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Medical Forum / Diseases and Disorders / Prostate BPH / December 2005Tale of Two BPH Sufferers...
By the way, I am 62 yrs old, had TUMT 7/2/04 followed by a PVP 2/23/05. Good results except for possible bladder neck involvement which may require further incision at a later date. Do have retro from PVP from the single incision of the bladder neck that was done with the PVP. I have a brother age 72 on the East Coast who has had BPH for 15 yrs. Advised by a cousin MD to "put off doing anything about that area as long as you can; you don't want anyone messing with that area." My brother has had 6-8 retention crises in that last 15 years, ended up in ERs getting catheters put in to relief the bladder. Now, he feels up against it. Getting up every hr, unable to go. Had cystoscopy about 10 days ago. Very painful, bloody process. Gland is 103 grms. Put on Uroxatral and Avodart which has taken the wind out of his sails. The debate now is whether he should have a TUMT or Open Prostatectomy. The problem with the TUMT is that many years ago, he had a metal mesh placed in his groin to repair an inguinal hernia. Now the question is whether a Targis procedure can be done safely. TURP is out of the question due to the size of the gland. He doesn't have the $ resources to go to see a URO who does PVP on larger glands (ie Dr Te). Open Prostatectomy is risky because of open heart surgery he had 9 yrs ago with a valve implant, aortic aneurism repair and a bypass. What to do??? My 72 friend is having some urgency and retention problems. Cystoscopy done yesterday by my PVP URO revealed some median lobe involvement. My friend did not find out the size of his gland. My URO says TUMT or PVP would help, but PVP is most likely to be his choice as he is a "perfect candidate for PVP." Likely my friend will opt for PVP after the first of the year. I write about these two people to illustrate how complicated options for treating bph can become. My brother now wishes that he had done something 10 years earlier and could have avoided more complicated procedures because of putting it off. Something for those out there facing bph to think about.... Does that Dr still accept chickens and vegetables as payment for his house calls? > Advised by a cousin MD to "put off doing anything about that area as > long as you can; you don't want anyone messing with that area." What is more important than your health? Sell the car, ask the family for money, what is the use of a material asset if you can't live? Te on the east coast is one of the best. Read My PVP on this site. Dr. Te accepts Medicare - or did 18 mos. ago. Jim W. > What is more important than your health? Sell the car, ask the family > for money, what is the use of a material asset if you can't live? Te > on the east coast is one of the best. Read My PVP on this site. Dear Chokman, I think PVP would be appropriate for your brother if you find an experienced PVP surgeon. If it is impossible to opt for this due to money aspects, he might want to consider learning self catheterisation. If he does not empty his bladder after voiding, his real bladder capacity is very small, and this could explain the high voiding frequency he has. Some patients learn to do this and it helps them manage their problem and avoid going to the ER if they feel they might start developing a retention. The technique is relatively easy to learn and one learns to live with it. Maybe self-catheterisation in and out twice a day could improve his situation, but he should discuss this with his urologist. In the past, castration (this horrible word means to supress testosterone production inside your body) was used for patients like him. Today, this can be achieved reversibly with medical treatment, and prostate size is markedly reduced in three months. He might want to consider this prior to a TURP of a 50 gram prostate.... All the best, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com Hi Chockman, what do you mean "Uroxatral and Avodart have taken the wind out of his sails"? do you mean he is having side effects? Dr Sanchez, thank you for your input into this group, it is very helpful, what are your experiences of patients on Uroxatral and Avodart? Regards, Magna In his case, I think he felt the side effects of the Uroxatral and Avodart which included tiredness, irritability and the general feeling of having the flu. No strength and get up and go for about 10-14 days. I think that he also felt the aftereffects of having had a pretty traumatic, painful, bloody cystoscopy due to the swelling and the amount of retention that he was experiencing. At age 72 both these factors wiped him out to the degree that he did not feel like going out to do his farm chores. > Hi Chockman, > [quoted text clipped - 6 lines] > > Regards, Magna Magna, Combination of an alpha blocker (uroxatral) and a 5 alpha reductase inhibitor (avodart) seems to be more effective than taking either of them alone. Tolerability is one of the problems of every drug, some patients experience secondary effects that preclude continuing with the treatment. Apparently after six months, he could quit the alphablocker and continue experiencing the benefits, this is because avodart takes a long time to work. Patients seem to do well on combination treatment, but it is expensive in the long run and it not always avoids the need for surgery or the emergence of complications, as urinary retention. Medical treatment of BPH was very successful because the surgical alternatives where feared by patients (TURP and open prostatectomy are relatively risky operations). Now with PVP I see more and more patients that would rather go for an operation that will end their suffering with minimal risk... All the best, Fernando http://drgomezsancha.blogspot.com Magna, will 2006 be the year you join the PVP success club? You have been sitting on the fence too long:-) Derek. > Hi Chockman, > [quoted text clipped - 6 lines] > > Regards, Magna |
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