Prostate and Bladder Issues: What to do?

Posted by ch665296f @ch665296f, Apr 19, 2016

I am a 68, nearly 69, year old man that has had bladder issues for years. I had green light prostate surgery 8 yrs. ago which helped for a while. Now, my prostate has had some regrowth and I have developed several bladder diverticulum. I have had just about every bladder test possible. I also have some incontinence issues, and manage by wearing diapers when necessary. I'm ok with that. My urologist had me on a combination of tamsulosin and finastride, but have not realized much of a difference. I'm a bit afraid of some of those drugs because I have read that they could mask the development of a more serious prostate cancer.

My urologist suggests that I may be a candidate for surgery, but what kind? Turp or total removal of the prostate? I have also read that turp sometimes needs to be repeated. Don't want that to happen either. What to do?

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@delmar418

No, they didn't offer it here- public health system. The uro that was assigned to me who specializes in TURP said it was "experimental," to which I commented, "so is the Pfizer V . . ." but that didn't stop anything." So I pressed on the point that the uro assigned to me who specializes in HolEP, was assigned to me, why am I not with him? I don't want a TURP. So he made an appointment with that uro. I looked him up on LinkedIn, Google and under various clinics where he practices. I left that appointment, with conversation recorded on my phone.

Jump-cut to April of last year: By permission I recorded our conversation, in case he wasn't bi-lingual- I'm in Spain. He told me the same thing about PAE and I commented that there have been multiple studies over five years post and with success. In the context of our conversation of my working with medical lasers, he lit up like a Christmas tree about the Holmium by "product name!" and that he had performed more than 300 procedures.
I had some confidence in him, that is, until he told me that he probably won't be my surgeon. After THAT boner-killer, I asked who the most experienced with this nucleation is, to which he referred to himself- I signed a consent form and left with recording in hand, he was making his own, concluding that the whole of the practice is funded by private insurance and manufacturer of the laser, that there isn't any money in it for him and there are no interventional radiologists who to my knowledge are not making this practice an adjunct to their practice, likely because it's government controlled. That's the deal-killer. If I had a few grand "liquid pour," I would head over to where they do do it and hand over the cash.

I'm still on the waiting list since this April last, and I'm regarded as "priority" because of the indwelling catheter I've had since last August.

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EDIT: "Jump-cut to April of last year: " this year, not last year. So I have been on a waiting list since this April 2023.

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@rfherald

@jwcooper, My RESUME WAS AN ABJECT FAILURE. MY UROLOGIST SAID THAT MY PROSTATE WAS GROWING BACK AND MY ONLY OPTION (WITH HIM) WAS TURP. THERE ARE MANY OPTIONS AVAILABLE AND ARE DISCUSSED ON CONNECT. I LIKE HOLEP AND AM CONNECTING WITH MY PCP TO GET A REFERRAL. GOOD LUCK TO YOU!

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I just read your Rezum post. I'm very sorry. Regrowth was my reason for not having TURP, apart from possibly needing a transfusion. I have no mRNA in my blood and I won't get into the controversy about this, but it is a concern and I'm already looking into medical requests for "auto-donation" pre-op for surgery- I'll receive my own blood. I just don't need any more health issues. Your choice for HoLEP is likely your best one & done with adequate hemostasis because the laser cauterizes as it passes so the need for transfusion is almost nil.
I've been in and out of operating rooms as a laser operator and I confess that I am literally having nightmares about general anesthetics and post-op recovery. Scared to death. I live alone, I'll have to depend on strangers to help me. Maybe I'm braver than I think?

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@delmar418 Delmar, I am sorry about the delay you've been handed. Socialized medicine is great but doesn't always hit the mark. Here's hoping that you get to the front of the line soon. Be sure to keep all of us in Connect up to date.

I have an appointment with my PCP and hope to get a referral to an experienced HoLEP Urologist.

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@rfherald

@delmar418 Delmar, I am sorry about the delay you've been handed. Socialized medicine is great but doesn't always hit the mark. Here's hoping that you get to the front of the line soon. Be sure to keep all of us in Connect up to date.

I have an appointment with my PCP and hope to get a referral to an experienced HoLEP Urologist.

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Thank you so much for your expression of wellness to me. The best and sometimes only virtue of Soc. Medicine is that it's available. I think HoLEP is probably the best bet until the PAE becomes more widely available. I strongly suggest asking in a diplomatic fashion- framing the context of the doctor in your shoes- that he would want to know how many procedures his doctor has done and the percentage of favorable outcomes out of those cases.
Some doctors gaslight and have egos, so framing your specialist as the patient is a smooth path. Write a list of questions, a lot of them. This isn't your first rodeo, so you already know this. There's a brilliant doctor, I think she works out of Texas? She has some videos of full procedures on youtube. I don't know if she's with MAYO, or not.
When there is news, I'll be sure to keep you informed.
It's rare I'll comment on many posts if I don't have enough to offer. I read them every day.
May your appointment be productive and give you assurance and confidence with a sound professional.

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@delmar418

No, they didn't offer it here- public health system. The uro that was assigned to me who specializes in TURP said it was "experimental," to which I commented, "so is the Pfizer V . . ." but that didn't stop anything." So I pressed on the point that the uro assigned to me who specializes in HolEP, was assigned to me, why am I not with him? I don't want a TURP. So he made an appointment with that uro. I looked him up on LinkedIn, Google and under various clinics where he practices. I left that appointment, with conversation recorded on my phone.

Jump-cut to April of last year: By permission I recorded our conversation, in case he wasn't bi-lingual- I'm in Spain. He told me the same thing about PAE and I commented that there have been multiple studies over five years post and with success. In the context of our conversation of my working with medical lasers, he lit up like a Christmas tree about the Holmium by "product name!" and that he had performed more than 300 procedures.
I had some confidence in him, that is, until he told me that he probably won't be my surgeon. After THAT boner-killer, I asked who the most experienced with this nucleation is, to which he referred to himself- I signed a consent form and left with recording in hand, he was making his own, concluding that the whole of the practice is funded by private insurance and manufacturer of the laser, that there isn't any money in it for him and there are no interventional radiologists who to my knowledge are not making this practice an adjunct to their practice, likely because it's government controlled. That's the deal-killer. If I had a few grand "liquid pour," I would head over to where they do do it and hand over the cash.

I'm still on the waiting list since this April last, and I'm regarded as "priority" because of the indwelling catheter I've had since last August.

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I had Foley catheter in/out for 1 1/2 years..mostly in. Had the Holep in Indianapolis at IU medical. This hospital preforms more Holep than any hospital in the USA....500+ per year. Go with experience...very important.

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@cent66

I had Foley catheter in/out for 1 1/2 years..mostly in. Had the Holep in Indianapolis at IU medical. This hospital preforms more Holep than any hospital in the USA....500+ per year. Go with experience...very important.

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How did yours go? Any complications? Incontinence issues? Down time? Pain?

Experience counts on this one. I will demand to have a face to face to ask questions. Of course they can lie. Once I'm out on the table they can stick a kid in there to use me as a practice doll and play Ninetendo with my penis with a crowd of grads behind him / her. I really shouldn't be having these thoughts. I see how they use AI to practice these days and the model they use probably doesn't look anything like my prostate, once you get in there and lose orientation things can get accidentally lased- through the capsule, bladder sphincter, so it's important to know if they are familiar with the "en bloc" technique.

" 'En Bloc' HoLEP with early apical release is a safe technique that allows for easier recognition of the surgical plane and preserves the external sphincter's mucosa to provide low rates of post-operative stress incontinence and significant functional results."

https://pubmed.ncbi.nlm.nih.gov/30035424/
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I had Hotep late October. First two weeks, pretty sore on urination....pass blood,etc. But able to urinate with good velocity stream. The second week, I noticed, the blood tapering off, each day brought a little less blood, until after 10 days...no blood in stool at all. Urination still painful, but also each week a little less sore. The burn is noticeable, but seems to be less and less. So far only complaint is frequent urination....when nature calls, you better be quick to the restroom. Have had a couple of instances where I could not hold it, very embarrassing . I'm learning to urinate about every 2 hours to keep safe, so far pretty good. Doc says learning to urinate is a no quick cure, just be patient and take time. I am at about 3 weeks now in recovery....had my foley catheter on for 1 1/2 years, feel tremendously better.....I would advise having this procedure.....it works !!

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@cent66

I had Hotep late October. First two weeks, pretty sore on urination....pass blood,etc. But able to urinate with good velocity stream. The second week, I noticed, the blood tapering off, each day brought a little less blood, until after 10 days...no blood in stool at all. Urination still painful, but also each week a little less sore. The burn is noticeable, but seems to be less and less. So far only complaint is frequent urination....when nature calls, you better be quick to the restroom. Have had a couple of instances where I could not hold it, very embarrassing . I'm learning to urinate about every 2 hours to keep safe, so far pretty good. Doc says learning to urinate is a no quick cure, just be patient and take time. I am at about 3 weeks now in recovery....had my foley catheter on for 1 1/2 years, feel tremendously better.....I would advise having this procedure.....it works !!

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Hello to all! I had HoLEP in May of 2022…..absolutely the best decision I could make. I still cannot believe how lucky I am to have found and pursued this procedure. I went to the Mayo Clinic in Jacksonville, FL and Dr. Dora is the best…I’m not kidding….so very glad to have gone this route. Recovery was great, bleeding stopped in about 2 weeks. I urinate easily, I have no issues. Best of luck to you and I hope everything goes well for you!

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5 weeks after HOTEP proceduce....Able to pass urine easily and with good flow. When I have to urinate it is immediate, now...no hesitation. IS there a way to control a little better when to release urine. Can be embarrasing in situations. Any help?

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@cent66

5 weeks after HOTEP proceduce....Able to pass urine easily and with good flow. When I have to urinate it is immediate, now...no hesitation. IS there a way to control a little better when to release urine. Can be embarrasing in situations. Any help?

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Sorry to hear of your sometimes “immediate” urge to empty. I did not experience this when I had my HoLEP procedure. I’m wondering if your symptoms are a result of having the Foley in for the extended period prior to your HoLEP procedure last month. I went back to see Dr. Dora at 90 days…..are you planning a follow up? Would be something to ask him for sure! You can probably ask that question now from your patient portal as well. Hope your symptoms improve soon.

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