 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate BPH / February 2006PVP on alarge prostate - Another view
A couple of days ago I posted (in the continuing large prostate thread) that I was going for a consult at Clark Urology Center @ UCLA, with Dr. Robert Reiter, who has been mentioned in this group. My prostate is 170gms or so. I had a TUMT about 4 years ago. TURP has not been suggested by either my current Uro or Dr. Reiter. While Dr. Reiter has done successful PVPs on prostates as large as mine, his opinion is that the best course of action is an open prostatectomy, in which all but the prostate capsule is removed surgically. Here's the interesting part, at least in relation to what I think I've been reading over the past couple of years: Dr. Reiter has concluded that the adverse risks of an Open Prostatectomy are actually of less concern than with a PVP He finds Retograde in about 70% of patients with either procedure. He finds Incontinence in less than 1% of patients with either procedure. With PVP (on such a large prostate) he feels there is likely to be prolonged bleeding (up to 8 weeks or so); treatable, but not a major issue with the OP. His basic conclusion is that PVP, on a large prostate, is indicated with older, less healthy patients, who might not tolerate invasive surgery. I am 62 and otherwise very healthy. With 20+ years of life expectancy, Dr. Reiter is recommending Open Prostatectomy. This wasn't exactly what I expected to hear, but it makes sense, given his experience with side effects. Hi Midlife, Interesting. Have you considered getting a second opinion? I assume you live in Southern California (as I do), and the two top PVP doctors that I know of around here are Dr. Reiter in L.A., and Dr. Laub in Santa Barbara. Dr Laub has done even more PVP's than Dr. Reiter, I believe. It would be interesting to hear what he has to say. Let us know what happens. Bruce > Hi Midlife, > [quoted text clipped - 6 lines] > > Bruce I have read about Dr. Laub here as well. Dr. Reiter WAS a second opinion. My regular Uro (in Orange County) is a good doctor and has been treating me for 8 years or so (did my TUMT). But....... I had to tell him about PVP and he has only done a few two years later, so he had no faith at all in the possibility of it working on a 170g prostate. His recommendation was for Open Prostatectomy, but I didn't feel comfortable taking the word of a doctor who is not thoroughly familiar with PVP. Is your comment just general.... or do you have reason to believe Dr. Laub has a different view of the possible risk %s associated with the two methods? Thanks. I don't have any particular reason to think that Dr. Laub would see it differently. For myself, I just try to get as much input as I can before I make decisions like this. This is probably a good trait to have, but to be honest, I sometimes drive myself crazy trying to weigh and analyze all the options. Bruce Open prostatectomy is a good option for a prostate as big as yours. The results of open prostatectomy are excellent in big prostates, but it entails a higher risk than PVP. There is risk of incontinence, of erectile dysfunction, of significant bleeding that might require transfusion, and you will need a catheter for five days. If you are not transfused, you will likely be anemic and will need to recover over a long period of time. PVP will remove much less tissue than an open prostatectomy, it will take longer in theatre (up to three hours or more) and will need several laser fibres if it is to be effective (3 or 4 in my experience). But it will be safer. I have happy patients after PVP with prostates up to 200 grams. But the biology of these prostates is to continue growing and there is a lot of tissue left in place. (the 200 gram prostate patient had a residual volume of approximately 100 grams). An alternative is to try to do a two staged operation, e.g. a first PVP and then a second PVP some weeks later, to remove as much hyperplastic tissue as possible. I always mention this possibility to patients with huge prostates, but they usually feel better after the first operation and decline to have a second stage. It is true that patients with huge prostates like yours tend to bleed on an off during the first six weeks and tend to have a worse postoperative recovery (more discomfort) than patients with prostates under 70 grams, but there are no transfusions, no risk of impotence, no other significant complications. I have seen wonderful results after open prostatectomy, but i have also seen a man receiving 24 units of blood during an open prostatectomy, another man having a cardiac arrest in theatre, incontinent patients and so on and this would have not happened with PVP. I understand why Dr. Reiter reached that conclusion, PVP in such big prostates is a lengthy procedure, and one feels that BPH tissue is being left in place, so it might regrow. And on the other hand, if you do not experience serious side effects of open prostatectomy the chances are you will be cured forever. You have to decide what risks are more acceptable for you. The potentially serious side effects of open prostatectomy in exchange for a good and long lasting result or the less aggressive PVP with a less predictable result after the first stage. By the way, never go for a one-hour PVP with one-laser-fiber with such a big prostate. The only chance of getting a good functional result after PVP is a very aggressive and very experienced PVP surgeon. Fernando Gomez Sancha http://drgomezsancha2.blogspot.com > A couple of days ago I posted (in the continuing large prostate > thread) that I was going for a consult at Clark Urology Center @ [quoted text clipped - 21 lines] > This wasn't exactly what I expected to hear, but it makes sense, > given his experience with side effects. Midlife...I am curious about something. When you went to Dr. Reiter (for your second opinion as stated in your next post), I assume he just did a digital exam and maybe an ultrasound. And then he told you about his recommendation for open prostatectomy. If you were to follow up on that, would he have to do a cysto on you first or would he just go ahead and schedule the surgery based on your estimated prostate size and your symptoms. I would think he would do a cysto first, but dunno :-) ...Pete >> A couple of days ago I posted (in the continuing large prostate >> thread) that I was going for a consult at Clark Urology Center @ [quoted text clipped - 29 lines] > schedule the surgery based on your estimated prostate size and your > symptoms. I would think he would do a cysto first, but dunno :-) ...Pete I have an 8+ year history with a Uro and he forwarded the essentials of my record to Dr. Reiter for the consult. I presume the results of previous exams were included, but what Dr. Reiter did was only a flow test and an ultrasound for urine retention. I had a rectal a month ago and have had a number of cystos and 16-point biopsies, as well as numerous ultrasounds over those years. What Dr. Reiter would do if I were to schedule a surgery with him wasn't something we discussed at this point. One additional fact- I've had a history of urinary infections (maybe 2 per year, and it is now treated with a daily dose of Septra. From all that, Dr. Reiter concluded that my problem is really a bladder problem, and opening the pathway through the prostate is essential to improving flow and reducing retention. BTW, for those interested, I've had consistent PSa in the low 9's for years. Biopsies have all been negative, and the conclusion is the high PSA is a function of prostate size. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.