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Medical Forum / Diseases and Disorders / Prostate BPH / January 2006PVP and large prostates
It's been a while since I've visited this NG, so I apologize if this question is redundant. I am now having some retention issues that are causing my Uro to suggest an open prostatectomy. He has done a few PVPs but says that there's too much blood and related risk with large prostates..... mine is 175cc+. I have made a consult appointment with Dr. David Reiter at UCLA (whose name I picked up here some time ago), as one who specializes in large prostates (or is at least not intimidated by them). I have an 8 year history of symptoms, had TUMT about 4 years ago, and a major bladder distension issue following an appendectomy. Frequency not too bad, urgency varies day to day, little night wakening. Main issue seems to be retention. If anyone is able to summarize or comment on the latest posting feedback re the success rates & issues of PVP on a large prostate, I would be grateful. The more specific to Dr. Reiter, the better, but all input would be appreciated. Thank you. Midlife >It's been a while since I've visited this NG, so I apologize if this >question is redundant. [quoted text clipped - 15 lines] >The more specific to Dr. Reiter, the better, but all input would be >appreciated. You might want to do a search on "Sancha" and "Dr. Te" in this newsgroup. Interesting stuff has been posted in the last month or two. Wow, 175 cc. I think you are the prostate king here. I am just at 150 cc. I am facing some of the same issues you are, so pls keep in touch and let us know what you find out and what success you have. Ed > It's been a while since I've visited this NG, so I apologize if this > question is redundant. [quoted text clipped - 19 lines] > > Midlife Your post reminded me of a Urology Times article by Dr. Reiter. Apparently well known in the PVP area. http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=155108&&pa geID=2 I have seen him mentioned in discussion groups as being an excellent Dr. Can I ask how large your prostate was when you were first diagnosed with BPH? Mine was 35grms when it was first checked in 1994 and 72grms prior to my PVP in July of last year. Derek. > It's been a while since I've visited this NG, so I apologize if this > question is redundant. [quoted text clipped - 24 lines] > > Midlife How do you guys find out the size of your prostate? I have been to three different URO's and have yet to be told the size of my prostate. Is this something the URO tells you or do you have to ask? Buford R >Can I ask how large your prostate was when you were first diagnosed with >BPH? Mine was 35grms when it was first checked in 1994 and 72grms prior to [quoted text clipped - 5 lines] >> >> Midlife The size is estimated from a transrectal ultrasound. A TRUS is done when you have a prostate biopsy, but probably can be done anytime the doc wants to. This is an imaging technique. A rough measure of the volume is determined from the dimensions. Don't take the number too seriously, it will vary. The uro can also estimate size by digital rectal examination, but that is even more approximate. Ed >How do you guys find out the size of your prostate? I have been to three >different URO's and have yet to be told the size of my prostate. Is this [quoted text clipped - 11 lines] >>> >>> Midlife The size can also be estimated via abdominal ultrasound (not as good as TRUS). Dr. Sancha explains this very nicely in his 12/11/05 post (5:08 AM)...Pete > The size is estimated from a transrectal ultrasound. A TRUS is done > when you have a prostate biopsy, but probably can be done anytime the [quoted text clipped - 22 lines] >>>> >>>> Midlife I had the TRUS done but never no mention of size. All I was told was I was a candidate for the PVP. As a matter of fact, before I had my second PVP, I had a follow up appointment with my URO that did the first one. He had me get a PSA before the visit. I specifically asked him if he had received my PSA results and his response was it was elevated but that is to be expected with the PVP plus he told me my PSA had a tendency to go up and down anyway. Never did find out what the reading was. I guess I am going to have to be more firm but some of them don't like it. Buford R >The size is estimated from a transrectal ultrasound. A TRUS is done >when you have a prostate biopsy, but probably can be done anytime the [quoted text clipped - 12 lines] >>>> >>>> Midlife > I had the TRUS done but never no mention of size. All I was told was > I was a candidate for the PVP. As a matter of fact, before I had my [quoted text clipped - 7 lines] > > Buford R Buford...you need to start getting copies of every test and procedure you have done. For lab tests like blood (and even pathology after a procedure ), you may either get them directly from the lab by presenting yourself and showing your ID, or you will always be able to get them from your doctors office for sure. I get copies of all my blood tests from my local lab (and most pathology stuff if it isn't farmed out). As far as procedures/surgeries, you should always get a copy of the doctors notes on the procedure afterwards. The next time you see him ask him for a copy or you can ask the girls up front. Some doc's these days are charging exorbitant reproduction costs (e.g. 50 cents per page or more), but most will give you copies without too much ado. And you're right, they may not like it. Another reason why I don't like them, like I have said so many times. In the U.S. we have the damn HIPPA laws which contain all kinds of bullshit about privacy, etc. And in there, it will also tell you that you have a right to get copies of everything in your medical file. Anyone who goes to a U.S. doctor will know about the HIPPA bullshit, since every doc is required to hand you a copy for his practice. I have a whole drawer full of them - lol ....Pete >> The size is estimated from a transrectal ultrasound. A TRUS is done >> when you have a prostate biopsy, but probably can be done anytime the [quoted text clipped - 13 lines] >>>>> >>>>> Midlife Thanks Pete, I will get to work on it and see how far I get. The last time I asked a lab for a report, I was told I would have to get it from the doctor. Buford R >> I had the TRUS done but never no mention of size. All I was told was >> I was a candidate for the PVP. As a matter of fact, before I had my [quoted text clipped - 29 lines] >>>>>> >>>>>> Midlife > Thanks Pete, I will get to work on it and see how far I get. The last > time I asked a lab for a report, I was told I would have to get it > from the doctor. Buford...that sounds like bullshit (but it could be true if that's what their policy is). You may want to ask a supervisor in the lab about what the policy is. I live in a small community (approx 35,000), and almost all bloodwork is taken by one laboratory (in several locations), and they will give you the results. They didn't used to, but started doing it about 2-3 years ago I believe. We can also get reports on all catscans and MRI's from the imaging center (and they will even give you a disc). But regardless of where you have to get them, I strongly recommend to you (and to everyone else) that you get a copy of every test and procedure that you have done. Take care...Pete > Buford R > [quoted text clipped - 34 lines] >>>>>>> >>>>>>> Midlife My URO did a TRUS before the TUMT was done. It is my practice to request copies of all office visit summaries and summaries of any tests that are done. I find it to be very helpful in understanding what was discussed during the office visit. I sometimes find information in the summaries or procedure reports that I failed to hear or understand during the office visit. My URO told me the size of the prostate and the written summary confirmed the findings. I highly recommend getting copies of all medical records. > How do you guys find out the size of your prostate? I have been to three > different URO's and have yet to be told the size of my prostate. Is this [quoted text clipped - 13 lines] >> >>>Midlife > My URO did a TRUS before the TUMT was done. It is my practice to > request copies of all office visit summaries and summaries of any [quoted text clipped - 4 lines] > of the prostate and the written summary confirmed the findings. I > highly recommend getting copies of all medical records. This is very true chockman...we have discussed this before. Most docotors won't tell you sh.t unless you specifiacally ask (and that includes tests you have to ask for also, like simple pvr's)...Pete >> How do you guys find out the size of your prostate? I have been to >> three different URO's and have yet to be told the size of my [quoted text clipped - 13 lines] >>> >>>> Midlife > How do you guys find out the size of your prostate? I have been to > three different URO's and have yet to be told the size of my > prostate. Is this something the URO tells you or do you have to ask? Buford...You usually have to ask. You also have to ask for tests and procedures sometimes. I had to ask for my last cystoscopy with uroflow, before my TURP last April. I always get nervous when I read somethings in the group here about what certain uro's say (except for our awesome Dr. Sancha). My basic experience is they don't tell you sh.t unless you ask...Pete > Buford R > [quoted text clipped - 7 lines] >>> >>> Midlife > Can I ask how large your prostate was when you were first diagnosed with > BPH? Mine was 35grms when it was first checked in 1994 and 72grms prior to > my PVP in July of last year. > Derek. The first time I recall a size being quoted it was around 70 or so. I know that's larger than most prostates where people have had symptoms I never had. Midlife, Your prostate is very big. It would usually be treated by an open prostatectomy. Open prostatectomy is a very effective operation, but it carries some risks that are significant, like bleeding, need for transfusions, incontinence, impotence and other surgical complications (wound infection, deep venous thrombosis and so on). It can usually be performed with safety, but the risks are real. PVP is better for smaller prostates, e.g. for a 60 gram prostate is a wonderful operation, as it takes little longer than an hour, and the tolerance of the procedure is excellent. It can also be used for bigger glands, but then the length of the operation is much longer, and the surgeon will need to use several laser fibres, which makes it a more expensive procedure. This way, a very wide cavity can be "carved" inside the prostate, and your symptoms will improve. To my knowledge, few surgeons are aggressive enough when treating large prostates like yours. I operated a man with a 200 gram prostate, and it took almost four hours in theatre and I used four laser fibres. He was left with a residual volume of about 100 grams, and he is very happy with the result. He empties his bladder completely and all his previous symptoms have dissapeared. I do not think a PVP using one fiber and one hour in theatre can be effective in such large prostates. I also advise my patients with very large prostates that a second stage could be necessary, although this is rare. I use a suprapubic trocar to enhance irrigation in patients with large prostates. This avoids having the bladder overdistended for such a long time and improves visibility. After using so much energy (up to 850.000 joules), my impression is that patients have more tendency to experience dysuria (dyscomfort when voiding) and episodes of blood in their urine. I recommend antiinflamatory drugs for dysuria if it happens and proscar (finasteride), as it reduces the chances of bleeding. So, for big prostates, it is a less ideal operation, but I have seen patients I operated almost three years ago and they are happy, they have a flow that is better than mine and they say they would choose it again. It is a safe way to deal with your problem, avoiding the risks of open prostatectomy, and it is imperative that the surgeon is both very experienced and aggressive. All the best, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com > Midlife, > [quoted text clipped - 49 lines] > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com Thank you Dr. Sancha. I have been following this board for five years or so, but the last year+ I have not been concerned by my symptoms, so I was not reading here. Your summary of things is extremely helpful and encouraging. What is happening now is that I have days when I don't need to urinate for 3 or 4 hours, and others when I will need to every hour or less. I can usually sleep through the night without being awakened to urinate (though my Uro has me waking myself up once to do so). When I wake in the morning I always can void two or three times within the first 30 minutes. My Uro says that the only explanation for that is excessive retention. Because I had an episode while in the hospital for an appendectomy, where my bladder became overly distended (1500cc accumulation due to poor monitoring) I have always thought that bladder viability might also be playing a part in my symptoms. But, either way, it would seem that full voiding is not going on and my prostate is undeniably more likely the problem. When I drink 24oz of water an hour prior to an ultrasound, it triggers symptoms much like when I first wake up, though with urgency that I don't feel normally. Last ultrasound saw 450cc retained, but I was able to urinate again immediately following the test. I am hoping Dr. Reiter will be able to put this all in perspective. My current Uro obviously does not have enough experience of faith in PVP and I do not want to take the risks of open surgery. |
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