Retention - Bipolar Vaporization

I just had every test done, Uro, cyst, kidneys, an it was an ultrasound that found the my bladder not voiding properly, My Urologist found a liter during the last visit and did the cystoscopy after using the catheter to drain the liter out. I have been self catherizing since them, 2 weeks now while I look for alternatives to the Bipolar Vaporization(I think this is a variation of TURP). I backed away from the Surgery that was scheduled this week as I feel there might be some better alternatives with less side effects. I did ask my doc about FLA and he pointed me to Urolift. The doc believes it's more of a damaged bladder as I don't void until I get to about 1100 ML so I'm not sure that these alternatives would work. He did detect some obstruction during the cystoscopy but he did say that he does not believe my prostate is very large. Am I wasting my time with the alternatives if it's my bladder? Very confused!

Have you had urodynamic testing? It tests bladder functionality and can help predict surgical outcomes. Without it, you and your doctor are just guessing. Ideally, you want video urodynamics. If your doc doesn't offer it, seek out the urology department at a large teaching hospital.

How is self cathing going? I was in perhaps a worse position than yours (they drained 1.5 liters) four years ago and recommended TURP. Long story short, I decided to self cath instead. Now, four years later, my IPSS sympton score has gone from "severe" to "mild" and my retention from that 1.5 liter to often under 100. Self cathing helped rehab my bladder and in fact I now only have to self cath once or twice a week.

Whatever you do, don't rush into anything without a lot of research. No magic bullets for everyone, regardless of what you may read. Every procedure carries some risks without any guaranteed outcome.

Jim

Given all of the tests that you have had, it seems that the doctors should be able to give you a more definitive diagnosis.  I had similar retainage issues, and I was retaining 1.5L of urine.  My bladder is distended, and neurogenic.  It is not creating enough pressure to empty it.  My prostate is also enlarged, but not to the extent that I should have this much difficulty voiding.  I have been self cathing for 7 months.  It has made a big difference in my quality of life.

Yes, I did the urodynamic test and I didn't think it went well since I could not void with 1100 ml pumped into me. Doc said there was some movement and that TURP would be the next step. He didn't think there was much of an obstruction but he felt the TURP could provide easier voiding from the bladder. Does that make sense?

I didn't know self cathing can help rehab the bladder, that's very positive news. Thank you!

Most of us could not void with 1000ml pumped into us, probably myself included. Hank

Tom,

I couldn't void on my urodynamic test either. My take is that they pumped too much fluid into my bladder too fast. Nothing at all like a real life situation. I'm still very pro urodynamic testing, but a lot has to do with how the test is performed and how it's interpreted. Did they find "high pressure", that usually indicates enough bladder integrity if either the obstruction is removed or the bladder is further rehabbed. Speaking of bladder rehab, I have several self cath threads on that topic. Self cathing isn't for everyone, but if it doesn't bother you, it's a great way to at least buy time, and if you're lucky, even fix things up. My uro finally admitted that my results from self cathing were as good as he gets from TURP!

Jim

Tom  It is a Turp which should not be use unless it is a last resort.  Being your doctor told you about the Urolift you are not there yest.  The urolift will open up your prostate and relax your bladder.  It make work for you and it will give you no side effects.  And it takes less time to heal.  Going on 3 years for me  Take care  Ken    

I'm surprised they didn't pump fluid in until you started to void.  That's what they did during mine, which was done at a university teaching hospital.  There should have been some measurement of your bladder pressure.  Mine is low.  If you also have low bladder pressure, will a TURP do anything for you?  Sounds to me like you may need more information before taking the surgery plunge.

Even with a pre-load of two cans of sardines, I'd never get 1000ml out smile

Jim

Low bladder suggests a poor surgical outcome. I told the urodynamic tech to STOP at 600ml. No way did I want them to blow me up a like a balloon.

Jim

It never occurred to me but I wonder if it would be detrimental to do a urodynamics test where they pump that much in AFTER I've been doing CIC for several months.  If you can't release any and they pump in 1100 ml or something, might that not stretch out the bladder again and undo all they good I may have been doing for months?

I don't think a one time "stretch" would make much of a difference long term, but I would discuss the situation prior to the fill. If you know that you're not going to void after say 600ml, there is really no reason for them to keep filling, so agreeing on an end point volume in advance might be a good idea. I would also ask them to fill on the slow side which more closely approximates the real world. Whether you void or not during urodynamics, my understanding is that they still can measure bladder pressure which is the important thing.

Jim

If  your problem is bladder related, it's hard to imagine why a TURP would help you.  My Uro told me I had bladder, sleep and prostate issues and said surgery and drugs probably wouldn't help much. It seems many guys on this site have had surgery with bad outcomes (also, lots good) so I think a lot of thought and research is necessary before making that decision.  

I wouldn’t put a lot of weight into the urodynamics test and the Doctors diagnosis. Lots of people here, myself included, failed that test. Couldn’t urinate after they put 1000 ml in my bladder. Told me I had a neurogenic Bladder, TURP might help me, etc. I had tons of tests after that, including MRI to see if nerve damage or MS was causing this. 

I decided to try removing some of the obstruction the prostate was causing after self cathing for months. 

I have had two different procedures done, Itind, and last year FLA. Both have given me relief, and my bladder seems to function fine, even though I was led to believe I might never pee normally again. 

My advice would be do a lot of research. But don’t take that test as the answer, or the Doctors word. Because they just don’t know what’s going on down there.

I flunked the urodynamic testing and have self cathing for about 18 months now. It took me a few months to get my head around the idea have potentially having to self cath for the rest of my life but I have found with time it became almost second nature in my case and there was lots of good advice on this site specifically from jimjames the first few months with any problems I had. Also with time I went from sometimes needing  6x a day to 2-3x /day now

As you have only been self cathing for a couple of weeks you might consider trying it for a few more months before making any other treatment decisions. There are lots of guys here doing CIC  that can give you advice should you run into any problems.

 

If he didn't detect any instructions, why does he want to remove pieces of your prostate?

He said there were obstructions, but his prostate was not large. That sounds like mine.

I was told removing any obstruction would make it easier on my bladder. I guess based on my results, that turned out to be true.

😂

What procedure did you have done?

Hello

I first had the Itind procedure done. It worked, but only for about 6 months. Not as aggressive as TURP. 

A year ago I had FLA done, and it is still working. 

There were a few people on here who had bladder problems worse than mine that had FLA with some success. You should read that thread. 

Self cathing can get you by, but it wasn’t an acceptable long term solution for me based on my lifestyle. I haven’t had to do it since I had the FLA done.