Hi. I have 2 or 3 posts relating my experience in a different but similar Mayo Connect thread called "Benign prostatic hyperplasia (BPH) Surgery Options". I had BipolEP (Bipolar Enucleation of the Prostate) done at the Mayo Clinic Rochester early in January 2022, so I thought I would update my experience since kayak461 seems to be in a very similar condition as I was.

Part I

Ok, some background on me. Like kayak, I am 69 years old and will be 70 in a couple of months. I have had known BPH for at least 20 years. All the doctors I have seen along the way always said, "Let me know when the symptoms get annoying enough and we will schedule you for surgery." The symptoms progress slowly and nobody ever really wants to have surgery, so we all accommodate and figure out strategies to deal with our issues and keep putting off the surgery until suddenly we can't empty our bladders. About 6 months ago, I started feeling like I was not emptying my bladder when I urinated. I live in a rural area and asked my general practitioner doctor for a referral to a urologist, which took several weeks to get. The day of my appointment, they told me to pee first and then immediately after, they did an ultrasound scan of my bladder to see if I had any Post Void Residual (PVR). The scan estimated that I was retaining 670ml of urine which surprised me at the time because I had no urgency or feeling that I needed to pee. The doctor told me that this is not good, that I was stretching out my bladder, backing up urine into my kidneys and that I needed to get this taken care of sooner rather than later. That was the first time any doctor had even suggested to me that now was the time to have surgery. He scheduled me for a follow up visit a couple of weeks later to do a cystoscopy... a tiny camera on a tube that they stick up your urethra and gives the doctor (and you) a real time view of what is going on inside your urinary track all the way up to and inside of your bladder. I have to say, I was apprehensive about having this done. But it wasn't nearly as bad as it sounds. I have had dental work done that was much more painful and took much longer. The cystoscopy took maybe 2 and a half minutes total. They use lidocaine to reduce some of the pain. The toughest part for me was when he pushed through my sphincter muscle which my doctor told me to expect as he was doing it, and it only lasted a few seconds. My prostate was quite enlarged and the urinary track through my prostate was fairly blocked so the doctor told me he was feeling quite a bit of resistance through there. But apparently there aren't many nerve endings inside the prostate because I didn't feel any "pain" as he went through there, just a general, slightly uncomfortable sensation that there was something in there. Once through the prostate, he then pushed the cystoscope up into my bladder. He was able to bend the camera around and view my bladder neck where the cystoscope had entered my bladder. That was when he saw that I had a large median lobe of prostate material protruding into my bladder. It looked to be about the size of a walnut and you could tell that if the cystoscope had not been there, the median lobe would have been directly over my bladder outlet acting as a ball valve and blocking the flow of urine out of my bladder. The doctor was watching all of this on a large monitor that he positioned so I could also see it and narrating what he was seeing in real time. I asked before hand if he would be recording it and he said he was not able to record it, but suggested that I could record it with my cell phone if I wanted to. So I did and I was surprised how well the recording came out. It was very helpful to have that recording when I later got second opinions and searched for a surgeon who could do HoLEP or BipolEP. As the saying goes, "one picture paints a thousand words". It was a real "ah ha!" moment for me... the moment I saw the median lobe on the monitor. I knew that I needed to have surgery to correct this issue. So men, if you are having serious issues trying to pee, as they say in all of the drug commercials... "ask your doctor if a cystoscope is right for you", haha. It really is the most definitive way for your doctor (and you) to see what is really going on inside of you. I also had a TRUS (TransRectalUltraSound) done during that appointment. It is a more accurate way to measure the size of your prostate, more accurate than a digital rectal exam. The TRUS estimated my prostate size at 90ml. I've noticed that some prostate size reports will use "ml" while others use "cc" or "grams". I am not sure, but I think all of those units of measurement are interchangeable.