Hello all. 54 years old, recently started having retention issues. Urologist has me on flomax, hated the side effects, now trying Uroxatrol (alfuzosin). While it mostly works, I suspect that I may not be fully emptying my bladder as even after urinating I feel like I should have to go. I can sleep through the night, it is more of a general discomfort during the day.
Anyhow, urologist recommends UroLift although he reiterates that TURP is the "gold standard". Told him to forget TURP. I was going to schedule UROLIFT but am now learing more about PAE and did speak to Dr. Issacson at UNC. Of course, my urologist is not keen on the PAE idea, asked if I really want to be the guinea pig and told stories of problems with AE in general.
Anyhow, Dr. Issacson noted that a good candidate for PAE has prostate of 30g or larger. I have no idea how large mine is. He suggested that a transrectal ultrasound is best way to determine size. My question now is, who does transrectal ultrasounds? I contacted two local "imaging centers" but neither offers this procedure, they said I may need to have it done in a hospital. It seems like it should be a fairly quick in-office type of thing?
And yes, I do feel old as I find myself looking at a forum for "prostate problems"!
Thanks.
Hi Mike,
Your urologist should be able to do that. The doc uses the same probe to measure the size of the prostate when he perform the biopsy, but you do not want the biopsy at this time. Ask him.
Thanks, I figured it is done by urologist. Will have to see if mine is willing to do so as he is not a fan of PAE. At least from what I have read, without the biopsy it is a pretty quick and simple procedure?
Hi Mike, I've been throgh the Urolift experience. I'm in Bethlehem; where in PA are you?
Yes, very quick & it is done in the office (not hospital). Another way to measure the size (in cm) by MRI scan. With a rough dimensions W/L/H, an good math person can calculate the volume & convert it into grams etc.
Hi Mike - I would suggest you also look into Dr. Bagla for your PAE. He has performed at least 4X as many as Dr. Isaacson and is more thorough with his methodology. I had a PAE with Dr. Isaacson back in the summer with no benefit from it but worse is he didn't seem to care at all about my outcomes. I would not recommend him. Good luck to you.
Neil
Standard Urologists perform ultra-sounds in their offices on a regular basis..It seems they're capable of offering a transrectum ultra-sound...They normally perform ultra-sounds to determine the Amount of Urine Retained in the Bladder after a normal void...Ultra-sounds are very quick, 1-2 minutes, and painless...FYI- Per Published Clinical Trial Results, PAE's and REZUM's had the highest success rates with the least amount of pain and complications, the quickest recoveries, etc...Dr. Isaacson appears to be an excellent PAE doctor, but some of his patients have had problems...GOOD LUCK!......
It seems like your symptoms aren't bad enough to go through the trauma of surgery. If you can sleep through the night, or get up once or twice only, your prostate can't be restricting your urine flow to any substantial degree. I always think that surgery is one of the last options to consider.
Thanks, That is in part why I cancelleed the Urolift. I figure the longer I can hold off on surgery the better.
At the moment I can indeed sleep through the night. The weird thing is that during the day I often feel bladder pressure as if I do need to go. That can happen even a few minutes after urinating. I can hold it for hours or go a little bit at will (not sure which is the better thing to do). Could be the prostate, could be the meds, maybe something else?
They don't like 'links' here so here's something from a piece in "US National Library of MedicineNational Institutes of Health" called:
"Accurate determination of prostate size via digital rectal examination and transrectal ultrasound."
It predates Urolift and PAE but seems to predict that the accurate assessment of size is becoming more needed.
"Abstract
Previously, prostate size did not play a significant role in the choice of treatment for benign prostatic hyperplasia (BPH). It has been postulated that prostate size does not correlate with symptom severity, flow rate, or the presence or absence of obstruction. However, in a published study of community-dwelling men, the odds of having moderate to severe symptoms were five times higher for men with enlarged prostates than for those with normal prostates. Response to certain types of BPH therapy, especially finasteride, depends on actual prostate volume. Therefore, it is important to have a simple way to accurately determine if a patient's prostate is enlarged. In an analysis of four studies, there was a distinct underestimation of prostate size by digital rectal examination (DRE) when compared with transrectal ultrasound (TRUS) measurement. The underestimation of prostate volume increased with increasing TRUS volume, particularly if the volume was greater than 30 mL. The average underestimation was between 9% and 12% for prostate volumes 30 to 39 mL and between 17% and 27% for prostate volumes 40 to 49 mL. Because of these results, a prospective study is currently in progress to develop models or visual aids to assist physicians in more accurately predicting a threshold prostate volume via DRE."
Sorry this was misdirected
They don't like 'links' here so here's something from a piece in "US National Library of MedicineNational Institutes of Health" called:
"Accurate determination of prostate size via digital rectal examination and transrectal ultrasound."
It predates Urolift and PAE but seems to predict that the accurate assessment of size is becoming more needed.
"Abstract
Previously, prostate size did not play a significant role in the choice of treatment for benign prostatic hyperplasia (BPH). It has been postulated that prostate size does not correlate with symptom severity, flow rate, or the presence or absence of obstruction. However, in a published study of community-dwelling men, the odds of having moderate to severe symptoms were five times higher for men with enlarged prostates than for those with normal prostates. Response to certain types of BPH therapy, especially finasteride, depends on actual prostate volume. Therefore, it is important to have a simple way to accurately determine if a patient's prostate is enlarged. In an analysis of four studies, there was a distinct underestimation of prostate size by digital rectal examination (DRE) when compared with transrectal ultrasound (TRUS) measurement. The underestimation of prostate volume increased with increasing TRUS volume, particularly if the volume was greater than 30 mL. The average underestimation was between 9% and 12% for prostate volumes 30 to 39 mL and between 17% and 27% for prostate volumes 40 to 49 mL. Because of these results, a prospective study is currently in progress to develop models or visual aids to assist physicians in more accurately predicting a threshold prostate volume via DRE."
Will a CT scan with contrast show prostate size?
Mike you do need to see your prostate volume (size). I did mine in what I feel is the best way.
Get a 3 Tesla MRI of the prostate. If read by a good interventional radiologist it will also tell you if they see cancer lesions which are cancer. Then, if you have a single lesion, you can get a single needle focal needle biopsy. Then you have several options including a folcal laser ablation of the Cancer. you need to find this out before a PAE as you cannot be a canidate for PAE if you have cancer. You can find out first with a simple 3TMRI for cancer lesions and it will tell you also the size and density of the prostate gland. No pain or anything in this procedure. Then you decide what to do as Cancer changes the ball game. My MRI showed NO cancer but a dark spot to watch and a huge prostate 125cc. So now I go a differnt direction and it may be PAE for size reduction and BPH relief.
The important thing at your age is preserving you sexaul functions and Focal Laser Ablation is best at that with low to intermediate grade cancer 3+4 gleason or less. All of that will be explained to you if you do have cancer and need a biopsy. All of this is just my opinion I am by no means a doctor.
good luck.
I forgot if you cannot find someone in your area who is trained in this then let me know and I will give you a few around the country to contact.
Again good luck.
Mike in Pa?,this is what happens when people are uniformed.Most Doctors and urologists are working from systems that were used before the Internet.Don't settle for any one answer. I recently posted that I went in for a UroLift evaluation and the uroligist told me that I would be a 50/50 cantidate for the procedure because my prostate had grown into my bladder and the part in my bladder my not respond to the lift.So I said what are my options?Is there anything on the horizon to help me?He said that the same people that invented the UroLift are 6 months away from being able to deal with my problem.Keep looking for answers.We are being totally manipulated by the medical industry.So always keep that in mind.
Hi Mike,
I have read that transrectal ultrasound is the most accurate, but more importantly if that is what the PAE doctor wants then that is the right process since he will be comparing your imaging to previous similar scans.
My understanding is that transrectal ultrasounds are done at imaging centers, often within hospitals, and not at the urologists office. Urologists mostly tend to have portable bladder scanners which are not at all the same thing.
How bad is your retention? Do you know your IPSS score? Have you tried daily 5mg Cialis? If not, maybe try it before opting for an operation or procedure. There is also self catherization that several members here, including myself adhere to. No drugs, no operation, complete bladder emptying and it can also buy you time for better procedures down the road. As a bonus, it may even rehab your bladder to the extent that you can stop the self cathing and go back to pretty normal bladder function. That is what happened in my case.
Jim
Urologists make no money on the PAE, so they do not recommend it.
My uro does them in office. But his office has 6 uros in it and is located in a hospital.
Lifestyle choices haven't been discussed much in this forum, but I think they can influence BPH symptoms. For example, last summer I was riding my bicycle a lot and consequently, (I believe) my symptoms worsened considerably. Most of the problem was in relaxing the muscles so I could initiate urination. Also, of course, diet and exercise play a role in prostate health.