My disappointing Urologist visit.

Men's health
1

  Last year, I went to see a urologist for the first time after a kidney scan revealed that I was retaining urine. At the uro office, a catheter was used by a nurse to measure the retention and it was 250ml.  

  My uro walked in, and he immediately offered TURP, no exam, no test. I told him I'll think about it. He gave me a DRE, told me he felt a nodule, and suggested biopsy. Again, I told him I'll think about it. He told me to come back every 3 months. I left, and never came back.

  This year, arming with an incredible amount of knowledge accumulated from this forum mainly, I went to see another uro, from the same medical group.  This time I know what to ask for: my prostate nodule, more information on my prostate, especially my prostate size, whether or not it has a median lobe, and an MRI. 

   Nodule: After performing DRE, he said that he can not be sure that there was a nodule, maybe it's just felt a little tighter than normal. (Maybe it just went away, I hope ) . After looking through my PSA history, he said that if he were I, he would not worry about it. Which I consider a good news.

   MRI: I then asked for an order for a 3T MRI, for my BPH as well as cancer diagnosis. His answer was not how it works. You can only get an MRI if you go to Cancer Center and only there, they will decide whether or not to give you a biopsy or a MRI-assisted biopsy. I told him my friends told me you can have an MRI without a biopsy. He said "your friends don't know what they are talking about."

  Prostate size: He then offered me a Urolift. He already knew I don't like TURP because of too much bleeding. I told him I'd like to know my prostate size. He said the only way is through a prostate scan. I asked if I can have one. He said you can have one when I do the Urolift. 

   Median lobe: I asked if I have a median lobe. His answer is you can find out only by having a camera in your bladder, and you can only have it if you have a Urolift.

   Overall, it was a dissappointing visit. It seems like I can not get the information  to make informed decisions on selecting a good procedure, without subjecting myself in one of the procedures first. 

   Is it similar to what happened to you ?

   Hank

2

Hank there is no perfect test, no damn perfect surgery, if I had listened to half these know it all here some, I would be totally screwed, of course my Turp was a toughie, I had a huge prostate, I have suffered for many many years, locking up using cold meds, did not know back then, getting up all nite having to pee, always having to know where the bathroom was every place I went, look listen to a specialist, ask a lot of questions, some procedures are short term fixes, my dr has preformed all of the procedures that are out there, he says thousands , he told me flat out, we can try this or that but you have had and have a huge prostate for years, if I preform Turp on you I guarantee it to not retry another procedure in my lifetime, it gives my patients the best results, now look do as your please, you mirth not need anything yet but meds and a change of lifestyle like what you eat and drink, and when you drink, how long before bed yada, so listen to your dr ad make a decision not from forms, but informed

3

Boy, sounds like you should find another medical group. Are you in the US? I had just a 3T MRI and there are several other men on this forum who have had that also. In my case I opted for a follow up biopsy as my PIRADS score was 4/5, but if the MRI had come back clean, I would not have had a biospy. And I have gotten prostate size measurements from the MRI and from and Ulstrasound without dosing any procedures. I'm kind of shocked at what the uros you saw are telling you.

Rich

 

4

You can sure pick your urologists :-)

Any competent GP can tell your prostate size by doing a DRE. A cystoscopy would show if there is a nodule.

All prostates have a median lobe.

The median lobe is found just posterior to the urethra along the midline of the prostate. The median lobe contains the ejaculatory ducts of the prostate. The posterior lobe forms a thin layer of tissue posterior to the median lobe and the lateral lobes.

5

Hi Rick, I am in the US and my medical group is UCSD in San Diego, not a small outfit. I wonder if they are falling behind or my uros are just snowing me. Hank

6

I am not sure how much bad information you have from your group but since any cystoscopy puts a camera into your bladder, I find what you are saying you were told by your urologist suspect.  Dump them!

7

The main thing that was similar to me was that I left my first appointment without much information except for a DVD re: GL and also a little brochure about same.  After this first meeting, my preop appointment (thats what they called it) was in two weeks and the surgery in three weeks.  If I hadn't discovered this forum, I probably would have gone through with it.  I couldn't get a urine sample out for the Urologist so I had to cath there while the doctor and nurse waited.  They said I didn't have any UTI and in fact it was very clear.  They also gave me a already opened box of Magic 14fr to take home with me no charge.  As these two weeks went on I got more comfortable with cathing and I wanted to think about this for awhile.  I went in for the preop appointment in two weeks.  My Urologist wasn't there but his PA (a female) was there.  I told her I wanted to hold off on everything for now; I told her about my learning to CIC and she seemed ok with that.  She also told me that my PSA level was "going in the right directions now" as well as another alert we got with my last blood test during hep c treatment: my creatine level had spiked.  But with the CIC that was also heading down.  I haven't had my 12 week SVR for being clear of the hep c virus just yet.  Its been about 10 weeks since I finished treatment.  I was clear (undetected) at 4 weeks and 8 weeks  so I'm expecting good news about that.  I guess I will try and contact my Urologist office again one of these days to see about a follow-up.  I have still never had a cystosco;y or a urodynamics test or anything but an ultrasound on my bladder and the glove test twice.  Yes, I do have an enlarged prostate and apparent BPH.  In fact, they seem to be so sure thats what it is that they never have done any other tests.  Perhaps they were going to do that in the preop but, like I said, that was only a week before the scheduled surgery.  Seemed to me like the GL was in my immediate future if I had just accepted it.  I realize there is a good chance it would have turned out alright, especially if retro ejaculation wasn't that important to me.  But now I still have all my options open I think.

 

8

Thanks Derek. I asked my URO about the size. He said "Without an ultrasound, all I can say is that it is not large."

About the nodule, it was felt during a DRE, which means it on the outsside of the prostate (actual note: right lateral lobe). I don't see how you can see it from a cystoscopy, which would look at the inside).

Median lobe: Perhaps I should use a more correct term :"large median lobe". I am referring to the part of the prostate that is protruding into the bladder neck.

Hank

9

I am glad I didn't read this forum before I decided on green light surgery or I probably would have decided against it.   Most of those writing are those with bad experiences.   The thousands and thousands of men who have had good results do not bother to write.   I am 4 weeks post op and not completely healed.  I was told preop that it would take 6 months or longer for total (whatever that means) healing.   Depending on how much I drink before bed I get up 2  to 4 times.   Retention is getting better but has a way to go.   I no longer wear a pad.

10

Thanks John for the advice. You are lucky to find a good doctor for your situation. I am not lucky so far so I am still looking. In the mean time I am taking meds and I already have a very healthy lifestyle. Hank

11

I knew he was referring to the cystoscopy. But I did not like the fact that he would not give me that without the Urolift. Hank

12

I don't have an explanation for their opinions, but if it was me I'd just say '"don't bother to get up, l'll show myself out". 

I've had similar experiences with docs and uro docs in particular, where I've gotten advice that would have been potentially extremely harmful. I suspect that some of the reason is due the pressure of having to see too many patients in too short a time. One uro doc even told me that after his group was purchased by a larger group, he was then scheduled for 10 mns with each patient. Incredible! And when he investigated starting a smaller group on his own, the insurance  reimbursements would have killed him. The other reason is that uros may have spent years and decades learning and performing one or two procedures, and are only passingly familiar with the many other procedures, so when you have a hammer, everything starts to look like a nail. Whatever the reason or reasons, this is our health and our bodies. In my opinion, it's up to us to thoroughly research all our options and to use uro docs as resources and helpers, but not necessarily experts with the final word.

Rich

13

There are many other options besides Turp and GL and urolift.

14

Where do you live? Heath in lifestyle is very important weight yada good food exercise, keep looking for a good dr, you sure as hell don't want to suffer the hell i have caused myself by not listening to my dr no going to the Dr An not taking my meds I paid s very high price for being a scary cat not anymore I have had three major surgeries An have learned my lesson on follow through keep taking your meds hope all works out for u sounds like you are doing tie right things 

15

Hi Keith,

We have similar experiences I guess. After I came home, from the exit printout, I found out that they already scheduled me from a procedure (probably Urolift) 2 weeks later. I canceled it. My symptoms are not too bad right now and I know CIC so I am not rushing into anything. Hank

16

I am really, really glad for you Glenn. Because it worked for you does not mean others should blindly accept what we offered to them. From my observations, informed decisions do reduce risks and that is what I intend to do. Learn from others but be selective. Some of the advises on this column saved lives and countless sufferings.

Hank

17

At the last cystoscopy I had two years ago the Uro said that I had a nodule on my median lobe and pointed it out to me on the screen.

Every DRE I've had over the years whether by a GP, Uro or urology nurse has been accurate and confirmed by a TRUSS or Cystoscopy later. The last DRE stimulated my vagal nerve and put me into AF. .  

18

That is why I stick around here to try to show that GL PVP works. Neither of my two laser procedures resulted in me needing to wear a pad and  complete healing took a few weeks not months.

After my first PVP I was out and about without a care on the third day. On day two I had a two hour train journey home and about another hour to get home from the station without the need to pee.On the old prostate news group where the first ever PVP patient posted around 2001 hundreds followed and all had good results. The difference ? perhaps then the ones doing the procedures were leaders in their field. The UK hospital where I had mine were conducting trials and I was one of the first forty patients done by their team of four urologists. At that time Laserscope made the equipment and one of their representatives used to attend most procedures. 

19

Thanks Rich, I did not have the feeling that this uro is rushing at all. In fact, he lingered and chatted with me for a long time, which I appreciated. And the fact that he booked me (without my knowledge, BTW) for a procedure (urolift I guess) 2 weeks after means he is not that busy. 

I have a feeling they are pushing us for procedures so they can make money. I am glad I am informed so I will not be pushed. Hank

20

Why are those Guys allowed to practice and why do the manufacturers allow the procedure to get a bad name with such people operating it?