Urolift for raised bladder neck

Hi , according to my knowledge and experience , the best method for median lobe obstruction is ** REZUM and FLA . I underwent FLA in April 2018 in Houston** .

PAE for this diagnosis has poor results.

Difficult is for Urolift, although there is new modification MEDLIFT of Urolift .

The middle lobe is part of the prostate that grows up beneath the bladder neck and either elevates the bladder neck or actually protrudes into the bladder. “All of the treatments for middle lobe are made more difficult because of this protruding tissue into the bladder,” Dr Rukstalis told Renal & Urology News. “Certainly standard transurethral resection tools can resect a middle lobe, but there is real risk of bladder neck perforation and undermining the bladder neck.”

The original LIFT trial focused on the treatment of the lateral lobes. “It was decided at that time that men with middle lobe enlargement were a different group of men and would not be examined in that trial,” Dr Rukstalis related. “So ultimately after that trial was successfully completed, middle lobe became a contraindication for the use of the UroLift. The MedLift trial was then designed as an extension of the original LIFT trial to address the treatment of the middle lobe.”For the MedLift trial, surgeons treated the lateral lobe in the standard manner and then treated the middle lobe with a new modification of the UroLift procedure that involved manipulating the middle lobe, displacing it to one side or the other of the prostate, and then implanting one of the lift devices to hold it displaced, further opening the bladder neck, he explained.

As with the established UroLift procedure, adverse events associated with middle lobe treatment were mild to moderate and resolved quickly. The improvements in LUTS mirrored, or even exceeded, those observed in the original LIFT trial.

In December of last year, the FDA approved extending the indications for UroLift to include treatment of the middle lobe. In addition, since the original approval of Urolift, FDA approved it for use in men aged 45 and older rather than 50 and older.

Reference

Rukstalis D, Grier D, Stroup S, et al. Multi-center prospective study of the prostatic urethral lift for obstructive median lobe: The MedLift study, an extension of the LIFT randomized study. Oral presentation at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. LBA15.

Important note :

Large Median Lobe protruding to bladder and causing obstruction are acting as Ball-Valve . This is the Reason Why Pills for Enlarged Prostate Such as Flomax and Finasteride (Proscar), Tamsulosin, Silodosin (Rapaflo) and Uroxatral (Alfuzosin) Do Not Work Well.

see enclosed my ball valve .

Good morning

Yes I still think as of May they are still in trail of working with men that have a larger prostate of over 100. They feel that the Urolgist can just pull the median lobe to one side and it will stay out of the way of the bladder neck.

There were no trail on the Urolift using it on the bladder neck. Doctor are just doing this. Andrew should have been told about it.

There are a few guys in the UK that they are having a problem. One man after a year is still have a problem. Still some pain and leaking. He has to ware a pad. Not a happy man

Man have to remember that if they do this it is 2 procedure and each has it own healing time. Urolift has about 4 to 6 weeks to heal and the bladder neck can take 12 weeks or more

Also Urolift has no side effects at all. Doing anything with the bladder neck you may end up with side effect. Being the bladder neck will not close right you can end up with leaking and retro ejaculation.

Research anything you are having don and make you you know what your going to have. Surprises are not good......Ken

Do you mean two hours a night or several two hour naps. If only two hours how do you manage to function during the day ? Probably in my case it is due one of the many effects of Cipro/Flouroquinolones. I waken after two hours and have difficulty getting back to sleep and if then for no more than an hour.

Sleeping in 2 hour segments was my life because of BPH. I then had a Greenlight procedure that had a bad outcome (permanent incontinence caused by strictures at the external sphincter as a result of the GL mishap). Finally, I had an AUS implant, so now I do manage to have a 4 or 5 hour segment of sleep.

2 hour naps would be a better description. I start work at 4 am, so I sleep in shifts. Afternoon naps rarely last more then an hour. Heaven forbid if I should have some beers in the evening!

Hello Glenn

I'm sorry I forgot that you had that done.

How is it working out. Has it been about 6 month's. I hope it is doing well for you. It may be a little different be it give you somewhat a normal outcome.

Take careKen

Hi Kenny,

If your raised bladder neck is caused by a median lobe then the latest urolift techniques can help with median lobes but you need a urologist who knows what to do; I would imagine an inexperienced one could cause problems.

See elsewhere in this thread for how I'm doing. Now its settling a bit I'm back down to getting up twice a night on average from 2 to 6 times pre-op and similar just after op. Last night was only once!

Andrew

I know what you are saying but they should not put any clips on the bladder neck. It should have not even been touch

The doctor takes the median lobe and bring it to one side and it clip there on the prostate or by the prostate. That will open up the bladder neck.

What it came down to is that he did something that you did not give him permission to do. Which was not right. It should have been your choice not his. If I read your first post right you have no clips on the prostate but 5 on the bladder neck.

But what done is done. It's your body you have to live with the outcome not the doctor

Ken

The AUS implant is working well. It's been a year since the implant surgery and 10.5 months since it was activated. I stay essentially dry. If we're going out to a performance, church or dinner, I wear a light pad, just in case. (If I sit on the edge of a hard chair briefly, it can depress the cuff around the bulbous urethra, thus forcing liquid from the cuff up to the reservoir. It would start refilling immediately, but until the cuff is refilled, I could leak a bit. For the same reason, I can't ride a bike anymore, and I really miss that.) Most days, I wear no pad at all so I at least have a bit of normalcy back in my life. It beats the two years that I was wearing 8 to 10 pairs of Depends pullups per day, or alternatively wearing a condom catheter and leg bag.

Thanks for asking.

Glenn

That is good to hear. I new it must have been longer then 6 months but I did not remember. At least you don't have to have a catheter like some men that can't control the bladder. I am happy for you.

On biking I know you may not be able to do it all the time but what about a girls seat it will not be in the groin so much Have you tried that. Maybe go yo the gym and try a bike there for a little or change the cushion. If you love doing it try. You never know.

Good luck and have a good day....Ken

Ken,

I don't know why you are saying: "Most of the men after a year still have pain and are leaking from holding the bladder neck open and will cause retro. There were never any trails on it per the company

There was a one year clinical trial on the Medlift procedure, that Stan mentioned. It was presented at the American Urological Association 2018 annual meeting in San Francisco, May 18–21, 2018. LBA15. Look it up on Google and read it. The results looked good. The clinical trial was funded by NeoTract, the company that invented Urolift.

As I understand, by a phone conversation with a NeoTract representative, The company is in the process of training doctors how to do the new procedure. NeoTract sends a team to each doctors location that assists the doctor in performing his first Medlift procedures.

Thomas

Thomas

I have read the trails and it has nothing to do with a bladder neck procedure. It has to do with taking the median lobe out of the bladder to open it up. They do not touch the bladder neck There have been no trail on putting clips on the bladder neck at all.

The men I'm taking about are the men that the doctors are using in the uk. One man in particular in the UK was going for just a Urolift that is all he needed Small Prostate Just before he was taking in the the surgery room he saw his doctor.

The doctor said i just saw a new way of doing the Urolift it's going to make it better. Well when he woke up he was in so much pain the doctor did not know what to say

It has been over a year he is still in pain and has to ware diapers because he leaks. This should have not happen.There was no trail on this what so every. That means no data.The Urolift stand by itself and if another procedure is added it changes the procedure and it side effect.

I also have been on the phone and e-mail with the company, the management and a guy name of Ted who was one of the inventors of the Urolift. They need to start to stand up to the doctor for there procedure.

The Urolift has worked for many men. And with them working on the median lobe it will save a lot of men from having a surgery they do not need.

Have a great day..........Ken

I do have pain but it is not too bad; just annoying; like I have a permanently bruised testicle or something pinching inside. Thankfully no leakage and symptoms have improved vs. pre-op. I am more comfortable and able to drink more without endless trips to the toilet.

I was not told work might be done on the bladder neck. The problem was, in my case, that the flexible cystoscopy was performed by someone else who just said prostate slightly enlarged and bladder neck normal. It is unfortunate that my urologist did not do the cystoscopy himself as then I would have had better information.

I guess when the uro was in there he saw that the prostate was not a problem but the raised bladder neck was and used the urolift to sort it out. He did say he had performed on median lobes before with urolift even though it is only a recent extension to the use of urolift.

Some better information pre-op would have been useful; for years I thought I had an enlarged prostate and was being treated as such by my GP. No wonder Tamsulosin wasn't doing much for me.

In summary, I think I was fortunate to have a urologist that knew how to use Urolift to sort out a median lobe causing the bladder neck to be raised. Shame I have some pain still; will have to see how that goes.

Andrew

Yes I'm glad your doing ok. But you also can say you were fortunate but he had no permission to touch your bladder neck. That is a whole different procedure with a whole different healing time and side effects. If you had a median lobe problem all he had to do is clip the lobe to the one side. That would get it out of the way.

It can something take 12 weeks our longer to heal and of course it can cause retro. This should have been disgust before surgery.

How would you like to go into a surgery for one thing and then come out with something else. Another thing why 2 different doctors. If you had the other doctor he would have done the wrong thing. It is 2 different doctor

I for one have learn the hard way. I do not give total control to the doctor. After reading what he is going to do and we have talk that is it nothing else. No thinking this would be better this way or maybe I will add this.

Not going to talk amount it anymore. It just makes me upset

Have a good day.What done is done .Ken

Hi Kenneth,

He was in there with permission to do a urolift. There was no bladder neck incision; only the urolift. I guess he saw the most likely problem and thought urolift could fix it and fixed it; why not as I was already under a general. I agree its different to what I had expected but he didn't know himself either until he took a look.

The reason someone else did the initial cystoscopy is that it was a lower-skilled person and in the UK, on the free NHS it is difficult to get to see the main consultant for routine stuff and waiting times are huge. They should have recorded the cystoscopy for the consultant to review but didn't; just wrote a report that everything looked normal.

Andrew

Yes you gave him permission to do a Urolift on your prostate. That you agreed to But that was not done. He did a whole new procedure on your bladder neck.

There are no trails or data on that procedure so we do not know if it will work how long the heal time is and the side effects.

I wrote the company again this morning after I read you post. This has to stop. It is one thing to add something to the procedure but to do a whole new one when it has not been tested. Is very wrong on the doctors part.

You should have been told first not after the fact. I do hope all goes well for you because the anchors can not be taking out. Unless they cut out....Ken

There is/was the 'MedLift' trial in Feb 2018 to treat median lobe.

Now I am not 100% sure but think a raised bladder neck is caused by the median lobe. Therefore as the Urolift has now been approved for treatment of median lobes and my Uro said he had done some already, then I think what he describes doing is to move the median lobe off the bladder neck.

Here is a quote from the letter the Uro wrote to my GP; see what you think "Five devices were deployed, two near the bladder neck at 10 and 2 o clock, two more laterally, and then one more at around 5 o clock to pull the bladder neck down"

Andrew

That is true. A Raised bladder neck is caused by a median lobe. And a Urolift has been approved to take care of it. ( I read the same report earlier in the year) If you pin the median lobe to the one side it frees up the bladder neck and opens it up which move the blockage. They are also working on it for larger prostate

I have read what you wrote but what he did was he took and used 2 clip laterally ( which means to the side ) so he use 2 clips to pin the median lobe down to one side and he put 3 clips on you bladder neck. They all ways use the clock has a reference for the bladder neck procedure.

If you look at the clock you will see where he put the 3 clips. 10 & 2 and 1 at 5 most likely on the side he clipped the median lobe to. If you get a chance read up on bladder neck surgery. Sometime they take 12 weeks and causes leaking and there is a 35% chance of retro. By doing that he change the 100 % of no side effect for the Urolift procedure.

It seam like they have been doing that a lot in the UK. I have been helping a man that was on this site. This doctor which is very well know really mess up this guy ( There are more ) It has been over a year and he still wear a diaper because he leaks and he wanted the Urolift done because he had a small prostate and he wanted no side effect.

Well he has had them all. He hate retro and the pain and wearing diapers for the rest of his life. He stopped going to that doctor and is seeing 2 other to see if they can help him. The only thing that can be done is cut the strings to release the bladder neck to see if that would help.

All that doctor did by adding that procedure is cause him more problem then he wanted. The doctor also told him the only thing he can do for him is do a Turp to cut everything out. That is why he is seeing other doctors.

I will be dealing with this problem for a while with the company. Doctor need to stop doing this to there patients without any data or trails on how good they work or not. And not given the permission to do it is not right. You should not weak up with a surprise. It like if you go to have a bunion done and instead he removes your big toe because you don't need it. That's wrong

The Urolift for a median lobe is a very good procedure by itself. It will take care of the blockage of the bladder The bladder neck does not have to be touch. My doctor has done the Urolift for 4 years and he has pin the median lobe to one side because the patient did not what to have anything cut.

I hope it works out for you but only time will tell. I wish you well....Ken

Very interesting Andrew. With this condition, do you ever notice that urinating and deficating seem to be linked sometimes? I've never even had a cystoscopy but my GP tells me using DRE that my prostate is "not that impressive" - not that big. And I notice sometimes that right after I poop I have to pee whereas I didn't even notice it before. Conversely, there are times when an urge to pee comes and goes and then I notice that I have to deficate; sometimes almost to the point of having dihurea. Almost like my urine is leaking into my intestine or something. Not usually a problem but I thought it might be a clue as to why I often can't get out even 30 ml. naturally without a catheter.

Good morning Keith.

There is some interesting things about that on the internet.

Did you know that sometime you don't have to pee when you go to the bathroom to poop. That goes the other way to. Not every one goes boop everyday but we do pee everyday.

I also read that if you force yourself to go to the bathroom you can push on the bladder and you will pee some. Also after you force your self to poop you will feel after that you have to pee. ( That is what you are feeling ) That is because everything is so close together in our bottom area.That is why most doctor will give you a stool softener after a prostate prostate procedure. They do not want you to stain yourself.

Take care Ken

Hi Kenneth,

Thank you for your concern and detailed replies.

I take your points but not sure whether there would have been any better treatment to try. A bladder neck incision can have poor side effects and that only leaves the TURP and laser variations of it.

So had I been woken up on the operating table and asked did I want to try using the urolift to see if it would improve the bladder neck, I would probably have agreed anyway.

I think in the UK we are generally more inclined to trust the urologist is doing his best for us than you folks in the US that want everything tied down with permissions and lawsuits. Apart from a few rogue cases the doctors and specialists want a good outcome for their patients. I researched the options very well but like the urologist, did not have enough information as to what my actual problem was.

On the NHS (free), pre-op I had cystoscopy, urodynamics and trans-rectal ultrasound but it was not until the specialist was in there that he could see what was most likely the problem. With hindsight I could have paid for the specialist to do the cystoscopy but hindsight is a wonderful thing. A less experienced specialist might have just done a standard uroflift which would not have helped me as the problem was not a standard enlarged prostate. So its swings and roundabouts as I see it. I didn't quite get what I expected but probably what I have got is as good as any other option as far as likely outcome and side effects are concerned.

Andrew

First of all what your doctor did is not a Urolift. He did a bladder neck procedure which he did not have your permission to do. This is really the bottom line. Having something done to your body and you had no say. A MidLift is a Urolift procedure that takes the median lobe and pins it to one side. It has nothing to do with putting pins on the bladder neck

Who told you that a Turp was the only way to fix your problem but your doctor has you going in circles. If he would have done the Urolift the way it is suppose to have been done it would have work with opening you up

There are a lot more Rogue patients then you know. I think that is because the doctor do what they want because it's free. Which is not right.

I can say a lot more but I'm done. I will keep my battle for the company to help the patients against the doctor. These procedure being done without permission is wrong. There is no data and no trail have been done. Just doctor doing what they want

You will have to live with the outcome of whatever happen. What done is done

Not all Doctor's in the US are bad and we don't have a lot of patient going to court because the doctor do have the patients permission to do what ever they are suppose to do. Not just do whatever.

What was done to do you should not have happen. What was the since of talking with you before hand about a procedure . You could have just gone one day and pick a procedure out of a hat and then let them do it.Because that is what was done to you

Have a good day...........Ken