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Medical Forum / Diseases and Disorders / Prostate BPH / October 2003Amount Of Tissue Removed By PVP
Does anyone know the amount of tissue that is removed from the prostate gland using PVP? I heard it was 95% for HoLEP and was wondering if it is the same for PVP. Dan > Does anyone know the amount of tissue that is removed from the > prostate gland using PVP? [quoted text clipped - 3 lines] > > Dan As I understand it, pretty much the same. I did pose this question and was told, "If you go in with a melon, you'll come out with a walnut". Not very enlightening but that is what they told me! Derry > Does anyone know the amount of tissue that is removed from the > prostate gland using PVP? [quoted text clipped - 3 lines] > > Dan Sure as heck not 95% .......PVP aims to core out the centre of the "walnut " prostate leaving outer core intact and is no way removes as much as TURP would and PVP does not damage the muscle at the base of the bladder so no risk of incontinance Retro is a possibilty but with RURP its a certainty > > Does anyone know the amount of tissue that is removed from the > > prostate gland using PVP? [quoted text clipped - 10 lines] > incontinance > Retro is a possibilty but with RURP its a certainty Not a certainty. Before the flaming starts, I am not saying that Turp is better than PVP. But I had the Turp and I don't feel that I was "butchered" as many in this group seem to think is a certainty. And I don't have retrograde ejaculation. Sex feels as good to me now as it ever did, which is very good and I ejaculate right out in the open like I always have. Maybe I am just the exception that proves the rule, but everyone who has the Turp does not come up with retrograde and I have read in this newsgroup that many of the fellows who have had PVP do have retrograde. I guess this just shows that nothing is certain except death and taxes? Hank > > > Does anyone know the amount of tissue that is removed from the > > > prostate gland using PVP? [quoted text clipped - 29 lines] > > Theres also a clear difference between the outcome of TURP or PVP on an enlarged Median Lobe .........seems retro is high probability with median lobe enlargement but PVP is much less damaging than TURP on median lobe > > > > Does anyone know the amount of tissue that is removed from the > > > > prostate gland using PVP? [quoted text clipped - 33 lines] > lobe enlargement > but PVP is much less damaging than TURP on median lobe Don't know that much about the medium lobe. I can only speak for myself. I had the Turp surgery. Had to wear a catheter for 48 hours. Was never any any real pain. Didn't even need to take a Tylenol. Needed nothing for pain. Had some trouble with blood clots on the second day which was not a pleasant experience, but as soon as the catheter was removed, I was fine. I suffered with bph for 15 years. Could never urinate over 3 ozs at a time. Had to get up repeatedly at night. Now I usually have to get up one time at night to urinate. I am empyting my bladder every time I urinate. I no longer have that old bloated feeling that I suffered with for all those years. No one has ever mentioned this, but a Turp allows the pathologist to examine a lot of tissue from the center of the prostate. When the doctor tells you that report came back negative, it's a good feeling. With the PVP, I assume that tissue is oblitered and can't be examined. I was grateful there was tissue to send off. The PVP may be God's gift to men, but I am just pointing out that we are all different and their are no absolutes. Once again, I am certainly not touting the Turp over the PVP. All the folks here agree that PVP is the route to go and I'm not trying to envoke their wrath. I'm just saying that no one can say positively that: "Retro is a possibility but with RURP its a certainty". I'm livin' proof that statement is incorrect. Hank > No one has ever mentioned this, > but a Turp allows the pathologist to examine a lot of > tissue from the center of the prostate. When the doctor > tells you that report came back negative, it's a good > feeling. That's fine. But if it is cancerous, wouldn't releasing all that malignant tissue be the last thing you'd want? I asked Muir (the uro at King's College Hospital, London) about this and he told me they are researching the subject. As I understand it, any cancer will be found in the outer layer of the prostate and that won't be destroyed by PVP either -- but at least it won't be made into mince for general re-distribution. I think I'll stick with PVP. My father and a long term friend both had open surgery for BPH and came through fine -- but I don't take that as a recommendation! Derry > > No one has ever mentioned this, > > but a Turp allows the pathologist to examine a lot of [quoted text clipped - 17 lines] > > Derry I am in no way trying to get anyone not to have the PVP. I am just stressing there may be benefits to either the Turp or PVP. Maybe PVP has the edge. Who knows? Remember, nothing is fail safe. I am no doctor, but I am surprised that Dr Muir would make the statement that all cancer is found in the outer layers of the prostate. I don't believe that to be an accurate statement. I'd put that right in the same category as the statement, "it's a certainity that the Turp will leave you with retro". It's my understanding that cancer can be in any part of your body and I don't think the center of the prostate is off limits. As far as scattering the cancer with surgery, if Dr Muir says there can be no cancer in the center of the prostate, there would be nothing to spread, would there? If there were cancer there, I would have been requesting another surgery just as soon as possible to take care of the situation. We are all different, but I'm glad there was tissue left from my surgery for a pathologist to examine. I guess what it amounts to is different strokes for different folks. Hank > > > No one has ever mentioned this, > > > but a Turp allows the pathologist to examine a lot of [quoted text clipped - 46 lines] > > Muir and his team have been carrying out research to see if anything is absorbed/spread into the body by PVP including the flushing solution ..........results have concluded that whereas TURP does cause the body to absorb the flushing solution etc which is also known to cause heart probs some years later ......theres no evidence that anything is absorbed as a result of PVP I am sure this is because the surfaces are sealed quickly rather than being open and bleeding for a while as with TURP As for the cancer issue I have not found any reports anywhere that counter Muirs statement about cancer only being in outer core of prostate ........and since he insists on patients having a low PSA or the addition of a biopsy if the PSA is middling I would suggest one is pretty safe > if Dr Muir says there can be no cancer in the center of > the prostate, there would be nothing to spread, would there? I did not say that and I think you are misleading yourself if you read things into my posts that are not there. After a 500 mile rail trip, sleepless night, then a stressful (for me) interview at the hospital, I asked Muir whether there was any advantage in that PVP evaporated tissue against TURP which effectively macerates it. Note: My words, my question. So far as I recollect, he said they (King's College Hospital) were doing research on this very subject BUT that the cancer was more likely to be in the outer casing of the prostate. That is my honest recollection and if you don't want to accept that, I suggest you contact Muir direct. I am not on this group to have an argument. Derry > > if Dr Muir says there can be no cancer in the center of > > the prostate, there would be nothing to spread, would there? [quoted text clipped - 16 lines] > > Derry Thoroughly agree Derry Good luck with your op ......its scandalous that the NHS makes you wait this long > > if Dr Muir says there can be no cancer in the center of > > the prostate, there would be nothing to spread, would there? [quoted text clipped - 16 lines] > > Derry You are right. I did misread and misquote your statement. Maybe I better get these glasses changed. I imagine my reading comprehension is tailing off in my later years. Please accept my apology. I am certainly not wanting to argue. This is, at least I think it is, a discussion group. I have said I am not touting Turp over PVP. With Turp there are many serious problems that can arise. My fear of major bladder complications is what made me decide to have the procedure. I have seen several of my very good friends die of heart problems and I have seen 3 die of bladder cancer. If I have a choice, I'll go with the heart problems. I know of a man who went into the hospital to have leg surgery and died of a blood clot. A girl, in our town, died while having her gums worked on. Too much anesthesia. There is no such thing as safe surgery. I had a laser poked down my throat to sear a crack in my vocal chords several years ago.. I was very nervous because before the surgery the doctor pointed out there would be oxygen and a laser in my throat at the same time. He told me it had never happened, but combustion was a possibility. I had to sign a waver that if my head was blown off, my wife couldn't sue the hospital. I didn't even know there was such a thing as PVP when I asked for the Turp. I just knew I needed some relief and I needed it as soon as I could get it. I hope not, but I imagine after PVP is around for awhile, we will find there are serious problems that will arise from that surgery also. You just can't get away from that sort of thing, but the risk is not as great as the reward. So we push forward. The reason for my original reply to bnd777 was to point out that I had the Turp and I do not have retro. I described the events after my surgery because in this discussion group, I have read so many horror stories of how the Turp butchers you and maims you. I just thought I would attempt to set the record straight. It didn't butcher me and I do not have retrograde. I feel fine and I can pee. I do think that is what this surgery is all about. I wish for you a very sucessful surgery. It seems to me you will be in as good hands as is possible. Your attitude is good. I think you will do fine. I hope when you come out of this, you can pee a stream 6 feet and you do not have retro, although I think retro is not nearly as bad as we all fear. Hank > There is no such thing as safe surgery. (Snip) If you read some of the past posts on this group, you will see that mood swings are a side effect of taking Flomax. I am afraid you did get a broadside from me which wasn't justified and my excuse is Flomax. I, too, apologize. Dealing with livestock every day I suppose farmers get a bit complacent about death. As Woody Allan said, "I just don't want to be there when it happens". Being under a general anaesthetic must be the next best thing. A good friend of mine died the other day. He was drinking a cup of tea in the kitchen when he mentioned to his wife that he thought his heart had skipped a beat. Thirty seconds later, he keeled over without a sound or a warning. Not a bad way to go -- if you've got to go! Personally, I intend sticking around and making a nuisance of myself a while longer. And I hope everyone on this group consents to do the same. It really is a damned good group which is quite surprising really as we could not have a wider cross section of humanity. Apart from the sexual discrimination, that is!<G> Derry Hank, Examining tissue AFTER a TURP is a terrible way to test for prostate cancer. Prostate Cancer should be ruled out BEFORE having either a PVP or TURPP by having a biopsy. Patrick > > > No one has ever mentioned this, > > > but a Turp allows the pathologist to examine a lot of [quoted text clipped - 44 lines] > > Hank > Hank, > Examining tissue AFTER a TURP is a terrible way to test for prostate cancer. > Prostate Cancer should be ruled out BEFORE having either a PVP or TURPP by > having a biopsy. > Patrick **************************************** Patrick, You are right and I agree with you wholeheartedly. I had 3 biopsies in the months preceding the Turp. The last one was 16 core samples and they were all negative. But, and I am no expert on this, I don't think they can biopsy anything except the outside of the prostate. They still insist in sending the tissue taken from the center of the prostate to a pathologist. Thay must think there is a chance of cancer cells being there. I don't want to come off as if I know everything because I sure don't. I was scared and I was so tired of worrying about my prostate and having a biopsy every 6 months. It got to where that was all I could think about. A few days before they were to do the 16 core sample biopsy I pleaded with the doctor to just take my prostate out. He said he couldn't take out a healthy organ. I remember asking him how could my prostate be healthy, if I were having to have a biopsy every time I saw him. Anyway, the biopsy on the tissue from the center of my prostate was negative also. I breathed a sigh of relief when I was told that. I go back in December and I guess the process starts all over again. It's a lot like playing Russian Roulette. Hank Hank, I too was freightened to have a biopsy but a 16 core biopsy is the best way known to test for Prostate Cancer. A biopsy checks all regions of the prostate and is very effective in picking up prostate cancer. My main point is that post-TURP tissue sample is one of the worse way I can think of to test for Prostate Cancer. It is a "after the fact", test. A biopsy is a far more effective way to test for prostate cancer before a TURP or a PVP. Because a positive result for prostate cancer says that you shouldn't have a TURP or a PVP, you need much different treatment. So the arguement that an advantage of TURP over PVP is the chance to examine tissue for prostate cancer is based on flawed reasoning. No one with prostate cancer should be undergoing either TURP or PVP. So testing for it afterwards is not an advantage. If the doctor suspects prostate cancer he should test before surgury not afterwards. Patrick Patrick > > Hank, > > Examining tissue AFTER a TURP is a terrible way to test for prostate [quoted text clipped - 34 lines] > > Hank > Hank, > I too was freightened to have a biopsy but a 16 core biopsy is the best way [quoted text clipped - 17 lines] > > Patrick **************************************** Patrick, I'm not saying that the fact that there is tissue to be examined after a Turp is reason to have a Turp rather than PVP. From what most people in this discussion group say PVP is almost like a walk in the park. I would get lynched by this group if I said something like that. I am saying it is one extra safeguard against cancer Turp provides and PVP doesn't. Turp tissue samples are just the last line of defense. Surely no one thinks it is wrong to examine them? I had the 4 core sample, the 8 core sample, and the 16 core sample biopsies and they were all negative. But as effective as those biopsies were, that needle still didn't reach to the center of my prostate. In fact my urologist told me he had a patient who had a consistently high psa and he couldn't find any evidence when he biopsied him. He finally put the gentleman in the hospital and did a 32 core sample biopsy on him while he was under general anesthesia. He did find a small nest of cancer cells that time. That what was driving up his psa number. I was very glad they sent the tissue to the pathologist after the report came back negative. The negative report put me just a little more at ease. Hank On 9/26/03 3:52 PM, in article Xns9402DEC45BA20derryadviegundogscou@130.133.1.4, "Derry Argue" <derry@adviegundogs.co.uk> wrote: >> No one has ever mentioned this, >> but a Turp allows the pathologist to examine a lot of [quoted text clipped - 17 lines] > > Derry In the end I doubt either procedure is much better from the point of view of prostate cancer. You do get tissue with a TURP, but you are right in that most, but by no means all prostate cancers are found in the outer part of the gland. If you have prostate cancer, and you want to have any therapy for cure (radiation or surgery), neither of these procedures are a good deal. They make doing the seeds very hard and increase your risk of having problems with external beam radiation. They make it harder to get the gland out with open surgery as well. Most urology docs are very aware of this and work very hard to make sure that the patient does not have prostate cancer before they do either of these procedures. ME > Don't know that much about the medium lobe. I can > only speak for myself. I had the Turp surgery. Had to wear a catheter for 48 [quoted text clipped - 27 lines] > > Hank Most people that have a TURP will do just as well. They are some of the more happy people that you operate on. I think each procedure has good things and bad things. You just need to talk to the patient and let them know. ME SNIP >but PVP is much less damaging than TURP on median lobe Perhaps you could indicate your evidence for this statement ? > SNIP > >but PVP is much less damaging than TURP on median lobe > > > Perhaps you could indicate your evidence for this statement ? If Turp is done on prostate enlargement it damages the muscle at base of the bladder which can mean incontinance this is especially a problem in median lobe enlargement where it grows up into the bladder PVP is green light laser which only acts on red blood cells ......ie prostate tissue not muscle tissue equally there is no need to remove as much tissue with PVP Any PVP surgeon can confirm the above Your explanation is somewhat correct but note that the spincter muscle that controls urination is not at the bladder neck, it is at the base of the prostate. So work done at the bladder neck will not result in incontinence. To much tissue removal at the bladder neck may result in retrograde ejaculations but not in incontinence. Incontinence will result if the spincter muscle below the prostate is damage. PVP is never done anywhere never that area, thus no cases of incontinence ever reported. Patrick > > SNIP > > >but PVP is much less damaging than TURP on median lobe [quoted text clipped - 10 lines] > > Any PVP surgeon can confirm the above > Your explanation is somewhat correct but note that the spincter muscle that > controls urination is not at the bladder neck, it is at the base of the [quoted text clipped - 25 lines] > > Tell me why patients who have TURP report Incontinance then ? On 10/4/03 6:41 AM, in article blmbkg$o69$1@hercules.btinternet.com, >> SNIP >>> but PVP is much less damaging than TURP on median lobe [quoted text clipped - 10 lines] > > Any PVP surgeon can confirm the above Loss of urine after a TURP or a PVP is more complex than that. People can have urine loss in several ways. One is if the external sphincter (a little muscle that is down stream of the prostate) is either hurt when the procedure is done, or was not working well before hand. It is a very, very rare thing for this guy to get hurt doing any transurethral procedure. People know where it is and try very hard to not cut it or laser it. Sometimes they are not where you think they are, and that is when they tend to get hurt. There is another sphincter. This one called the internal sphincter. This is often taken on purpose during a TURP to open the bladder neck up. This is the one that causes retrograde ejac (semen going into the bladder and not out the tip of the penis). This can be taken or damaged in either procedure and is not a complication in my mind. About 1/3 of people that get the PVP will have this problem and 80-90%+ that have a TURP will. This just comes from the different ways that people do the operation with a laser or the classic TURP. Then people can also have urine loss secondary to a bad bladder. Maybe it is just so tired that it will not empty even after you open up the prostate. These will just leak when they get too full. Maybe it has gotten "twitchy" from years of working against a prostate that has obstructed the urine flow. This can be a very common cause of urine loss and can happen no matter what type of procedure you do (TURP or PVP). You can treat this with meds that can relax the bladder. 2/3 of the time it will get better on its own just from taking care of the obstruction. There are also many other reasons why people can have urine control problems. Many of them people will first note just after surgery and will get better with time. I hope this helps. ME On 9/26/03 12:13 PM, in article bl1s3o$j3k$2@titan.btinternet.com, "bnd777" >>>> Does anyone know the amount of tissue that is removed from the >>>> prostate gland using PVP? [quoted text clipped - 33 lines] > lobe enlargement > but PVP is much less damaging than TURP on median lobe Oh, I do not know about that with regard to the median lobe. If you do either of the procedures right you will remove all of the median lobe. PVP does have a lower rate of retrograde ejac, but it is not zero. Most of the papers that have come out on this subject seem to show a rate a bit less than 1/3 of people that have a PVP will have retrograde ejac. The numbers for the TURP are about 70-80%+. In the end this is usually not a big deal to the patient as long as they do not wish to have more kids and you let them know before you do the procedure. I think much of the difference comes from the way people do the classic TURP. In this you take down the bladder neck so that this area is WIDE open. When you do the PVP you just do not do this as much. You could if you wanted to, but the way most people do it is to take it down just to the fibers of the bladder neck and not much more. ME I posed this same question to Dr. Dumont who was about to do a PVP on me. I told him that I imagine that you only remove enough to clear out a channel to make a passage for urine flow. Otherwise the gland would collapse if supporting tissue were not left within it. He said "no, we remove as much as we can. We clean almost all of the glandular tissue from within the prostate leaving only the outer wall. It does collapse, we count on that." I should point out this is the doctor who then told me that he had only done a few PVP prior to the one he was about to do on me. That is when I got out of bed, and put on my pants and left the hospital. I eventually found a very experienced doctor and had a successful PVP. During that same conversation Dr. Dumont also told me that in time the charred pitted surface left within the prostate gland after PVP is replaced with smooth tissue like that which is in the urethra. Dave > Does anyone know the amount of tissue that is removed from the > prostate gland using PVP? [quoted text clipped - 3 lines] > > Dan Why the question? Here is my humble assessment. Dr Laub gave me pictures of before and after PVP. It is impossible to measure how much material of the total was vaporized out, but I doubt it is 90%. What I see, is a view of the urethra with two cheeks growing in from the sides and touching. The efective opening looks like an squashed figure eight. After PVP the opening looks like an 0. I guess that there are several of these cheeks which have to be lased. I don't think they remove more than is needed to make a channel equal to the normal urethra diameter. PVP is a slow process, about one minute or more per gram. A large prostate of 60 g would take over one hour and the length worked on may be 1.2-1.5 inches. This is lot of time spent on a small area. Why would they do more than needed to clear a path? Fred Henzi > Does anyone know the amount of tissue that is removed from the > prostate gland using PVP? [quoted text clipped - 3 lines] > > Dan My problem isn't blockage, but rather a prostate so enlarged (including a middle lobe) that it is pushing up into the bladder, reducing it's capacity and causing frequent urination. If the focus of the PVP laser surgery is primarily to open a channel, does this mean that I would be mistaken to undergo PVP in hopes of getting relief from the abovestated condition? > Why the question? > Here is my humble assessment. Dr Laub gave me pictures of before and after [quoted text clipped - 18 lines] > > > > Dan Rob, PVP is the best way known to get relief from an enlarged median lobe. You have been waiting a long time? What are you waiting for? Your median lobe to magically disappear? Your bladder to stop being damaged? How bad are your symptoms? By the end of this year there will have been over 10,000 PVPs done worldwide over a 5 year period. Isn't this enough to convince you that it is time to take action to improve your quality of life? Because of the wonderful quality of life improvements I got from PVP, I am mystified why someone would continue to endure a enlarged median lobe when there is PVP so readily available. Patrick PVP June 2002 Dr. Te NYC > My problem isn't blockage, but rather a prostate so enlarged > (including a middle lobe) that it is pushing up into the bladder, [quoted text clipped - 26 lines] > > > > > > Dan > My problem isn't blockage, but rather a prostate so enlarged > (including a middle lobe) that it is pushing up into the bladder, [quoted text clipped - 26 lines] > > > > > > Dan You are simply in the same situation as I was I totally rejected a TURP and all its risks in favour of PVP 6 weeks ago ......just 3 hrs later walked out of hospital ....and instant cure of previous problems and discomfort .......no catheter ...no 3/4 day stay in hospital......no bleeding .......a total success |
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