Hi Yani,
FYI, I used Flomax for several years, and had difficult side effects (severe nasal congestion). One of the problems is that it comes in capsule form, so you can't cut in in half to reduce the dosage. I recently switched to daily Cialis. So far it seems to be as effective, and since it is tablet form I can cut in half to adjust the dosage to match my body's needs.
Rich
Hi Yani,
As mentioned, 5mg Daily Cialis is an alternative to Flomax. No retrograde ejaculation with Cialis, some enhancement of erections but you might also experience other side effects. Everyone reacts differently to these drugs so have to experiment.
As to the scanners, as mentioned earlier in the thread, there are two types, each with its advantages and disadvantages. In either case, if you buy one, it's important to make sure it has a return policy so that you can test its accuracy against either catherized volumes at home (via CIC) or against the machine at your doctor's office. Less of an issue with a new scanner but those prices are significantly higher.
A 2D real time bladder scanner very similar to the one I have just came on ebay the other day. It's around $1,000. I will private message you the link later. There is also a place in Florida that sells refurbished Verathon BVI 3000's for around $2,000. That is a 3D scanner that gives you a digital readout but no bladder picture. Especially important with these units to test them against a catherized volume and/or another scanner since you are relying on the readout. A third option is to get a new 3D scan unit with a real time image. These run $6,000 and up. Check your PMs in a bit.
Jim
I'm actually testing out 2.5 mg Daily Cialis. Might not be quite enough, but I will give it some more time. Seems to wear off at about 16 to 20 hours or so,
Turns out my copay for 2.5 mg and 5 mg for 30 pills was identical, so I got the 5 mg and am using a pill splitter to cut them in half. One could also get the the 2.5 mg and split those for a super small dose.
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There was a study that used 2.5 and 5mg. Benefits were shown with the 2.5 but more with the 5. That said, always good to experiment and if a lower dose gives enough benefit that's great. Less meds in the system and more money in the pocket! I stopped the 5mg because the marginal benefits did not outweigh the side effects. I might just try 2.5 one day and see how it works.
Jim
Hi Jim,
What side effects did you have with the 5 mg? For a couple of weeks, I seemed to be doing really well with the 2.5 mg, but out of the blue I had a weird intense spell in the middle of last night: major post nasal drip and congestion and peeing volumes, over a 2 hour stretch (considerably more than I usually pee in an entire night). I'm stumped. I don't think it was allergies, and I'm guessing it wasn't the eclipse
Hi Jim:
I just purchased a used Mediwatch MD-6000 (which is essentially the Laborie Portascan 3D) off of eBay. I've been searching on the internet, but haven't found a guideline for how often a bladder scan can be conducted without safety concerns. I know that ultrasound is generally safe and the scan period is fairly brief, but am curious if you have any information on this topic. Thanks.
Congrads! Nice machine. That's a newer version of my Portascan Plus. Main difference is that it's a 3-D scanner as opposed to mine which is 2D. Only disadvantage, if I'm correct in this assumption, is that unlike with the Portascan Plus, the software does not allow you to manually re-draw the bladder outline. This only becomes a problem if you have an irregular shapped bladder or a diverticulum like I have. Or maybe they revised the software since I checked to allow manual re-drawing?
You can use to your heart's content, ultrasound has no radiation and is perfectly safe.
Can I asked why your purchased it? Two popular reasons are to measure PVR and/or bladder retraining with overactive bladder. Have you tested its accuracy against either your doctor's machine, or better yet against catherized voids?
If I may ask, how much did you pay?
Jim
Let me answer your last question first. The scanner was listed for $3400 on eBay. I liked it because it was listed as having all of the accessories (probe, two batteries, adapter and manuals) in addition to the scanner. I initially offered $1600 and we settled on $2,000.
I suffer from BPH and prostatitis a couple of times a year. My urologist is of little help and I'm beginning to realize he is a "cutter". The last episode of prostatitis, which yielded a high PSA, he balked at prescribing antibiotics preferring instead to schedule a biopsy. I finally convinced him to prescribe antibiotics and lo and behold my symptoms subsided, my PSA dropped to acceptable levels and free PSA and PCA-3 test results were normal. I've also had three episodes of acute retention (two recently). While I have never been catheterized nor did I seek medical help, they were painful and worrisome.
I plan to retire soon and want to travel alot. However, traveling with LUTS can be very problematic. I have been keeping a voiding diary and it seems to me that I now need to know the PVR. My diary has shown that the amounts voided during the daytime per trip are relatively low (around 150 ml). I would like to increase this amount, but need to understand more about how my bladder is working and the various factors that affect both frequency and amount voided per trip.
My goal is to establish a "baseline" at this point in time so I have something to compare future improvement or detioration against. Although I could get PVR measurements at the urologist, there seems to be some evidence that the occassional bladder scan in a clinical setting provides nothing more than a ballpark number. Also, in a previous life, I was an engineering researcher, so I don't mind collecting and analyzing data (although there are many more variables with LUTS than I'm used to).
I used the bladder scanner for the first time today. I'm using it by myself (i.e. no assistant). I had some problems with initial readings that were very low (around 2 to 30 ml). I realized that I really needed to move the scanner head (much more than what was shown in the training video) in order to get what seem like reasonable readings. I'm guessing that from my vantage point, I'm not placing the scanner in the middle nor at the right location (with practice I should get better at it). It would seem to me that I could "calibrate" or check the results by taking a bladder scan just before voiding and right after voiding and in between peeing into a graduated beaker to get the amount voided. I'll try to do this in the next day or so (I'm still getting used to the machine).
Some literature that I've been reading seems to indicate a correlation between peak urination flowrate and LUTS symptoms. With a stop watch I can only measure the average flowrate. I need a flowmeter type device to measure peak flowrate. There's only a couple listed on eBay and it's hard to get much information. Do you have any experience with peak urination flowrates you care to share?
Excellent price for that unit. Everything you say makes sense regarding getting the unit. I'm assuming this is a real time scanner meaning you see an actual ultrasound image of the bladder as opposed to a video representation? If so, you should notice that when you move the probe the bladder size and shape will change. You want to get the reading when the bladder is the largest. There are Youtube videos that show proper scan technique and angles. They may even have a video for your specific scanner. Don't be afraid to push firmly down and change the angle of the probe moving it back and forth to get the right angle. Also, use the ultrasound gel liberally because it's the gel medium that will get you the good pictures. I use Aquasonic 100 and bought a case on Amazon. It was the one I saw being used in my uroloigst's office. Some people do ok with a store bought water based lube like K-Y.
That said, you really want to check it's accuracy. One way is by taking it to the uro and doing back to back scans with his machine versus yours. You can accomplish the same or even better at home.
Like you say, one method is to hydrate up, do a scan, void into a measured beaker, and right away do another scan. The difference between the two scans should be close to what is in the beaker.
Better than that is to use a catheter where you can empty your bladder completely. Sounds like you've never used one but as long as you've gone this far something to consider. With a catheter, you will be able to completely empty your bladder and and get a base zero reading on your scanner. You can also hydrate up, and measure your total bladder volume. Then void and measure your PVR. Then self cath. The amount you self cath should be close to what the estimated PVR was from the scanner. Keep in mind these scanners are not 100% accurate all the time. And that includes the one in your doctor's office, but they do give you a very good general idea on volumes.
I thing a lot of people (and uros) get too hung up on flow rates. As long as you empty your bladder completely what difference does it matter if it takes you 30 or 45 seconds? Also, there are other things besides LUTS that effect flow rates such as how hydrated you are, salt intake, alcohol and coffee consumption, even your diet. For example, on a high protein/low carb diet you tend to void faster because the diet is somewhat diuretic.
That said, there are some devices on Amazon that say they measure flow rates. I'd read the reviews. A DIY method is to get a stop watch and a beaker. I'd let the stream get started for a second or two and then hit the stop watch for ten seconds. As soon as the stop watch starts aim for the beaker and aim away after ten seconds. Then divide the ml in the beaker by 10 and you have your ml/sec flow. You will not however get "peak" flow from this method, just sort of an average flow. To get peak flow you need some sort of uroflow device like the inexpensive ones on Amazon or you could invest in a pro version if you felt it important. I suppose if you are very coordinated you could try to capture only a few seconds of flow when it was peaking with the stop watch. Also, there may be some formulas for correlating peak flow to average flow you can use.
Jim
I thought the price was good too. For these scanners, I don't think there is any reason to offer anywhere near full price. I suspect most vendors will take a much lower price.
You are right about trying to capture just an incremental portion of the urine stream after it gets going in order to get an approximate estimate of the peak flowrate. From the literature I've read, a number greater than 15 ml/sec is good. I'll give it a go.
Which flowmeters on Amazon are you referring to? I've ordered something called a Uflow meter for $11. I couldn't figure out how it works exactly from the description, but have ordered it anyway just because it is cheap.
One last thing I'll mention is that after my last acute retention episode (middle of May), I had my GP prescribe Flowmax. I only tried one pill and then became concerned about potential side effects (my BP is already a bit low and I'm concerned about the impact on the eyes). However, shortly after I took that one pill, I was able to void about 240 ml, which is unheard of for me during the day. I still have the whole bottle and will probably try it again. But first I want to establish my baseline parameters/statistics before I try various treatments. Thanks.
If you go to ebay and search under "uroflow" you should get some hits starting at $150. I saw the one on Amazon as well for $11. Personally, never really looked into them and have just used stop watch from time to time. If you have already had acute urinary retention then learning how to self cath might be something to consider. Beyond checking the accuracy of your scanner it can save you a trip to the ER. Let me know if you go in that direction and I can tell you what to get and use etc. Start slow on the Flomax and maybe cut the dose in half until the body adjusts. Another alternative is daily 5mg Cialis with the bonus of enhanced sexual performance. That said, all these alpha blockers tend to have some side effects so have to experiment with them and dosages.
Jim
I have two comments awaiting moderation, probably because they have links or refer to links.
OK, I'll give it one more try. Sorry, I didn't respond to your comments on the scanner. Yes, it is the type where if you move the scanning head, the image changes. There is a video of the unit in action on the Laborie website. Go to their website and click on the menu item labeled "Products" and then click on "Urology & Urogynecology". On the web page that comes up, scroll down and click on "Portascan 3D". On the web page that is displayed scroll down a ways and click on the training video titled "Portascan 3D Proper Scanning Technique". My scanner looks exactly like this one except for the names (unit model number and distributor).
Yes, Laborie just acquired the distribution rights recently. Previously it was Meditwatch. Before that I think GE. Bard in England had some of the identical units, at least the 2D models I have. No idea who really made the unit. The key again to get a good scan is to keep slightly rocking the probe to get the largest bladder image before taking the volume. I always use mine by myself so that isn't an issue, just need to prop up the unit in a way that will give you a good view of the sceen while you are doing the scan. I noticed in the listing that you have a 30 day return, so just make sure you do your accuracy testing within that time frame by comparing the results against known volumes as described in my previous posts. I wouldn't worry if it's not within the 10% claimed but if you keep getting say 2 to 30 ml PVRs when in actuality the PVR is 100 or more, then either: (1) wrong technique; (2) faulty unit or needs calibration; (3) incompatible bladder (diverticulum, etc).
Jim
Jim
So I received the $11 urine flowmeter that I purchased from Amazon (MDTI Uflow meter). Their website contains information on how the unit works. The unit has a funnel on top and three narrow chambers below it ultimately ending in an orifice. When urine flows through the device it backs up into one of the chambers because the orifice constricts the outflow. While urinating, the urine level in one of the chambers will at some point remain steady for some amount of time (depends on how much is urinated). The instructions say that when the urine level is constant (steady), the person should note which chamber that occurs in. If the level is constant in the lowest chamber (closest to the orifice) the peak flow rate is less than 10 ml/sec. In the middle chamber the peak flow rate is between 10 and 15 ml/sec. In the top chamber the peak flow rate is greater than 15 ml/sec. The instructions say to lean forward in order to see where the level is in the device. I've found it is easier to lean a bit to the side and look at the urine level from the side. The instructions say that "if most of your measurements are in the top of the tube (> 15ml/sec), your urine flow is acceptable. If most of your measurements are in the bottom or middle of the tube, you should seek advice from your doctor/nurse".
While this is a coarse instrument, it does give you a rough estimate of the peak flow rate. Many urologists and researchers believe that measuring the peak flow rate is a proxy for the level of constriction in the urinary tract. This makes sense to me.
While the chambers do seem to only provide an approximate value, it seems to me that if the level is in the middle chamber (10 to 15 ml/sec), then where that levei is in that chamber might allow for interpolations. For example, if the steady level of urine is halfway up the middle chamber, then the peak flow rate is probably halfway between 10 and 15 ml/sec. This interpolation probably cannot be made in the top chamber (> 15 ml/sec). For the bottom chamber one would have to assume that a level right at the orifice results in a flow of 0 ml/sec in order to interpolate.
At any rate it is a cheap, easy-to-use instrument for home use. It might be useful for watching worsening or easing of LUTS symptoms.
Glad it worked out. Yes, uro's use uroflow as a proxy but PVR and IPSS score is more important. For example, I'd hate for some with low PVR and IPSS score get a procedure solely because of poor flow. My brother has slow flow but everything else is fine. The extra 20 seconds voiding hasn't impacted his life too much 
Jim
Agree that low peak flow is just one "data point" to watch. But I also suspect that low flow rate leads to higher PVR. Do you know of any studies that suggest there is no correlation between peak flow rate and PVR?
I guess what I am saying is if peak flow data is low it probably makes sense to have a PVR measurement done, if not already available. But I agree that if the PVR and IPSS scores are good, why have surgery done or even start medication? An extra minute or two to "go" shouldn't really impact anyone.
I'm sure there IS a correlation but the decision making process has other considerations. PVR is easy enough to track, especially when you have a scanner at home!
Jim
Hi Jim.
What kind of variation do you usually see when taking multiple readings? I'm getting better at it, but still tend to see a range of readings (example: 163, 123, 134, 113; in this example, I threw out the high and low numbers). Also, you said previously to look for the largest image when scanning. Some of my images look somewhat triangular (but not pointed at the top). But others really have a weird elongated horizontal shape and they tend to result in the higher readings. Any advice? Thanks.