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Medical Forum / Diseases and Disorders / Prostate BPH / November 2005Any bad PVP experiences?
I have been following this group for quite a while. PVP is continuously praised. I just wonder if anyone has had or has heard of any bad experiences. One post said something to that effect but did not give any details. Others report good results with TURP but a few have with what might be called horror stories. This is a can of worms to re-open. Let me say this: there have been a few that have had much longer than expected recovery periods and a couple with less than satisfactory results. Most reporting here have been satisfied overall. >I have been following this group for quite a while. PVP is continuously > praised. I just wonder if anyone has had or has heard of any bad [quoted text clipped - 3 lines] > Others report good results with TURP but a few have with what might be > called horror stories. Rich 256: I've had two PVP treatments without any benefit. After the first (Dec 03), which had no effect on my symptoms, my uro did a second cysoscopy and reported that some residual scar tissue from the first operation was the culprit. Against my better judgement, I agreed to a second PVP in December 2004, which was also ineffective in relieving my symptoms. It seems that everybody else is doing well after PVP and I'm happy for them. I wish I could join them. The odds sure are favorable. Terry > Rich 256: > [quoted text clipped - 7 lines] > > Terry What explanation were you given for the second failure? Derek. Derek: He scratched his head and said "well, I'll be damned, must be something to do with your bladder." He offered to do another cystoscopy (at my expense), but I quoted the old adage "Fool me once......etc." and plan to see somebody else after reviewing my situation. I suspect it will be a while before I'll regain any confidence in the profession. though. Terry Rich' I had PVP almost 2 year ago . It sure didn't help me any at nighttime. I would like to hear comments from people that it did help and also from people that PVP didn't help their nighttime urination. Dean, >I have been following this group for quite a while. PVP is continuously > praised. I just wonder if anyone has had or has heard of any bad [quoted text clipped - 3 lines] > Others report good results with TURP but a few have with what might be > called horror stories. > Rich' > I had PVP almost 2 year ago . It sure didn't help me any at [quoted text clipped - 9 lines] >> Others report good results with TURP but a few have with what might be >> called horror stories. We recently had a thread on Night Time Urination and most people seemed to agree that Nocturia is a symptom of something else and that it is not the fault of a failed PVP.After 12 weeks I still have to get up on average three times a night and pass up to a total of 1.5 litres. That volume is about what I would pass in five daytime voids. Derek. Rich, My experience immediately after my pvp could be considered bad: The general anasthetic left me in a mentally deranged state for a day. The evening after the pvp I thought that if I allowed myself to fall asleep I would never wake up again so I tried everything not to fall asleep the first night. Funny looking back at it but it certainly upset my wife at the time, not to mention me. I had to wear a catheter for 7 days because of the degree of bleeding. Also, I did not get the immediate improved flowrate that I had been expecting, so I went though a few weeks not knowing what the final outcome would be. My nocturia worsened for a few months and I also had "urgency" that would come on at a moment's notice and make me run for the bathroom. I found I had retrograde ejaculation and diminished sensation of orgasm. Both have now resolved. However, at two months there was significant improvement and at three months I was overjoyed with the results. Also my nocturia had almost gone and the retro had diminished. Now at over 5 months it is difficult to remember the slow urination and the dependence on Flomax for almost a decade and the stupid urologists who told me nothing could be done about it and that I would eventually have to catheterise for the rest of my life. Every now and then it hits me (usually when I am peeing effortlessly) how normal everything is now. I cannot remember the last time I woke up during the night to pee. Even now there seems to be continual improvement of bladder function. After pvp my bladder held 200-250 cc. Now it is 300-350 ccs which is fine with me. At five months post-op I am a very happy customer. Looking back, I can see that the healing takes time, or at least it did in my case. From reading this forum it seems that some people walk away from the procedure with instant results and rapid healing, but this was not my case. However, in talking with my uro during follow-ups, my case was typical in his opinion. If you are considering pvp I believe it pays to find an experienced urologist who has performed at least 100 procedures. Then ask him what problems he has encountered in performing this procedure. All the best, Dave Thanks to everyone who is responding to my question. It has cleared up a few suspicions. The bottom line still seems to be that PVP is far superior to TURP. However, as with any procedure it is not perfect every time or may simply take longer to take effect. Anesthesia often has adverse effects on patients. Dave C, is this the first time you have had problems with an anesthesia? Have you had been anesthetized many times before? Perhaps that is not as important as they type of anesthesia that they use. My URO talked me into trying TUMT a few months ago. The results are marginal but the main problem still seems to be having to get up at night. Not much problem during the day. The URO said that sometimes it takes up to a year for full improvement. He has done over 50 PVP and said he has had good success with them too. Of course the advantage or disadvantage as the case may be, of TUMT is that you do are fully awake for the whole procedure and get full appreciation of the pain involved!! It was only momentary sharp pains and no problem what so ever afterwards. I did wear a catheter for 5 days and got 5 full nights of sleep. No bleeding. Only a couple times did I note the tissue being ejected. I had endoscopic sinus surgery a few years ago. That was the most uncomfortable recovery I ever went through. I did a lot of searching before selecting a surgeon that I would allow to cut that close to my brain and eyeballs. A tiny slip during that procedure and you can be a vegetable or blind for the rest of your life. Rich, I have had general anesthesia three times prior to pvp, twice as a child for tonsils and adenoids and once as a young adult, 21, each time in the UK with no bad results. The pvp was done in North Carolina, USA. I am now 53. Regarding pvp, from my understanding, a less than satisfactory outcome can result from two separate issues, one, the bladder and two, the prostate. If a person has had bph for a long time the bladder muscle can be damaged from long term straining against the blockage. The bladder muscle thickens and the bladder becomes less elastic and eventually the muscle just gives up. In this situation a pvp, or for that matter, turp, tuna, tuip, tumt etc, will remove the blockage but the bladder no longer has the power to empty itself. A uro can determine the condition of the bladder before pvp by various urodynamic tests. Or the prostate causes the problem after pvp. Several things can happen but I believe they can be corrected. The pvp can cause scar tissue to form that blocks the urethra again. Or part of the prostate collapses into the urethral passage. Or the prostate swells due to the trauma of the procedure and takes a few weeks to go down which is what happened to me. There may be factors that cannot be anticipated that cause a bad outcome but I have no knowledge of them. Perhaps someone can add to this? Dave Thanks for the information. I expect my bladder could be a significant problem now too. I am 75. However, I have not had bph problems for a long time. Since I am in relatively good health I wanted to get treatment now. And I would expect that it would take a while for even PVP to heal. After all the urethra experiences one hell of a sunburn. I did TUMT ( Thermatrx DOT) June 04 and had catheter for 1 week but unfortunately the result only last for around two months. If I found this news group earlier, I would NOT be talked by my NJ uro Dr. W into TUMT. Fortunately, I found this NG at the end of 04, have follow it ever since. I visited Dr. Te of NY Presbyterian hospital in June 05 and had urodynamics, cystoscopy and ultrasound in following several visits. Then had PVP on 8/17/05. I'm 54 with a 100 g size prostate. I had taked Cardular or Flomax for 6 years and could not pee without them before having PVP. Because of my big size prostate with median lobe protrusion, I stayed one night at the hospital with a catheter. They removed the catheter at 6:30 am the next morning and after I peed successfully twice by myself at a suprise big flow I walked out the NYP at 11:30. Now my peak flow is 35ml/s vs. <5 ml/s and become a happy camper. Go for a experienced PVP uro to see if PVP fit you. Many thanks to those pioneers, Patrick, Al, Dave C, forlorn hope, Mr. B, nambucca, Richard F Somer, Robo, Spread deMocracy, ... in this NG I had green laser about 1 1/2 years ago. For me, it was not as great as made out to be. I probably should have heeded another doc's advise to use the "gold standard" which was TURP. For me, it wasn't simply a 2 - 4 week recovery. I am still experiencing abnormal things, however, a lot has improved over the 1 1/2 years. Urine flow is much stronger and I only get up twice a night to go. My greatest problem is after ejaculation, when I urinate, a lot a blood comes out, even in clumps. Either my doc screwed up or it is not uncommon for this procedure. > I had green laser about 1 1/2 years ago. For me, it was not as great as > made out to be. I probably should have heeded another doc's advise to use [quoted text clipped - 4 lines] > urinate, a lot a blood comes out, even in clumps. Either my doc screwed up > or it is not uncommon for this procedure. Gee, that is scary. I would sure be hunting out another doctor. What I have found is that the doctors that recommend TURP don't have access to the equipment for PVP. In my area it goes by hospital. The first URO I was going to said PVP was about the same as TURP. Then I found that the hospital he uses doesn't have the equipment. All the UROs that do PVP are associated with particular hospitals that have the equipment and they no longer routinely perform TURP. I was talking to a retired doctor. He said a friend of his was having PVP. When he woke up he found that the laser had broke down so they finished with TURP. He was very upset that they did not just reschedule to finish later with PVP. I have heard that they usually have you sign something allowing them to switch if needed. When/If I have PVP I will be certain to specify that only if medically necessary and not because of equipment breakdown. >I had green laser about 1 1/2 years ago. For me, it was not as great as > made out to be. I probably should have heeded another doc's advise to use [quoted text clipped - 6 lines] > up > or it is not uncommon for this procedure. I am at week 13 post PVP. I stopped passing any blood in my urine after three weeks and only had one bit that could be regarded as a clot. I had no sign of scabs but little bread crumb pieces are sometimes passed, including one yesterday. I have not had any blood in my ejaculation, I think that you should get that checked out as a matter of urgency. I am going for my first check up on Friday and await with interest to see what my flow rate and retention will be. My stream is not a great as I expected and I have get up two or three times in the night compared to 3/5 times before the procedure. My night time problem seems be nocturia and not to be connected to the PVP and the volumes I pass each time during the night (500ml) are more than during the day. Derek. Derek, I am at week 7 post PVP. Does your uro ask you to take Avodart or Proscar after pvp? Mine did but I decide not to bacause I rather to have another PVP after years than having side effect of taking Avodart. My peak flow is 35 ml/s vs <<5 ml/s. Prior to pvp, I got up 0-1time per night with very weak flow and low volume but now after pvp it becomes 1-2 times per night with very strong flow and around 300-400ml each. I think it is the problem of "gravity". During the day I pass only 120-250 ml each time. I am very satisfied with PVP. > Derek, I am at week 7 post PVP. Does your uro ask you to take Avodart or > Proscar after pvp? Mine did but I decide not to bacause I rather to have [quoted text clipped - 4 lines] > it is the problem of "gravity". During the day I pass only 120-250 ml each > time. I am very satisfied with PVP. Interesting about the flow rate. I unfortunately let my URO talk me into trying the TUMT first. Had it last March. In July I had very little retention but the flow has not been what I hoped. I just started checking the volume. I get up two or three times a night and pass only 100-150 ml. But during the day it is 200-250. I thought or hoped I could be able to wait for 500 ml. Anyway, my "gravity" experience seems to be the oposite of yours. I suppose it all depends on how > Derek, I am at week 7 post PVP. Does your uro ask you to take Avodart or > Proscar after pvp? Mine did but I decide not to bacause I rather to have [quoted text clipped - 6 lines] > it is the problem of "gravity". During the day I pass only 120-250 ml each > time. I am very satisfied with PVP. No he did not suggest Avodart or Proscar as I had told him of my bad reactions to it. I am sure that he does not recommend it to others either. Some Uro's here in the UK put patients on to it in the month prior to the procedure if they are not already on it. During the day I pass around 300ml at a time but I always go to the toilet before going out when not really needing and then only pass around 125ml. Same applies when about to make the journey home. My Qmax Flow rate prior to PVP was 11.7 mls sec. I am very sure that I cannot compete with your present flow. Derek. Rich256, I have read your posts since March 05. I had TUMT in June 04 with catheter for one week but the result dimished within a couple of months. If I found this NG earlier, I would not waste health, time and money for TUMT. I had my pvp 7 weeks ago and everything is fine till now, no pain but gain. I do have retro prior to pvp because I had Flomax for 3.5 years as well as proscar for 1.5 years. Derek, may you have a pleasant visit to your uro today. > Rich256, I have read your posts since March 05. I had TUMT in June 04 with > catheter for one week but the result dimished within a couple of months. If [quoted text clipped - 4 lines] > > Derek, may you have a pleasant visit to your uro today. I really don't think there was anything really bad about TUMT. I sure would recommend it before trying TURP. Except for having a few sharp pains the procedure was pretty uneventful. And fortunately the woman who did most of the procedure called the night before and filled me in on all possible pains I might experience. She said of the 500 procedures they have performed 80% said they would do it again and only 2 said they would never do it again. One friend of mine is avoiding PVP because of his experiences with anesthesia. It almost killed him. I keep my eye on here to see what the responses are. I don't plan on doing anything more until next year. I won't know now until next March if I am having any retention. Flomax really hit me with everything it has. I took it for less than a month. Age 76 here so have lots of time to check these groups. It wasn't until I got here that I found out about PVP. The previous URO only suggested TUMT or TURP. Apparently his hospital does not have the equipment. The new URO is about 10 miles instead of 1. Seems that some with PVP did not get a lot better results. A ultrasound three months after the TUMT indicated very little retention. It seems to me that the peak improvement came in about two or three weeks. I am not posting the complete article as I have done so in the past and a google will bring it up. I had very serious complications with TUMT and want to be sure that you have seen this before making a descision. Burr FDA Public Health Notification: Serious Injuries from Microwave Thermotherapy for Benign Prostatic Hyperplasia (You are encouraged to copy and distribute this information) October 11, 2000 Dear Colleague: This is to notify you of the potential for serious thermal injury and related complications associated with the use of microwave energy to treat benign prostatic hyperplasia (BPH), and to provide information that can help avoid these complications. Although the use of microwave thermotherapy for the treatment of BPH has been demonstrated to be safe and effective, and more than 25,000 procedures have been performed, we are concerned about some unexpected procedure-related complications that have occurred since the marketing of these devices. Currently marketed devices include the Prostatron (Edap Technomed, Inc.) and the Targis System (Urologix, Inc.). Dornier Medical Systems, Inc. has received approval to market their UroWave System but is not yet marketing it. We are working with the manufacturers to ensure that labeling and training programs address these complications. Nature of the Problem Since 1996, we have received reports of 16 thermal injuries related to microwave thermotherapy systems. Of these, 10 resulted in fistula formation and 6 resulted in clinically significant tissue damage to the penis or urethra. These injuries may not be apparent at the time of treatment, and may take hours or days to develop. (Note that the original labeling for these devices did not list fistula formation as a procedure-related complication.) The reported injuries have required colostomies, partial amputation of the penis, and/or other therapeutic interventions. >> Rich256, I have read your posts since March 05. I had TUMT in June 04 > with [quoted text clipped - 40 lines] > me > that the peak improvement came in about two or three weeks. > I am not posting the complete article as I have done so in the past and a > google will bring it up. I had very serious complications with TUMT and want [quoted text clipped - 5 lines] > Serious Injuries from Microwave Thermotherapy for Benign Prostatic > Hyperplasia That notice was five years ago. Others make references to that FDA warning but I have not seen anything new. As with any procedure it is the skill of the doctor. http://www.healthatoz.com/healthatoz/Atoz/dc/caz/kidn/bphs/bphnewtreatment.jsp "Microwave therapy has been associated with serious thermal injuries when not performed properly. With any new technology, there is a learning curve. Be sure to ascertain your surgeon's level of experience with this new procedure" You find references of injury from PVP as well. And, I personally know two individuals who had severe aftereffects from TURP. There was a report by someone here about having pain during TUMT. The operator did not do anything and even left the room while he was hooked up to the equipment. That is unforgiveable. > Rich256, I have read your posts since March 05. I had TUMT in June 04 > with [quoted text clipped - 8 lines] > > Derek, may you have a pleasant visit to your uro today. Unfortunately I was unwell and had to cancel my appointment as it entails a 130 mile train trip to get there. We were going to make a weekend of it and come home Monday. Now I am sitting miserably at home but feeing better than I did early this morning. Derek. CJ /........... something is definitely not right with your symptoms.......you need to go back for more investigations I had PVP 2.5 yrs ago having rejected TURP .......PVP was a total breeze and I have not regretted one single day > I had green laser about 1 1/2 years ago. For me, it was not as great as > made out to be. I probably should have heeded another doc's advise to use [quoted text clipped - 4 lines] > urinate, a lot a blood comes out, even in clumps. Either my doc screwed up > or it is not uncommon for this procedure. According to a urologist in California: PVP and Turp are a toss up. Either one has its benefits and drawabacks. Just don't believe the advertising hype of Laserscope. As you can see, reading these posts, this surgery is no picnic for many patients. Be prepared for a less than satisfying experience, and thank modern medicine for any help that might result. Marcus CJ /........... something is definitely not right with your symptoms.......you need to go back for more investigations I had PVP 2.5 yrs ago having rejected TURP .......PVP was a total breeze and I have not regretted one single day > I had green laser about 1 1/2 years ago. For me, it was not as great as > made out to be. I probably should have heeded another doc's advise to use > the "gold standard" which was TURP. For me, it wasn't simply a 2 - 4 week > recovery. I am still experiencing abnormal things, however, a lot has > improved over the 1 1/2 years. Urine flow is much stronger and I only get > up twice a night to go. My greatest problem is after ejaculation, when I > urinate, a lot a blood comes out, even in clumps. Either my doc screwed up > or it is not uncommon for this procedure. I had pvp exactly 2 weeks ago tommorrow (11-8-05). I stayed at home for 3 days, the 4th day went to work, the 5th day (the one I felt the best), I went to work. Then later drove to a concert almost 2 hours away from home, the concert was 2.5 hours long and then drove back home. It was a long day but I had no problems. Then I started having a bit of angst at the end of urination. Now it's at the start, sometimes during and afterwords. It's like there is a fair amount of irritation there which is upsetting to me. The uro told me to take the drug that turns your urine orange (forgot the name) at night but it does not seem to help. Any suggestions or am I being too impatient since it's only been 2 weeks post op. Realtor 1: You are doing fine and will be better as days go by. It's normal to have a strange feeling at the begin or/and end of urination for weeks. Wish you good. >I had pvp exactly 2 weeks ago tommorrow (11-8-05). I stayed at home >for 3 days, the 4th day went to work, .... Then I started having >a bit of angst at the end of urination. Now it's at the start, >sometimes during and afterwords. It's like there is a fair amount of >irritation there which is upsetting to me. .... Any suggestions or am I being too impatient >since it's only been 2 weeks post op. The point has been made here previously that the less successful patients are the ones with a reason to post after the procedure: either to moan or to ask if others are having similar problems. The instant successes have no real need to read the NG or report continued improvement. I am 71 and 20 weeks post PVP and have had no problems. I travelled home by train from Newcastle (England) to Edinburgh (Scotland) on day two. The next day I went to the racetrack and was on my feet for over six hours. From then my life and exercise were as normal apart from avoiding lifting and carrying anything heavier than a bag of groceries. Basically bleeding had stopped in the first week with just a few drops at the start of urination for the next couple of weeks, no retention, no retro. My flow is much better than before but not as good as I had hoped for but it is still improving and my Uro suggests that my bladder had been somewhat stretched and that Kegel exercises will help. My AUA SYMPTOM INDEX was 22 prior to PVP and is now 11 it would be lower but for night time urination still being a problem (I marked that as a 3 ) However my night time visits are down from 4/5 to 2/3. I could not reasonably expect the PVP to cure Nocturia and I usually pass between 1000 and 1500 mls in total during the night, the same as before but more at a time. Derek. > According to a urologist in California: PVP and Turp are a toss up. Either > one has its benefits and drawabacks. [quoted text clipped - 24 lines] > up >> or it is not uncommon for this procedure. The point has been made here previously that the less successful patients are the ones with a reason to post after the procedure: either to moan or to ask if others are having similar problems. The instant successes have no real need to read the NG or report continued improvement. I am 71 and 20 weeks post PVP and have had no problems. I travelled home by train from Newcastle (England) to Edinburgh (Scotland) on day two. The next day I went to the racetrack and was on my feet for over six hours. From then my life and exercise were as normal apart from avoiding lifting and carrying anything heavier than a bag of groceries. Basically bleeding had stopped in the first week with just a few drops at the start of urination for the next couple of weeks, no retention, no retro. My flow is much better than before but not as good as I had hoped for but it is still improving and my Uro suggests that my bladder had been somewhat stretched and that Kegel exercises will help. My AUA SYMPTOM INDEX was 22 prior to PVP and is now 11 it would be lower but for night time urination still being a problem (I marked that as a 3 ) However my night time visits are down from 4/5 to 2/3. I could not reasonably expect the PVP to cure Nocturia and I usually pass between 1000 and 1500 mls in total during the night, the same as before but more at a time. Derek. > According to a urologist in California: PVP and Turp are a toss up. Either > one has its benefits and drawabacks. [quoted text clipped - 24 lines] > up >> or it is not uncommon for this procedure. Nice summary of reasonable expectations concerning Nocturia post-PVP. Jim W. " However my night time visits are down from 4/5 to 2/3. I could not reasonably expect the PVP to cure Nocturia and I usually pass between 1000 and 1500 mls in total during the night, the same as before but more at a time." >Nice summary of reasonable expectations concerning Nocturia post-PVP. Jim >W. [quoted text clipped - 3 lines] >pass between 1000 and 1500 mls in total during the night, the same as before >but more at a time." I've been keeping track of the amount I produce per night. It is usually 300-500 mL. What I've noticed is that my night-time difficulties depend greatly on that nightly production. If I make 200-300 mL, I get up once or twice. Peeing goes okay and I'm back in bed in a couple of minutes. If I'm around 600-700, I'm up 3-4 times, and each time can be stressful, taking maybe 45 minutes each time to void completely. By stressful, I mean that straining might be required, and I pee only a bit at a time, having to wait 5 minutes before I can try again. If total production is around 800-900 mL, I risk going into acute retention and require a catheter. Fortunately this does not happen often. So my strategy is to try to minimize nightly production, without going to such extremes that I'm noticeably thirsty, which could risk problems such as kidney stones. I usually don't drink in the evening, and have a salty snack before retiring. This usually works pretty good, although there are unexplained exceptions! Overall, I have difficulty around once a month. 1000-1500 mL seems like an awful lot! I would be at emerg having a catheter. Ed Ed, I remember that you mentioned your prostate size is around 150g before. My heard goes with you that you need so many minutes to void at night. Why don't you go to a uro (must be capable of doing good pvp) to see if pvp fit you? My average flow was around 5 cc/s with urgency, retaintion,...prior my 08/2005 pvp and had taken Cardura or Flomax for 6 years. My size was 100g. Fortunately, I found this NG early 05 and thanks to those pioneers of Patrick, Al, Dave C, Jim W, Mr. B, Spread deMocracy,...(to name a few). I am totally satified with my pvp. According my searches within this NG, Richard F Somer's size was 190g( shrank from 250g by taking Advodart for year), then had pvp by Dr. Te (my pvp doc too) in NY city with good outcome. Another example, David DeBar's size was 150g. Here were his words, Dr. Lin is a world calss doc of pvp who has a human touch...it was worth the long trip from N. Virginia to Floria, Flagler hospital... Please search "PVP" + one of those names I mentioned above within this NG and you will find many good posts. This is my 2 cents opinion. Wish you the best. >If I'm around 600-700, I'm up 3-4 times, and each time can be >stressful, taking maybe 45 minutes each time to void completely. By >stressful, I mean that straining might be required, and I pee only a >bit at a time, having to wait 5 minutes before I can try again. Thanks... I have seen a uro and he told me my prostate was too big for a PVP. When they get that big, there are issues with bleeding, possible collapse of the prostate afterwards creating a new constriction, and burning up of the laser probe. Those probes are only good for so much energy. The uro is a well-known name in Toronto -- and I'm in Alberta, Canada, so there is the problem of distance too. My problems don't occur that often. I can wait. PVP hasn't arrived in Alberta. My uro here is a great guy and I don't want to piss him off by asking him to send my records to uros in the States, unless I know I have to make a move. I'm hunkering, taking my time, wondering if some other improvements might come along. Ed >Ed, I remember that you mentioned your prostate size is around 150g before. >My heard goes with you that you need so many minutes to void at night. Why [quoted text clipped - 16 lines] >>stressful, I mean that straining might be required, and I pee only a >>bit at a time, having to wait 5 minutes before I can try again. Ed, You may ask your uro if you can have Avodart to shrank your prostate and if you can do self-catherization to give yourself and your baldder a break daily or so. You can search "intermittent cathetherization" or "CISC" in this NG for reference. Best wish! >... I have seen a uro and he told me my prostate was too big for >a PVP. >>>, having to wait 5 minutes before I can try again. |
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