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What did they say, “it was the best of times, it was the worst of times”. Sort of like that in 2017 regarding a watchful waiting strategy for BPH/LUTS.
It is the best of times in that newer procedures such as Urolift, REZUM, iTind, PAE and now FLA are offering relief without the high incidence of sexual side effects of the old guard TURP, GL and HOLEP. But it is also the worst of times since all these procedures are still relatively new and not yet fully proven, and in the case of PAE and FLA, not usually covered by insurance.
This makes watchful waiting a different decision today than it was let’s say three years ago when I joined this discussion group and offered self cathing (CIC) as an alternative to extend the watchful waiting period.
Because the newer procedures are promising, less invasive, and less risk of sexual side effects, it is quite reasonable for men to pull the trigger earlier on watchful waiting than when the only alternative was TURP.
On the other hand, the fact that these procedures are still new, some still not covered by insurance, and that hopefully other less invasive procedures are on the horizon -- it is also reasonable to conclude that there has never been a better time for watchful waiting.
There are different watchful waiting strategies including drugs and lifestyle changes. When these don’t work, there is also the self catherization (CIC) option that can safely extend the watchful waiting period indefinitely in most men if they so choose.
I choose watchful waiting over TURP many years ago and when the drugs and lifestyle changes didn’t work, I choose CIC which has kept me out of surgery while protecting both my bladder and kidneys.
Self cathing is not for everyone but it has worked well for me and many others. Unfortunately, other than in the SCI (spinal chord injury) community, urologists rarely offer this option to extend watchful waiting, even though it’s mentioned as a viable alternative in the responsible medical literature.
For those unfamiliar with CIC, and want more information, there are several ongoing threads such as the main one here:
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