Why Urolift isn't that successful in the US

After consulting 5 uros what did you decide?

Hi Lester; Short answer; My situation was partly described in my previous comment.

Added to that I did the Urolift and eventually had a bi-polar TURP.

I use an intermittent catheter at the end of the day at midnight to empty residue.

Very long answer; Every man's situation is different. Again find a urologist/treatment which is right for you.

I had avoided seeing a urologist in early 2018 for various reasons which I won't get into now. Result; I had severe retention last summer, went to the ER & had a permanent/Foley catheter put in.

First procedure; I found a urologist who was awarded by NeoTract for the Urolift. I wanted to see if this would work and keep my prostate intact. (I had two cystoscopys with him. This urologist was the local hospital department head but was not good at explaining things. He was usually too busy.)

Unfortunately the Urolift did not work. I still had a Foley catheter.

Second urologist; I found a uro who did the urodynamic test. This showed I still had some bladder strength but his report said I could not completely empty my bladder even with no obstruction.

He recommended a TURP to be done by urologist #3.

Third urologist; he did a cystoscopy and showed me the screen. He said the blockage was in the bladder neck where no minimal invasive procedure could reach. His report said the median lobe was not involved. He recommended a TURP.

Fourth urologist; This was a top expert. He reviewed reports from urologists 2 & 3. He said damage to the bladder could mean trouble urinating no matter what the surgical procedure. He said sometimes the Urolift didn't open up all of the urethra.

He recommended the intermittent catheter to improve bladder strength. I had failed to learn this with two nurses. I used a Foley with a valve (no bag). He said that was OK but the intermittent catheter was better.

For surgery, he recommended a TURP which he would do with a Greenlight laser. (With any TURP I would have retrograde ejaculation.)

In January I learned the intermittent catheter. I did it every 3 to 4 hours. It was painful, slow (40 minutes each time) & hard on my back standing and limited what I could do even compared with the Foley+valve.

I decided on the TURP surgery to reduce my intermittent caths.

What kind; laser or bi-polar, should I have?

Driving distance was a problem as my wife can't drive more than 30 miles. Uro #4 is 60 miles away which ruled him out.

Fifth urologist; He was 30 miles away and was an expert with the greenlight laser. He preferred it. But after reviewing all my documents, he said a bi-polar TURP would be the best choice for me. He said it was precise in completely clearing a path for urine flow.

First urologist; I went back to him because he was 10 miles away & was also an expert with the greenlight laser TURP. He said if he did my TURP it would be the bi-polar.

I had urologist #1 do the TURP procedure.

Besides a short driving distance, he had one of the best nurses (a nurse practitioner) who did the follow up.

Outcome; my life is normal except for two things.

I intermittent cath at midnight for 30 minutes. CIC is easier now but I wouldn't want to do it on a plane.

Second retrograde ejaculation in some ways is uncomfortable. But I knew it would happen and before the TURP my sex life was almost zero since the summer.

Final thoughts; I'm going to dinner tonight for the entire evening at a busy restaurant with friends. I can do that now since the TURP. I feel I have most of my life back.

Hello BB

I just have to say a few words. You had the Urolift and it did not work because your prostate was not the problem. You bladder neck was.

I am happy that you took the time to get a lot of opinions. By the way how big was your procedure. And being your prostate was not the problem. I wonder if a Bladder Neck Incision would have worked for you instead.

The Turp worked to a point but you still have to do CIC. So what was the point of doing the procedure. If it come to doing CIC or a Turp Why just do the CIC and forget the surgery if you still have to do CIC

Did your doctor tell you that before your surgery and why you still have to do CIC??

Just asking. I hope you improve and get better.....Ken

Kenneth; I wonder where this discussion will go.

1. A prostate can block the urethra at the bladder neck. How do I know this? Because urologists told me a prostate can be large enough to block the urethra at the bladder neck.

• Just do a search for "prostate blocking bladder neck".

  This is from the Healthline website; "An enlarged prostate is often responsible for causing bladder neck obstruction."

2. So, my bladder neck itself was not defective. It works fine. It was the prostate which blocked the urethra at the bladder neck.
3. You wonder. We are not qualified to make specific urology treatment recommendations for individual patients.

   I have a masters degree in psychology but I don't speculate to people about what specific urology treatment they should do especially contradicting the advice of several doctors. Why? Because I am not a urologist.

4. The TURP worked as well as any prostate surgery could work for my condition. It cleared the prostate blockage at the bladder neck.
5. As for why I didn't just do CIC 4 to 5 times per day for the rest of my life, some of the reasons are in my post.

   Also, keep in mind you do not do CIC. And please don't bring up experiences with CIC from people you know. The comfort with CIC varies depending on the patient. I explained in my post why I wanted to reduce its frequency.

6. I knew before my TURP surgery that the best probable outcome for my damaged bladder was a reduction in the frequency of CIC. Not the elimination of CIC. The nurse practitioner thought that after my TURP I might have to CIC twice a day. My outcome exceeded that by reducing CIC to one time per day.

PS. From katelarisurology website about the TURP and bladder neck obstruction;

"TURP is the gold standard treatment for prostatic bladder neck obstruction."

Dear BB

It can go on forever if we want. You picked what was good for you. It just that if the urolift pull you open and it was not a median lobe. What part of the prostate was blocking the inside of the bladder neck

I'm glad what you picked work for you somewhat but that was you choice. Very happy for you. And I do do CIC sometime to keep my stricture open. Works great.

I hope all goes well for you. And if a Turp procedure was so great they would not have come up with other treatment for BPH. I am not giving anyone advice I wasjust asking a question because the way I read your post it was your bladder neck that was the problem

Have a great day

Ken; we've had a discussion before and it didn't go far because you do not accept the statements from the urologists I've seen and plain text from the internet which I provided to you.

In this discussion, I've answered your questions but you refuse to accept the answers.

As for why urologists use the TURP. Every urologist website I've found, every urologist I've seen, has the TURP as one of the procedures that they perform.

Why ask me why the TURP is done? I'm not a urologist.

My suggestion. Ask your urologist.

Why ask me why there are other BPH procedures? I had a Urolift but I'm not a urologist.

Again I advise, talking to your urologist about this.

What you read was what you wanted to see and not accept what I wrote about urologist opinions and my answer to you which had quotes from the internet.

The prostate can cause an obstruction at the bladder neck. Ask your urologist why this can happen is my advice to you.

On a more positive note.

Thank you for telling me you do a CIC sometimes.

As every patient's experience is different, my CIC experience was very difficult for reasons I've explained.

BB

It is not problem I remember talking to you before. I was just asking a question.

I'm not trying to get you mad It was just a question. The way I read it is you had a urolift and it did not work. ( My prostate is still wide open still ) Also you said that it was not a median lobe. So what was blocking the bladder neck The prostate only has so many lobe. Was your prostate large.

My urologist and his partner do very few Turps. When I talk to him a few months ago They have only done 3 in the last year. He said it is a last resort procedure.

Being everyone is different and we all have different concerns.

I wish you well and hope all works out for you...Ken

I think Turp was a standard when they went to school. Life goes on

bb, given the circumstances, you did as well as it could be done. Congratulations, and thanks for sharing. I am just curious, why does it take you so long to do CIC ? What catheters are you using?