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Medical Forum / Diseases and Disorders / Prostate BPH / February 2006Tests for blockages after PVP
Yesterday, I visited Dr. Lin because I was still having flow problems from my second PVP. He injected me with some sort of deadening which I assume was lidocaine and then started a series of inserting some sort of metal rod down my penis. He would pull out the first rod and insert another one, with each one getting larger each time. He either inserted a series of four or five of those rods. Anyone ever had anything like this. If so, what is the procedure called? It was painful and I don't want it again. He said when he finished that my channel was clear and maybe that cured the problem. He wanted an update from me in 2 weeks. You just had what's called a 'dilation' procedure, Buford, to open up any restrictions in the channel. Dr Lin did the same to me about a month after my PVP when my stream had slowed--he thought it might be scar tissue or adhesions, but the procedure cleared it up. (First time I had it done about 15 years ago, no lidocane, and the rods were hard, cold metal, not the flexible type used these days.) Hope all clears up for you. Vince  Signature"Some men see things as they are and say 'Why?' I dream of things that never were and say 'Why not?'" --George Bernard Shaw > Yesterday, I visited Dr. Lin because I was still having flow problems from > my [quoted text clipped - 10 lines] > that my channel was clear and maybe that cured the problem. He wanted an > update from me in 2 weeks. Thank you Vince. I was really hurting when he finished and I forgot to ask what exactly the procedure was called. >You just had what's called a 'dilation' procedure, Buford, to open up any >restrictions in the channel. Dr Lin did the same to me about a month after [quoted text clipped - 12 lines] >> that my channel was clear and maybe that cured the problem. He wanted an >> update from me in 2 weeks. > You just had what's called a 'dilation' procedure, Buford, to open up > any restrictions in the channel. Dr Lin did the same to me about a > month after my PVP when my stream had slowed--he thought it might be > scar tissue or adhesions, but the procedure cleared it up. (First > time I had it done about 15 years ago, no lidocane, and the rods were > hard, cold metal, not the flexible type used these days.) Vince and Buford...I have pasted the following from http://www.laserurology.com/faq.html, by Dr. Lin. ------------------------------------------------------------------------------------------ Q: It's been 6 weeks following my Greenlight PVP procedure and I am still having difficulty urinating. In fact, it's worse than before. What is going on? A: You likely have developed scar tissue in the urethra or bladder neck. The incidence is about 5% with Greenlight PVP. The is easily corrected with either a simple dilation procedure in the office or vaporization of the scar using Greenlight PVP as an outpatient. ------------------------------------------------------------------------------------------- I have read about the dilation procedure before. As a matter of fact I had it done when I was a very young man (approx 20 years old) almost 40 years ago - nothing to do with BPH - boy it hurt like a son of a bitch :-) . But I do not see how dilation will permanently solve the PVP problem if it is caused by scar tissue. It seems to me like it will enlarge the urethral opening temporarily, but I don't see how it will remove the scar tissue, or solve the problem if it is being caused by scar tissue. In other words the dilation will stretch the tissue and muscles so to speak. So what is to prevent it from going back to its original shape shortly thereafter. Dr. Sancha if you are reading this please comment. I am very interested in this. Thanks...Pete > Hope all clears up for you. > [quoted text clipped - 18 lines] >> Message posted via MedKB.com >> http://www.medkb.com/Uwe/Forums.aspx/prostate-bhp/200602/1 Thanks Pete. Again, I do not "think" this is my problem since this is my second PVP and had the same issues with the first one. Got to be something else, I would think. Buford R >> You just had what's called a 'dilation' procedure, Buford, to open up >> any restrictions in the channel. Dr Lin did the same to me about a [quoted text clipped - 18 lines] >>> finished that my channel was clear and maybe that cured the problem. >>> He wanted an update from me in 2 weeks. Buford...As I have said before my heart is with you, and I have been (and remain) concerned about your situation. Could you ask Dr. Lin about my questions about the dilation the next time you see him (or perhaps you could e-mail him - you said he answers his patients e-mails right away). I hope Dr. Sancha responds to my inquiry. As always I wish you the best, and please keep us informed on your development :-) ...Pete > Thanks Pete. Again, I do not "think" this is my problem since this is > my second PVP and had the same issues with the first one. Got to be > something else, I would think. > > Buford R >>> You just had what's called a 'dilation' procedure, Buford, to open >>> up any restrictions in the channel. Dr Lin did the same to me [quoted text clipped - 34 lines] >>>> finished that my channel was clear and maybe that cured the >>>> problem. He wanted an update from me in 2 weeks. I will ask Dr. Lin and see what he says. He told me to email him in 2 weeks and let him know how I was doing so I will ask then. I think I was sending him to many emails so I want to hold off as much as I can. Seems like your question is right on point and from what I have read on the internet this weekend, there are a lot of different views by physicians on the dilation procedure. Some think it helps; others do not. Anyway stay in touch. Buford >Buford...As I have said before my heart is with you, and I have been (and >remain) concerned about your situation. Could you ask Dr. Lin about my [quoted text clipped - 14 lines] >>>>> finished that my channel was clear and maybe that cured the >>>>> problem. He wanted an update from me in 2 weeks. > I will ask Dr. Lin and see what he says. He told me to email him in 2 > weeks and let him know how I was doing so I will ask then. I think I [quoted text clipped - 3 lines] > by physicians on the dilation procedure. Some think it helps; others > do not. Anyway stay in touch. Buford...I don't believe you told us if the dilation gave you any immediate relief. It was a couple days ago. Has it helped or not. My concern is even if it has helped, it would only seem to be a temporary fix as I stated in my post...Pete > Buford > [quoted text clipped - 17 lines] >>>>>> finished that my channel was clear and maybe that cured the >>>>>> problem. He wanted an update from me in 2 weeks. It does seemed to have helped although I cannot tell for sure because I am still on 2 Flomax a day but It does seem the flow is a little stronger. Dr. Lin told me to stay on the Flomax until I had passed all the debris and I have had a lot more of that since the procedure. He seemed to think the debris still in my system may be one of the problems causing the blockage and thought the dialation procedure might help that. I have had a lot more debris come out with this PVP than the first one. Dr. Lin said it takes longer for a diabetic to heal also. Dr. Lin is a very concerned doctor. I told him he needed to charge more for his procedures. His PVP was $1200 but since he was a preferred provider with my insurance, he only received around $300. (Doesn't seem like much money since he was in surgery for 1 1/2 hours).The doctor that did my first PVP charged $5300 for the PVP and $375 for the cysto. Dr. Lin's price included both procedures. Amazing isn't it? Thanks for your concern. Buford R >> I will ask Dr. Lin and see what he says. He told me to email him in 2 >> weeks and let him know how I was doing so I will ask then. I think I [quoted text clipped - 12 lines] >>>>>>> finished that my channel was clear and maybe that cured the >>>>>>> problem. He wanted an update from me in 2 weeks. > It does seemed to have helped although I cannot tell for sure because > I am still on 2 Flomax a day but It does seem the flow is a little [quoted text clipped - 11 lines] > $375 for the cysto. Dr. Lin's price included both procedures. Amazing > isn't it? Thanks for your concern. It is amazing Buford. Dr. Lin sounds like a nice person. You don't want to get me going on the bullshit insurance crap where the doctors have two sets of books (one for the insurance patients - and one for the patients without insurance, who are likely to, but not necessarily, get a professional courtesy). And then there is the one for the patients who have insurance but the doctor doesn't accept it, and he "may" give them a professional courtesy also, but not as likely as the person who doesn't have insurance at all. It is a damn game. The actual cash price is bogus. If it wasn't for insurance, doctors wouldn't be in business, and the insurance companies only pay 25-50 percent (their allowed amount) of the artificially inflated cash price for most procedures. That's why all the doctors are starting to drop my blue cross, because their allowed amounts are too low. Sorry about all that. How much did your insurance company pay for the uro who charged you $5300 for your first PVP...Pete > Buford R > [quoted text clipped - 15 lines] >>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>> problem. He wanted an update from me in 2 weeks. They paid the other doctor $2200. I guess he coded it different. I am or was with Blue Cross at the time also. Buford R >> It does seemed to have helped although I cannot tell for sure because >> I am still on 2 Flomax a day but It does seem the flow is a little [quoted text clipped - 23 lines] >>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>> problem. He wanted an update from me in 2 weeks. By the way, when I told Dr. Lin the difference in the two doctor's prices, he responded, "Oh well, as long as I get what medicare allows it is fine with me. " How many doctors would tell you that. Buford R >> It does seemed to have helped although I cannot tell for sure because >> I am still on 2 Flomax a day but It does seem the flow is a little [quoted text clipped - 23 lines] >>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>> problem. He wanted an update from me in 2 weeks. I guess dilatation could break adhesions inside the prostatic capsule. These could form postoperatively and impair voiding. There is a report in the mayo clinic series of soft bladder neck contracture that was balloon dilated with success. I guess it is not unreasonable to try dilatation if voiding does not improve after PVP. I prefer to do a flexible cystoscopy rather than a blind dilatation, to assess what could be the cause of the impaired voiding. I had once a patient in whom I left a bit of tissue at 11 o´clock that acted as an embolus and impaired voiding. I performed a rigid cystoscopy under sedation and vaporised it in 10 minutes, he was sent home three hours later and the patient is now very happy. If cystoscopy is OK, then a urodinamic study would be indicated, to find out why voiding is not improving. Some patients have weak bladders and this explains the low flow in absence of obstruction. Dr. Lin seems to be a good guy, stick with him and he will solve the problem. I hope you will get better, Buford. Fernando Gomez Sancha http://drgomezsancha2.blogspot.com > By the way, when I told Dr. Lin the difference in the two doctor's > prices, he responded, "Oh well, as long as I get what medicare allows > it is fine with me. " How many doctors would tell you that. What a great person - one of a kind. You shouldn't tell him too much Buford, or he will raise his rates for your office visits - lol . He looks Chinese, does he speak good english...Pete > Buford R > [quoted text clipped - 28 lines] >>>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>>> problem. He wanted an update from me in 2 weeks. He speaks fairly well. A little hard to understand at times but for the most part, o.k. I really like him. I just read the post from Dr. Sancha with great interest. If down the road it comes down to it, I have great concern about the uro dynamic study from what I have read about it (and shared privately with Dr. Sancha) and it also appears that even if they find out it is indeed a weak bladder there is no cure for it so why do the tests? Buford R >> By the way, when I told Dr. Lin the difference in the two doctor's >> prices, he responded, "Oh well, as long as I get what medicare allows [quoted text clipped - 9 lines] >>>>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>>>> problem. He wanted an update from me in 2 weeks. > He speaks fairly well. A little hard to understand at times but for > the most part, o.k. I really like him. [quoted text clipped - 3 lines] > study from what I have read about it (and shared privately with Dr. > Sancha) Buford...I wasn't going to ask this, but what the hell. Exactly what did you mean by "shared privately with Dr. Sancha". I assume you meant it to be via his conversations in the newsgroup...Pete and it also appears that even if they find out it is indeed a > weak bladder there is no cure for it so why do the tests? > [quoted text clipped - 13 lines] >>>>>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>>>>> problem. He wanted an update from me in 2 weeks. I emailed Dr. Sancha outside the newsgroup. I went to his blog and he had a post where you could submit a private message and I did that and believe it or not got a response from him to my home email address within 30 minutes. It was just some personal reservations I had about going through the urodynamic study, if in fact it got to that. Thanks. Buford R >> He speaks fairly well. A little hard to understand at times but for >> the most part, o.k. I really like him. [quoted text clipped - 12 lines] >>>>>>>>>>>>> finished that my channel was clear and maybe that cured the >>>>>>>>>>>>> problem. He wanted an update from me in 2 weeks. > I emailed Dr. Sancha outside the newsgroup. I went to his blog and he > had a post where you could submit a private message and I did that > and believe it or not got a response from him to my home email > address within 30 minutes. It was just some personal reservations I > had about going through the urodynamic study, if in fact it got to > that. Thanks. Buford...I checked the blog before I asked you about this, and I just checked it again, and I don't see anything about submitting a private message. Could you clarify it a little more (ie where on the web page). Maybe I'm blind or just can't find it (or perhaps its my adblock, but I don't think so)...Pete > Buford R > [quoted text clipped - 14 lines] >>>>>>>>>>>>>> finished that my channel was clear and maybe that cured >>>>>>>>>>>>>> the problem. He wanted an update from me in 2 weeks. >> I emailed Dr. Sancha outside the newsgroup. I went to his blog and he >> had a post where you could submit a private message and I did that [quoted text clipped - 8 lines] > page). Maybe I'm blind or just can't find it (or perhaps its my > adblock, but I don't think so)...Pete Buford...I checked the site once again (inside and out) and can not find any reference to sending Dr. Sancha a private message. Please explain exactly where you found his e-mail address or this post you are talking about. I am very interested in this...Pete >> Buford R >> [quoted text clipped - 14 lines] >>>>>>>>>>>>>>> finished that my channel was clear and maybe that cured >>>>>>>>>>>>>>> the problem. He wanted an update from me in 2 weeks. Go to the blog. You will see a profile on the right side and at the bottom of the profile it will say something to the effect to click here for complete profile. When you go to that page, there will be a link on the left side to send him an email. If you still cannot find it, let me know. Thanks. Buford >>> I emailed Dr. Sancha outside the newsgroup. I went to his blog and he >>> had a post where you could submit a private message and I did that [quoted text clipped - 12 lines] >>>>>>>>>>>>>>>> finished that my channel was clear and maybe that cured >>>>>>>>>>>>>>>> the problem. He wanted an update from me in 2 weeks. > Go to the blog. You will see a profile on the right side and at the > bottom of the profile it will say something to the effect to click > here for complete profile. When you go to that page, there will be a > link on the left side to send him an email. If you still cannot find > it, let me know. Thanks. Thank you so much Buford...God, I hate it when that happens. I thought I already tried that but maybe not, or maybe when I saw the begginning of his profile on the right in Spanish, it deterred me from clicking further in that area (dunno). But I found it now. Dr.Sancha is such a dedicated doctor. It's unbelievable that he finds the time to participate in the ng, and even put his e-mail address open to the world. What a beautiful person, and he is so knowledgeable. It sounds like your doctor Lin is very dedicated also. Does he just answer e-mails to his patients (I didn't see any global e-mail at his site). Thanks again and keep us informed...Pete >> Go to the blog. You will see a profile on the right side and at the >> bottom of the profile it will say something to the effect to click [quoted text clipped - 13 lines] > patients (I didn't see any global e-mail at his site). Thanks again and > keep us informed...Pete Pete, Did you notice that same robot on his blog? >>> Go to the blog. You will see a profile on the right side and at the >>> bottom of the profile it will say something to the effect to click [quoted text clipped - 17 lines] > > Did you notice that same robot on his blog? Sure did Rich. Your uro must be awesome to beat doctor Sancha to the test :-):-) . Do you know how many of these robots there are in the U.S. (or the world for that matter). It looks like it has been around since about 2000, and I saw the FDA approved it for various procedures, but no date when (I need to search more). I have seen the concept on TV. I think it was for another medical discipline though. Take care...Pete >> Pete, >> [quoted text clipped - 6 lines] > need to search more). I have seen the concept on TV. I think it was for > another medical discipline though. Take care...Pete The link I gave: http://www.porterhospital.org/index.php?s=optional_2 says there are only 200 worldwide but there is no date except "2005". If you go to the Da Vinci Link you will see a listing of what hospitals have the system. For example in MD you see six doctors and three hospitals: George Washington University, Johns Hopkins Hospital, St. Joseph's Towson I am surprised to see that my former URO/Hospital who does not do PVP (OR at least did not a year ago) is also listed as having the Da Vinci system. I did hear he is now doing PVP but have not seen him listed on Laserscope site. However, being proficient at treating cancer does not mean they are also involved with bph. Vince, When you had the dilation procedure done with Dr. Lin did you pass a lot of debris (blood clots)? I have passed probably 15-20 in the last 4 days and that really seems unusual to me but I have never had one of these procedures. I know with my first PVP, I passed probably a total of 3. Thanks. Buford R >You just had what's called a 'dilation' procedure, Buford, to open up any >restrictions in the channel. Dr Lin did the same to me about a month after [quoted text clipped - 12 lines] >> that my channel was clear and maybe that cured the problem. He wanted an >> update from me in 2 weeks. > Vince, > [quoted text clipped - 3 lines] > of these procedures. I know with my first PVP, I passed probably a > total of 3. Thanks. Buford...lets hope that's a good sign and that the reaming process knocked off (or cleaned up) some off the scar tissue that may have been present. Keep us informed if you improve any. I guess you won't really know till after you get off the flomax though. Best wishes...Pete > Buford R > [quoted text clipped - 14 lines] >>> that my channel was clear and maybe that cured the problem. He >>> wanted an update from me in 2 weeks. You can rest assured I will keep you posted. All you guys have been great! Buford R >> Vince, >> [quoted text clipped - 12 lines] >>>> that my channel was clear and maybe that cured the problem. He >>>> wanted an update from me in 2 weeks. Buford, I passed a few small pieces of what appeared to be scar tissue, no clots, but only a few and only for a short time, as I recall. Hope that helps. Vince Signature"Some men see things as they are and say 'Why?' I dream of things that never were and say 'Why not?'" --George Bernard Shaw > Vince, > [quoted text clipped - 26 lines] >>> that my channel was clear and maybe that cured the problem. He wanted an >>> update from me in 2 weeks. I have emailed Dr. Lin to see if the quantity that I am passing is normal. Hopefully, I will hear from him tomorrow morning. He usually does not respond to his emails until after midnight. Buford >Buford, > [quoted text clipped - 8 lines] >>>> that my channel was clear and maybe that cured the problem. He wanted an >>>> update from me in 2 weeks. |
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