I first noticed difficulty urinating 14 years ago when I was 37. At 50, two years ago, DRE suggested abnormality. DRE last year -the same thing:- ' "it does not feel right" Both years PSA is 4.8. GP referred to urologist at age 51 who prescribed Tamsulosin. To the end, I strain to urinate and carry pee bottle with me in the car and in my office. Last month cystoscopy reveals bladder stone and BPH. Prostate biopsy ultrasound measures my prostate to be 103 cc in volume. Ct scan ob abdomen/kidneys was normal except for large prostate. I was close to renal backup after these procedures so I am using a Foley Catheter. The 30 year 'veteran' urologist suggested TURP while tomorrow the Gleason score will be returned. Each man must decide carefully own his own but your comments are appreciated.
Your probably not a candidate for Rezum (too large) or Urolift (total retention), so maybe look at Holep. Another person just posted their Holep experience at your age.
listen to your urologist.
Also too large for Urolift.
I too strain like you to urinate. It is awful. It used to be around 15-25 minutes, but lately about 1/2 hour and more sometime. I was going to have a TURP Operation, but the URO asked me if I really wanted it the morning of the surgury. I told him my urinations were getting better, some at around 15 minutes. He said it was better to not have the surgery, because 15 minutes wasn't bad and I could live with that. I have been struggling and consumed by time it takes to take care of the urinations since then and it really affects my life. The URO says my prostrate isn 't bad enough to operate on. My stream is o.k., he says. I am going in to tell him about the awful long urinations. In two weeks I get evaluated by another URO group that was referred by the first URO. It has taken a long time. Too long....
you mean it takes you 30 min to void?!
I refused a TURP as far back as 1995 when I was 60 due to it being a form of butchery with unwelcome outcomes. I waited for GL PVP to come along and that had a good outcome and a quick recovery from it and no RE. (75 grm prostate). It regrew and I then had Thulium/Holmium that is similar to HoLep in 2013 and have had no later problems. I had RE after that but that had already started from taking Tamsulosin and I was 79 by then.
In relation to straining to pee, some guys have a burning sensation when peeing. I found URAL sachets mixed with water to relieve a lot of discomfort while peeing.
Thank you for your reply.
Thanks for the info.
Mark, I used to have the same problems as you. What I found to be helpful, is doing CIC. After three surgeries over a period of 14 years, the best thing for me was self catheterization. I feel great and really comfortable after I self cath. Yesterday, the time between self catherization was 7 hours. Usually, it's around 3 to 4 hours.
Ask your uro, if you can try self catherization for awhile. It's the best feeling when you have a totally empty bladder.
I used to be able to do it in 3 seconds, from inserting the catheter, till it reached the bladder. I stopped doing that, because it was foolish of me to try and see how fast I could do it. The last time, I tried going for speed, the catheter must have scraped the inside of the bladder, and blood in the urine, was the result. Now, I go really slow, so as not to injure anything. What was once 3 seconds, is now around a minute.
I suggest you give it a try. Instead of you going to urinate, every 15 minutes, it will be hours in between toilet trips!
You've been given a lot of really bad info - from your doc and from this forum. The facts:
1) You can get Rezum with a prostate of your size. The recovery is longer (more tissue to ablate) but the results are comparably good. 2) They shouldn't be doing a Gleason score unless/until they confirm that you have prostate cancer. A PSA of 4.8 doesn't mean that you do. An MRI, or if your URO is in the dark ages a needle biopsy is necessary to confirm cancer. And 95% of all prostate cancers never cause any problems. So don't even consider treating cancer unless you confirm you have it. If you do, then look at the Gleason scores and make an informed decision. 3) DO NOT have a TURP. Its the oldest and most invasive treatment for BPH and as a result, should only be a last resort. In order of preference should be 1) Rezum - very good success profile, very low chance of permanent side effects (5-10% for RE, almost 0 for anything else) and doesn't preclude any other procedure. 2) Greenlight. More invasive than Rezum, but less than a full blown surgery - 50/50 chance of RE and recovery can be messy for a month, but the results are good in experienced hands. DO NOT let anyone who hasn't done hundreds of these do this. In the wrong hands serious damage can be done. In the right hands the results are generally good. 3) Holep - a full blown surgery that will leave you with a very high chance of RE, but if the others fail will likely work well. Less invasive and shorter recovery that TURP. Good luck and I agree that CIC is the way to go until you decide to do something else. It will prevent bladder damage and allow a normal life. Some are fine doing it indefinitely and that is an option. If you want to lose the catheter, find someone who does Rezum IMO.
Holep is NOT a full blown surgery. It's considered a minimally invasive procedure, with very high success rate, less bleeding and shorter recovery time than most.
Hi Chris I like you had an enlarged prostate from an early age. Now I am 62 and have had 5 biopsies and and MRI. My prostate was 190 gm two years ago. I did research and decided not to get on medications that my Urologist(s) recommended as side effects were too great a risk in my opinion. I tried herbal and that helped (saw palmeto and beta sisterine and lycopene). Urination got really difficult- had to pee every 45 min to an hour- up 6+ times a night, urgency, etc . My IPSS score was 28. On Dec 20th 2018, I had a PAE procedure done. The doctor could only plug one artery because the other seemed to be attached to penis blood supply. I had to have a foley for 5 days (mostly because of Christmas holiday). My PSA went up 10 fold after the procedure (which the doctor- Dr. Shaw in Texas who is an Interventional Radiologist, said was a good sign). So it has been less than a month- now my IPSS score is 4. All my symptoms are much reduced to gone. I can go 3 hours + without peeing, sleep all night ( at most getting up twice at 12 and 3), urgency is reduced, sex life was unaffected. I would highly recommend PAE- mine was covered by insurance- just paying the deductible. Urologist will say there is a danger - but I disagree the IR doctors are very careful and do not harm, whereas Uro want to cut and give meds the solve one issue and cause another. Anyway that is my 2 cents worth. good luck
Hi Chris,
I had the PAE and it didn't work for me - largely because I have an enlarged median lobe. Since I'm not yet comfortable w/ the risk/reward profile of other procedures, I've been self catheterizing (CIC) for 4 years. I think it's the best option. It allows you to go on your own to the extent that you can but then empty your bladder when you can't.
I was on the Foley for 2 months and my Dr. was trying to get me to CIC but I was hesitant. I learned how to do it in 10 minutes and it isn't nearly as bad as you might imagine. The more you do it the easier it becomes.
The one that works best for me is the speedicath male compact by coloplast.
Best of luck!
If you need general anesthesia, it's a full blown surgery.
For holep, "... Intradural anesthesia was the most common technique...", not general anesthesia.
Thank-you very much Dennis. I will ask my URO. The only thing is that I'm on fiber tablets and that may interfere with the self cathing. Probably wouldn't need them if I cath though. I would love to have time to live life again.
Thanks for the replies to this post. Met with the 31 year URO veteran. 12-core Prostate biopsy was all negative except for a small 'ASAP'. I have a 12 mm stone in my bladder. He will use Light Amplification for the Stimulated Emission of Radiation ('LASER') to break it up since the urethra is only 9 mm wide. I asked about Rezum but he claims he needs a more sharp cutting tool (vis-a-vis bipolar current probe ) to remove a relative large amount of the median lobe. Button TURP is not as effective for large prostates. Since my overall health is 'good' and CT scan showed no other abnormalities and since 14 years trying to pee and frustration, TURP sounds like a 'relatively' good solution. HoLEP is not a efficient solution for the URO nor is Rezum. I will meet with a 25 year URO , his partner, 2 days before my surgery next week. Hard to reason why my small size 5'9, 160 lbs has such a large prostate at age 52. Thank God for no cancer...yet. Again thank you for your comments.
Oldbuzzard mentions "DO NOT let anyone who hasn't done hundreds of these do this. " This is very wise advice for any major surgery. I had a full blown radical prostatectomy and was treated by a guy who has done >500 operations. Volume of patients a doctor has treated does not assure success but minimises risk and complications, in my opinion.