated with radiographic evidence of obstruction at the bladder neck is adequate to diagnose PBNO. Chassange and colleagues22 proposed cut points for obstruction of 15 mL/s or less for Qmax and greater than 20 cm H2O for detrusor pressure at maximum flow. The Blaivas-Groutz nomogram has also been proposed to diagnose obstruction.23 However, if either of the latter 2 methods is used, a simultaneous radiographic study is still needed to localize the obstruction and make a definitive diagnosis (Figure 3).
Our team at New York University compared urodynamic findings in men and women with PBNO using the 2 groups described above. Flow parameters were similar, with a mean Qmax of 10.6 mL/s for men and 8.0 mL/s for women (P = .101). However, detrusor pressure at maximum flow was significantly higher in men than in women: 52.5 cm H2O versus 38.5 cm H2O (P = .027). PVR was significantly higher in women: 180 mL versus 33 mL (P < .001).
Treatment of PBNO
The treatment options for men and women with PBNO are the same and include watchful waiting, pharmacotherapy, and surgical intervention. Watchful waiting is an option for patients who are not bothered much by their symptoms and have no clinical or urodynamic evidence of upper and/or lower urinary tract decompensation. Unfortunately, the natural history of PBNO is not well characterized. It is not known how many men or women who elect watchful waiting have progressive symptoms, develop decompensation, or subsequently receive treatment. It is likely that, in some cases, older men with LUTS presumed to be caused by BPH who had the start of symptoms in their twenties or thirties actually have long-standing PBNO.
A review of the literature provides some reasonable guidelines for the treatment of PBNO in men, albeit without the benefit of randomized, controlled trials. For women, however, most treatment options are based on “expert opinion,” with only a few small series available for review.
Pharmacotherapy
α-Blockers have been the mainstay of pharmacotherapy for PBNO. Although much of their effect is presumed to involve the smooth muscle of the bladder neck, α-blockers may also affect the bladder via local or central mechanisms, as is assumed to be the case in BPH treatment. However, unlike α-blocker therapy for BPH, only variable success has been reported for α-blocker therapy for PBNO. Most studies have been small, nonrandomized, and noncontrolled, with no consistency in type or dosage of drug. In addition, there are no reported placebo-controlled studies, and outcomes have been variable. Most studies report subjective results, with relative underdosing of medication, and no parameters have been consistently reported to predict success or failure.
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Fifty percent of subjects responded to α-blockade with decreased symptoms, increased flow, and decreased PVR. Specifically, in responders, Qmax increased from 9.5 mL/s to 15.1 mL/s and PVR decreased from 277 mL to 27 mL. No validated symptom assessment was used to evaluate symptom response.
Surgery
PBNO can be treated surgically with unilateral or bilateral transurethral incision of the bladder neck. The main concern with bladder neck incision is the development of postoperative retrograde ejaculation. Retrograde ejaculation is less likely to occur with unilateral incision as opposed to bilateral incision.17,24
Bladder neck incision is highly effective. In 1986, Norlen and Blaivas3 performed incision or resection in 18 of 23 men with PBNO. All patients experienced “symptomatic relief” (no objective parameters were used), and mean Qmax increased from 9.1 mL/s to 26.1 mL/s. In 1994, Kaplan and colleagues17 reported the results of unilateral incision in 31 men. Thirty men experienced a subjective improvement in symptoms, with mean Boyarsky symptom score decreasing from 16.4 to 6.4 and mean Qmax increasing from 9.2 mL/s to 15.7 mL/s. No retrograde ejaculation was reported in this series with unilateral incision.
Unilateral bladder neck incision was also performed by Kochakarn and Lertsithichai26 in 35 men aged 36 to 46 years. Objective outcomes were measured with respect to IPSS, flow rate, and sperm count. Patients were evaluated at 3, 6, and 12 months postsurgery. Of note, there was continued improvement in IPSS and flow rates up to 1 year after surgery. At 1 year, there was a mean 55% decrease in IPSS and a mean 95% increase in flow rate. Postoperative sperm counts were decreased at 6 to 12 months (70% mean decrease from preoperative); however, the authors could not offer a satisfactory explanation for this decrease, because it did not appear to be related to ejaculatory volume. In a study by Trockman and colleagues,24 18 of 36 men diagnosed with PBNO underwent bilateral incision. A “successful” outcome was obtained in 16 (89%) of the men. Mean AUA symptom score decreased from 17.1 to 4.3, and mean Qmax increased from 8.2 mL/s to 26.7 mL/s. Antegrade ejaculation was maintained in 73% of subjects.
Bladder neck incision and resection may also be used to treat PBNO in women. Axelrod and Blaivas5 performed bilateral incisions at 5 o’clock and 7 o’clock in 3 women with PBNO and reported success in all cases, with no subject developing incontinence. Gronbaek and colleagues19 performed a single incision initially and a second incision as needed in 38 women with PBNO. At a mean follow-up of 55 months, the success rate was 76%. One patient (3%) developed incontinence. Kumar and colleagues20 performed a single incision at 12 o’clock using a pediatric resectoscope in 6 women with PBNO who had failed α-blockade. Success was reported in all 6 subjects, with Qmax increasing from 8.5 mL/s to 15.5 mL/s and PVR decreasing from 256 mL to 40 mL. Mild stress urinary incontinence was reported in 2 (33%) of the women.
Main Points
Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding, resulting in increased striated sphincter activity or obstruction of urinary flow in the absence of another anatomic obstruction.
PBNO can present with a variety of symptoms, including voiding symptoms (decreased force of stream, hesitancy, intermittent stream, incomplete emptying), storage symptoms (frequency, urgency, urge incontinence, nocturia), or a combination of both.
PBNO is a videourodynamic diagnosis, the hallmark of which is relative high-pressure, low-flow voiding with radiographic evidence of obstruction at the bladder neck with relaxation of the striated sphincter and no evidence of distal obstruction.
α-Blockers have been the mainstay of pharmacotherapy for PBNO. Although much of their effect is presumed to involve the smooth muscle of the bladder neck, α-blockers may also affect the bladder via local or central mechanisms.
PBNO can be treated surgically with unilateral or bilateral transurethral incision of the bladder neck.
Uniform diagnostic criteria for PBNO need to be developed to help
kenneth1955 dl0808
Posted
Thank you. I read that one to. I think it all depends on how deep they cut the bladder neck. They do it at the 5 and 7 o'clock and they will removed so of the prostate at the bottom of the bladder neck.
It is very interesting. Doctor have to make sure what is the problem before they do a surgery. It can be the prostate or the bladder neck. Why do 2 when one would take care of the problem
Take care Ken