Hello all,
My husband had a crisis on Saturday night with acute urinary retention, absolutely nothing coming out and left at the mercy of Aand E for several hours in agony. Now home with a catheter, awaiting test results ( PSa etc) and an appt. with a urologist. I am terrified it is cancer but trying not to think about that to much so now throwing myself into researching BPH and our options so we are well informed at our appt. I don't want to accept surgery or strong drugs forever if there are other options.
I would bery very much appreciate any advice from you lovely gents on supporting my husband and any success with alternatives to avoid surgery ( saw palmetto, pumpkin oil etc) .
Maybe be I should mention he is 54 ,in very good health generally but has a ' slow' flow in the mornings for a few years . I am 4 months pregnant with our first long awaited child and need someone to give me a kick up the bum to start thinking positive!!
many thanks in advance for any advice
Ali
Hi Ali,
My profile is much like your husbands...I am 63 and was peeing slowly the last few years, but never a problem with complete retention. Then one day in Feb. all of a sudden, I could not pee! I am very healthy, never had health issues before. Went to ER, got catheterized and tested and told I had a 136cm enlarged prostate. No signs overtly of cancer, but high PSA of 7. So after some research , I elected for gettting a PAE surgery at UNC by Dr. Issacson. I am three months out from that I feel great, no side effects, peeing stronger than before surgery! Only slight issue is that when I have orgasm, not very much semen comes out, but orgasm still is great. So, hope that helps. Definietly PAE is worth considering if its an enlarged prostate. especially if it is very large, this works great on it!
Greg
All: Rest easy as urine retention due to an enlarged prostate can be the result of infection, BPH, calcification (stones) in the wrong place in the bladder neck and so on. Please don't jump to concerns about prostate cancer (PCa) unless your urologist has established this is the case following tests. The urologist will want PSA results from a blood test, a digital rectal examination (DRE),and may recommend other tests.
Don't let him be subjected to a biopsy unless it is guided by having a MRI first, finances permitting. I am sure that at 54 years of age, he will be fine.
Hi Alil!
The gentlest of kicks in your bum here: your husband's situation (statistically) does NOT likely have anything to do with the dreaded C word! It much more likely has to do with a simple physical phenomenon: that damned little bugger (the prostate) just keeps on growing, puts the squeeze on the urethra until it is unable to pass urine at all.
Your husband is likely experiencing the shock of his situation; we have all been where he is now, and we have adjusted to the "new normal," as can he (and can you!)
No, I'm not a doctor (I'm an artist!). That said, overactive prostates can be dealt with many ways these days, from the "standard" TURP that his doctor will likely push him to accept, to the "green light surgery," the Urolift, PAE and a few other options that others will hopefully describe to you. We all have our favorite remedies to recommend. I favor the Urolift, which is the only reversible procedure, but not all men can have it. I STRONGLY urge your husband to NOT accept TURP without researching his options, as it can severely affect and limit his personal and your joint quality-of-life.
Also, wearing that bag is a hideous experience, and for me was very disorienting. I went from that to CIC (intermittant cathetertizing) after one week, refused the TURP my urologist wanted to do to me, and cathed every time I needed to pee. This went on for 15 months until I had the Urolift surgery. It became second nature and my wife was quite supportive. I highly recommend this approach, as will others who refused the TURP. Best brand in my experience: SpeediCath. Second best: Magic 3, based on ease of use/simplicity.
We are happy to offer support and answer your husband's questions, down to the most delicate ones! :-)
If he's not too shy about it, get him on-line; we've all been where he is now!
Hi Ali,
Sorry about the scare you are going through.
First, none of us are doctors here so please keep that in mind with the answers you will be getting.
It's understandable that you are thinking cancer, but in all probability, given your husband's age and history, it's probably bph.
You are on the right track being looking for different options as opposed to simply surgery. That said, it it is bph, be prepared for the urologist to recommend surgery. Here in the States the most common recommendation is TURP or GreenLight. In both cases your husband would end up with something called retrograde ejaculation also known as a dry orgasm. This doesn't bother some men, but it does bother others. Having children in the future could also be a concern.
As for alternatives, there are some newer less invasive options now available that will not result in retrograde ejaculation. Even better ones hopefully on the horizon.
Meanwhile, there are some drugs such as Tamsulosin (Flomax) and Daily Cialias that help some men with BPH. These are often tried before surgery is offered. Also, there's self catherization (CIC) that can manage BPH symptons quite well as a temporary solution or even as a long term one. I personally have been self catherizing for almost three years now because I did not like any of the surgical alternatives being offered.
As to saw palmetto, pumpkin oil, etc, some people take them, some don't, but I don't think you should expect the kind of results being advertised online if he truly has an obstruction causing bph.
Jim
Tell your husband not to panic. I've had similar problems since I was 45, I'm now 64. Over the years have had 5 to 6 biopsies because of an elevated PSA of 20. All the biopsies have been negative. One of my urologists said I have a "state fair" size prostate. 1st I tried all the over the counter therapies, none of that worked for me. Now I'm on Flomax and Finasteride. Up to this point it has helped, but was never able to void like a young man. I would say 5 years ago I had my 1st catheter put in. I recovered from that and my urologist increased my meds, I was able to void again until this point. Digressing a bit I had the Green Light procedure, for me it was an absolute waist of time and money. Subsequent urologist agreed with me, they never use that procedure. Now in a short time period since January Ist, I have had 3 catheters in, trying to avoid a TURIP procedure. My body has told me it's time to do something, for me it seems it's Turip. I reascearched urolift and other new procedures, for me and my urologist we feel
those procedures are to new to have an established track record. So on the 24th of May I'm scheduled to have a turip. Hope this was of some help? Denis
Just want to add you and your husband should not be scared or bullied by a doctor for a quick decision. This sometimes happens if acute retention remains a concern. Or, as "Cartoonman" said, don't let them send him home with a Foley Catheter and a a bag unless it's very short term such as under two weeks. If longer, ask/demand that he be instructed in self catherization (CIC) which will let him empty his bladder whenever he wants while giving him freedom of movement. And, as previously stated, it should also clear up all his bph symptons buying him time so he's not rushed into a decision.
Jim
PSA test is a simple blood test and of itself not very reliable unless unusually high. One has to watch how the readings change over a few months for that test to be useful. There are certain drugs, two in particular, finasteride and tamulosin are known to actually 'do something', but typically take a few weeks to show any improvements. Alternatives from the saw palmetto onwards have never had any rigorous proof of effectiveness, although some men think they do.
As others have already said, it is best not to allow him to be bumped into any operation until more is known, but my advice would be to get him taught how to self-catheterise with a supply of catheters. Sudden acute retention is a horribly agonising experience. In parts of the world where prostate operations are a source of lots of revenue, you will get strong resistance from urinary consultants to learning catheterisation, because catherisation allows an almost indefinte delay in making a operation decision, which is great for a patient, terrible for a surgeon !!
In the UK this is well recognised, and doing CIC as it is called (clean intermittent catheterisation) is often looked on perfectly sympathetically.
At 54, he needs to be very wary of procedures virtually guaranteed to cause fairly major sexual changes (and that includes the two medicines I mentioned sadly).
In summary, after the absolute trauma he has just been through (retention), it is difficult to accept that in reality, provided he has the means to empty his bladder easily at any time, there is rarely any need for 'instant action' so to speak. Hope this helps.
Hi Denknee,
Do you mean "Turip" or "Tulip"? I couldn't find anything about "Turip" after a quick search. "Tulip" on the other hand is a treatment for BPH, but an older one that I believe has fallen out of favor for various reasons. So, if that's the case, maybe getting a second or third opinion might be in order.
Jim
Sorry Turp procedure, a typo. It's self-evident for me since Flomax and Finasteride are no longer doing the job and I have had 3 catheters since January and a camera was inserted in my penis, looking at my bladder and a "urine flow" test, forgot the name of that test, all points to a Turp for me. I don't have the money for a 2nd opinion and my insurance will not pay for one. Thanks for your concern, Denis
I second <cartoonman. and <jimjames>. They may not be doctors butn they have Experience and know what theyare talking about!
Alan
Hi Ali,
Don't panic!
I had acute urine retention in my 50s following general anaesthetic. Peed OK at first and was allowed home, but during the journey, my bladder got more and more full and overnight kept trying to pee but only managed a few dribbles. A & E (UK) sorted me out with in-dwelling foley catheter, leg bag and prescription for Tamsulosin, which the doc said I'd have to be on for life. In fact both catheter and Medication were not required after a few weeks, and all was normal for a couple of years. Even now, at nearly 66, although I have had catheters both in-dwelling and intermittent, I only had trouble voiding last year because of infections, which have finally cleared with 3 months on Nitrofurantoin. One urologist scheduled me for TURP, but on the day the consultant decided to wait, as the infections had cleared and my prostate is not greatly enlarged. Instead, I'm back on the Tamsulosin and I've been asked to try cutting out all tea and coffee, for up to a year. Others have mentioned that drugs like Tamsulosin cause semen to go back into the bladder rather than out at orgasm, so if you want more children, your husbands choices might nedd to be taken with extra care. Best of luck to both of you, and remember, even Prostate Cancer is not as scary as it used to be. I've had minimal cancer diagnosed and results of psa scores around 8 for many years without treatment needed.
I'm 61 and had a similar experience at 57. After some flow issues, one day I woke up and couldn't pee. After three miserable days with a foley cath, I was put on meds (alfusozin - not retro ejaculation) saw palmetto and did some PT. I was able to manage and only had to self cath once in 3/12 years. At the time, there was no proocudure that didn't come with too many risks and side effeccts to consider.
DO NOT let him consent to a TURP at 54 with only one child. It's last century's surgery, often causes real problems and will ensure that you'll never have another child. There are many that are less invasive - PAE is one (Urologists don't recommend it because its performed by Internevtional radiologists) and Rezum is another. Both use different methods to kill part of the prostate and the dead tissue is absorbed over time by the body - leaving a smaller functioning prostate and no real side effects. Both are performed without anesthesia. Urolift sort of staples down the prostate, opening up the flow - also non invasive with no side effects.
Its unlikely that your husband has cancer, as it grows progressivley and typically doesn't cause you to wake up one day unable to pee wihtout porgressive warning. From your vervbiage, it sounds like you're from the UK. Not sure what's avaiable there, how long it takes to be approved, etc. But I would avoid TURP at all costs, lokk into the less invasive options - if none are available, I wouldrecommend considering self cathing til they are, or if you can afford it, pay out of pocket for Urolift, PAE or Rezum, before opting for any surgery.
Hi AliL,
From my experience he should learn CIC ASAP and use speedicath or speedicath compact male catheters (maybe mix depending on whether at home or not). Also, Alfuzosin has the best side effect profile of the alpha-blocker drugs. Might be best to try it first.
If he opts for a procedure, PAE might be the best way to go w/ minimal side effects (esp. sexual). The 2 docs who have done the most in the US are Dr. Ari Isaacson at UNC Healthcare and Dr. Bagla in VA. Good luck!
your husband had an acute urine detention ,but before of that has he had a great drinking ?i have had two times but only becausse i drunk mouch water( the second time the eografist told me drink one liter water for better ecography,,,,,,,,
PC is the least likely thing for it to be. As you did not mention pain it is less likely to be prostatitis and probably BPH. Many of your replies have been from Americans who have different options from us in the UK but the advice to avoid TURP is universal. If you go to the NICE web site (moderator does not like links) it has write ups on all of the options.
High PSA is also not a thing to worry about. Mine went from 5.0 to 9.8 over the years when I was refusing TURP and waiting for something better in the way of a aser procedure. Now I would want PAE as the first choice over Holep.
Hi AliL.
Not a doctor but all of us been there and done that, as many of the fine gents that have given you their honest opinion will attest. My guess is that PCa is not causing urine retention plus BPH tends to elevate PSA as stated in many medical journals. Your URO can do other tests for PCa.
My solution after emergency room Foley was to self- catherize and do a PAE, less than a week ago. Still self - catherizing and waiting for the PAE to kick in. As stated by my partners in this blog, CIC gives you the freedom to do what you want, eliminates bladder distention/infections and takes 1-2 minutes to get CIC done at home or away. Would agree with other statements here: TURP IS THE VERY LAST RESORT WHEN ALL ELSE FAILS!!
My spouse, like others am sure, is very supportive and just wants me to live a more normal life. Bottom line: though no doctors here, you have received the best and most honest recommendations from men that have dealt/dealing with BPH. You and your husband just need to decide on what to do once ur research on BPH medical procedures is exhausted.
Wish you Godspeed with the new Baby !!! Hope this long response helps. And follow up in the UK Med system for non-invasive treatment. Cheers
Hey Ali,
Sorry you and your husband are going through this. I am 56 and my first PSA came back 18.5! The first thing he needs to do (if the PSA comes back high) is a minimum 30 day round of antibiotics because infection in the prostate can influence the PSA score. If the score is still high (as in my case) DO NOT agree to a biopsy until a 3t MRI is performed. If no areas of concern are found then have a PCA3 test (urine) performed. This is considered by many more accurate than the PSA which by itself is not a good reason to jump on the biopsy table.
If either the MRI or PCA3 test indicate concern for cancer, (which was my situation), then and only then have a biopsy. I am not a doctor. These were just the steps I found logical for me to follow.
It is very common for men to have an enlarged prostate without it being cancer.
If a biopsy is warranted I would be happy to share my experience (as are others on this site) the logic I used to determine the number of cores I allowed/restricted the urologist to, and how to minimize the effects of the experience.
Same acute urinary retention happened to me on beginning oh April of this year. I went to ER and was catheterized but instead oh lieving catheter in me I dcided to do CIC self intermittent catheterization and ER doc gave me prescription for catheters. I am using speedi cath type of catheters and it is easy and pain free to do it. Prior to retention I had high PVR up to 450 ml. I am scheduled for TURP on June 1. I am also on tamsulosin twice a day and still have hard time urinating. I can gat some of urine but still stays lot in my bladder. I am 51 years old. I want to fix this problem and that is why I decided to go with TURP. I hope to have good outcome for good number of years. I am also in good shape and very active. Your husband problem is most likely caused by enlarged prostate that is pressing on his urethra and causing retention. So he is not alone here with this problem. I hope he will find solution that will work for him.
Since CIC seems to be working so well, why the rush for a TURP? I also had a hard time urinating after only two months of CIC, but after the second year my bladder has rehabilitated itself to the extent that I can sometimes go for days without CIC and can empty naturally down to below 50cc without any drugs like Tamsulosin. Before CIC, my PVR was similar to yours. I know you're in a rush to fix things, but newer procedures are available and more in the works, procedures much less invasive than TURP and procedures that won't leave you with retro ejaculation. Also, why the Tamsulosin if you're doing CIC. CIC empties your bladder completely so no reason for pharmaceutical help. Consider letting CIC buy you time for something better than TURP.
Jim