I posted another thread about catheter size and the problems I have had inserting the catheter into the bladder. My primary care provider has scheduled me for a Urology consult which I thought was just for a cytoscopy but after reading the order I see she also wants an evaluation for TURP.
I am not convinced that my problems are caused by an enlarged prostate. I was in a car wreck about 20 years ago resulting in a severe TBI and damage to my cervical spine. I had a MRI a week ago and it showed moderate narrowing of the spinal canal at C6 & C7 along with severe narrowing of the nerve canal on the right side at C6 & C7.
When doing CIC the cathether seems to pass thru my prostate fairly easily, its only when it reaches the bladder that I have problems with insertion. From doing some research it seems TURP is focused on making the passage through the prostate larger, I'm not sure if this will help my condition.
Is there a way that they can actualy tell if it is the prostate causing the problems or the damaged nerves and brain ?
I'm a veteran so I get all my care from the VA. I'm scheduled to see both Urology and Nuerosurgery on the same day in the next couple of weeks. I'm just trying to prepare myself to know what questions to ask when I see them. I suspect I'll continue with the CIC but would appreciate any insight others may have...
Great question, which I can't answer. However, if it's an evaluation for TURP, isn't this exactly what your appointment is for so that you and the doctors can check for the correct treatment in your individual case? Why would you think they would make such a graring error as to do the TURP without questioning your individual issues? I was scheduled for TURP in April this year by a NHS Locum Urologist following a year of repeat episodes of Urine Infections. I had all the pre-checks for operation day. However my own Urologist didn't go ahead with the TURP on the day and sent me home with different advice, because he knew my history and checked whether the procedure was really the best approach before doing it. Maybe I was too trusting in agreeing to do all the preparations, but it was ultimately a reassurance that my Uro didn't want to do surgery on me if it wasn't going to deal with my problem! I've followed his advice since and haven't had any further UTIs and have even come off the previous medication (Tamsulosin).
Electromyography (EMG) which is part of Urodynamic testing will help differentiate whether your bladder problems are being caused by an obstruction (large prostate) or nerve damage. Urodynamic testing yields other results as well and is therefore suggested before procedures such as TURP.
Jim
I meant glaring error - sorry for the typo!
I wish you luck and a good outcome on whatever is decided for your condition. I can't answer your questions but I know there are test to confirm what should / need to be done. Good luck
Normally they do a Cystoscopy, the camera inserted up the penis and they checked mine after doing the TURP and it showed a round edge cut out of my Prostate with plenty of room for catheters. Previously they struggled to get an 8mm catheter in.
Thanks for the info.
Becasuse I'm getting my care with the VA I deal with lots of interns and residents the first go round. I've found its a good idea to know a little about what is ailing me before talking to them, I eventually will see someone very well qualified but getting past the beginners can take a bit of time unless I have an idea of what they are looking for...
I get that. Wishing you well.
The scope will show them if it's a prostate problem
The scope can suggest a prostate problem but it can not rule out a nerve problem. You can have both and one can be dominant. Proper urodynamic testing will tell you if it's a nerve problem or not. In any event, urodynamics is recommended as part of a TURP evaluation, so you shouuld have it anyway if you're thinking of that direction.
Jim
Urodynamic testing would help but also ...how large is your
prostate? ...SONOGRAM of the prostate would be very helpful
to confirm size and configuation of the gland. Not always but
as a rule the larger the prostate the chance of obstruction is
greater...As mentioned on this forum many times Holep is the
preferred method of operation if needed..yield less complications
and a less chance that reoperation would be needed. Others
have gone with a PAE..this is done by radiologists not
urologist so...they probably wouldnt be recommending a PAE.
But look into these if you can wait..and get all the workups done
before proceeding.
Good Luck
Prostate size is not necessarily related to the severity of BPH. You can have a large prostate with few symptons or a small prostate with significant symptons. Sonogram is helpful but it will not rule out nerve damage because even if it showed an obstruction you could still have nerve damage in addition which would mean that even a "successful" TURP wouldn't work because the nerve damage would not make the bladder empty correctly. Personally, I think the likelihood is that it's obstruction and not nerve damage, but you won't know for sure until Urodynamics are done where they actually can measure the nerve impulse (or lack of it).
Jim
When it comes to TURP, uros are kind of 'trigger happy'. Just like you, when I CICed, I felt almost no prostate resistance, only sphincter resistance. I was referred to an uro after a kidney scan that showed urinary retention. The IPPS score was only 7. Yet the uro suggested TURP right away. I politely postponed the decision and chose CIC instead. I am not sure that TURP or any other procedures will help me and I do not want to make a bet on that.
Hank
The original plan was for me to take Finesteride and self cath for the next 6 months. Which seemed reasonable to me.
It seems because I couldn't cram a 16FR into the old bladder they want to change everything. I do have a lot of numbness and tingling in my right arm and both legs that the MRI seems to valiidate which leads me to think the nerves are involved. Just dont see why they have changed from a conservative approach I can live with to possible over treatment that I can't live with..
Read about Finesteride both here and elsewhere. It has side effects, possibly irreversible, that many don't like. What size catheter are you now using and are you having any problems? Normally, they start with size 14, not 16. A lot of here have then moved to the next smaller size which is 12. You will find a hydrophillic catheter much easier to insert because they are very slippery. One popular model here is Coloplast Speedicath with Coude Tip. The Coude (bent) tip makes it easier to get around an enlarged prostate.
Jim
I did read about the Finesteride I had some concerns about the side effects but after 6 weeks have not noticed any.
I'm mostly using the Coloplast Speedicath 14 straight tip now but occasionally use the 16 when I can't get the 14 into the bladder. As I'm with the VA don't really have any choice as far as the manufacturer goes. I'm finding with practice and maybe just getting used to the idea of sticking something up there its becoming alot easier. I'm thinking of asking the Uro guys for some samples of the Coude Tip.
I monitor the urine output every week or so, its consistantly between 2700-2900 ml/day and I void about 15 times a day. The RV from the catherization is usually between 200-300 ml. I've been checked for conditions like diabiates that could account for the 15 times a day and they found nothing. I just need to go all the time...
Have been on Finasteride for 18 months and no known problems. What could they be ?.
Finasteride did nothing for me. It did make my wallet thinner. Lol. Prostate stayed the same
Hi Supertractorman,
My urologist listed these possible side effects with the Finasteride, impotence, problem having an orgasm, retro ejaculation, swelling in hands, feet, and breasts (man boobs), and dizziness. But the one that really got my attention was that statistically, if I developed prostate cancer in the future, chances are it will be a more aggrassive form of cancer. He also told me it takes a long time (6 months or longer) to show results and might not fix my problem. I decided not to take it. I do take Tamsulosin.
John
Thanks John, they took me off Tamsulosin to put me on Finasteride. !!.