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Medical Forum / Diseases and Disorders / Prostate BPH / June 2005Frequency puzzle?
I'm 69 years old and have been troubled by frequency problem for more than 10 years. Have been taking Proscar daily for more than nine years. Condition has neither improved nor worsened in that time. I find I must urinate almost hourly. More frequent in late mornings. Less frequent in afternoon and evenings. During night, I wake up appx. every hour-and-a-half to two hours. Stream is anywhere from slow to very good depending on time of day and amount of urine to pass. I have residual during sleeping hours and must go twice each time. Not so during waking hours. Have had cystoscopy and ultrasound. My uro showed me images indicating an enlarged middle lobe which I could see was pushing into the bladder causing the bladder to almost bifurcate. Uro says this is the trouble caused by enlarged prostate. I've meanwhile heard, received and read different opinions about whether this is actually the cause of the frequency need. As a result, I'm ambivalent about doing PVP. Some say they've had PVP or TURP and still have frequency need. Since I'm not blocked and haven't been, the sole purpose of considering PVP is to relieve the frequency need. I'd appreciate any thoughts or suggestions on this, also your own experience if you've had this problem. Also, any reference to published work on this specific subject. Thanks, Rob Marks I am 61, had the same symptoms you describe until an appt with an ENT Specialist who injected Afrin nose spray into my nasal passages to diagnose a deviated septum. Two days later, I went into urinary retention which was relieved to a degree with Uroxatral. But I did not want to be on Uroxatral because of the side effects (tiredness, low back pain). Had TUMT July 2, 2004 which brought my AUA score from 21 to 10. Night bathroom visits were decreased from every 1.5 hrs to 2.5 hrs between visits. Still had some symptoms of slow flow, difficulty starting stream, some feeling that bladder was not empty. Had cysto Feb 2, 05 which demonstrated that the furtherest half of the prostatic urethra away from the bladder neck was still pretty much occluded. Had PVP Feb 23, 05. For the first time in years, I had 2 nights this week with only 1 bathroom visit per night. Flow is good. Would put my AUA score at about 4. Still have some retro but believe that may resolve with more time. Still have some urgency issues but those are gradually resolving. Your symptoms follow many of mine...if I could do it over, I probably would skip TUMT and opt for PVP. From friends undergoing TURP, I have deduced that I would not opt for TURP if PVP would be available (complications with extended periods of bleeding--weeks versus my 12 hr period of bleeding post PVP). Did the TRUS show how large your prostate is? My experience has been that when you have either the TUMT or the PVP procedure, things will get worse with the frequency issues before they get better. I found some relief with TUMT but believe that the PVP will result in even less frequent bathroom visits when things finally settle down. After 14 weeks things are better, but I believe that there will be more resolution with time. One person's experience. If you have questions, feel free to send them. chockman@canby.com > I'm 69 years old and have been troubled by frequency problem for more > than 10 years. Have been taking Proscar daily for more than nine [quoted text clipped - 25 lines] > > Rob Marks Chock, Thanks for sharing your experience. What I've read from others' experiences with PVP thus far coincide with yours. Since I have no blockage, my only interest in PVP is to reduce frequency. I'd be very interested to know how things are a few months from now and whether your frequency will gradually reduce. Please keep us posted. Thanks again, Rob Chockman: Sorry to hear of your troubles, sounds like you have had a hard time of it. I was interested in your comments regarding the side effects of Uroxatral. I have been on this medication for a little over a year now and also have developed low back pain as well as some testicular pain. I have no history of back pain, and no life style changes to account for it. I was wondering if you could say more about your back pain, and in particular how long you were on Uroxatral before you noticed it. Hi Dan... Can't say that I have had a "hard time of it" but the whole scenario has been more of a nuisance than anything else. I was on Uroxatral from 5/28/04 through the TUMT 7/2/04, stopped it 9/1/04 and restarted it again 10/6/04 because of hesitancy and reduced flow. The TUMT seemed to help at first but effectiveness declined as time went on. The low back pain developed gradually over the period of time that I used it. Just before the PVP, it was strong enough that I felt really stiff and uncomfortable when getting up in the morning. Stopped it again 2/8/05 with the PVP which was done 2/23/05. Since I stopped the Uroxatral, I have had no low back pain. I can not relate the low back pain to anything other than the Uroxatral. Off it I feel so much better, less tired, less irritable and more like my old self. And the PVP seems to have relieved most of the retention feelings (incomplete emptying of the bladder) that I used to feel. The only problems remaining now are the urgency issues and the retro. I believe both are getting better gradually. > Chockman: Sorry to hear of your troubles, sounds like you have had a > hard time of it. [quoted text clipped - 7 lines] > I was wondering if you could say more about your back pain, and in > particular how long you were on Uroxatral before you noticed it. Have you tried one of the overactive bladder meds like Detrol or Ditropan? > I'm 69 years old and have been troubled by frequency problem for more > than 10 years. Have been taking Proscar daily for more than nine [quoted text clipped - 25 lines] > > Rob Marks I had a large medial lobe that protruded into the neck of the bladder. It caused about 40% retention and a very slow stream, about 3 ml/sec. Needless to say the frequency was about 1 to 2 hrs, although at night was never more than twice. Had the PVP two years ago, everything was fine in about 3 weeks, the stream is still about 12 to 13 ml/sec with very little or no retention. Frequency about every 3 or four hours, without any urgency. I do have retro which I was told, before the procedure, was a real possibility because of the bladder neck blockage. Hope that helps some. Jack [snip] >> I find I must urinate almost hourly. More frequent in late mornings. >> Less frequent in afternoon and evenings. During night, I wake up appx. [quoted text clipped - 7 lines] >> causing the bladder to almost bifurcate. Uro says this is the trouble >> caused by enlarged prostate. [snip] >> Rob Marks This will be a 'strange" possible solution Rob. Have you ever had a sleep test? After being diagnosed with sleep apnea, I started using a c-pap (breathing machine) every night. Guess What? No more trips to terlet. Regular sleep cycle seems to be about an hour and a half. When you are awaken because of apnea, your bladder wakes up too and thinks its morning each time. Just a thought. Ask your doc who can refer you if you want to. Mike I had similar frequency/urgency problems. Had an ILC in 2000 which slightly improved the situation but still required that I take Flomax. Had a PVP in July last year by Dr. Te who found the median lobe into the bladder problem. Frequency/Urgency is now cut in half and slowly improving over time. Flow rate is incredible. If I had done this sooner I believe my results would have been even better as there was bladder wall thickening over the years. I recommend PVP: good results, piece of cake recovery. Jim W. > I'm 69 years old and have been troubled by frequency problem for more > than 10 years. Have been taking Proscar daily for more than nine [quoted text clipped - 25 lines] > > Rob Marks A QUESTION FOR BOTH JIM AND JACK: Both your inputs are quite valuable and are right on target as affects my situation. I too have an enlarged median lobe. My question: When your uros performed the PVP, did they work exclusively or primarly on reducing the size of the median lobe to achieve results or did they go in and attempt to ablate (or vaporize) ALL of the enlarged tissue in the entire prostate? It would be useful for me to have this info because my uro talks about working on the middle lobe. Thanks again! Rob I really don't know the details of what Dr. Te did, just that he evacuated a very large path. I know my prostate was not particularly large, it was just the median lobe that needed work I guess. Dr. Te said the procedure took about 50 minutes. Jim W. >A QUESTION FOR BOTH JIM AND JACK: > [quoted text clipped - 14 lines] > > Rob Jim, thanks for reply. If I possibly can, I'd like to be able to undergo PVP with ONLY work on the median lobe which appears to be culprit. The sonograms showing it pushing into the bladder neck. I suppose what I need to do is schedule appointments with two or more uros and try to determine whether such is standard practice or if its even possible. This would seem a lot less invasive and involve less risk than going the whole nine yards with a complete vaporization of the entire prostate gland. Thanks again, Rob |
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