Surprise results from Ultrasound. Sympathetic technician's dad's has enlarged prostate.

Men's health
1

Thank you, everyone, for your well wishes and prayers -- they helped me, as in Law of Attraction.

Bad news: My prostate is 97mL, nearly double my uro's estimate from her digi-rectal exam. My prostate is protruding into bladder. There was no pain nor discomfort at all. Will upload photos for your comments.

Good new: No cancer anywhere. Probably no need for 3T MRI or biopsy for now; especially since I have metal staples in my groin, from a hernia operation, which apparently distort MRI images, or cast a shadow.

Ultrasound test took 1.5 hours, including drinking water. tieing off (blocking) the urine leg bag, and waiting until the bladder was full.

For reference, how big is your prostate, and were you able to reduce it?

What would you do next, in my shoes? I have a Foley catheter in my bladder and the leg-bag.

I'll post interesting stuff I also learned, in follow-up posts.

Cheers!

 

2

Here's the photo link:

https://patient.info/forums/discuss/ultrasound-images-photos-the-round-ball-is-the-foley-balloon--680072

The technician said her dad isn't going for the recommended surgery for his very large prostate because his buddy died 3 months after a prostate surgery.  However, her dad doesn't know how to shrink the prostate -- he's merely somehow keeping it from growing, by pharmaceutical meds.

If you had success in shrinking your prostate **quickly**, please share, share, sugar bear!  Wanna' hear your story, please, and thank you!

 

3

 There is always death in any surgery, same as walking on the road may be hit by a car. I have read many trial reports using Various BPH surgery techniques and have not come across that patients died because of the surgery. Yes, in some trials, there were death, but it is very rare. Also most BPH patients are very old, they could have other illnesses during the surgery , their health were not as good as a young man. Thus , it is difficult to pin point the death was due to the surgery. Even with that  the death rate is exceedingly small. So please excercise caution  when u said thing like that in a forum in which there are many readers seeking information. 

97cc is a large prostate. For example, TURP does not want to operate on a prostate larger than 80cc. There is risk of waiting too long to seek surgical correction as the bladder has to work hard on forcing the urine out and could be damaged. For such a large prostate, the best procedure is HoLEP. There is a lot of info on HoLEP on the website steadyhealth , just google HoLEP enucleation experience.

Yes, there is s kind of drug  called 5-Alpha Reductase Inhibitors that may shrink the prostate. Firstly, it may take a long time to work and secondly It may work for some and some have severe side effects. 

From wedmd:

5-Alpha Reductase Inhibitors

These stop your body from creating one of the hormones that makes your prostate larger. They prevent growth and in some cases even shrink it. This can improve your urine flow and ease other BPH symptoms as well. They seem to be most helpful to men with very large prostates.

These drugs have two other benefits as well. They may:

Lower the odds that BPH will lead to other problems, such bladder damage

Make you less likely to need surgery

It can take up to 6 months to see the full effects of 5-ARIs, and you have to keep taking them to get results.

Side effects: This medication is not for use by women. Pregnant women should not be exposed to itbecause it can lead to birth defects in male babies.

Other side effects when men take it may include:

Erectile dysfunction

Lower sex drive

Retrograde ejaculation

Some of these side effects may get better as your body gets used to the medicine.

5-ARIs may also lower your PSA (prostate-specific antigen), which affects one way that doctors look for prostate cancer. That isn’t harmful, but it may help to get a PSA test before starting these drugs. Also, the FDA now requires labels on 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer.

Names: There are two main 5-alpha reductase inhibitors:

Finasteride (Propecia, Proscar)

Dutasteride (Avodart) 

4

Drugs will never reduce it to a satisfactory level.

I've had two laser surgeries as they usually regrow. The first GL PVP in 2004 when my prostate was 75grms and the second in 2013 using Thulium/Holmium (similar to HoLep) when it was 135 grms. Both were easy and no later problems. In each case I was back to normal daily activities on day two .Long train journey home and  a day at the races on day three without looking out for a toilet. Actually I was surprised that I had not needed all afternoon..

My ECG prior to first surgery concerned them and I had to have an echocardiogram to put their minds at ease. .

5

I agree that "Drugs will never reduce it to a satisfactory level.". 10 year durability for GL PVP is a very good result.

6

Friend who had his GL PVP just before me has not needed it repeated. He does get up in the night and takes one a day Cialis to help his flow but his urologist says no need for another procedure.

7

It is all statistics and one's luck. HoLEP durability is more than 10 years with 2-5% re-operation rate and I think thulium laser enucleation should have the same durability as HoLEP. 

My choice would be the same as yours that is do thulium instead of taking drug and suffer BPH for the next 10 years.

just wondering if u had any complications after thulium. Retrograde ejaculation (88%) and incontinence (2-17%) are the two common complications after HoLEP. 

8

I had no problems after GL but retro after Thulium/Holmium but that had started before when using  Tamsulosin and age was probably also a factor as I was by then 79.

Neither procedure gave me the flow I expected. It is rather variable and despite tests no reason was found for it but it is not really a problem as I have no urgency or retention. The second procedure reduced my prostate from 135grms to 55.  

 

9

135cc is a very large prostate. I would think it is a big succes to be able to reduce it to 55cc.  Low Flow rate or Qmax could be due to two causes: either a restricted urethra or the low pressure from the bladder. The former could be checked by cystoscopy and the latter by urodynamics. Have u got a chance to do either?

10

Re low pressure from the bladder - how is that cured?

11

I believe that low pressure from the bladder means the bladder tissue has lost elasticity and I don't know if there is a cure. That is the reason I had suggested to u that not to wait too long to seek treatment of ur problem. But like derek76 said drug to shrink prostrate might not the best treatment. Utrasound or TRUS can only measure the size of the prostrate. The only tool to allow the urologist to look inside the prostate and bladder is cystoscopy, which is a scope inserted thru the penis into the prostate and bladder to examine the blockage of the urethra. I heard The newer type uses fiber optic, the older type uses a metal tube.

If u ar worry about bladder pressure, the correct procedure is urodynamic, a  plastic tube with a water pump on one end under computer control is inserted thru the penis to the bladder. This allow urine flow rate and pressure to be measured. 

if u want to discuss surgical options, plse let us know.

12

I stress it again 97cc is a large prostrate (the average prostate size if I remember correctly is 55cc) and that u seem to have a large medium lobe protruding into the bladder. If I were u, I would be very concerned.

13

Thanks, and yes, I am very concerned!  Right now, I've got a Foley catheter, so some tests are maybe not possible, or easy.  My uro has been wrong on my prostate size, and also that my first Foley can be taken out by a locum (big bloddy mistake there!)  There's no cancer, per the US technician.  I'm not rushing into the operating table or even MRI, given Chuck Norris' wife's side effect.  It's near impossible to get a second uro in my jurisdiction.  

14

Yes I've had both without any reason found for the variable and sometimes 'thin' flow. As I said it is not really a problem. After the GL I spoke to a couple of other patients at the same hospital and they said that they were disappointed with their flow. It may have been as they did a bladder neck sparing version to avoid retro in their patients and we had been early patients in their trials of GL.I was the teams 38th and my surgeons 8th patient. I would have gone back there when I needed the second procedure but we had moved to another part of the country. 

After the Thulium/Holmium procedure the surgeon said that I had ruined his back as it took 3 1/2 hours.

He sent 37 grms of tissue for testing that was clear and my PSA went down from round 8.0 to 0.74. After the previous GL it only went down to 5.0 from 9.8. 

15

I cannot believe that any Uro still uses the rigid scope. I had one in 1983, all since 2004 have been the fibre optic ones.

The one in 1983 was memorable as well for the Uro's name Miss Waterfall. I was a patient on the day she was retiring and going to India to work for a charity.

16

Glad to hear that thulium seems to work out well for u.

I am eager  to learn more about the "bladder neck sparing technique"

It was a GL PVP trial in which the bladder neck sparing technique was used. Yes? Do u know if other patients also had "slow flow"?

if u have time to share ur info, I would appreciate it.

  

17

You answered this on bladder neck saving yourself recently.

https://patient.info/forums/discuss/retrograde-ejaculation-or-ejaculation-preservation-after-turp-greenlight-pvp-holep-or-urolift--668799

 

18

I heard from other HoLEP patients that Dr. Miller of Vanderbilt University uses the bladder neck sparing technique in HoLEP and her patients said that they had no incontinence, which created a lot of interest.

i have suspected that the bladder neck sparing technique may have left tissues near the bladder neck not removed, which otherwise would have been removed. The unremoved tissues near the bladder neck preserve the internal sphincter and reduce the chance of incontinence but will impede urine flow. So it is a tradeoff. But this is just a guess.

U seem to have real life experince and I hope to hear your opinion. Your answer would be of great interest to would be HoLEP patients.

19

I probably misinformed. The scope in cystoscopy uses fiber optics. My apology. Glad that u pointed out my mistake.

20

Incontinence?  Does that mean diapers, forever?