Uro Lift confusion

Hi Vaughan

Would you please tellet us where did you have your Green light later done. Did you have any median lobe protruding in the bladder

FJ

He said I had a high bladder neck. I had it done in Clarion, Pa.

I had 2 bad infections due to retention and my prostate had the uretha totally shut down. I had to do something quick. I think I got lucky. Retained all sexual functions. No retro.

Thanks for your happy-ending report, jjjj!  Yeah, sleep-deprivation really messed me up, too.  Before my prostate shut me down completely, August of 2014, I was up 3-4 times a night, no fun.  This is why I went to self-cathing (after one horrible week on a cath-n-bag set up, UGH!  

I wonder then, why the self-cathing-at-bedtime isn't taught or encouraged more often.  Again, maybe uro-docs just aren't creative thinkers.  But this up-many-times-a-night problem is what drives guys to buy into spending $$$ on TURPS.  What do they say?  Follow the money!  I'm not saying, but still...    But it's the most common complaint that causes guys to buy into TURPS, you know?  I am currently in a holding pattern, awaiting a second  Urolift.  I'm working with my doc, to see if a different approach can solve my reoccurent blockage.  But in the meantime, I self-cath a couple of times each day, and before bed.  

And did I mention my up-at-night number is near-zero????  :-)

 

Urologists don't talk self catherization because they don't make money on surgeries if the patients finds it's a good solution for them.  Instead, they give patients the line about TURP being the gold standard, scare them with what might happen if they don't have TURP, and like sheep, they rush to surgery.  I was one of the sheep, have had two procedures already this year, and will have a third (artificial sphincter) before the end of the year to try to correct for the damage from the 1st and/or second procedure.  I have original medicare and BC/BS secondary, and I still expect my out-of-pocket for doctors, theraphists ,medications, incontinence supplies, etc. to be close to $10,000 for 2016.

Thanks, Glenn, for giving an example of the screw-ups that can results from faulty TURPs.  My doc wanted to do TURP, and said,"Only 4-5% of guys have problems."  (Since the, what I've seen and learned tells me the number is way higher!).  I replied to his assertion, "Yeah, but would YOU want to be one of those 4-5%?"  I learned to cath right after that, and started reading/learning.   I can pee some, must cath some, my love-life apparatus works as it should (and I'm 67) and I never have experienced incontinence.  I feel very fortunate, even if I am in a "holding pattern"...

I can't find it now but on one of the urolift threads on patient info, people asked if Urolift would block MRIs. The official urolift web site's FAQs says : "In non-clinical testing, the image artifact caused by the device extends approximately 15 mm from the UroLift Implant when imaged with a gradient echo pulse sequence and a 3.0 Tesla MRI system".  That means each tab blocks MRI coverage for 15mm (1.5 cm) in all directions around it, I think.  My uro' mentioned this effect when we discussed urolift (which he offers).  It seems kind of a nuisance. 

...and you can self-time/measure your flow rate, by cathing (or peeing) into a measuring cup or similarly marked container, check your watch, see how much you pee/cath, divide amount by time. E.g., 600cc divided by 60 seconds= 100 cc/10 secs, a good flow.  

Also, I am having the same experience as you, that flow slowed after a few months.  I will have a second Urolift, about a year after the first.  Medicare covers it.  Yes, less invasive, and unlike ALL the other options, it's reversible, if you decide on another choice later...  :-)

 

I do hope the second urolift works for you

A point of detail : >>unlike ALL the other options, it's reversible

- Partly reversible : they can snip off the innermost tabs from inside the urethra and remove them, but they are unable to remove either the sutures or the outermost tabs.  The outermost tabs might, I worried (I didn't have it) work loose and change orientation and poke you in the bladder or prostate during exercise.  Though I have never heard of that happening.  Maybe the suture has enough static friction to hold in place in the prostate tissue, or maybe the outermost tabs have typically "ingrown" enough to be immobile anyway.  The outermost tabs do leave a 16mm dead zone around each which a future MRI (as a precursor to an MRI-guided biopsy, for high PSA) can't see through, and I suspect they would preclude radiation therapy and microwave procedures like Rezum - but don't know for sure. 

Nothing's perfect : having always said I didn't care about retrograde ejac (which urolift avoids), I am (probably temporarily - maybe even, only today - I am abed with flu, therefore very grumpy about everything !) feeling a bit annoyed with that (just psychologically !), given me by holep (like most holep/TURP/PVP men), which at least a few (I'm never clear of the proportion) men even get just from Flowmax, so one may conclude there's probably not for many years a "perfect" one-size-fits-all cure for LUTS issues caused by inflamed or oversized prostates.  And yes I have read a lot of accounts of PAE, rezum, i-tind ... none sound like they always work, without any hazards.  I can't see how i-tind can work for many years, as the channels created by the egg-whisk-like stent in just 5 days, would surely slowly contract ?

PAE does sound quite cool (I almost wish I'd had it...) apart from minor risks of allergic reaction from the "silt", and one or two said on blogs when the uro' was finding the right artery it was properly painful.  I expect that's a rare problem though.  I bet in 10 years time, something like PAE might be reliable and first-choice - although for someone already in retention, not willing or able to wait 6 months for it to shrink (I bet if you can't get the catheter in to do CISelf-C, having a supra-pubic one put in must be painful ?? - but that's just an assumption, could be quite wrong), maybe PAE could take too long to work for those men. 

Anyway, I do hope the second urolift works for you, I have read several contributors who had extra tabs fitted, or tabs tightened, and that worked for them.  So there must be a good chance. 

Thinking about it, when I wrote about urolift tabs in the post above " I suspect they would preclude radiation therapy and microwave procedures" about the remaining outermost tabs after a urolift is decommissioned, I don't think that would be true of radiation therapy.  Radiation therapy doesn't, I think, use particulate radiation (alpha and beta) - insufficiently penetrative (grossly so, for alpha ! - beta is stopped by 2mm of copper - not sure how much tissue it can get through) ... I feel sure they use electromagnetic radiation on the gamma/x-ray part of the spectrum.  And it's aimed I think from a range of angles that focus on the tumour, so that the surrounding tissues don't get much dose but the tumour does.  If those metal outermost tabs from a decommissioned, or indeed still active (innermost tabs present too !) urolift, were in the path of the radiation beam, because it sweeps in from many angles at least in a semicircle, maybe even a part-sphere (the latter would seem even better than just a 2D approach), a bit of mitigation where the beam, from one input angle, hits the metal tabs, shouldn't make any difference because the beam also sweeps in at other times from angles that DON'T go through that tab - and I doubt it'd heat the tab up.  So I think I'd be likely to be wrong about that.  Possible issue with microwave-based technieques though; certainly if I mistakenly put a cup with metal glaze or trim on the handle in a cooking microwave, I've found I get a marked burn from that metal when removing it. NB we need more uro's contributing to this site, wouldn't need to second-guess these points of detail then (I am an engineer, not a medic).

Good questions you raise, Engineer Paul!  :-)  I went to Lehigh U (as an eventual political sciene major; it's complicated...  :-) ), and have have had close contact with actual engineers!  Although not with too many EEs...  :-)

Yes, the radiation/microwave treatments might be off the table.  I can raise the question with my Salt Lake Uro-lift guy, who has concerns about any of the newer treatments (Yes, the ones done by radiologists, but he says he's concerned about "collateral damage" that those techniques can cause...).  I too womder just how much heating would be generated by microwaves---and thinking of what happens with those non-micro-safe cups and plates, well, I would not want THAT going on inside me!  No SIR!

 

>>Yes, the ones done by radiologists, but he says he's concerned about "collateral damage" that those techniques can cause...)

 - yes, during my PSA=16.9 scare, now behind me, I read a little about treatments P Ca.  Radiation therapy both external and internal (pellet based), seems to cause tissue damage to the whole prostate so that the "margins" when performing a radical prostatectomy, open or robot based, as to what to remove and what to leave, are too hard to assess.  I seemed to gather that a very high percentage of uro's/oncologists might for this reason, refuse to do a radical prostatectomy if you have first had radiation therapy of any sort.  But, it sounded as though radiation therapy has less risk of side effects - thus creating a treatment choice conundrum for the man (I'd have just gone for radical prostatectomy, which in this instance one CAN'T call the "nuclear option" even tho' it is the most extreme !)

Great post Paul. I am going next week for FLA my criteria for procedure decision was a save, fast results, effective, longer lasting and most important no sexual side effects. Have too large a gland with large medial lobe for Urolift.

They can't remove the prostate after radiation - if there is a recurrance they do what's known in the trade as salvage surgery and its quite ugly. But radiation works as well in most cases as removal with a much better side effect profile and most cases of prostate cancer should be untreated. 95% never amount to anything and they can score the ones that are most agressive.

FLA sounds interesting.  I hope it goes well.  Been used I gather for a long time for prostate cancer, more recently for BPH.  Concentrates on the area of blockage.  Avoids retrograde ejaculation.  No more risk of sepsis than from a rectal biopsy.  i.e. low risk.  I wonder if it is reliant on the area of blockage being quite localised, or if it can clear a channel up and down the prostatic urethra ?  (my clumsy googling is unrevealing on exact qualification criteria or how much it can clear).  Good luck, if it works well it does sound really good.  Do post when you are able afterwards as little has been posted about this by actual patients (that I can see). This might be of interest to a lot of men. 

NB you shouldn't get pee pain or clotting or all that, that TURP/PVP/Holep and even some urolift men have to go through.  Possibility minor blood in urine, that's all.  Just based on googling !