I am fairly new to this world. I'm about 50. I've been reading through this forum about all the different interventions available to treat BPH. I had no idea there were so many options out there.
The last couple of years, I've slowly experienced worsening symptoms. I went from sleeping through the night up until a couple of years ago to waking up to use the bathroom once or twice a night a few times a week...and have had an uptick in that recently. I am looking for a urologist so I can get a start can figure out a proper diagnosis. Are there any specific questions I should ask from the start? Is there a standard treatment hierarchy that most urologists go through? Are most of the options like PAE, HoLEP, FLA, and others usually reserved for those who have tried several different medications first?
Mainly...what advice would you give to someone who is just starting this journey? What do you wish you knew when you first started?
If you are in the USA most states have a physician profile website where you can research and check out a doctor. As for meds most will not work for everyone and beware of supplements and herbals. They are not regulated because they do nothing.
Here are a couple of things I would ask. First of all, we know that you have nocturia (waking during the night and going to the toilet.). Maybe you have BPH, but it could be primarily because of sleep disturbance waking you, and THEN you go to the toilet. If your urologist is not aware of that possibility, consider a different urologist. Moving beyond that possibility, if you actually do have BPH, find out the estimated size of your prostate. And ask if you have median lobe enlargement, for that is a subset that is problematic, as the lobe can start pushing into the bladder. Finally, if you are diagnosed with BPH, the doctor will probably want to prescribe a medication. Carefully read up on the possible side effects of any prescription medications, and come here for input from someone who has been down that road.
Well. For a start I want to welcome you to this forum. We have all gone through these problem. Now with your getting up at night you may have to watch what you drink. Do not drink anything after 7PM. When you are looking for a Urologist you need to find one that care about you not rushing you into a surgery. You will have to have a lot of test to make sure what is going on. He may start you on pills first. But try to stay away from Flomax & Rapaflo. Some men do not like the side effects. It can give you retro ejaculation. Which the sperm goes backwards instead of out. What every meds he give you before you start check out the side effects and tell the doctor you have a problem. With all the procedure there are 9 out of the 10 top procedure cause retro ejaculation. Urolift is the only one that does not cause retro. Because it does no cutting of the prostate. It is done with clips. You are going to have to sit down and do your pros and cons of everything. You will know if they are a good doctor when they listen you you and your concerns. I wish you well. Ken
I would ask for an ultrasound first before any other invasive test. It should tell you the approximate size of your prostate and check to see if you have a problem with retention. Very easy to do in the doctors office and could be done before all the other tests.
The first step is to find a Urologist, probably recommended by your GP, or a friend. You will probably first try lifestyle changes, like not drinking liquids in the evening. Do not take cold medicines, like antihistamines, they can make BPH problems worse.
If those don't help your Urologist may want you to try some drugs. The first is usually an Alpha blocker like Flomax or Alfuzosin. These are not bad . The side effects can be low blood pressure, dizziness, and retrograde ejaculation. All the effects are temporary and go away within one day when you stop taking the drug. For me the retro lasted about 8 hours so by timing when you take it, problems can be avoided. Some people take Cialis, to increase flow, and of course it does not cause retro, and can be a benefit to sexual function because it is like Viagra. Cialis can be expensive and insurance may not cover it.
A Urologist may suggest Avodart or Finisteride. Be careful of these drugs because they can cause loss of libido and erectile disfunction which may last for years after you stop taking the drug. The effects may even be permanent.
If the drugs don't help or lose their effect you can try Self Catheterization, CIC. There are some good discussions on this web site about this. If you don't want to CIC the next options are PAE, Urolift, or Rezum, in the order of least invasive to more invasive. Before you do any of these procedures you should get tests from your Urologist like DRE, Flow rate, Cystoscopy, Trus to determine prostate size, and possibly a Urodynamics test for bladder function.
Be aware that Urolift even though one of the least invasive procedures leaves metal clips in your prostate that cause distortions in MRI images and may interfere with the use of MRI for biopsy and FLA (Focal Laser Ablation) later.
I am also a newbie. Was in ER several times and got ultrasound and CT scan but no one at this major hospital said that the bladder scanner (which was used twice on me) could "size" my prostate.
The uro didn't mention this either. Your post sounds very logical. Could you, or others, expand on this subject and your experience with prostate sonograms?
Also new on this journey. Learned that I had nocturnia, from drinking too much liquid. My Foley bladder bag was doing 2+ Liters from midnight to 8am. That's why I was urinating at night. Nocturnia is not a disease, from what I now know. However, drinking too much liquid at night along with spicy food triggered my initial bladder blockage --- without warning. Never drink a lot of any liquid at one time, was the take-away. Also, key info: Squat to defacate, sit to urinate.
A couple of follow-up comments to some of the previous posts. I took Flomax for quite a while, and had pretty bad side effects: severe nasal congestion along with a persistent cough.
A urologist will most likely not recommend PAE as the procedure is performed by interventional radiologists. My urologist is top notch for kidney stones, but even a year after my PAE he kept citing "facts" about PAE that were very out of date and unfavorable in nature. Glad I didn't listen to him about that.
I concur with TruthMatters. Haven't heard of retro being a possibility with PAE. It doesn't even make sense anatomically.
Main advice: Treat your uro docs and other docs as sources of info, but not as infallible. They can have gaps in knowledge, married to the one or two procedures that they have been doing for decades, and also a financial interest in them as well. Take what they have to say and do your research. This forum is invaluable in that regard. Then weigh the pros and cons of all your options and make a decision about how to proceed. No one solution works for everyone.
Many thanks to all of you for your replies! I really appreciate it.
That is interesting about the nocturia. I really haven't given it much thought about what actually woke me up. I assumed it was the need to use the toilet, but you're right; there could be another reason.
When I first started reading about things to avoid, I saw that antihistamines were on the list. It's truly a "pick your poison" kind of issue, as I suffer with allergies frequently.
Thanks for the heads up on asking for an ultrasound. Will most urologists do this anyway on a first visit?
Regarding PAE, FAL, and others, why don't urologists do these procedures? I mean, it seems like the procedures would/should be in their wheelhouse, as it were. As far as I can tell, there is only one office doing PAE in my state. I wouldn't have a problem traveling to get this (or other procedure) done if it meant having someone who is a practiced expert do it...but don't want to get ahead of myself here.
A few of you mentioned side effects with the drug options like Flomax and Rapaflo. Do they work reasonably well for most people? Some of the potential side effects could be non-starters for me, like stuffy nose, as that is a somewhat frequent thing for me anyway. I'm glad to know that the side effects go away quickly when you get off them.
Is there a treatment that is on the horizon that looks more promising than what is already available to us? The "silver bullet", as it were?
Thanks again, everyone, for your welcoming posts. This forum is fantastic.
One other question about PAE, Urolift, Rezum, FLA, and other procedures. If prostate cancer (I have some cancer history in family) is detected down the line, will any of them be an issue with treating the cancer?
To answer your question about why urologists don't perform PAE, FLA (Focal Laser Ablation), those are procedures that require the special extended training and facilities that radiologists have. I know I wouldn't have wanted my first urologist guiding fine wires into my arteries, given that during a Greenlight Laser procedure, he managed to damage my external sphincter, leaving me permanently incontinent. Legally, I think any doctor can attempt to do just about anything. I think it's best to have a specialist who has trained as a fellow under another highly skilled and experienced specialist. As an example, the doctor who did my AUS implant does over 150 implants per year, while training other doctors who serve as his "fellow" for an extended period, imparting his knowledge to them.
No silver bullet that I am aware of. Let us know if you hear about one!
PAE and FLA are done by interventional radiologists ... completely different specialty:
Interventional radiology is a medical sub-specialty of radiology utilizing minimally-invasive image-guided procedures to diagnose and treat diseases in nearly every organ system.
What state are you in? I traveled several hundred miles to get my PAE for the same reason that you mentioned: to be treated by someone who had performed hundreds of the procedures and who had been highly(! ) recommended by posters on the forum who had been to him.
In my case, the flomax worked well re: the BPH symptoms, but I couldn't tolerate the nasal congestion side effects. Daily Cialis is an alternative that might have less severe side effects.
According to the Urolift FAQs the metal clips that are used with Urolift cause distortion in MRI images up to 15mm around the clip. Also according to the FAQs the limit on MRI strength is 3 Tesla. Which is the strongest MRI as of 2018 anyway. I have not been able to get more details from NeoTract so far.
According to Dr Karmaranian in Texas that would make an MRI biopsy or a FLA more difficult but not necessarily impossible. However he said he has never done FLA on a patient with Urolift so did not know for sure.
Of course the old method of biopsy using 12 to 18 needles could still be done as far as I know.
Kenneth, I don't think we know that a person would have more volume of semen with an enlarged prostate. I have never heard of any studies showing that. It is a deseased condition so I doubt that it would put out more volume and probably works less efficiently. This is a good question for Urologists or researchers, although I doubt there is much interest in studying it.
That is true to a point. This is what is said on the back of my card. ** The Urolift implants is MRI conditional. It can be safely scanned in an MR system meeting the conditions on the back of this card ** I had 2 last year no problem. I also talk with Dr. K. And yes he did say that he has not done anyone that had a Urolift yet. But he also said that he would be willing to try. Ken