Uro Lift confusion

Good story and thanks for sharing, Riverkilt!  Bttw, if you are not squeamish about self-cathing, you could dath before beddy-bye time and likely sleep RIGHT THROUGH THE NIGHT!  Some more bragging rights, doncha think???  :-D

 

Where was your Uro-lift done?

  A  rather young but reputable urologist performed the procedure in his  office.   The only doctor in a town of about 60,000 who does the procedure. 

Well, that is a discrete description!   :-)   Because it's a relatively new procedure in the US, I sought out the most experienced guy in the country (He did the trials for FDA approval!).  Downside: I had to travel from home (eastern PA) to Salt Lake City for the rpocedure!  I felt the extra expense was worth having expert and experienced care... vs. my hometown uro, newly on-board (a year after trying to order me a TURP...) who told me, "I will be certified in three months!  Keep on cathing, and you can be one of my FIRST ONES!"  Um, no thank you...  :-/

 

You make a good point. I may not have done my homework.  I live in a small southern university town with a medical university.  Do not want to be too exact for obvious reasons.  

   Not sure how many operations the doctor has done. It seemed like a rather simple procedure.   I hope that I am not  becoming incontinent.  

    Years ago I had an inner ear operation and went to the Mayo and very glad I did.  I regret not doing what you did.

     . 

My post op experience was just like yours (miserable!) and my urodoc had done way over a 100 of them. I do not have your frequency issues though but the rest of did not improve from the proceedure. So I am not big on the urolift at all.

You can have the procedure redone by someone with more experience, or have it reversed and try Rezum/PAE or that other procedure (can't remember the name) that are also non invasive and usually work.

This is the good thing about Urolifts (Lester and Evidlos)--- they are REVERSIBLE!  (Or supposed to be, anyway.)  I may ultimately have to have mine reversed...

Thanks for the note. My first of four trips to the emergency facility  was by ambulance  and the worst. Did not think I was going to make it. I was introduced to the uro-lift procedure by invitation to a lecture by the doctor who introduced the procedure to the area. The lecture did not correspond at all to what I went through and am still experiencing. I am three weeks into the post uro-liftand I may be getting back to the point I was before the procedure.

   At 77 I may not ha a great candidate for the uro-lift. I think I got a marginal passing grade for the procedure in my prep test. I wil give it about 6 months and see ihow it goes. Do not know much about Rezum/PAE but will start doing my homework.

​     I have two friends who are very satisfied wiith the Turp. But

​     I play golf with a retired urologist in his mid 70s. He is avoiding all operations and procedures and just sagely gives a negative shake of his head when I mention any of them.  

Guys, I think I am inspired by cartoonman in his enthusiasm for self Cath after urolift 8dec 2016. My procedure went well until the Cath came out next day from procedure and still haven't been without Cath since and 4 trips to Ed to drain my bladder. It looks like my lift was not the only problem because I can't open my sphincters to pee so maybe I had 2 problems or a new one post OP . Doctor wants me to have turps but I'm hanging in for a better treatment. Urolift isn't for everyone but I still believe it works for many just not me😥

By the way, I think many urologists have a vested interest in urolift so caveat emptor buyers beware!

And yes they do not have an interest in self catheter because there's no$$$for them, although my urologist reluctantly admitted it's an option to turps. Already spent over$11000 so far so what's 45c for a speedy Cath?

It may be that your plumbing just needs to adjust to the idea of this regular "visitor" (the cath).  I am concerned that as the Urolift becomes more popular, that there will be more uro-docs doing them, when more focus on $$$ than on their patients.  Not pointing to any individual doctos, just a sense of how these things develop.  I was on the margin, regarding being a good candidate, so I was not totally surprised when the plumbing closed up after only a few months.

As for CIC, yes, it's an anjustment, but I, too, consider myself just "holding steady," until something better (not TURP!) comes along...

Too true, getting adjusted obviously will take time. My concern regarding the urologist is he was quick to suggest turps after only 4 weeks since urolift so I was a little taken aback because he seemed so confident in the lift then hen suddenly went to turps. I want to give it some time and he just wants another payment for the Ferrari😣

Not rushing into turps, I want to stall for time until something better comes along. Catheter seems lesser of two evils. Cheers Gipsy

A question for everyone doing self catherization.  Is there any concern that an injury causing a stricture could happen from doing self catherization?  Are there any reports of this happening?    After my Green Light disaster, I acquired single use catheters on my own (urology office wouldn't order them) so I could avoid additional trips to the ER (ED) with accute retention from the swelling.  I used them maybe 4 or 5 times with no real difficulty when I was have acute retention.

Then, I had a second procedure (Gyrus Turp) to clean up a lot of debris and inflammed material from the GL procedure.  That healed up pretty quickly, but I'm still totally incontinent 10 months after the GL.  I did physical theraphy for several months, and that was of no value.  So I went to a second doctor who concluded that I would never regain continence (as I had concluded myself), and he scheduled surgery to implace an artificial sphincter.

The surgey started, and in the process, he scoped me to make sure everything was in good shape.  He found two strictures, and could no go ahead with the sphincter surgery.   I suspect that the strictures were caused by my first doctor when he did the two surgical procedures and two cystoscopies.  Or, they could have been caused when I visited the ER for acute retention after the GL, and a Foley was reinstalled... very painfully.

In any event, when a copy of my records went from my first doctor to my new doctor, there was no mention of strictures.  I had never heard of them at this point.   What I did know was that my average urine flow seemed pretty slow after the the GL and Gyrus TURP procedures.  (I could retain urine while lying down, or sitting in a soft chair... up to 200 or 300 cc.)  I used a stop watch and measured the volume collected in a urinal  when I peed, and divide the volume by the time.  My average rate would vary from 3.5 to 5 or maybe 5.5 cc/second.  I thought this was low, mentioned it to my doctor, his nurse and then to the physical threaphists, and they just ignored my concern.  Consequently, the strictures were not found.  (Maybe he didn't want to find them?)

My new doctor went ahead and did a ballon dilation when he found the strictures at the start of the aborted artificial sphincter surgery.  One month out from the dilation, I now average rates of 10-13 cc/seconds, and their hasn't been any decreas over those 4 weeks that I can see.  I can actually stand up and pee now, and not sit and dribble. (I'm still incontinent though, and only can do the measurements after sitting for 90 to two hours, or at night when I wake up due to bladder pressure.  Otherwise, no urine accumulates in the bladder to cause me to go pee.

Am I wrong to think my 1st doctor's treatment was p*ss poor?

There are a lot of options that are less invasie with fewer to no side effects between urolift and TURP. You might want to find another Urologist who has done Rezum - which might work for you - but its important to find out why Urolift failed before doing anything else.

PAE is another option with litttle downside and few side effects and there are threads with quite a bit of info on both. 

I must admit I was very surprised that the urologist didn't take that approach, I am an engineer and was surprised he gave up so quickly and made no attempt to get to the bottom of my issue. It seems problem solving is not his strong suit. Will read on about those options, what's resume? Just a brief summary, I know about law.

Damn self correcting pad, I meant Rezum and PAE.

Don't expect your urlologist to think as a problem solver.  He or she will administer the IPSS test, and if the score is high enough, tell you that you need TURP (the gold standard, no less), and suggest all the bad things that will happen if you neglect your BPH, or whatever it is that's ailing you.  (I'm an engineer too, so I understand your concern.)   I wish that I had been informed enough to not take my urologist's advice a year ago, and allow him to rush me down a path I regret every waking hour of the day.  (Even some sleep hours, as it's invaded my dreams now.)

Yes I think it is very poor that the doctor's response is get a bigger hammer. Where are you? I'm in NSW Australia.

I'm in the SE US, North Carolina to be specific where we are looking out at 8 inches or so of snow at the moment.

Oh Glenn sorry to hear that you're having difficulty, my catheter is minor issue but I'm not disappointed with the urolift just that it hasn't worked so far. I will consider options further out but for now the catheter give me time to get my system working if possible by tweaking before getting a big hammer? You are up late/early so I guess you are waiting for a pee? 😂 Cheers Gipsy

oops time zone problem, I am a day ahead here (well 17 hours)

Understood.  I spent a year of my life a time zone or two away from you back in 65-66.  Didn't matter much then when I communicated with my bride by snail mail that took about 10 days.

65-66? where were you? military? me too

 

Right, Vietnam.  First west of Qui Nhon, and then down in the Cam Rahn Bay area before going up to Nha Trang area.

Rezum is a new procdure. They spray the enlarged prostate with steam which kills the excess tissue, allowing you to pee more normally. It's done without anesthesia nd brings little in the way of long term side effects. Retro Ejaculation is around 3% and there is virtually no incidence of loss of sexual function, incontinence or retention. PAE does the same thing, but by cutting off the blood supply to parts of the prostate, with what seems to be similar results and side effect profile. Your Uro won't mention PAE becuse its performed by ingterventional radiologists, not urologists.

There are a growing number or docs performing Rezum now - best bet for PAE are docs in either the DC area or UNC Chapel Hill. Not sure what the vailability of PAE is outside the US, but Rezum is being performed all over the world.

Thanks for that, I am reading up on both but for now I will look at self catheter and try to buy some time. Not excited about any cutting burning or frying anything for now as I am stuck with an indwelling catheter for the present.

Cheers Gipsy

Get rid of that indwelling catheter for sure. Self cathing isn't ideal, but it lets you live resonably normally, which the indwelling one doesn't. And you should find out why the urolift made things worse before considering anything else.

Absolutely, my urologist is champing at the bit to do a rebore even though he hasn't considered why the urolift didn't work! Only had it 8 Dec last so only 4weeks and he has given up.. so much for his confidence in urolift 😎

Even if it didn't help, it shouldn't have mde things worse - and urolift is reversable, you yu can at least go back to square one if you want to. My guess is that your doc didn't perform it properly or you weren't a good candidate for it (prostate over 80 and a lobe into the bladder are the two things that should screen you out). There are guys in this forum who had urolift failures and had them done a second time with good results.

Sounds like its time to find a new doctor. First, find out what went wrong with the Urolift. Reversal or redo might be in order. Then, arrive at another treatment - whether its another Urolift or something else. Ideally find a doc that does Urolift and Rezum so they can assess and retreat as appropriate. And run like the wind at the mention of TURP - the mere suggestion of it by a doc in this day and age with very few exceptions is a total disqualifier in my opinion.

Glenn, Glad you made it back (from Nam)!  I was ER (Enlisted Reserve), '67-'69, going to college on ROTC Scholarship... really gung ho, and innocent.  Then the Tet Offensive happened, and the La La Glasses shattered.  And I started reading.  And I started reassessing.  A fortunate sports accident (knee)  occusred in the fall of '68, and I was able to parlay it into a medical discharge and a 1-Y.  WHich was better than the alternative for me.  The doc said I would be a cripple by the time I was 50, but 2 months ago my wife and I were roping our way through slot canyons in Southern Utah (I'm 67.).  I hope your "souvenirs" from Nam were small and manageable--- although if you were in Air Special Ops in Nha Trang, I suspect you were rather busy...

Cartoon and Gipsy,

A recent article discussed how insurance companies are paying less for TURP thereby making in-office procedures like Urolift the big money makers for urologists. So, yes, even though less invasive than TURP, no doubt there will be many urolifts performed on marginal candidates. As Cartoon says, CIC is an excellent "holding steady" strategy especially right now with newer procedures and new questions on how good they are. But it can also turn into a long term solution, resolving lower urinary tract symptons as well as an operation. And in certain cases, I use myself as an example, it can even get you off the catheter completely. 

Not present company but a lot of people look at CIC as sort of a last resort but it's really a kinda cool thing sorta giving the middle finger to docs saying let me cut open your prostate or you will never p*ss normally again. It's a way to take total control of all your symptons, almost overnight, and in most cases with very little initial comfort. In most cases, after a short while it becomes as easy and fast (actually faster) than brushing your teeth. I urge anyone on the edge with CIC to give it a one or two month trial and if you're like me, you will wonder why you didn't try it years ago.

Jim 

Cartoon and Gipsy,

Note to self and others-- make a copy before posting anything here because it can end up disappearing into moderation for no apparent reason. PS if I don't see my post to both of you reappear soon I will try and reconstruct it. 

Jim

Got you Jim

Jim---

Thnaks for the reminder about copying long posts!  Good pointer, that!  

And yes, CIC becomes rote after a while... even at 4:00am!  :-)