My BPH symptoms were first diagnosed in 1995 (I am now 70) when my prostate
was 35g. Flow
and residual tests at that time showed that I had retained 400 mls.and I was
advised to have a TURP as a matter of urgency. After researching TURP I
turned the offer down to wait for something better to come along. TUNA and
TUMP did not really catch on with British urologists and were not readily
available. My symptoms did not change all that much over the years but my
prostate continued to grow to 72g . My PSA was 5.2 in 1995 and latterly
swung between 6.5 and 9.0 and during this time I had three negative
biopsies.
My test results in September 2004 showed my first void as 339 mls with  a
QMAX flow of 11.7 mls/sec and a residual of 411 mls. I was asked to void
again 30 minutes later and passed 309 mls this time at QMAX flow of 11.7 and
now a residual of 371 mls. I had been using Saw Palmetto all this time and
had only briefly tried  Flowmax and Proscar which caused tachycardia and
headaches.
I  read of PVP on it's first mention on this NG and it seemed to be what I
had been waiting for but it was only about two years ago that it arrived in
the UK at Kings College Hospital. The NHS waiting list soon became quite
long there and last year the UK representative for Laserscope Mike Degun
told me that the Freeman Hospital in Newcastle (North East England) had
started doing the procedure. Newcastle is only about 110 miles away from
Edinburgh where I live. I contacted them last October to find how long it
would take to get an appointment and how long the waiting list was for the
procedure. I was told that it was about three months for the initial
appointment with the urologist and probably a further three months to get it
done if accepted as a suitable patient. I liked the Newcastle way of doing
things as they take the patient in on a Thursday for tests, do the procedure
on the Friday and let them out on the Saturday. This seems much less
stressful than being done at break of dawn and out on the street by
lunchtime as Kings College and America do it.
The urologist in Edinburgh agreed to refer me to Newcastle as an NHS patient
and I had my outpatient appointment there with the Staff Urologist John
Davies on January 9th. Mr Davies was very thorough doing all the tests
himself rather than getting a urology nurse to do them. He was already very
enthusiastic and committed to PVP. We spent about 25 minutes discussing its
merits and the benefits of it over TURP. He said that only 25 procedures had
so far been carried out at the hospital as they were only doing them on
Fridays if an operating theatre was available. He had performed six by that
time under supervision and would do mine. The rest had been done by the
consultants Phil Powell and Mr Thorpe.I reckoned that by the time my
procedure
was done they would all be pretty good at it and Mike Degun had said that
they were a 'Red hot team' It was confirmed that the waiting time was still
three months but I might lose out a bit as the NHS area accountants have to
agree to pay for their patients to be done in another Health Authority area.
In early June I got June 30th as the magic admission day with the usual NHS
proviso that you have to phone on the day to confirm that a bed is
available. I phoned at 10 am and was told that Matron was still allocating
beds and that they would call me back within two hours. I explained that I
was coming from a distance by train and that I would need to get the 11 am
train. They called back within five nail biting minutes to confirm that a
bed was available and I arrived at the hospital by 1.30. A doctor was soon
on the scene to examine me, take my
medical history, do blood tests and send me to get an ECG (aka EKG). Soon
John Davies was round to see me followed by the anaesthetist who did his own
medical exam. I have hypertension and am Glucose Intolerant. He was
concerned about my heart murmur and some conflicting
information on the health summary my GP had supplied so I had to go for and
Echo Cardiogram. He was happy with both sets of results and he discussed the
anaesthetic options. I told him that this part was my only fear as an uncle
with angina had arrested and died when undergoing an anaesthetic for a
fairly routine operation and my mother previously a very sharp minded 82
year old had suffered cognitive dysfunctions after major surgery. We
discussed epidural as an option but I was not too keen on that as I have
twice had vaso-vagal syncope, once before an angiogram and the other time
when having a tumour removed from my ear. Where my body is concerned I am
one of the great world cowards:-)
I went down to theatre the next day at 1.30 by now convinced that the
excellent anaesthetist would not kill me! I came round about 4.00PM feeling
a slight pain in my penis and what felt like the need to urinate, however
that feeling was probably due to the catheter being in. John Davies came
round
to see me pleased with how the procedure had gone. He said that they started
lasing at 1.53 and finished at 2.50. He said that the Median Lobe was not
bad and that the Lateral Lobes had been my problem. He described them as
looking like a floppy saggy bottom pressing against each side my bladder. He
said that no bladder neck resection was needed and that Mr Powell tries to
avoid that as it is the cause of retrograde ejaculation. John did the
procedure and said that Phil had been there at the start when they had
planned what to do and that Phil had popped in a couple of times from the
next theatre to see how things were going and again before John had started
on the Lateral Lobes. I had been give shots of two types of broad band
penicillin during the procedure and a shot of morphine.I had every
confidence in John who is a lovely guy, very enthusiastic in what he does
and very caring. Soon I was drinking a cup of tea and waiting for dinner. I
had no pain during the night and did not need any painkillers. I kept on
drinking and watching the catheter bag fill up with a nice Red Wine, it
needed to be emptied three times before the catheter was removed the next
morning at seven.
Now for the moment of truth by peeing on my own.  I was drinking plenty (the
nurse said too much) but it was not until 11.45 that I passed a red 100ml.
John came in to see me and said that he would come back in the afternoon and
that if I was voiding properly could go home.He suggested that I might be
dehydrated but I did not think so from the volumes passed in the night. My
wife had already checked out of her hotel as we had assumed that things
would be OK.
1PM 250 ml pink. 2.30 150 ml pink and a scan showed a residue of 193 ml.
2.50PM  190 ml and much lighter but the scan showed 329 ml retained. John
came back in and said that as I had a long journey he would be happier if
stayed overnight. My wife went off to find another hotel as the Best Western
had no vacancies for that night.
5.10PM  220 ml rosy but only due to the few drops of blood at the start.
8.05PM  150 ml retained 290 ml.
11.00PM 300 ml quickly followed by another 100 ml before bed. Woke up at
2.00 AM and passed 500 ml with a decent flow and another 300 ml at 3.45
AM.
7.00AM 300 ml followed by 100 ml at 7.30. but back to my usual slow rate
ending in a weak dribble. Drinking a lot but no more until 10.30 200 ml.
Passed another 250 ml at 11.30 but the scan showed 416 ml retained. We went
for a walk to get some fresh air and missed John's visit (He had said that
he would just phone the ward to check on me) He said that I could go and
that when drinking normally at home things should settle down. He also gave
me a three day course of Trimethoprim.
I was restless the first night at home and kept on going and passed 1700 ml
in small amounts all crystal clear.During the morning I passed a total of
1000 ml in five visits to the toilet.  I felt 100% well and set off for a
day at
the local racecourse. Just like any normal day dodging around from the
paddock to the bookies and climbing up the grandstand to get a good view.
With G8 riots going on in Edinburgh we had to take an indirect route. Our
journey took 90 minutes using busses rather than the usual 40.
Normally I get off the bus and go straight to the toilet but not yesterday.
I had two large mugs of coffee and was getting worried that I had not needed
yet and tried about 4.45 and probably passed only 200ml. I seem to get a
period like that every day but the rest of the time my prostate symptoms are
still the same, slow flow that goes down to a trickle and only about 200 ml.
Last night was better waking up at 2.50 and 5.30 passing a total of 800 ml.
I have not been drinking so much today to see what that does and results
have been on the low slow side and I have been forgetting to record the
volumes.
Not  worried yet, I am sure that things will gradually adjust. John Davies
did say that my sense of urgency might remain, did he mean forever I forgot
to ask!
Derek.