My Profile (Second Issue)

Hi, All. I have been absent for a few weeks and much has happened during that time. First order of business is to give you an outline of myself and an idea of my concerns and the focus of my future contributions.

I am an 87 year old male with a background in mechanical engineering. Not medically trained specifically, but with enough medical knowledge to follow discussions. Concerning health, I will keep to my urological issues. My principal malaise is urine retention (150 ml/330 ml approximate average), moderately enlarged prostate encircling the urethra, with paruresis (shy bladder) following as a lower priority. Years ago (1947) I did experience a single episode of renal calculus (kidney stone) which led to my first cystoscopy (rigid because the flexible cystoscope had not been invented yet). The next cystoscopy I underwent was performed on June 30th, 2016 in the Drs. office. This was followed by urodynamic testing done on August 25th, 2016 at UVM Medical Center.

Of the “Patient” contributors who have helped me along the way my sincere thanks goes to “Cartoonman”, who helped me out of the wet noodle syndrome, and “jimjames” for a wealth of very valuable and utterly reliable information derived from his experiences. And to a host of others who I have touched base with, both from “Patient” and from other sources. To all of you, my heartfelt thanks! You’re a great bunch, both men and women and, as a former mariner, I have a special feeling for the close camaraderie you all show!

Regarding the issues I am interested in, I will post my comments individually to make them easier to reference. Please search for “My Flexible Cystoscopy Done At Last” and “Urodynamic Testing – Now I Have Finally Experienced This Procedure, Too” by early next week, at the latest. The first posting of “My Profile”, which should have preceded these two, has vanished into limbo, so here goes a repeat issue; I hope this one “takes”!

Bye for now. Alan86734.

 

"Wet noodle syndrome:" an unexpected afternoon laugh, here in the Studio this rainy afternoon.   RIGID cystoscope???  OUCH!   And if I retained only 300cc, I wouldn't even be on this site!  (I retain 450-800cc!!! ---Permantly stretched-out bladder)!!!   :-)

Welcome back, Oh Venerable Elder Peeman...  :-)

Hi Alan, I am in the same boat. I am 87 years old with urine rentention. I had a cystoscopy in the doctors office . Dr then suggested i have Turp procedure.

Did you have this procedure done? I have an appoint Oct 4 with a new urologist ,to discuss uro lift. Was the Urodynamic test very stressful? I have been on medicine for 3 months,with a catheter .Once a month catheter comes out and a void test is done.So far i still have urine retention. My doctor says this medicine Avodart could shrinlk the prostate.Kindly keep me posted with your decisions.

Hi Alan, I am in the same boat. I am 87 years old with urine rentention. I had a cystoscopy in the doctors office . Dr then suggested i have Turp procedure.

Did you have this procedure done? I have an appoint Oct 4 with a new urologist ,to discuss uro lift. Was the Urodynamic test very stressful? I have been on medicine for 3 months,with a catheter .Once a month catheter comes out and a void test is done.So far i still have urine retention. My doctor says this medicine Avodart could shrinlk the prostate.Kindly keep me posted with your decisions.

TURP is a rather brutal procedure at any time and more so for ones in our age range. The URO who did my GL PVP said that he did GL on a Guy of 92 with a prostate around 150 grms as it is such a gentle proedure. .

I had a general anaesthetic when I had a rigid cystoscopy in 1983.It was very uncomfortable after but worse was that they had used some type of gel in the head of my penis that caused the skin to be very raw and peel off. We were going on holiday to Italy two days later and that holiday was both uncomfortable and sexless..

Frank, I'm 20 years behind you, and extrapolating from my experience (at 65) having a cath in for only one week, I can't imagine having one for any longer---and wouldn't want to.  Are your hands steady?  If so, have you considered self-catheterizing?  I couldn't pee at all when my prostate shut things down.  I switched to self-cathing after one week of the cath-and-bag approach,  and feel "normal," or at least normal enough.  

Also, I had the Urolift in December (after turning down my urologist's advise to let him do a TURP, which he called, "The Gold Standard," in AUg of 2014), and it cleared up some of my issues, though not all.  Btw, my home-urologist has since been trained in Urolift!  Not that I would trust a "newbie;" I flew to Salt Lake City (from PA) to get treatment by the most experienced Urolift guy in the country...

Anyway, if you're able, I'd suggest considering self-cathing.  Don't be "older" than you have to be!  :-)

I’ve been following this blog for about 9 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  I used tamsulosin (Flomax) and dutasteride which did help, but eventually as the prostate continued to grow, the effect was lessened. Plus I realized later the drugs zapped my sex drive.

Some procedures seem to work for some but not all.  Worse yet, some have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

The best answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it back out.

Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

I have heard varied reports on PAE which is done by interventional radiologists.  It is an outpatient procedure and far less invasive.  However, I don’t believe it’s covered by most insurance, and because of the iffy results, don’t think I’d try it.

 Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

That's exactly where you always scored; you brought a laugh to us all, but always  a laugh "with" rather than "at"! Then there was your nurse who had "Inquisition Apparatus Management" in her ancestry.

Well, how lucky could I be? My nurse was the angelic counterpart. She even invited me to insert the 3-way Fr. 14 catheter. It was obvious silicone and very pliable. I faile miserably  so handed operations back to her. But more of all this later; its worth it!

 

Paul, you mentioned that you did not know much about PAE. There is another thead on prostate artery embolization, which includes a meta research. I think you will find that the results are very good. It's been around for a few years, but urologists cannot perform this procedure, so you won't see many urologists talking it up.

Alan, you mentioned urine retention as your primary malaise, citing moderate prostatic pressure on the urethra. Check out the thread on Prostatic Artery Embolization. There is a lot of information there. PAE procedure is non invasive and has particularly good outcomes for acute urinary retention. It also has no sexual performance side effects. You will also see why it is not the proverbial talk of the town when uros are explaining procedure options to pts with AUR.

You're right.... I did not research it as I was not aware of its exitence at the time.  However, in reporting what folks on this blog have said, it did not work for some, or had limited results, and it was out of pocket. 

I certainly advise anyone looking for a BPH solution to study all the options, but I know that HoLEP is very effective, and have heard zero reports on this blog about 2nd procedures, cathing afterwards, incontinence or any other side effect (other than RE, which is not a surprise). 

I'll not spend more time researching procedures, as it's all moot for me now..... just reflecting what everyone else has said.  Great blog!

Hi, Frank, thanks for your reply.

 

Your question, "Did you have this [TURP] procedure done?" No, and unlikely to ever have it done.

"Was the Urodynamic test very stressful?" Not really, but I did have local sedation (quite unintentionally), and the nurse operator was extremely good. I should also point out that I have a high pain threshhold (pain tolerance) so probably the worse possible candidate for evaluating a procedure.

My case is a little different to yours. The Dr. heading up the urodynamic test voted TURP while my Uro (enlightened man) voted CIC. I'll do my best to keep you updated. And for you, Frank, I wish you a trip back to normality ASAP!

alan86734.

 

Hi, Paul. Many thanks for replying to my post. Your 9 month effort directed to researching this issue is to be commrnended. I concur with you entirely. The general opinion out there seems to be that  drugs are essentially short-term. My encounter with tamsulosin (Flomax) lasted precisely seven days. This is not to say the drug is no good; its just no good for some of us.

If I were to offer you any advice it would be, in each and every case to make quite sure that you own the decision. Those who proffer their opinion, "Do this" or "Do that", have a nasty habit of vanishing into the night if thing go wrong!

Medicine is a very imprecise scienace

Best of luck! alan86734.

Hi, 333health. Many thanks for you suggestions. PAE does seem to be a vey promising procedure, but it also has risks. In a recent post a patient dircovered, after the procedure, that he was allergic to the glass beads!

Moral of the story, ask your uro for a handful of beads for evaluation purposes. I must admit, I would have thought glass was stable enought to trust blindly. I guess not!

Thanks for the suggestion, anyway. Right now I expect to last a year or two relying on CIC, a procedure I tolerate well. If and when th time comes I think I'll go for the PAE.

Warm regards, alan86734

 

Hi Alan, Do you know if PAE is covered by medicare? other Insuranc e plans?

Where do they do thei procedure?

Hi Alan,Thanks for your response.You said your urologist voted CIC? What is CIC?Did you have a Uro-lift done?

Thanks<

Hi Derek, Did you have the GL PVP  done in a hospital?How long were you in ?

Sorry, Frank. I haven't arrived there yet. However, I am very interested in PAE and will be more than happy to share whatever I uncover.

Best of luck, alan86734.

Hi Frank. CIC is the same old acronym for Clean Intermittent Catheterization, minus periods. Apologies for my laziness!

All the best! alan86734