 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate BPH / March 2005PVP or Open Prostatectomy for post void retention
I am 55 in generally good health and physical condition, except for a large prostate (~90g) and significant post voiding urinary retention (pvr). I ran from my former uro's office when he proudly anounced that he would perform a TURP on my then 108g gland! I found a local uro who is experienced in PVP as well as radical (for cancer) and open prostatectomies. He prescribed Avodart and Uroxatral. While my gland has shrunk in the past 6 months, my retention has gotten worse (but not total). My current uro initially had told me that if meds could shrink the gland to <100g he would perform a PVP but warned that I might need two treatments. Now he is back peddling and trying to convince me that the better procedure given the extent and duration of the pvr problem is an open prostatectomy. I intentionally sought out a uro with experience with the PVP on larger prostates in my area (southern California) so as to take the most conservative approach. No mention was previously made that the condition of my bladder would require an open prostatectomy instead of a PVP. Has anyone else dealth with this dual problem of a large prostate and significant and long term pvr? Has anyone had a large gland successfully treated by PVP such that the bladder regained its elasticity and muscle strenght? Is there a way to test my bladder to determine if it is functioning OK but just unable to overcome the restriction casued by a large gland with a median lobe that is now growing into the baldder neck? I am particularly interested in finding a uro in the southern California area who has successfully dealt with this compound problem using PVP. I know of Dr. Te and Dr. Lin and the success they have had. I have to believe there is someone of their caliber in my area. Any input would be apprecitated. I now self-catheterize each evening and it is the pits! I need to make a decision ASAP and would at least like to get a qualified second opinion. Input from this group will be greatly appreciated. > I am 55 in generally good health and physical condition, except for a > large prostate (~90g) and significant post voiding urinary retention > (pvr). <snip> > Has anyone else dealth with this dual problem of a large prostate and > significant and long term pvr? Has anyone had a large gland [quoted text clipped - 10 lines] > decision ASAP and would at least like to get a qualified second > opinion. Input from this group will be greatly appreciated. I have a similar situation, though my prostate is much larger, and the retention is inconsistent and minimal (usually under 100cc). Symptomatically, I am OK (quality of life-wise), but it's just a matter of time. My own Uro (also in So Cal) does some PVP's but seems concerned that it will likely take 2 procedures in my case, and is more in favor of TURP or or Open Prostatectomy, but I have stood firm so far. There is a Dr. Robert Reiter, at UCLA, who is apparently on of the 'go-to-guys' in the LA/OC area for PVP. I haven't seen him yet, but would certainly be interested in hearing what he has to say should you see him. Dr. Reiter is my current uro. I sought him out because of his experience in perfroming both PVP and Open procedures. He is willing to perform a PVP but has expressed his opinion that the Open procedure would be better given the pvr issue and my age and overall health. I will consult again with Dr. Reiter to pin him down on exactly he feels the Open procedure is better for me and then I will post here with the details. Ironically, my difficulty in urinating has increased noticeabley since I started self-cath but the pvr is down to half of what it was. Go figure. > Dr. Reiter is my current uro. I sought him out because of his > experience in perfroming both PVP and Open procedures. He is willing [quoted text clipped - 5 lines] > noticeabley since I started self-cath but the pvr is down to half of > what it was. Go figure. Not really a coincidence, given the respect that UCLA has in this area. I should probably go to see Dr. Reiter myself, but even my own local Uro doesn't seem to think it's really necessary to do another procedure at this point. He estimates my prostate at 170g, and I had a serious distention of my bladder a few years ago (following an appendectomy) so our concerns are as much over bladder viability as over the prostate itself. Frequency and urgency are not a significant issue for me, in general, nor is difficulty in urinating. I do have significant prostatitis attacks maybe twice a year (lots of room for bacteria to hide in a 170g gland). This all adds up to the inevitability or some some type of crisis occurring unless we do a pro-active procedure at some point. I had to self-cath, for about 90 days, following the bladder distention. It was surprisingly easy until it suddenly became quite painful. Seems logical that the tissue the catheter has to pass through could be irritated enough to cause difficulty and increase retention, but the more likely explanation I've seen here lately is that a compromised (distended) bladder develops pockets in places where normal flow is impeded. That makes even more sense, at least given my own symptoms. As far as the Open surgery is concerned, my Uro has said that, with a very large prostate, any 'coring'-type procedure can be less that fully effective because the remaining tissue can just collapse around the new channel, making things worse. That seems logical, but posters here have suggested it's not statistically correct. My Uro is suggesting, of course, that if you remove the prostate entirely, that issue goes away. So...... the success of PVP on very large prostates is of great importance to me. Not ready for the increased likelihood or impotence just yet. Good luck..... and please do post further as you go along. > I am 55 in generally good health and physical condition, except for a > large prostate (~90g) and significant post voiding urinary retention [quoted text clipped - 27 lines] > decision ASAP and would at least like to get a qualified second > opinion. Input from this group will be greatly appreciated. UNDOUBTABLY PVP absolutely no contest .........i had a 70 gram median lobe which was causing identical problems to yours I ran a mile from an arrogant uro who insisted TURP was the gold standard The drugs were totally useless as they are with median lobe You most certainly do not want or need open prostatectomy especially if you wish to stay potent I had PVP July 18 months ago walked in the hospital at 7.30 am walked out at 12.30 and after an hour of being driven home spent the rest of the day sitting in the garden Recovery proceeded by the book with slight pulling sensation lasting for around 3 months Retrograde corrected itself by 6 months post op and i only wish PVP had been available here sooner and that i had not wasted 2 years messing around before i demanded a referral If it regrows then i will simply go back for another PVP 2 yrs ago at age 69, had 105g pvp by dr laub in santa barbara. so far so good. i have seen more than one posting of some with 150g glands successfully pvp'd. >I am 55 in generally good health and physical condition, except for a > large prostate (~90g) and significant post voiding urinary retention [quoted text clipped - 27 lines] > decision ASAP and would at least like to get a qualified second > opinion. Input from this group will be greatly appreciated. >I am 55 in generally good health and physical condition, except for a >large prostate (~90g) and significant post voiding urinary retention >(pvr). I ran from my former uro's office when he proudly anounced that >he would perform a TURP on my then 108g gland! More fool you. You pay for a qualified expert consultation and then "run" when he tells you something which you have become scared of from reading garbage on a NG !!!!!!!!! SNIP > I need to make a >decision ASAP and would at least like to get a qualified second >opinion. Input from this group will be greatly appreciated. And you expect to get a "qualified second opinion" from this newsgroup ? With all due respect , your problem is not from an overlarge prostate but from an undersize brain . The idea of doing 2 PVP's for a large prostate is new to me. Before my op on a 135g gland,I was asked if I would agree to the extra cost of another laser probe if necessary due to the length of the procedure. The probe burns out eventually. Seemed reasonable to me. Never any talk of doing it twice. I'm interested in why there is a need for this,and what time between ops...days,months ? My outcome is fine after 7 months. Flow much better but bladder capacity still low.I am going to try to fix that in a few months and I have the feeling that it's going to be harder than giving up smoking.I might go for the pills. Best wishes Richie >I am 55 in generally good health and physical condition, except for a >large prostate (~90g) and significant post voiding urinary retention [quoted text clipped - 27 lines] >decision ASAP and would at least like to get a qualified second >opinion. Input from this group will be greatly appreciated. > The idea of doing 2 PVP's for a large prostate is new to me. Before my > op on a 135g gland,I was asked if I would agree to the extra cost of [quoted text clipped - 8 lines] > > Best wishes Richie I can't say for certain, but I believe the reason for two separate procedures is that a laser procedure does not completely vaporize the tissue it destroys, and that the body can only be expected to safely eliminate a finite amount of the material that remains. So, it becomes a factor of how much material has to be removed in total, and how much can be done safely at one time. At least that's the closest I've been able to understand the reasoning. All additional input welcomed. >> The idea of doing 2 PVP's for a large prostate is new to me. Before my >> op on a 135g gland,I was asked if I would agree to the extra cost of [quoted text clipped - 16 lines] >one time. At least that's the closest I've been able to understand the >reasoning. All additional input welcomed. That is interesting. It may explain the trouble some large prostate patients have had with subsequent large clots and bleeding. A few in this group have had severe problems causing retention. With hindsight I still would not have personally chosen 2 ops,but some people may benefit. Richie |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.