Gene I am sorry that it coming to that. Insurance company and going to pay for your surgery but not to better your life or even let you have one. ( Saving the nerves ) To me it's just hard to believe we have come to this...God help us Ken
Good morning DL It's almost 5:30 am can't sleep. Was kinda of excited about Dave SRP until I watch the video of the surgery. ( Dr. Jason Engel ) I watch it 4 or 5 times and can't get it out of my head.........................................
The way Dave's doctor said that I will core out the prostate and save the nerves. Sounds great. The video I watch they went through the bladder because this man had a large bladder stone........................................
After getting the stone out he also had a large median lobe which was blocking the bladder neck. They took a needle and put it through the lobe and pulled it into the bladder which brought the whole prostate into the bladder where they cut it out. After that they sew everything up and then put the bladder back together.........
What I can figure out is when they pulled the prostate into the bladder how did they leave the outer core. And with the doctor bringing the prostate inside would that not bring the ejaculatory ducts to. Being that they are near the base of the prostate...
I may have to watch that again. I have been looking trying to find out haw it is done and what is taking out but can't find anything about it. And then I thought of you and I know you have done research on many procedures.
I am hoping you know something. Or maybe when I see my urologist maybe he can tell me.. Have a great day and a good Sunday Ken
Very interesting stuff you guys are talking about. I do not know the specific details on how my doctor performed the exact procedure other than what I have shared so far. I can add that I was positioned in the OR practically on my head for the 4-hrs that I was under. I guess this aides in letting gravity move the internal organs out of the way some as he comes in with the robotics.
Good morning Dave. That is something that they do not mention when you read about the procedure. Have not been to bed yet. Been trying to read up on the Procedure. I just got done writing a letter in a doctor in Washington DC. Been a doctor for over 25 years. He has been doing SRP and others for years. Also watch a few of his videos on the procedures. I have some question for him. By the way. Where did you have yours done and who was your doctor. Glad all is going good for you Ken
Hello Gene:
Thank you for the response. You are right, one size does not fit all. My anesthesia was intravenous and I was under for 4-hrs, and yes, I was stood on my head the whole time. I also agree that I was lucky to find a surgeon that was skillful and confident in the SRP procedure. This was a concern as I researched the procedure and questioned him before it was done. Sparing nerve bundles was at the top of my list. I told my doctor that I wanted that garden hose he promised and I wanted to continue having sex (I believe I said I wanted a garden hose and a love stick). He laughed and came through for me.
As for my health, you are also right. At 61 years old, I have always been healthy and take no medications to manage my life. I am sure good DNA comes into play. Blood pressure has always been good, even when body weight goes up. Have always been a gym rat and back in the day, competed as a powerlifter. I still train with weights and do cardio. I am a true believer in muscle groups supporting our skeletal structure.
I read a lot about prostate procedures and remember seeing that if you were sexually active before procedure that you were a candidate for continuation after surgery. Not sure how accurate this is, especially if certain nerves are damaged, removed, etc., but I have always been active sexually. I can also add that sex/erotic behavior comes first from the brain. Kind of hard to explain this, but the brain is very powerful and our thoughts can take us to many places.
On being rich, that would not be me. However, I am resourceful. I have two health insurances (fortunate) and I seeked out the right provider and forced a referral. In other words, I fended for myself. I learned years ago in the military that nobody watches out for you better than you. I took control and made certain things happen and got myself in to see the doctor I ended up using. I also researched alternatives and tried my best to understand what was happening to me. I had one urologist that tried to teach me self-catheterization and that was a complete failure and traumatic (made myself bleed). To me, this was treating a symptom, not fixing my problem. I am aggressive in problem fixing and anti in band-aid treatments for symptoms. I hope I never have to see another catheter for the rest of my life.
Gene, thanks for sharing. Kudos to your dad for living to 101. That DNA might rub off on you.
Dave
Hello Hank:
To be honest, HoLEP was never on the table for me to consider, and I am not sure I would have went there. What I read about Simple Robotic Prostatectomy seemed to be the way to go, although to some it still sounds like major surgery, or more invasive. My thoughts were I did not want anything messing with my urethra, my sphincters, or my nerve bundles. What I did want was this great mass taken out so I could pee freely and without any difficulties, while at the same time, allow me to maintain sexual activity. Luckily, I seemed to have found it.
Dave
Hello Alan:
My shy bladder has gone away after the SRP because I am now able to "push" my bladder and push out my urine, regardless of who is around me . Before the operation, I never really pushed and had to relax and let it flow. My prostate was so large that it was pushing up into my bladder. How I was peeing at all is a mystery to me. I even use to try my best to not hit the water because I thought others could hear how weak my stream was (weird, I know), or how long I stood at the urinal to finish. Now it is all about making noise (hitting the water with a great force) and finishing before most other men (wondering if they are having troubles). I am now actually able to completely void, where before I do not think I ever completely emptied my bladder.
Dave
Hello Tommy:
Best to you. They say robotics is more accurate (precession and magnification). If you are having the same procedure as me, look to being a little sore in the abdomen area. First 4-days post-op are the most tender, then it starts getting better each day thereafter. I never took more than Tylenol and Motrin to manage pain. As soon as I could, I stopped both (I like staying in touch with my pain and recovery). Walking around is important after surgery, but at the same time, respect your recovery time.
You will probably be on a catheter for 10-14 days after surgery. Mine was a large diameter catheter hose. Take a stool softener so having a bowel movement is not causing you to strain too much. You will feel an emptiness in your groin area because of the removal. Even farting causes you to feel a different sensation in the pelvic area. The body has to recover from the removal and if having the SRP like me, the prostate capsules are empty and need to heal (yes there is internal scabbing).
Once the catheter comes out, you will be peeing like a young man (almost over shot the toilet the first time). I swear it looks like my stream is as big around as my little finger. Before, it was just trickle, if at all (retention). Because the prostate is healing, you will have more of a frequency to pee after surgery, but to me, I considered it fantastic because I could do it on my own without a catheter. I did not mind waking up during the night because I was peeing with a vengeance on my own. I knew it was healing and things would get better. Now 10-weeks afterwards, I am only getting up once at night during 8-hours of sleeping and my bladder capacity is getting better. I am able to hold more as the bladder is healing. Everyday it keeps getting better and I gain more and more confidence.
One more thing. When urinating after surgery, and after the catheter is removed, for awhile you will see pink in your pee. The bladder is still healing and the prostate is also. At about 8-weeks is when I noticed it was going away. The prostate bleeds a little at the very end of peeing when you are trying to completely void your bladder and you are working the pelvic floor muscles to get it all out. This also stops. Lastly, as your new garden hose is pushing out all that pee, you will experience a funny feeling at the end when the bladder empties. Do not worry. Your body is healing and getting better.
Before you know it, your quality of life will improve, at least it has for me.
Dave
I'm glad all the guys I'm reading about in this forum have had great success from the various procedures. I however did not have a positive outcome. I had UroLift at age 52 (I'm now 54, 2 years post surgery) and suffer from ED, I can't achieve erections at all and have spent thousands of dollars trying every pill on the market, as well as generic ED meds and even penis injections, all of which have produced zero results. After much effort spent communicating with the company that makes the UroLift device, as well as talking to my urologist who performed my surgery, I am left with an apology and the statement that "UroLift isn't for everyone." I was a vibrant man with a very healthy sex life prior to the UroLift surgery. but my prostate was so enlarged I could not pee without self cathing. I was in tremendous pain almost constantly from the inability to void my bladder. I was assured repeatedly that the surgery would not affect my sexual function. I'm approaching the 2 year mark since having the surgery and I am a shell of a man, angry and frustrated and have nothing but constant regrets that I ever agreed to have the UroLift surgery. I just needed to share, it doesn't really change anything to vent, but venting is all I have now.
All the best to all who have had success with their various procedures. I only wish I had had a similar outcome.
Den
Hello Den:
Vent as you need to. Always welcomed.
Before my SRP, I briefly reviewed the Urolift and asked my previous urologist about it. I was quickly told my prostate was too big.
Can the Urolift bands be removed and other alternatives consider? Just wondering. I feel for you and with all the ways to treat/correct our prostate issues, we seem to never know the "right" one for us. We also struggle understanding our own anatomy and what each part does (nerve bundles, urethra, sphincters, etc.), let alone what procedure threatens those parts in us.
You just made me think about how the Urolift is performed and how the metal bands are applied. When I first saw it on the Internet, I thought that sounds simple, never realizing how the bands could interfere with nerve bundles (which are on the outside of our prostate capsules) and the cuts that happens in our urethra.
Hang in there and do not give up on solutions. I know it is easier said than done, but as I shared in an earlier post, nobody watches out for us than ourselves.
Dave
Dave, good arguments you have. Glad it worked out well. Thanks for sharing. Hank
Den, did Urolift at least solve your urinating problem ? Also, wasn't self cathing sufficient enough so that you were still in constant pain ? Hank
good suggestion. i had considered and had done research on urolift . i understand that one of the features of urolift is that the implants can be removed by cutting the sutures. after cutting , the internal metal tabs in the urethra can be removed by a special tool whereas the external metal tabs each with the suture attached remained in the body.
with the old set of implants all removed, a new set of implants by a different and more experienced urologist. perhaps, this time, the nerve bundle might be avoided. other type of surgeries may have much higher chance of RE. i would stick with urolift if preserving ejaculation is the objective.
Ken, the resident urolift expert, is a good person to comment on this.
Dave, glad everything went well ! Holep, SRP and SOP do get the job done on large prostates. Low RE operations rates to address BPH returning is the Big plus. 10 year outcomes are extremely encouraging ...Thanks for the post.
hello gene,
u are right that if the doctor does not accept medicare, then having medicare covered holep will not help the patient much. but for holep, most patients are focused on finding a very experienced doctor to ensure success. they don't seem to mind travelling great distance. i seldom see posts discuss insurance coverage.
i agree that the result for larger prostate is unpredictable. thus readers with large prostate should not expect they would get the same OP result as dave. for very large prostate such as the one dave had at 343cc, holep and open prostatectomy are the only options. it would be helpful to understand the complications from each procedure. those readers who are interested in OP may want to do some research before deciding. But i have no interested in OP.
one bothersome complication from holep is transient incontinence, typically is about 17%. but some surgeons use a technique called bladderneck preservation. with this technique, the TUI post hoelp is reduced to less than 2%. there is also a new holep technique called no touch en bloc low power holep. it has lower complication rate. i learned all these from a forum called steadyhealth which has far more info on holep than the patient info forum.
these holep techniques are not generally known to patients who are trying to decide on a bph surgery. the variety of techniques available to bph patients cause endless confusion, me including.
i don't know anything about insurance coverage for PAE.
in the eastcoast, holep could cost as high as $30,000 if pay put of pocket.
Hi Dave,
I appreciate the kind words and the encouragement to not give up on solutions, At this point, I have resigned myself to the hand fate has dealt me. I was stupid to have the surgery, It just goes to prove that we shouldn't believe everything we are told by doctors. Some have suggested I have the UroLift removed but I feel more surgery could add to the damage already done as opposed to "fixing" my problem. And to be totally honest, at this point I do not trust anything any urologist says. Thanks again, glad you are doing well.
Den
hello ken,
glad to see u are so enthusiastic, sacrificing ur sleep to understand op. i also had watched jason engel's operations on youtube. indeed, SRP is complicated. some surgeons cut the prostate and some cut the bladder, not sure how they decide.
DL I was not going to say anything but being you put my name in it I will say something. I have talk with Den before when he first came on. What he is not telling you is that he was on JALYN from 2010. ( Dutasteride & Tamsulosin ) The main side effects of it is impotence. I have talk with the company and my Urologist My doctor said that he has never giving that pill to any of his patients because of the side effects. Neotract over the last 8 years have had no man have impotence or retro. The only way that could happen is by the pill or if the doctor did something wrong. And if he did he is not going to tell you. What I feel what happen being that he was younger when he started the Jalyn when your younger you have no problem with erection and when you get older some men do have a problem and I think the Jalyn just caught up with him I hope there is something they can do for him to help him. But only time will tell. That is why I say when a doctor give you a pill to take. Look up and get the information on it and see what the side effects are. I would not have taking that pill. Men please do your research. Ken
Hi Ken & DL:
With all the options that are out there, and all the conditions each of us are experiencing, what if we boiled it down to the procedure that does not touch our bladder neck, our urethra, the outer sides of our prostate, our sphincters, and our nerve bundles? For me, this is what it came down to. If I was able to find the right doctor to preserve these things, while removing my enormous prostate, why should I worry about invasiveness or not?
I know, post-op and feeling great makes it easy for me to say these things, but this is how we learn from each other. Granted, we are all different, but as males, we all share the same anatomy. I am going to wave the flag that we protect and guard what is precious to us and get rid of what causes us grief and pain.
Dave
Hi DL:
When the EOB was sent to my insurance provider after my SRP, the bill was $117,000. Granted, this is probably at multiple times the allowable, but expensive nonetheless. Thank goodness I had a primary and a secondary. Nothing out of my pocket. Very fortunate.
Dave