Whether to go for Prostrate operation
Posted , 12 users are following.
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
0 likes, 31 replies
lester90053 nirbhar52734
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.
nirbhar52734 lester90053
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
derek76 nirbhar52734
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 .
nirbhar52734 derek76
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
derek76 nirbhar52734
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?
derek76 nirbhar52734
Posted
If you google Prostate Enlargement Surgery Cost in India a lot of options come up and it seems that foreign patients are still travelling there.
oldbuzzard nirbhar52734
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.
nirbhar52734 oldbuzzard
Posted
Thanks oldbuzzard for very insightful comment.
ramblin nirbhar52734
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.
nirbhar52734 ramblin
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
oldbuzzard nirbhar52734
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.
nirbhar52734 oldbuzzard
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
Marty02 nirbhar52734
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!
nirbhar52734 Marty02
Posted
Thanks Marty.
Yes, I am going to get opinion of other doctors.
Best,
nirbhar
glenn77 nirbhar52734
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
nirbhar52734 glenn77
Posted
Thanks glenn for your suggestions. I will ask the doctor.
Best,
nirbhar