Update On My 2 Days Appointment With 2 Different Urologist

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On Monday I went to see my HOLEP urologist for a rectal echo, doctor said that my prostate is 100 gram and that I need the operation to remove 80% of the prostate, I also asked him about going the medication route, he told me that combo med will take up to one year to work.

On Tuesday I went to see the Green Light Urologist, he had me do a cystoscopy again, I had one done by the first TURP urologist last March. Turns out that he aslo said that my prostate is large but the bladder looks fine and strong. He then filled my bladder with liquid and told me to go urinate. Well I just couldn't, I stayed about 15 min in the washroom trying and trying and trying but nothing came out. I finally asked the staff to give me some time to relax since they kept knocking on the bathroom door to see what I was doing, they told me to take my time and come back and see them later on during the day so I did. Took a nice lunch and drank a coffee, took a long walk, all this time I could feel my bladder full and the urge to urinate. So again I tried and I tried and nothing came out not a single drop, I tried many other times and finally, 4 hours later I decided to go back to the urology department. They had to re-install a catheter again, I did talk about CIC and asked them to be trained by a staff of the department, so I took an appointment for that but have to wait some weeks, now I have another infection so back on Cypro and also very sore from the cystoscopy which is not too pleasant. I also was given the choice of medication, so I have now Tamsulosin and Avodart but this Urologist told me it takes about 3 months to work and to shrink 30% of the prostate. So not sure if I want to start taking them to mess up something else in my body.

So I did ask the urologist why I could urinate before the first event of cystoscopy 3 months ago with the TURP doctor, he didn't really knew what to say other than the prostate is big and blocking the urethra and according to the cystoscopy everything else was normal with strong bladder so he couldn't see any other reasons why I could not urinate at all.

So now I have the HOLEP operation option with a tentative date in the end of July (not convinced they will keep the date, got this date because of my pressure I put on the departement). With the Green Light doctors, he has no date for me nothing for the next 6 months or he could refer me to TURP doctors and get it done within the next 2 weeks or so. Of course if I decide on an operation, it will be the HOLEP one.

My next option is CIC which is blocking me but I'll do everything in my power to try it with a trained nurse in a few weeks or so.

All comments are appreciated

Thanks and God bless you all

John

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  • Posted

    Your best bet now is to catheter one way or another otherwise you could pass out. If you wait long enough your system could return the way it was. Mine did after 8 mos.
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    • Posted

      Hi Lester thanks for the message, you mean keeping a catheter or doing CIC I could eventually urinate. Not sure if I want to take my medication especially if I go for the HOLEP operation. 

      Much appreciated

      John

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  • Posted

    Hi John,

    With my enlarged prostate i had similar problems and I had a TUNA procedure which helped for about two years. Then I started having more and more problems, including burning and what you describe. I took Rapaflo for about a year and it helped tremendously. It only took a few days to start working. I didn't care for the side effects and got a PAE in 2014. Quality of life restored! Check out all the comments on PAE and urologists on these boards and you'll hear that it's not something that will be recommended by your doc. 

     

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    • Posted

      Hi Kc

      Thanks for sharing your story, I'm not too crazy about medication since it's just patching something that will eventually need more invasive methods to cure it, I haven't really researched PAE but my green light urologist mentionned that method as well.

      I'll keep you posted,

      Thanks

      John

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  • Posted

    Why is everything so far into the future wiyj your doctors?  Are they yhat busy?  Do they have that many patients?

    Tom

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    • Posted

      Hi Tom, yes just a terrible medical system in the province of Quebec, since medicare is paid by the Government and doctors are under paid and overworked compare to the States, the waiting time is longer especially for HOLEP and Green Light, If I wanted TURP I could have been operated after 1 month wait. My HOLEP urologist has 70 plus patient waiting for the operation. If I had money I would go to the Mayo clinic in the States but unfortunately it's not the case, I don't even have a family doctor because it takes months to years before they assign you one.

      Thanks for your question

      John

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    • Posted

      No insult to you but the Canadian system is always held up to our faces as the gold standard of medical care by the socialistic minded in this country.

      When oh when will the world learn that socialism has NEVER worked ANYWHERE it's been tried!

      Johm T, as you have recognized, it appears that it's a large part of your problem.

      Tom

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    • Posted

      Even if the US you are often better off driving for several hours to an academic medical center. That is not to say that smaller cities have incompetent urologists, but for complex cases the amc's treat a higher volume of patients, which improves their diagnostic and treatment proficiency.They are also more likely to utilize advanced technologies, and be knowledgeable in the continually evolving field of minimally invasive procedures.
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    • Posted

      Yes it is Tom but here in Canada it's more a problem of what province and city you live in . Montreal where I live is one of the biggest cities in Canada with over 8 million people and just HOLEP specialist to treat thousands of men if I was living in Ontario province I could of got a TURP in about 3 weeks time from the beginning of my problems over 3 months ago even here in Montreal all are doing TURP within 3 weeks it's a long wait time for green light and HOLEP
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    • Posted

      To me it sounds like there trying to force you into having a turp.  If you want a turp we will give you one in 3 weeks.  If you want anything else you have to wait.  Sounds like they get more money for Turp????  Look into something else please John   Ken 
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    • Posted

      Hi Ken not really I`m talking about 3 Different urologist specializing in different methods, the green light one that I say Tuesday told me he has a 6 month waiting list and referred me to another uro that is doing TURP, so the Green Light urologist is not doing TURP, hospital already called me to do an rectal echo with another urologist most likely for the TURP but I will never go for that.

      John

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  • Posted

    How much water did he fill your bladder with? Sounds like he did an instant urodynamic test on the cheap. 

    There can be a big difference between loading the bladder up artificially and how it works in the real world. I don't understand that if you could urinate before the procedure without a catheter why they left the catheter in after you couldn't urinate under artificial conditions? I would ask them to take the catheter out and see if you can return to normal urination. 

    FWIW I don't do well when my bladder is artifically loaded either. My urodynamic test was not great. And when they asked me to drink a gallon or so of water before my ultrasound I had a hard time getting rid of it. 

    But in the real world not so much of a problem. If I drink normal amounts of fluid (8 glasses a day) I can usually urinate just fine and empty my bladder down to under 50cc. 

    You live in the real world not the world where they are forcing fluids into your bladder. For that reason some urologists don't put as much  faith in these artificial tests others. Get that catheter out right away if you don't need it. 

    As far as CIC is concerned, it will at a minium give you time to decide on whether you want an operation and which one you want. But do you really even need CIC? Have your PVR measured in the doctor's office under NORMAL conditions with the portable bladder scanner most of them have. In other words don't load up on fluids, have your bladder tested with what you usually drink. If the PVR is still high, then "yes', CIC or something should be done to help empty the bladder. However, if the PVR is say under 200, you can probably dispense with catheter, CIC, and both of those operations and simply continue a watch n' wait strategy depending on what your other symptons are and the condition of your kidneys which should be evident from blood tests and an ultrasound. 

    Jim

    Jim

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    • Posted

       Hi Jim

      Thanks for the message

      They put around 400ml in there, then I drank an apple juice and had a coffee so about 600 ml was in there when they re-cathed me.

      What had originally happen is I went in not because I could not urinate but because I felt sick, my creatinine in the blood was up to 230, so after other tests they did the bladder scan and say that I had 800ml after urination, so from that point on the inserted the catheter for 5 days and I had a cystoscopy, following the systoscopy (at the point the TURP urologist told me my bladder was streched and swollen, so she could only put 300ml of water in there) I tried to urinate and I couldn't, the uro told me that if you can't urinate, come back to the ER and they will have to re-cath you, so I left and went home, so from 3:00pm until 01:00 am I could not pee, just a few drop so this is when I went back to the ER and they re-cathed me again.

      So if I again remove my catheter and can't urinate, I have only one choice other than a permanent cath and that is to do CIC. So now I have a complete blockage so how will this come back to normal, I did ask both urologist HOLEP and Green Light, how come I could urinate before and now I can't , they both said it's because my prostate is too big and blocking the urethra.

      So should I take my medication, and remove the cath in a few weeks and try again, it that fails, I do CIC and decide for the operation.

      I'll keep you posted

      John

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    • Posted

      You bring up an interesting issue over artificial bladder loading. It is quite likely that some patients don't do well on the PVR due to anxiety, When I had my first artificial loading test at the Cleveland Clinic, I didn't do well, so they sent me to the nurse who educates patients on CIC use. During the twenty minute wait to see her I had a strong urge and had to void in the restroom. The second residual was much better. Since having the Rezum, I'm still using CIC to determine PVR, 21 days later. The PVR ranges from 100-150, which isn't perfect but is a huge improvement from the pre Rezum PVRs. I'm hoping for even better results in the next few weeks.
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    • Posted

      You say your "PVR ranges from 100-150" but how much fluid is your bladder carrying? That would be the total of your natural void plus your catherized void. If the total is over 400ml, you might consider a self cathing program to keep the total under 400ml, or even under 300ml in order to give the bladder a rest so it can regain some elasticity. If you don't see results "in a few weeks" be patient. My bladder rehab program took many months to see results but the results did come. 

      You bring up a good point about anxiety in the docs office effecting PVR results but it seems they also loaded you up with water. I think they do that so that you will urinate faster and therefore not overly extend your appointment time. The downside again is when you overload an already atonic/flaccid bladder, you create an artificial situation where the results can be badly skewed. This leads to a wrong diagnosis and often to incorrect treatments. Your real PVR is your real PVR, not the PVR measured through forced drinking of fluids. Fortunately you can now easily measure your real PVR at home through CIC under normal conditions.

      I wonder how many people are getting operated on partly based on artificially inflated PVRs?

      Jim

       

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    • Posted

      When you had 800ml PVR, was that after they water loaded you or was that taken with your normal daily fluid intake? If the former, then I would have them take out the catheter now and see if you can urinate. Then have them measure your PVR under normal conditions. If it's not too bad then just let your system heal and perhaps take a relaxant drug like Flomax. If it's high, then CIC might be preferable to having a Foley 24/7. CIC will also buy you time to see how you will do when everything calms down. The docs have a tendency to make a quick diagnosis and then point you toward their go-to operation. It's really up to you to help steer them to a course more in your favor. My urologists said I would never be able to empty my bladder completely on my own without a TURP. Well, guess what, never had a TURP and my PVR is often under 50ml.

      Jim

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    • Posted

      Hi David,

      May I ask where you had the Rezum done and the name of the doctor.  Would you recommend the procedure?  Would you recommend the doctor you had?

      Thanks a lot and good luck!

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