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Medical Forum / Diseases and Disorders / Prostate BPH / February 2006What are the problems with Green Light Laser on a large prostate?
My uro tells me that my prostate is too big for the green light laser. He says that the laser only removes a millimeter of tissue at a time and that would take too long to do my prostate. He says I should have a TURP using the Gyrus device which removes more tissue. My uro says that doing my prostate which is 67 grams and removing 55 grams of tissue with a green light laser will leave layers of dead tissue inside the capsule. However, when I read other thread and some other uro's websites they seem to think they can handle prostates over 100grams, one did one of 250 grams with a good outcome. Is it true that the laser will leave necrotic tissue behind that will flak off and create problems after the surgery? > My uro tells me that my prostate is too big for the green light laser. He > says that the laser only removes a millimeter of tissue at a time and that [quoted text clipped - 9 lines] > Is it true that the laser will leave necrotic tissue behind that will flak > off and create problems after the surgery? Maybe someone else could comment on the removal of 55 grams out of 67. That sound like a huge amount. Is this for BPH? I got the impression here that 50 gram is ideal for using PVP for BPH problems and 100 and over would be large but still possible. Did you look at the video on Dr. Sancha's blog? He does a 100 gram one. http://drgomezsancha2.blogspot.com Does your doctor do PVP? If not I would talk to one that does it before doing anything more. Laserscope has a listing: http://www.laserscope.com/surgical/consumers/fad.php > My uro tells me that my prostate is too big for the green light laser. He > says that the laser only removes a millimeter of tissue at a time and that [quoted text clipped - 9 lines] > Is it true that the laser will leave necrotic tissue behind that will flak > off and create problems after the surgery? Hopefully Dr. Sancha will respond. You can look back to my 1/20/06 post and his response as well. My prostate is about 175cc (I've been told that's the same number in grams). Anyway, Dr. Sancha speaks of a 4 hour PVP, using 4-5 laser wires, but says it could be done. My own Uro won't even consider it. I have a consultation with Dr. Reiter, at UCLA, this week. He also has a reputation for large prostate PVP success. I'll post after seeing him. > > My uro tells me that my prostate is too big for the green light laser. He > > says that the laser only removes a millimeter of tissue at a time and that [quoted text clipped - 16 lines] > it. I have a consultation with Dr. Reiter, at UCLA, this week. He also has > a reputation for large prostate PVP success. I'll post after seeing him. In November of '05, after several years of trying every pill from Saw Palmetto, to Flomax, to Uroxatral, and stumbling through multiple visits to the bathroom every night, I finally realized that delaying the frightening thought of the TURP procedure was no longer possible. Than, quite by accident I happened across the Green Light laser through a newspaper article. My local urologist, who does not perform the Green Light, described the Green Light as "unproven" and assured me that other procedures ... microwave, TURP, were more effective. Desperate to avoid the TURP, I made calls until I located a urologist in a neighboring town who not only knew of the Green Light, but had done "dozens" of them with great success. I had the Green Light done a short time later and am delighted to report that my "twice the size of normal" prostate responded well, that my 3.9 PSA is now 2.3 and that my post-operative and recovery to date has been WITHOUT PAIN, without discomfort, and best of all, I now void about 90% and sleep the night through. Unless you have problems that absolutely preclude use of the Green Light, I would counsel you to not allow any uro to come near you with a TURP device. Bruce Ferguson > In November of '05, after several years of trying every pill from Saw > Palmetto, to Flomax, to Uroxatral, and stumbling through multiple [quoted text clipped - 14 lines] > absolutely preclude use of the Green Light, I would counsel you to not > allow any uro to come near you with a TURP device. Bruce Ferguson I am still puzzled by the doctor wanting to remove 55 grams of a 67 gram prostate. Could this be a treatment for something else? cancer? If so this is the wrong group. And I would be looking around to find out about the radioactive seed treatment. Three friends of mine have had that treatment in the past three years with excellent results. The "normal" prostate is said to be approx. 30 grams. Removing tissue below the "normal" level would seem to be excessive. My research does not mention use of the Green Light as a cancer tool, only an effective means of vaporizing the interior prostate tissue in order to relieve the pressure on the tube leading from the bladder and out into the world. Best advice is to ask your urologist why he feels it is necessary to remove so much tissue. If you don't care for his answer, see another urologist. My experience is that these guys are there to help where possible, but they have big office expenses and must do procedures in order to stay in business. In my own case my local uro down-played the Green Light in favor of pushing what he had available. Now, little more than two months after I was forced to search for help outside my town, the local hospital has contracted to acquire a Laserscope, making the procedure available to thousands more men. Based on my personal results I believe the Green Light is sure to become the gold standard for treating enlarged prostates and the dreaded TURP will become a thing of the past. Good riddance! Bruce Ferguson Is there really a tube? I thought someone posted that basically the urine passes through prostate in a channel, and that there is no separate tube. If there is a tube, how does the laser pass through the tube's wall to zap the protate tissue? >T My research does >not mention use of the Green Light as a cancer tool, only an effective >means of vaporizing the interior prostate tissue in order to relieve >the pressure on the tube leading from the bladder and out into the >world. > Is there really a tube? I thought someone posted that basically the > urine passes through prostate in a channel, and that there is no > separate tube. If there is a tube, how does the laser pass through the > tube's wall to zap the protate tissue? Nitwit...there is no separate tube. Re-read what I said on 2/7/06 (3:35pm) in the "PVP Question" thread. The prostate forms the prostatic urethra. I thought I explained it pretty good in my post...Pete >> T My research does >> not mention use of the Green Light as a cancer tool, only an >> effective means of vaporizing the interior prostate tissue in order >> to relieve the pressure on the tube leading from the bladder and out >> into the world. I don't need to reread it. I posted the question because I did remember it, and now there seems to be another view. I assume you believe your view is correct. I was just looking for further verification. >> Is there really a tube? I thought someone posted that basically the >> urine passes through prostate in a channel, and that there is no [quoted text clipped - 10 lines] >>> to relieve the pressure on the tube leading from the bladder and out >>> into the world. > I don't need to reread it. I posted the question because I did > remember it, and now there seems to be another view. The author of that other view (Bruce) made a misnomer. The prostate does not push on a tube. If it enlarges, it is merely closing off the channel that is running through it. The channel is not a separate tube, or pipe, or conduit, like a blood vessel. The prostate forms the channel. > I assume you believe your view is correct. I was just looking for > further verification. I do not believe I am correct. I am correct. This is simple anatomy 101. Just look at the pics on the wall of your uro's office. If you do image searches in google or wherever you may be mislead by some sort of "double line thickness for the urethra", but that is just for display purposes. Dr. Sancha can easily verify what I have said (ie, the prostate forms the prostatic urethra and there is no separate tube)...Pete >>> Is there really a tube? I thought someone posted that basically the >>> urine passes through prostate in a channel, and that there is no [quoted text clipped - 11 lines] >>>> to relieve the pressure on the tube leading from the bladder and >>>> out into the world. My uro is into TURP and uses laser to remove as much tissue as he can. He says that the TURP is the only way to go and will use Gyrus or Green Light to clean out the gland. He say he has many patients who had Green Light who come to him for follow up sugery-- Turp. I am not planning to use him. He says that retrograde ejaculations are to be expected from him procedure. I plan to contact Dr. Lin in St Augutine Florida who has done more than 200 Green Lights and a gland as large as 250 grams. My PSA is .9 so no cancer concern. >> In November of '05, after several years of trying every pill from Saw >> Palmetto, to Flomax, to Uroxatral, and stumbling through multiple [quoted text clipped - 8 lines] >out about the radioactive seed treatment. Three friends of mine have >had that treatment in the past three years with excellent results. It is amazing that with such a large prostate that your PSA is so low. Derek. > My uro is into TURP and uses laser to remove as much tissue as he can. > He [quoted text clipped - 23 lines] >>out about the radioactive seed treatment. Three friends of mine have >>had that treatment in the past three years with excellent results. Bill...You still haven't addressed Rich's comments (he mentioned it twice), as to why the uro wants to remove 55 grams of a 67 gram prostate - I too am very curious. Did you make a typo or what. Please explain...Pete > My uro is into TURP and uses laser to remove as much tissue as he > can. He says that the TURP is the only way to go and will use [quoted text clipped - 22 lines] >> out about the radioactive seed treatment. Three friends of mine have >> had that treatment in the past three years with excellent results. > My uro tells me that my prostate is too big for the green light laser. > He [quoted text clipped - 13 lines] > Is it true that the laser will leave necrotic tissue behind that will flak > off and create problems after the surgery? Have you looked at the Gyrus web site? I don't think from my research that there is a big difference between the procedures.Gyrus seems to give the surgeon more accuracy/control and is even more blood free. PVP here in the UK is not widely available and Gyrus even more difficult to find but at least two NHS hospitals have done hundreds of cases but have a 12 month waiting list. I went for PVP as I could get it done more quickly. If you do a Google search on this NG you should find at least two people who reported back on Gyrus. http://www.gyrusplc.com/case_urology.html Derek. Thanks, I have checked out the Gyrus site. I am not sure it offers more control. I know it allows the doc to take out more tisssue faster. It also involves more blood than green light. Since my uro is into getting as much of the gland out as he can he prefers Gyrus. I am going to get a second opinionl >> My uro tells me that my prostate is too big for the green light laser. >> He [quoted text clipped - 12 lines] >http://www.gyrusplc.com/case_urology.html >Derek. > Thanks, I have checked out the Gyrus site. I am not sure it offers more > control. I know it allows the doc to take out more tisssue faster. It > also involves more blood than green light. Since my uro is into getting as > much of the gland out as he can he prefers Gyrus. I am going to get a > second opinionl What puzzles me is why he wants to get so much out. It appears to me that all that is needed is clean out obstructive tissue. That is even illustrated in the Laserscope material. They show how the green light doesn't deeply penetrate. http://www.laserscope.com/surgical/professionals/physics.html >> Thanks, I have checked out the Gyrus site. I am not sure it offers more >> control. I know it allows the doc to take out more tisssue faster. It [quoted text clipped - 9 lines] > > http://www.laserscope.com/surgical/professionals/physics.html It is the deep parts of the prostate (the lateral and median lobes) that are causing the problem by pressing on the bladder so just opening up the urethra will not give complete relief. I had an excellent write up on the Gyrus procedure by Allan Eaton at Kings Lynn hospital in England where he had done over 200 at the time but it seems to have hidden itself deep in my computer. Derek. The urethra is the tube or duct that carries urine from the bladder through the penis and out into the world. Enlarged prostates squeeze the urethra, impeding the flow of urine, causing retention of urine in the bladder and creating a frequent, undeniable urge to urinate. In worst cases long term avoidance of corrective procedures can result in excessive retention of urine and can cause the bladder to become "lazy" losing its ability to squeeze. Call the urethra a channel or a conduit or a pipe, take your choice, whatever the name, its job is to conduct urine from bladder to ouside world. The essence of the need for any enlarged prostate procedure is to make it possible to void completely and eliminate the frequent feelings of urgency as well as those annoying multiple trips to the bathroom each night. The obvious reason TURP is pushed by most uro's is a combination of their med-school TURP training and the availability (or lack) of alternate equipment. Having friends who had endured the TURP with painful and long term recoveries, I chose to seek out a uro who was familiar with all of the available procedures and who, after personal experience in employing the lot, chose the Green Light as the procedure of choice. From the patient's (our) standpoint, aside from pain and suffering, there's also the matter of comparative cost. TURP involves hospitalization and costs thousands of dollars more than the Green Light ... not to mention the totally unacceptable discomfort (PAIN) and long term recovery. The Green Light procedure is brief, requires only overnight in hospital (some procedures are now being done in-office as out-patient). Given a choice, how many urologists in need of prostate reduction treatment do you suppose would personally choose TURP over the Green Light for themselves? Personally, three months post-op, I am very pleased at having undergone the Green Light procedure. An overnight stay in the hospital, a day or so of lounging about, then back to my ordinary pursuits. No Pain. No more pills. No more searching out restrooms in restaurants and theatres. No retrograde. No more getting up several times each night. Bruce Ferguson > The urethra is the tube or duct that carries urine from the bladder > through the penis and out into the world. Enlarged prostates squeeze > the urethra, impeding the flow of urine, Bruce...damn it there you go again. You have a complete misunderstanding of what the urethra is anatomically. Didn't you read what I wrote nitwit. The prostate does not squeeze the urethra. The urethra is not a tube or a duct or a pipe or anything that is like a blood vessel. For the fourth time now (including other threads in the past), the prostatic urethra is formed by the prostate, and the prostate therefore is the uretha (in a sense). When the prostate enlarges it is merely closing off the channel that it has formed (ie it is growing both outward and inward). I can't be much clearer than that...Pete causing retention of urine in > the bladder and creating a frequent, undeniable urge to urinate. In > worst cases long term avoidance of corrective procedures can result in [quoted text clipped - 26 lines] > retrograde. No more getting up several times each night. Bruce > Ferguson >> The urethra is the tube or duct that carries urine from the bladder >> through the penis and out into the world. Enlarged prostates squeeze [quoted text clipped - 10 lines] >merely closing off the channel that it has formed (ie it is growing both >outward and inward). I can't be much clearer than that...Pete I don't see any difference in that you guys are saying. Ed >>> The urethra is the tube or duct that carries urine from the bladder >>> through the penis and out into the world. Enlarged prostates squeeze [quoted text clipped - 15 lines] > > Ed Ed...you got to be kidding. Bruce, and nitwit, and others in the past have a misconception that the urethra is a separate entity like a blood vessel (with its own walls, etc), which is not the case. I can't believe you can't understand the conversations on this. I have explained it very clearly...Pete >>>> The urethra is the tube or duct that carries urine from the bladder >>>> through the penis and out into the world. Enlarged prostates squeeze [quoted text clipped - 19 lines] > understand the conversations on this. I have explained it very > clearly...Pete Pete, I think I have to go along with Ed on this one. Regardless of how you might think of the hole through the prostate is still called the urethra. When talking about the hole is being closed it is most descriptive to call it the urethra. >>>>> The urethra is the tube or duct that carries urine from the >>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 26 lines] > urethra. When talking about the hole is being closed it is most > descriptive to call it the urethra. Sorry guys...I disagree strongly on this. The prostate forms the prostatic urethra, and it is called the prostatic urethra. If you read what nitwit said, he was confused that it was a separate tube, and was asking how did the laser pass through the tubes wall. Dr. Sancha if you are reading this, please help me out here. I said it's equivalent to a hole in a bowling ball, and have given various other descriptive analogies, but it is not a separate entity, which some people perceive it to be...Pete >>>>>> The urethra is the tube or duct that carries urine from the >>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 33 lines] > ball, and have given various other descriptive analogies, but it is not a > separate entity, which some people perceive it to be...Pete I agree that there is no wall and your explanation is fine there. But what Bruce said about the urethra is perfectly acceptable. Urethra just happens to be a name applied to that duct. Many part of the body are similar. Take the heart for example. It's various parts have names but really they are all part of one massive structure. Makes it easier to refer to the left or right ventricles and atria than to try to explain which cavity you are referring to. >>>>>> The urethra is the tube or duct that carries urine from the >>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 34 lines] >ball, and have given various other descriptive analogies, but it is not a >separate entity, which some people perceive it to be...Pete Imagine if you will... some guy arguing till he's RED in the face, with people he doesn't know, about some TRIVIAL anatomic matter that he knows nothing about anyway... then resorting to NAME CALLING, as if that would clinch his argument... And the outcome of the argument makes NO DIFFERENCE to any of us... That is the true spirit of usenet!! Keep it up, guys!!! B. >>>>>>> The urethra is the tube or duct that carries urine from the >>>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 37 lines] > he knows nothing about anyway... then resorting to NAME CALLING, as if > that would clinch his argument... Pete isn't name calling!! nitwit is the guys email name. Took me a minute to realize that too. Sorry. Now Pete and I are both wrong. Best part is we're on the same side of a problem destined to plague vitually every man who lives long enough. Pete's heart in in the right place, but his sources of information could stand improvement. Bruce Ferguson > Sorry. Now Pete and I are both wrong. Best part is we're on the same > side of a problem destined to plague vitually every man who lives long > enough. Pete's heart in in the right place, but his sources of > information could stand improvement. Bruce Ferguson With Pete having so many ailments it's quite possible his heart is not in the right place :-) Derek. >> Sorry. Now Pete and I are both wrong. Best part is we're on the same >> side of a problem destined to plague vitually every man who lives [quoted text clipped - 4 lines] > not in the right place :-) > Derek. Thanks a lot Derek. I resemble that - lol ...Pete >>>>>>>> The urethra is the tube or duct that carries urine from the >>>>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 41 lines] > Pete isn't name calling!! nitwit is the guys email name. Took me a > minute to realize that too. Thanks Rich...And I understand what you said about the heart. This same line of thinking can apply (in a sense) to the nasal passages, ear canal, anal canal etc. I should not have let this get out of hand...Pete This may help to clarify. Sorry (a bit) about the binary post. Chuck I might as well post the text that went with the illustration. " 3b. 4. The Male Urethra (Urethra Virilis) The male urethra (Fig. 1142) extends from the internal urethral orifice in the urinary bladder to the external urethral orifice at the end of the penis. It presents a double curve in the ordinary relaxed state of the penis (Fig. 1137). Its length varies from 17.5 to 20 cm.; and it is divided into three portions, the prostatic, membranous, and cavernous, the structure and relations of which are essentially different. Except during the passage of the urine or semen, the greater part of the urethral canal is a mere transverse cleft or slit, with its upper and under surfaces in contact; at the external orifice the slit is vertical, in the membranous portion irregular or stellate, and in the prostatic portion somewhat arched. The prostatic portion (pars prostatica), the widest and most dilatable part of the canal, is about 3 cm. long, It runs almost vertically through the prostate from its base to its apex, lying nearer its anterior than its posterior surface; the form of the canal is spindle-shaped, being wider in the middle than at either extremity, and narrowest below, where it joins the membranous portion. A transverse section of the canal as it lies in the prostate is horse-shoe-shaped, with the convexity directed forward. Upon the posterior wall or floor is a narrow longitudinal ridge, the urethral crest (verumontanum), formed by an elevation of the mucous membrane and its subjacent tissue. It is from 15 to 17 mm. in length, and about 3 mm. in height, and contains, according to Kobelt, muscular and erectile tissue. When distended, it may serve to prevent the passage of the semen backward into the bladder. On either side of the crest is a slightly depressed fossa, the prostatic sinus, the floor of which is perforated by numerous apertures, the orifices of the prostatic ducts from the lateral lobes of the prostate; the ducts of the middle lobe open behind the crest. At the forepart of the urethral crest, below its summit, is a median elevation, the colliculus seminalis, upon or within the margins of which are the orifices of the prostatic utricle and the slit-like openings of the ejaculatory ducts. The prostatic utricle (sinus pocularis) forms a cul-de-sac about 6 mm. long, which runs upward and backward in the substance of the prostate behind the middle lobe. Its walls are composed of fibrous tissue, muscular fibers, and mucous membrane, and numerous small glands open on its inner surface. It was called by Weber the uterus masculinus, from its being developed from the united lower ends of the atrophied Müllerian ducts, and therefore homologous with the uterus and vagina in the female. The membranous portion (pars membranacea) is the shortest, least dilatable, and, with the exception of the external orifice, the narrowest part of the canal. It extends downward and forward, with a slight anterior concavity, between the apex of the prostate and the bulb of the urethra, perforating the urogenital diaphragm about 2.5 cm. below and behind the pubic symphysis. The hinder part of the urethral bulb lies in apposition with the inferior fascia of the urogenital diaphragm, but its upper portion diverges somewhat from this fascia: the anterior wall of the membranous urethra is thus prolonged for a short distance in front of the urogenital diaphragm; it measures about 2 cm. in length, while the posterior wall which is between the two fasciæ of the diaphragm is only 1.25 cm. long. The membranous portion of the urethra is completely surrounded by the fibers of the Sphincter urethræ membranaceæ. In front of it the deep dorsal vein of the penis enters the pelvis between the transverse ligament of the pelvis and the arcuate pubic ligament; on either side near its termination are the bulbourethral glands. The cavernous portion (pars cavernosa; penile or spongy portion) is the longest part of the urethra, and is contained in the corpus cavernosum urethræ. It is about 15 cm. long, and extends from the termination of the membranous portion to the external urethral orifice. Commencing below the inferior fascia of the urogenital diaphragm it passes forward and upward to the front of the symphysis pubis; and then, in the flaccid condition of the penis, it bends downward and forward. It is narrow, and of uniform size in the body of the penis, measuring about 6 mm. in diameter; it is dilated behind, within the bulb, and again anteriorly within the glans penis, where it forms the fossa navicularis urethræ. The external urethral orifice (orificium urethræ externum; meatus urinarius) is the most contracted part of the urethra; it is a vertical slit, about 6 mm. long, bounded on either side by two small labia. The lining membrane of the urethra, especially on the floor of the cavernous portion, presents the orifices of numerous mucous glands and follicles situated in the submucous tissue, and named the urethral glands (Littré). Besides these there are a number of small pit-like recesses, or lacunæ, of varying sizes. Their orifices are directed forward, so that they may easily intercept the point of a catheter in its passage along the canal. One of these lacunæ, larger than the rest, is situated on the upper surface of the fossa navicularis; it is called the lacuna magna. The bulbo-urethral glands open into the cavernous portion about 2.5 cm. in front of the inferior fascia of the urogenital diaphragm. Structure.The urethra is composed of mucous membrane, supported by a submucous tissue which connects it with the various structures through which it passes. The mucous coat forms part of the genito-urinary mucous membrane. It is continuous with the mucous membrane of the bladder, ureters, and kidneys; externally, with the integument covering the glans penis; and is prolonged into the ducts of the glands which open into the urethra, viz., the bulbo-urethral glands and the prostate; and into the ductus deferentes and vesiculæ seminales, through the ejaculatory ducts. In the cavernous and membranous portions the mucous membrane is arranged in longitudinal folds when the tube is empty. Small papillæ are found upon it, near the external urethral orifice; its epithelial lining is of the columnar variety except near the external orifice, where it is squamous and stratified. The submucous tissue consists of a vascular erectile layer; outside this is a layer of unstriped muscular fibers, arranged, in a circular direction, which separates the mucous membrane and submucous tissue from the tissue of the corpus cavernosum urethræ. " From http://education.yahoo.com/reference/gray/subjects/subject?id=256 Chuck >>>>>>> The urethra is the tube or duct that carries urine from the >>>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 40 lines] > he knows nothing about anyway... then resorting to NAME CALLING, as if > that would clinch his argument... Beauregard...you don't know what *you* are talking about. I have always been very polite in this newsgroup and have thanked many people many times (esp Dr. Sancha repeatedly). I have not done any namecalling whatsoever. I assume you are referring to the name "nitwit" I used. If you are so damn smart you would have seen that "nitwit" was the persons handle, or logo, or address name. I was merely referring to his posts by the name he presented. I believe you owe me an apology for falsely accusing me of name calling, as I did not. Also, I see this is your first post in here (going back to August 2005), so you are not a regular in here, and have no right jumping in and making false accusations. If you want to see some name calling write back some more false attacks...Pete > And the outcome of the argument makes NO DIFFERENCE to any of us... > [quoted text clipped - 4 lines] > *** Encrypt your Internet usage with a free VPN account from > http://www.SecureIX.com *** >>>>>> The urethra is the tube or duct that carries urine from the >>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 35 lines] > analogies, but it is not a separate entity, which some people perceive it > to be...Pete I love that comparison to the hole in the bowling ball ! Derek. >>>> The urethra is the tube or duct that carries urine from the bladder >>>> through the penis and out into the world. Enlarged prostates squeeze [quoted text clipped - 21 lines] >understand the conversations on this. I have explained it very >clearly...Pete Reminds me of the time I heard some little girls arguing in their back yard. This kid said, "That's not a bird, that's a robin!" Ed >>>> The urethra is the tube or duct that carries urine from the bladder >>>> through the penis and out into the world. Enlarged prostates squeeze [quoted text clipped - 21 lines] > you can't understand the conversations on this. I have explained it very > clearly...Pete Pete, what do YOU you then call the the part of your anatomy below the prostate that urine comes down from the bladder if not the urethra ? Wikopedia he say:- In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes, to pass urine to the outside, and also a reproductive function in the male, as a passage for sperm. The external urethral sphincter is a striated smooth muscle that allows voluntary control over urination. And for a picture see http://en.wikipedia.org/wiki/Urethra Derek. >>>>> The urethra is the tube or duct that carries urine from the >>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 38 lines] > > Derek. Come on Derek. You know what I meant - I always write very specific. It is not a separate entity or organ (if you wish), like a blood vessel or one of the intestines. I have already said several times there were other "canals" in the body with similar features. And to hell with the wikipedia definition - I do not consider it to be a tube and believe that is a poor choice of words (so please don't come back and quote me that a tube is synonymous with a duct or channel, as well as other words). IMO the urethra is a channel formed by the bladder neck, the prostate, and the penis (and if you want to get really detailed you have to read the post from Chuck Lurker). I thought we were killing this, but you had to dig at me one more time...Pete >>>>>> The urethra is the tube or duct that carries urine from the >>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 50 lines] >Lurker). I thought we were killing this, but you had to dig at me one more >time...Pete The prostatic urethra is not made of prostste tissue. It is made of a mucous coat. This same mucous layer runs the entire length of the urethra, and furthermore goes into the bladder as well.. and on into the kidneys. When a TURP or PVP is done, the uro and his tools remove this mucous membrane along with the prostatic tissue. At that point, after the TURP or PVP, you DO have bare prostatic tissue forming the channel that has been formed, until the mucuous coat grows back. Ed >>>>>>> The urethra is the tube or duct that carries urine from the >>>>>>> bladder through the penis and out into the world. Enlarged [quoted text clipped - 63 lines] > > Ed Acknowledged Ed...almost every internal organ that forms a cavity or canal is lined with a protective mucous membrane, or mucosa. If it wasn't for the mucosa in your stomach, the acid in your stomach would literally eat your stomach up :-) ...Pete Pete: Perhaps we can agree the prostate is the cause of our mutual difficulty. That being the case we might also agree one must do something to deal with the blockage of urine flow caused by a swollen prostate. Since you appear to be an impatient man determined to ignore descriptions and explanations offered by professionals who deal with prostate problems on a daily basis, may I suggest you consult phoenix5.org.glossary/urethra. There you will not only find a cogent (that means clear) explanation, you will also find a diagram illustrating the urethra and the path it takes from bladder through penis. If you find the explanation and diagram confusing, ask your grandson or some other person having a normal IQ to explain it to you. Bruce Ferguson phd nitwit. Now kids , lets not fight. > Pete: Perhaps we can agree the prostate is the cause of our mutual > difficulty. That being the case we might also agree one must do [quoted text clipped - 8 lines] > grandson or some other person having a normal IQ to explain it to you. > Bruce Ferguson phd nitwit. > Pete: Perhaps we can agree the prostate is the cause of our mutual > difficulty. That being the case we might also agree one must do [quoted text clipped - 8 lines] > grandson or some other person having a normal IQ to explain it to you. > Bruce Ferguson phd nitwit. Bruce...I know what the prostatic urethra looks like from both pictures and videos and I could not find your site above in Firefox (not worth my time checking it in IE). And I don't know where your coming off with your sarcasm about my ignoring descriptions and explanations offered by professionals. And "nitwit" was the persons e-mail address he gave, and I was not insulting anyone. This has been acknowledged already. There are many orifices in the body that are similar in a sense to what we are talking about, and it has gotten out of hand. I was just trying to explain to "nitwit" (remember that's his name) that the urethra wasn't a separate tube with its own walls (excuuuuse me). Pete: Truce. Let's all agree the prostate problem we face is one of man's meanest since the rascal is located so deep within that its tough to deal with. Now that Green Light is coming on, TURP practioners are going to have to update themselves or face empty waiting rooms. We have only three uros in my community, none of whom push anything other than pills and TURP or micro. While I was waiting in the office of one of them (a TURP specialist) a few years ago the doctor came into the room. I was startled to hear an older gentleman address him with "Hello Doctor, have you killed anybody today?" Although I've heard of no deaths by TURP, I have heard many horror stories of pain and suffering combined with too-long recovery periods. Perhaps the Green Light is just another improvement along the way, but I'm grateful to have found it and have an abiding sorrow for any man who undergoes other procedures without at first checking to determine if he is an appropriate candidate for Green Light. Kindest regards to you, Pete. Bruce Ferguson > Pete: Truce. Let's all agree the prostate problem we face is one of > man's meanest since the rascal is located so deep within that its [quoted text clipped - 12 lines] > to determine if he is an appropriate candidate for Green Light. > Kindest regards to you, Pete. Bruce Ferguson Thanks Bruce...no hard feelings whatsoever, and I appreciate your kind response. I have had a TUIP in 1995 and TURP last April/05 (that just exacerbated my chronic prostatitis - I was in bad shape for three months). My problems go way beyond BPH, and I do not consider myself a well person or a happy camper. I also live in a small community and all the uro's (five of them plus the PA) are in one room (its a friggin factory). And they don't even know what a PVP is (I asked the surgeon who snuck the TURP in on me when I was under - he was just supposed to remove some scar tissue from the TUIP - lol). I think that is pretty poor that they haven't even read about PVP in their damn journals - oh well. Take care :-) ...Pete Pete: Somewhere in a larger city near you is a uro or a uro clinic having people on staff who could very likely provide the relief you sought when you went through the TURP and other bodily outrages at the hands of local uro's. I was a turn-a-round specialist for businesses in real life (before retirement) and I was always amused when asking executives of businesses why they did certain things certain ways. Their reply was invariably "Because we always did it that way." Such is the attitude of many urologists. They learned to do the TURP in college and have done them throughout their careers, paying little time or attention to advancements like the Green Light. Part of it has to do with cash flow. Part has to do with stubborness and part with laziness. The end result is that many patients suffer from what I see as gross mistreatment and criminally poor medicine. Every patient has the right to expect his physician to at the very least be acquainted with the latest procedures. If the physician chooses not to employ newer techniques or procedures, he should refer the questioning patient to someone who does. Patients are not property. Territorial rights do not apply. Referral is a responsibility, not an option. Any good mechanic arms himself with the latest tools. Should we expect any less from a urologist? It snowed here today. Thanks to my having had the Green Light procedure, I could have written my name in the snow. I wish the same for you. Bruce Ferguson > Pete: Somewhere in a larger city near you is a uro or a uro clinic > having people on staff who could very likely provide the relief you [quoted text clipped - 18 lines] > my having had the Green Light procedure, I could have written my name > in the snow. I wish the same for you. Bruce Ferguson Thanks Bruce...I understand all that and agree with you. I hate to sound like a tape recorder but I have been to an inordinate amount of doctors in my life and I do not like them in general. I do not have a large prostate (I had stricture problems from scar tissue from the previous TUIP, and the damn uro wasn't even supposed to do a TURP like I said). My problems are more prostatitis related than BPH related, although I believe there is across over that I have talked about in here many times. I know where all the doc's are that do PVP's in the adjacent cities . If you recall I live by myself and don't have anyone to help me except one person and its difficult at best. Take care...Pete Pete: Any physician calling himself a urologist who is not at least familiar with the Green Light and who does not discuss same with any patient facing TURP or similar procedures should not be practicing. Every patient deserves to know his alternatives and it's the physician's responsibility to describe them. If the patient indicates an interest in a procedure not offered by the attending uro, the uro should refer the patient to another uro or clinic. The only problem I can cite with the Green Light is that Laserscope has very poor publicity to the general public. They need to hire a good public relations outfit to spread the word in the same manner that pharmaceutical outfits fill TV ad schedules. That will drive patients to uro's for information about non-TURP procedures. A chart showing the comparative costs and patient recovery time of Green Light vs the rest would help greatly. I respect physicians for their education and experience but I insist on the right to be fully informed about my condition and alternatives in order that I may make my own decisions. It's my life and my body. Bruce Ferguson Unfortunately the prices even depend on which state/country the doctor lives in. The obstetricians are being driven out of Nevada and Wyoming because of the outrageous insurance fees (outrageous awards by juries on medical cases). A short time ago I saw a female lawyer on TV complaining that her Obstetrician dropped her as a patient. The doctor responded that in the morning of a particular day she was in court calling him a quack and then was complaining in the afternoon that he was late for her appointment. Obviously the case against PVP is the initial cost of the unit. The doctors in rural communities don't have the quantity of patients to justify the cost. Most "country doctors" will send you off to the big city for operations. Just happened to come across a photo that mentions my URO. http://www.porterhospital.org/index.php?s=optional_2 $1.2 million for just the equipment takes a bunch of patients to get paid off. I also see it as a problem of hospitals within a city trying to stay ahead of the others. Not long ago it was the MRI machines. In our youth the doctors big expense was his office and a couple instruments. The hospital's only expensive equipment was an xray machine. > Pete: Any physician calling himself a urologist who is not at least > familiar with the Green Light and who does not discuss same with any [quoted text clipped - 13 lines] > condition and alternatives in order that I may make my own decisions. > It's my life and my body. Bruce Ferguson > Unfortunately the prices even depend on which state/country the doctor > lives in. The obstetricians are being driven out of Nevada and [quoted text clipped - 11 lines] > > Just happened to come across a photo that mentions my URO. Rich...boy, aren't you the lucky one :-):-) . I'm not sure if I would want a robot to operate on me :-) ...Pete > http://www.porterhospital.org/index.php?s=optional_2 > [quoted text clipped - 25 lines] >> informed about my condition and alternatives in order that I may >> make my own decisions. It's my life and my body. Bruce Ferguson >> Unfortunately the prices even depend on which state/country the doctor >> lives in. The obstetricians are being driven out of Nevada and [quoted text clipped - 14 lines] > Rich...boy, aren't you the lucky one :-):-) . I'm not sure if I would want a > robot to operate on me :-) ...Pete Better than a Frank Burns :-) I had sinus surgery about five years ago. It took me a long time to find a doctor I trusted to cut that close to my brain. Fortunately I had found the sinus group and asked what "Endoscopic Sinus Surgery" was. The first guy to respond said to find a really good doctor. He had it done three years previous and was learning to walk and talk again!! The second contact said his sister had it done and they had to open her skull and go in behind the eyeballs to fix what the surgeon had done. That might be an area where a robot would be an excellent choice. Working with the prostate doesn't worry me quite as much. >>> Unfortunately the prices even depend on which state/country the >>> doctor lives in. The obstetricians are being driven out of Nevada [quoted text clipped - 28 lines] > > Working with the prostate doesn't worry me quite as much. Gotcha. I wonder how many people picked up on the "Frank Burns". Very clever. But "Hawkeye" would probably be okay :-) ...Pete > Pete: Any physician calling himself a urologist who is not at least > familiar with the Green Light and who does not discuss same with any [quoted text clipped - 13 lines] > condition and alternatives in order that I may make my own decisions. > It's my life and my body. Bruce Ferguson Bruce, you seem to be pretty opinionated (not that I am not), and obviously have feelings similar to mine regarding a uro not knowing what a PVP was. It looks like you are relatively new here, other than a couple posts you made back in October/05, one in January, and now the recent discussions over the dreaded urethra. I expressed a concern about the uro who did my TURP not knowing about a PVP back in December/05 and thought it was piss poor, that I know what a PVP was and he did not. The thread was titled "Question for Dr. Sanchez", dtd 12/11/05. The person who wrote the thread misspelled his name, it's Dr. Sancha, and he is one of the rare breed of kind and caring doctors IMO, as well as being extremely knowledgeable, and I am sure he is one of the top PVP surgeons on the planet. May I request that you read his response to my concern about a uro not knowing what a PVP was (and why didn't he at least read about it in his journals, etc). Dr. Sancha's response was dtd 12/18/05 (3:36 AM) in the thread I mentioned above. He was being very diplomatic in his defense for certain doctors who might not be aware of the latest procedures (even though I did cite that PVP had been around a while now). Please read what he said, or reread it if you already have read it a couple of months ago, and don't remember it. I don't like doctors in general, and have said that repeatedly in this group (and have given my reasons), but I have a great deal of respect for Dr. Sancha, and wish he was my uro, as I have said many times. I have saved all of his posts to my hard drive, and I hope he stays with the group as long as he can. He is a very busy doctor, but still finds time to comment in the ng, which is remarkable. Pete >>> Thanks, I have checked out the Gyrus site. I am not sure it offers >>> more control. I know it allows the doc to take out more tisssue [quoted text clipped - 16 lines] > but it seems to have hidden itself deep in my computer. > Derek. Keep looking for it Derek, and let us know when you find it :-) ...Pete My uro explained his thinking to me. He believes in TURPS, what he believes is that all the tissue needs to be removed. When he used the green light and the technican told him he had a good opening, my uro went in with his Gryus and removed more tissue. He says most doc don't know how to to do a good turp. I don't plan on using him. >> Thanks, I have checked out the Gyrus site. I am not sure it offers more >> control. I know it allows the doc to take out more tisssue faster. It [quoted text clipped - 8 lines] > >http://www.laserscope.com/surgical/professionals/physics.html Perhaps you have already seen this article from the May 2002, Urology Times. http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=18965 There appears to be quite a wide range of results experienced by those on this site. However, most all are quite satisfied compared to those that had TURP. Those with less than satisfactory may be due to very large prostates or inexperienced doctors. And as Dr. Sancha said, find someone who had done at least 100 PVP. Even the Holmium laser gets better press than TURP: http://www.urologytimes.com/urologytimes/article/articleDetail.jsp?id=132772 > My uro explained his thinking to me. He believes in TURPS, what he believes > is that all the tissue needs to be removed. When he used the green light and [quoted text clipped - 13 lines] >> >> http://www.laserscope.com/surgical/professionals/physics.html > My uro explained his thinking to me. He believes in TURPS, what he > believes is that all the tissue needs to be removed. When he used > the green light and the technican told him he had a good opening, my > uro went in with his Gryus and removed more tissue. He says most doc > don't know how to to do a good turp. I don't plan on using him. Bill...this guy sounds like a quack. If you don't have cancer, I don't see why he would want to remove most of your prostate (ie 55 out of 65 grams as stated in your OP), and if you did have cancer I would assume the vehicle would be open prostatectomy. But I'm not a doctor :-) ...Pete >>> Thanks, I have checked out the Gyrus site. I am not sure it offers >>> more control. I know it allows the doc to take out more tisssue [quoted text clipped - 8 lines] >> >> http://www.laserscope.com/surgical/professionals/physics.html Pete, he is not a quack, but he sure as hell believe in TURPS. No cancer here and I will see a uro who has few hundred lasers in his experience before I get anything done; >> My uro explained his thinking to me. He believes in TURPS, what he >> believes is that all the tissue needs to be removed. When he used [quoted text clipped - 12 lines] >>> >>> http://www.laserscope.com/surgical/professionals/physics.html > Pete, he is not a quack, but he sure as hell believe in TURPS. No cancer > here and I will see a uro who has few hundred lasers in his experience before > I get anything done; One that has done a few hundred may be hard to find. A year ago my uro had done about 50. When I talked to him in September he had done over 100 & he said all were very successful. So maybe I go for it this summer. I made the mistake of trying the TUMT last year. He had done more than 500 of them and claimed an 80% satisfaction rate. It was some help but not what I hoped. I will talk to him again next month. |
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