Hi John,Ross, Mike, Jimjames, and all,
Finally went to UCSF and had a 3T MRI today. Fairly uncomfortable with the endorectal coil but it is now done. I told them to send the results to Dr. K. After checking with Dr. K., I refused the contrast media, as he says he does not need it and it's not exactly health food! Have an appointment this Friday with my doc at UC to go over results and options. They keep trying to talk me into a TURP, but I will not go for that. Will update when I get the results. Best to all of you and thanks for your support.
Fred
Hi Fred,
Good diagnostics leads to appropriate treatment which leads to best chance for good outcome! Best of luck.
Pete
Doctor K will honestly show and tell you what he feels his results will be and just how he will do it before he agrees to do the FLA. He will tell someone that another treatment is best if he sees that in the MRI and he has done so several times. This is why he requires a potential patient to provide a 3T-MRI before he will schedule them. With that MRI, he will show you the stricture causing the issue and how and where he will remove it. This type of communication is what assured me of no sexual side effects and convinced me to move forward with FLA. No one else offered this in all the other options I looked at.
Glad you are finding the direction that will allow you the relief we received with FLA. Dr. Karamainian is very comfortable and much more experienced now with the many procedures he has done in the last year for BPH. It is so much more straight forward than the FLA done for PCa which has been done for many years.
I am positive, they could not pay me to do the TURP. It is just too much in every way for me. Too much blood, too much recovery, too much living with those side effects. Though it does work if that is what one wants. And it is readily called the "Gold Standard" by the the guys who sell it. But strangely enough it seems they would never have the procedure themselves if you get them to answer honestly?
Good Luck Fred and please stay in touch as we are always here for support no matter what way you go.
Also, Houston is back to normal for the most part which is great news.
I'm a bit confused by your use of "stricture," since a urinary tract stricture is essentially scar tissue caused by infections, passage of kidney stones or instruments. Are you referring to the obstruction associated with BPH, and the enlarged prostate pressing on the urethra as it passes through the prostate?
Thanks for your helpful and supportive post. Yes, I was glad to hear that Dr. K did not sustain too much damage in the storm and I am looking forward to hearing from him after he reviews the CD I'm sending. Will update then.
Very best wishes,
Sorry for the confusion. In direct answer to your question, YES that is the reference meant in that use.
Stricture: An abnormal narrowing of a body passage, especially a tube or a canal.
Urethral stricture may be caused by swelling or scar tissue from surgery. It can also occur after a injury or disease such as Benign prostatic hyperplasia (BPH).
The manic cell reproduction that takes place in the BPH condition is what pinches the urethra. This reproduction is actually the a 2-1 reproduction and continues to double with each daughter cell produced at an exponential pace. Hence you wind up with a prostate like mine, the size of a tennis ball. Those cells that are reproducing next to the urethra cause the problem with urination which we are all too familiar with. When those cells are removed during FLA up to and within the tolerance of 1 ml of the urethra the flow restriction is alleviated.
Again, sorry the choice of words was somewhat confusing.
Good luck ! whatever path you choose
Glen, the same is true in a lot of cases with the median lobe growth issue protruding and pushing up into the bladder and causing retention. This condition can be seen on the MRI and can be address and treated by the doctor who knows what he is doing with the laser in that median lobe. I was shown mine before the procedure then I was shown the "after" MRI with the bladder being in a relaxed shape after the tissue removal of the FLA..
I apparently had a doctor who didn't know what he was doing when he created a channel in my overgrown median lobe. While employing a Greenlight laser, he somehow damaged the urethra in the vicinity of the sphincter and outward, rendering me incontinent since that procedure over 18 months ago. I've found these particular strictures call sphincter strictures.
Well I am so sad and sorry to hear that. This kind of stuff make we go postal I just want to find a uro and hit him in the mouth.
Hi Light, Is there another option other than with endorectal coil, like lap coil, for 3T MRI ? Thanks. Hank
Hi Hank,
I'm not an expert on this, but I understand that there is a pelvic coil that is just placed on your abdomen as an alternative. Also, you can have the MRI without a coil at all. My information is that it all has to do with image resolution. Some people even say that the endorectal coil results in a distorted image in some cases. I had requested a pelvic coil. The doctor who wrote the order for my MRI had his nurse investigate and she called me to say they don't really use the pelvic coil at UC. When I went for the test, I asked the techs and they seemed to think resolution would be far superior with the endorectal coil. Given I had made a big issue out of the contrast medium, I decided the coil was negotiable. Seemed to me it would not cause permanent health problems, but just 45 minutes of discomfort. It did hurt quite a bit when they inserted it. If you go to Dr. Sperling's website, he has a statement about why he does not use an endorectal coil. It basically says he can get good imagery without it and he sees no reason to subject his patients to it. A pretty good sales pitch,in my estimation! Overall, I would say it was unpleasant, but not excruciating.
I am going to see a UCSD uro tomorrow, planning to ask for a 3t MRI. What is the issue with the contrast medium, BTW ? Thanks again. Hank
Hi Hank,
You can do an internet search for adverse effects of mri contrast media and there's a lot of information available. I'm not an expert, however there are minor side effects such as headache, nausea, dizziness, more serious side effects, such as kidney damage or allergic reactions, and long-lasting issues such as retention of a certain amount of the contrast medium in bones and/or brain. It's a personal choice to make on the basis of benefit vs. potential cost. The docs I talked with said they could get a clear enough image without it so I was happy to be able to bypass the potential (in my estimation) negative health effects.
Good luck with your appointment tomorrow!
Now I am ready. Thanks. Hank
Hi Light, you did mention that you sent the MRI result to Dr K. What else do you need to send him for FLA , like uroflow or urodynamic results ? Thanks. Hank
Hank, there are 2 types of coils I would suggest you have the coil. The contrast is good if you have not had it in the passed. I had it 4 Times in a year and did not have an issue. Dr. K would tell you that the prostate MRI with contrast only enhances the quality about 15- 20 percent over the no contrast. Again if this is your initial and first one it should not be an issue. But if it consensus you, call Dr. K and discuss it to help you decide.
Pelvic coils are are simple as they just lay them on top of you. But they are sometimes harder to fined. Endorectal coils are inserted in the rectum for about a 30 minute time frame. They are not large about the size of a small cigar and half the length. I have had both. Prefer the pelvic but had no issue or problem with in rectal coil. Got to have the coil. Contrast is up to you and doctor K. If I can help you with more info just pm or call me tomorrow. I am around all day if you need to discuss. I will give you details if you want them. Good luck, John.
Thanks John. What else do I need besides the MRI ? Hank
Hank, the only other thing I had was a PSA and Free PSA blood test score but that was not needed for Dr. K to show me the dynamics of the issue that I had. I Urodynamic flow study is done by some also some get an ultra sound of the bladder to check again the retention. The MRI will also show that retention and will show bladder wall tribeculaton. The MRI will also give the data need to calculate the size of the prostate. I feel the MRI is the most important as it shows the gland and organ. i also think the important thing is who is reading the film and you have that covered.
I never had a biopsy and that was what started my entire journey. I did not want one and started looking for another way. I first learned what a Focal laser biopsy was. Then when I had my MRI to see if there was anything to biopsy, I sent it to 4 different Interventional Radiologist who all agreed that, though I had a 125 cc prostate, I did not have any cancer. My PSA was 5.7 and my Urologist really want to do the random biopsy. I told him no and we don't speak anymore.
John, last year I went to see a uro because a scan showed I had retention, 250ml. He immediately suggested TURP, no exam no test. I said I'll think about it. So he gave me DRE, said he felt a nodule, and suggested biopsy. Again, I said I'll think about it, but like you, I did not return. 😀 This year, I asked to see another uro for a second opinion on the nodule. I think most likely it will be confirmed, especially since both uros are in the same medical group. Either way, I will ask for an MRI and go from there. No blind biopsy for me.
I would like to send the MRI to Dr K to have his opinion on my chances with FLA. I am a little concerned that maybe my bladder is the main culprit. Thanks again. Hank