Whether to go for Prostrate operation

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I am 69 years old. I have BPH for last 10 years. I have low flow of urine, a bit of dribbling, sometimes stop and go(specially towards end of urination). Night time urination mostly 2 times but sometimes 3times. Post void urine retention about 200ml and Prostrate size 25gm as per latest ultrasound. Urine flowmetry result:

  • Max flow rate: 5.2 ml/s
  • Mean flow rate 3.1 ml/s
  • Time to max flow: 37 sec

    There is no obstruction in th passage as per RGU study done about 2 years back.

Should I go for Prostrate opeartion? if yes then whether TURP or HoLEP considering my prostrate size.

Please suggest.

What happens if I postpone the surgery? What kind of emergency may arise?

Thanks,

Nirbhar

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  • Posted

    Suggest you get as many opinions as you can from different urologists as there are a lot of procedures available but not all are for everyone. You will have to sign a waiver of liability prior to any surgery which protects the doctors, facility and staff.

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    • Posted

      Thanks lester.

      I don't have many options with me. I understand that TURP & HoLEP will be the main stay considering doctor's expertise. but as you suggested , I will try to visit other doctors.

      BEST,

      nirbhar

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  • Posted

    Which country are you in as often that limits your options. Of your two mentioned procedures Holep is by far the better. At ten years you have left it long enough. You did not say your prostate size .

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    • Posted

      Thanks derek.

      I am from india and choices are limited. But what I am concerned with is that whether with small prostrate size (25g) I will get sufficient relief. As of now my symptoms are not very troubling. But as per the doctors urine retention volume is high (200 ml) & flow is low. So, if I postpone the surgery what kind of emergencies are expected?

      Best,

      nirbhar

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    • Posted

      At the time GL laser started around 2004 there were evidently several huge hospitals specialising in it India and Americans were going there for cut price surgery. What is the situation now for surgery?

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    • Posted

      Size isn't always the best indicator. There are men with 100 g prostates who pee fine and mine is 30 and I suffered with severe BPH. I don't know what tests are available in India, but the thing to be concerned about are your PVRs. It doesn't sound as though BPH is causing it, but the only way to find out is with a scope and urodynamics test. The scope will see if there is any blockage and urodynamics will test you r bladder function. From your description, signs point more to bladder than prostate issues.

      If you have BPH (a big if at this point) then if it gets worse, it can cause significant bladder damage. If not, you should figure out what's causing the 200 ml Pvrs. You should be under 100.

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  • Posted

    Those are both extreme operations. Have you tried medication? As to surgery, PAE is the least invasive and a good one to start. If that doesn't work, green light might be next, or rezume. I don't recommend urolift, because it has caused me a lot of problems.

    In any event, you need a cystoscopy, and an evaluation of the size of your prostate. This can be done through ultrasound or CT scan. By the way, PAE is not from a urologist, but an interventional radiologist.

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    • Posted

      Thanks ramblin.

      As I mentioned as per ultrasound my prostrate size is 25gm. I am taking a capsule with Silodosin and Dutasteride combination for several years. However, urine retention is high and flow is low.

      Best,

      nirbhar

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  • Posted

    200 PVRs is too much. See if you can get Rezum - but first you should confirm blockage. 25 is pretty small, but it can still happen. if you aren't blocked by your prostate, no BPH procedure will help.

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    • Posted

      Thanks oldbuzzard.

      I am taking a capsule consisting of Silodosin and Dutasteride for several years. By the way how does one confirm that blockage IS due prostrate?

      Best,

      nirbhar

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  • Posted

    If there is no obstruction, I would think a bph surgery is not going to do much. Get other doctor opinions.

    Weak or incomplete urine flow can be neurogenic, perhaps even caused by a tight pelvic floor.

    If you are looking at BPH surgery, possibly consider PAE as a first procedure and Aquablation as second (see my discussion on Aquablation). Both require, however, some prostate caused obstruction. There are several procedures out there, with more on the way. Do your homework.

    Yes, urologists often sell what they know and put down what they dont know (particularly PAE, a procedure done by radiologists, not urologists). Shop doctors!

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  • Posted

    With the modest size of your prostate, I would guess that you have median lobe growth rather than general growth of the prostate. You might want to ask your doctor about that. Also, you should inquire to see if the use of intermittent catheters to empty the bladder is an option.

    Glenn

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