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Medical Forum / Diseases and Disorders / Prostate BPH / April 2006Denver PVP
I had Targis TUMT over a year ago. Results were marginal. Flomax and Uroxatral doesn’t agree with me. Yesterday I went in to see my URO, Jim Fagelson. Since I have some plans for the summer I thought about trying PVP this fall. He took a look inside and suggested PVP. He suggested going ahead now. So, I am now waiting to get a schedule. Most likely within the next two or three weeks. One advantage of having the TUMT first is that he has had another year of experience with PVP. I think now has performed maybe a couple hundred. They gave me the option of Swedish, Sky Ridge and Englwood hospitals. All three apparently have the laserscope machines. >I had Targis TUMT over a year ago. Results were marginal. >Flomax and Uroxatral doesnt agree with me. [quoted text clipped - 10 lines] >They gave me the option of Swedish, Sky Ridge and Englwood hospitals. >All three apparently have the laserscope machines. Good luck. Please let us know the outcome. Ed > I had Targis TUMT over a year ago. Results were marginal. > Flomax and Uroxatral doesn’t agree with me. > > Yesterday I went in to see my URO, Jim Fagelson. Since I have some > plans for the summer I thought about trying PVP this fall. He took a > look inside and suggested PVP. Hi Rich...You guys must go to different doctors than I do. Are you saying you went to see your uro (for a discussion type visit, which could also include some minor testing), and he ended up doing a cystoscopy on you without prescheduling it first. I don't understand that, and have never experienced anything like that, especially since it takes a little more time and is a "procedure" (even though no anesthesia was required obviously), and the tech or nurse has to prep you (local anesthesia etc) and get the scope ready, da da da da. There is no way can I just walk into my uro's office and get a cysto unless it was prescheduled in advance. Please explain...Pete He suggested going ahead now. So, I > am now waiting to get a schedule. Most likely within the next two or > three weeks. [quoted text clipped - 4 lines] > They gave me the option of Swedish, Sky Ridge and Englwood hospitals. > All three apparently have the laserscope machines. > Hi Rich...You guys must go to different doctors than I do. Are you saying > you went to see your uro (for a discussion type visit, which could also [quoted text clipped - 7 lines] > > Please explain...Pete http://www.uradenver.com/ I was in to see him a month ago. And for every visit he has me come with a full bladder. His nurse has me pee in a bucket (flow test) and does an ultrasound before I talk to him. He suggested trying the medication first. That Uroxatral just didn't agree. So yeah, his nurse got me up in the stirrup, She told me to take a big breath and then squirted something that stung a bit and then he came in and did the cystoscopy. I don't think I even took a breath the whole time. Pee'd "pins and needles" for a while last night. Before he started I asked him if there was anything he did that didn't hurt. His comment "not much". Then he recommended the PVP and asked if I had any questions. Told him I guess not and he commented that I obviously knew a lot more about it than most all of his patients. Actually the first time I visited him over a year ago it was much the same. When he got though with the cystoscopy he recommended trying TUMT first as PVP could always be done later. I don't think he had performed a lot of them at that time. Another doctor I talked to yesterday said that their success with TUMT is normally about 85%. That really is not bad. However, that procedure is undoubtedly the most painful. The most painful was when he injected something into the prostate. And then I had to wear a catheter for five days. I really didn't mind that. I got five good nights of sleep. He sends his patients home with a catheter after PVP. Then they remove it themselves the next day. I still haven't got a schedule. At least for PVP there is very little preparation. No enema etc. Just not eat after midnight. Drink water up to four hours before the procedure. As I was coming into the office I overhead a patient saying something about microwave. I didn't get much chance to talk to him but asked if he got on newsgroups. He said he didn't know about them so I gave him the name of this group. Maybe he will show up. > I still haven't got a schedule. At least for PVP there is very little > preparation. No enema etc. Just not eat after midnight. Drink water > up to four hours before the procedure. I did have to have an enema before my PVP. And it's interesting that you got five good nights of sleep with the catheter in. I felt like I had to pee the whole time mine was in (just overnight). When the nurse did the "fill & pull" she could only get 200 ml in my bladder. She said I must have a really tiny bladder (and we all know that size matters). Then when she pulled the cath, I peed out 400 ml. It was a great gushing thing, a sight to behold, started instantly, over in no time (my pre-PVP flow was 3.7 ml/sec.). Apparently I was retaining 200 ml with the cath in. No wonder I felt like I had to pee the whole time it was in. Go for the PVP, Rich. It's worth it just to get off the meds - Hytrin, in my case, and the Flonase I had to take because of the Hytrin. Just make sure he takes enough tissue out. >> I still haven't got a schedule. At least for PVP there is very little >> preparation. No enema etc. Just not eat after midnight. Drink water [quoted text clipped - 14 lines] > in my case, and the Flonase I had to take because of the Hytrin. Just > make sure he takes enough tissue out. The only discomfort of the catheter was a pulling sensation at times. Never any sensation of having to pee for the full five days. I just heard a comment from someone else that had the same feeling as me. He said that after several years of bph problems he could get used to it very fast. He too only had it for one night. I just got an email from a friend who had the radio active seed treatment in January. He had big time problems and has had to wear a catheter ever since. He hopefully gets it out next week. Hopefully his problem has been only that the prostate was irritated from being poked with a needle 114 times. Two other guys I know didn't have any problems with that procedure. >> I still haven't got a schedule. At least for PVP there is very >> little preparation. No enema etc. Just not eat after midnight. [quoted text clipped - 14 lines] > Hytrin, in my case, and the Flonase I had to take because of the > Hytrin. Just make sure he takes enough tissue out. Temujin (and Rich)...I had a 22 F (.288 inches dia) catheter put in me after my TURP (for three days) and the discomfort of having to pee was unbelievable (non stop), and it drove me looney. One of the worst things I ever experienced. That's like having a pencil jammed up your dick for 3 days. Never slept a minute, and the pain killers did nothing. I had the procedure on Friday, and didn't get the catheter out until Monday, but damn near yanked it out myself ahead of time (I had the info about draining the balloon). Temujin...I don't understand how you could have been retaining with the catheter in (that is the purpose of the cath to drain urine - unless the little balloon held the inlet holes that much above your bladder neck, or she shoved it in too far and didn't pull the balloon back snug with the bladder neck, and it didn't come back out due to friction - if that was the case that would certainly border on incompetence). I really don't know what you are talking about. And your saying you peed 400 ml, but were only retaining 200 ml (very confusing). Rich...your uro's look like a friendly bunch of guys (does your uro have a good bedside manner and respect your right to do research). It sounds like you did have the cysto without prescheduling it directly, but it sounds like he knew he was going to do it, but I would think he would have scheduled an extra long appointment, or some bullshit like that. I still think it is highly unusual. All the better for you :-) ...Pete >>> I still haven't got a schedule. At least for PVP there is very >>> little preparation. No enema etc. Just not eat after midnight. [quoted text clipped - 38 lines] > extra long appointment, or some bullshit like that. I still think it is > highly unusual. All the better for you :-) ...Pete Well, even with the cysto he did not spend all that much time with me. His nurse did all the preparations. He took a look at my flow rate and retention and it was obvious that the TUMT had not produced the hoped for results. A month ago he suggested trying the medication first. It didn't help so this time after a quick look at the data he said he wanted to take a look inside before recommending the PVP. It was as he expected so recommended the PVP. Off to the surgery schedule woman. She gave me the option of one of three hospitals and said the surgery would not be next week. I have called her twice now and get her answering machine. The last time I told her I would like to at least know when to expect to hear from her. As I said the catheter really was a bit of relief for me. Five good nights of sleep and could schedule my going to the bathroom when ever the bag got heavy. Someone talked about the balloon being blown up too much making it very uncomfortable for him. I think he said something about complaining and they adjusted it and no more problems. I might expect that if it is inflated too much it would put pressure on the bladder giving the urge to urinate. Maybe that was Temujin's problem. The balloon was filling up so much of the bladder that they could not get much in. Pete, What I meant about the 200 ml retain was that the nurse could only get 200 ml in when she filled it, yet I peed out 400ml, so there must have already been 200 ml in there. And the balloon was already drained by then, so that shouldn't have affected it. I guess your theory about shoving it in too far is the most logical explanation. I mentioned it to the uro and he just kind of shook his head. > Temujin...I don't understand how you could have been retaining with the > catheter in (that is the purpose of the cath to drain urine - unless the [quoted text clipped - 4 lines] > you are talking about. And your saying you peed 400 ml, but were only > retaining 200 ml (very confusing). Your bladder is not like a gas tank with a clear liquid level. It's more like a water balloon. So why should it make a difference how far in it was? ... unless it was in so far that it interferred with bladder contraction. Seems a bit of a stretch, so to speak. Ed >Pete, What I meant about the 200 ml retain was that the nurse could >only get 200 ml in when she filled it, yet I peed out 400ml, so there [quoted text clipped - 11 lines] >> you are talking about. And your saying you peed 400 ml, but were only >> retaining 200 ml (very confusing). > Your bladder is not like a gas tank with a clear liquid level. It's > more like a water balloon. So why should it make a difference how far [quoted text clipped - 4 lines] > > Ed I hear you Ed, but it sure makes sense to have the drain hole for the catheter as close as possible to the bladder neck, especially if you are in an upright standing or sitting position (ie even a balloon has a low point and a high point to it as it changes shape). :-) ...Pete >> Pete, What I meant about the 200 ml retain was that the nurse could >> only get 200 ml in when she filled it, yet I peed out 400ml, so there [quoted text clipped - 12 lines] >>> about. And your saying you peed 400 ml, but were only retaining >>> 200 ml (very confusing). >> Your bladder is not like a gas tank with a clear liquid level. It's >> more like a water balloon. So why should it make a difference how far [quoted text clipped - 9 lines] >an upright standing or sitting position (ie even a balloon has a low point >and a high point to it as it changes shape). :-) ...Pete Okay, tonight I'm going to try to pee standing on my head. I'll bet it works fine. Ed >>> Your bladder is not like a gas tank with a clear liquid level. It's >>> more like a water balloon. So why should it make a difference how [quoted text clipped - 15 lines] > > Ed Thats rediculous and silly. > Pete, What I meant about the 200 ml retain was that the nurse could > only get 200 ml in when she filled it, yet I peed out 400ml, so there > must have already been 200 ml in there. And the balloon was already > drained by then, so that shouldn't have affected it. I guess your > theory about shoving it in too far is the most logical explanation. I > mentioned it to the uro and he just kind of shook his head. Temujin...I don't understand what the "fill and pull" thing is that the nurse did. Why didn't she just drain the balloon and pull the catheter out. I'm lost :-) ...Pete >> Temujin...I don't understand how you could have been retaining with >> the catheter in (that is the purpose of the cath to drain urine - [quoted text clipped - 5 lines] >> And your saying you peed 400 ml, but were only retaining 200 ml >> (very confusing). The "fill and pull" was what I had to go before they would let me go home after the PVP. The idea was to fill my bladder (by pouring water INTO the catheter), and then pull the catheter out. I then peed in a cup to make sure I could urinate normally. If not, they would put the catheter back in for a few days and try again. I was so miserable with the catheter in that I was praying I would be able to pee. The staff used the term "fill & pull" so casually that I thought it must be some standard uro lingo. If nobody else has heard the term it must be some local dialect. > The "fill and pull" was what I had to go before they would let me go > home after the PVP. The idea was to fill my bladder (by pouring water [quoted text clipped - 5 lines] > be some standard uro lingo. If nobody else has heard the term it > must be some local dialect. Temujin...I still don't understand. You previously said you had the catheter in overnight. Now you are indicating they did the "fill and pull" before they would let you go home. Are you saying you stayed overnight in the hospital after the procedure. Most people report that they go home shortly after the procedure (ie same day). >Temujin...I still don't understand. You previously said you had the >catheter in overnight. Now you are indicating they did the "fill and pull" >before they would let you go home. Are you saying you stayed overnight in >the hospital after the procedure. Most people report that they go home >shortly after the procedure (ie same day). Boy, you can't get away with anything around here. Sorry for the confusion. I live several hours away from Columbia, SC, where the procedure was performed. My wife and I stayed in a local hotel that night (with the catheter), then I went in the following morning for the fill & pull. It wasn't so much that I couldn't go home, it was just to see if they needed to leave the catheter in before we made the long drive back home. Sometimes by trying to shorten a story, you make it incomprehensible. Sorry about that. If you're still confused (and I couldn't blame you), that's the best I can do. >> Temujin...I still don't understand. You previously said you had the >> catheter in overnight. Now you are indicating they did the "fill and [quoted text clipped - 11 lines] > you make it incomprehensible. Sorry about that. If you're still > confused (and I couldn't blame you), that's the best I can do. Thanks Temujin...I now see the picture :-):-) >> Hi Rich...You guys must go to different doctors than I do. Are you >> saying you went to see your uro (for a discussion type visit, which [quoted text clipped - 17 lines] > then squirted something that stung a bit and then he came in and did > the cystoscopy. Rich...one more question. Does your uro have the video assisted (ie color monitor and taping capability) setup in his office (when he does cystos in his office), or would he have to do them in a hospital. My uro's do all the cysto's the old way in the office (ie they have to look through the eye piece), which sucks because their is no record of what they saw, and is really becoming obsolete I believe. As a matter of fact, I don't believe they took any movies of my TURP either :-) . I wouldn't thing the video stuff would be cost prohibitive, especially for a group of uro's with six doc's...Pete I don't think I even took a breath the whole time. > Pee'd "pins and needles" for a while last night. Before he started I > asked him if there was anything he did that didn't hurt. His comment "not [quoted text clipped - 25 lines] > he got on newsgroups. He said he didn't know about them so I gave him > the name of this group. Maybe he will show up. >>> Hi Rich...You guys must go to different doctors than I do. Are you >>> saying you went to see your uro (for a discussion type visit, which [quoted text clipped - 26 lines] > stuff would be cost prohibitive, especially for a group of uro's with six > doc's...Pete I really don't know. I had my eyes closed and holding my breath most of the time!!! However, there was a monitor sitting there and they turned off the lights during the procedure. No idea if it was recorded. I was a bit surprised that the PVP will not be done at the hospital next door to the office where I visit him. They have three offices. The hospital next door has the robot machine but apparently doesn't have the green light laser. All four of these hospitals are in the southern part or suburbs of Denver. I think there must be at least three or more PVP machines in other parts of town. Perhaps even in a hospital that is about a mile from me (my old URO may be doing it now but not listed on the Laserscope site). Maybe our hospitals are smaller here than in the larger eastern cities. Our population is more spread out. I am still waiting for a schedule. Better be before mid May or I will have to postpone it for a couple months. >>>> Hi Rich...You guys must go to different doctors than I do. Are you >>>> saying you went to see your uro (for a discussion type visit, which [quoted text clipped - 30 lines] > I really don't know. I had my eyes closed and holding my breath most > of the time!!! Rich...Did holding your breath help with the pain. My recent one last year hurt like a son of a bitch, but not as bad as the one I had years before that with the old rigid scope (damn near killed me). I am thinking about having general anesthesia for the next one, but it's inconvenient getting a ride...Pete However, there was a monitor sitting there and they > turned off the lights during the procedure. No idea if it was > recorded. [quoted text clipped - 10 lines] > I am still waiting for a schedule. Better be before mid May or I will > have to postpone it for a couple months. >>>>> Hi Rich...You guys must go to different doctors than I do. Are you >>>>> saying you went to see your uro (for a discussion type visit, which [quoted text clipped - 34 lines] > having general anesthesia for the next one, but it's inconvenient getting a > ride...Pete Yeah, I think so. The nurse told me to take a deep breath before she stuck some stuff in first. That I think was supposed to kill the pain a bit but it didn't do much. Just a stinging sensation but nothing only for a minute or so. But I would not even think of a general anesthesia. Can't have that in a doctors office anyway. Reminds me of when I was a teen and got a couple plantar warts on the bottom of my feet. My old country doctor, who was a "you won't even feel this" type, says "better get a hold on the table because this might hurt a bit. Then injects Novocaine into the bottom of my foot. Then gets ready to do the other foot. I often wonder what it cost to straighten out the stainless steel bars on the table and file out my finger prints. Good old guy though. I figure he saved my life a couple times. We didn't have all the protection from pneumonia and the like in those days. He did sort of lose his composure once when doing a hernia check on a buddy of mine. The doc says "cough" and my buddy says "How can I when you got me by the throat". >>>>>> Hi Rich...You guys must go to different doctors than I do. Are >>>>>> you saying you went to see your uro (for a discussion type [quoted text clipped - 39 lines] > pain a bit but it didn't do much. Just a stinging sensation but > nothing only for a minute or so. The lidocaine for the local they put in your penis is a joke. Does nothing for me at all. > But I would not even think of a general anesthesia. Can't have that > in a doctors office anyway. I got one on you Rich. That surprises me for a big city like Denver (probably because you have so many hospitals nearby - but I'm sure you also have a shitload of endoscopy centers for EGD's and colonoscopies - boy do the gastro's get rich off those). I live in western Maryland (out in the country so to speak - city of approx. 35,000). All the uro's are in one huge office, as you have heard me say before, and they have a complete surgical suite and the whole ball of wax (for more serious stuff they go to the county hospital). They have an anesthesiologist visit them whenever they do a procedure requiring GA. But remember, these guys didn't even know what a PVP was when I asked them if they did it :-) . The uro even did my TURP in his surgical suite (whereas they normally do them in the hospital - at least that's what his PA told me), but I thought he was only supposed to remove some scar tissue from my previous TUIP, but I had signed the form, and he did the TURP when I was under. Told you all about that before. Take care...Pete > Reminds me of when I was a teen and got a couple plantar warts on the > bottom of my feet. My old country doctor, who was a "you won't even [quoted text clipped - 9 lines] > buddy of mine. The doc says "cough" and my buddy says "How can I when > you got me by the throat". >>>>>>> Hi Rich...You guys must go to different doctors than I do. Are >>>>>>> you saying you went to see your uro (for a discussion type [quoted text clipped - 64 lines] > had signed the form, and he did the TURP when I was under. Told you all > about that before. Take care...Pete Still, Denver is considered a cow town by many in the east. Total state population is less than many eastern cities. And Denver's metro population is probably about a million but spread out over at least a 30 mile diameter area. When I visit in the east, even though having lived there for a while, I have to get used to how densely populated the cities are. Especially after living in Los Angeles for many years, where you can drive for 100 miles and still be in town. Schedule set for May 2. Switched to Littleton Hospital so I have to drive an additional 5 miles (15 miles total). Arrive 8:30, Surgery 10:30. I just got an email from Laserscope. Probably won't be able to make it: Free PVP Patient Education Seminar Learn more about BPH and treatment options including the PVP procedure using the GreenLight™ laser. PVP delivers rapid symptom relief and dramatic urine flow. WHEN: Thursday, April 27, 2006 6:30pm - 8:00pm WHERE: Recreation Center - East Ridge Facility 9568 South University Boulevard Highlands Ranch, CO 80126 >>>>>>>> Hi Rich...You guys must go to different doctors than I do. Are >>>>>>>> you saying you went to see your uro (for a discussion type [quoted text clipped - 81 lines] > it: > Free PVP Patient Education Seminar Rich...since you are one of the staunch regulars in the group here, I doubt that there is much that Laserscope can tell you, that you don't already know. Hell, maybe you can help them teach the class :-) . Good luck on May second, and looking forward to hearing a good result. I meant to ask you before. You mentioned your low flow rate and retention, but I don't remember you saying how much you were retaining (I assume you are retaining somewhat). Pete > Learn more about BPH and treatment options including the > PVP procedure using the GreenLight™ laser. [quoted text clipped - 6 lines] > 9568 South University Boulevard > Highlands Ranch, CO 80126 >>>>>>>>> Hi Rich...You guys must go to different doctors than I do. Are >>>>>>>>> you saying you went to see your uro (for a discussion type [quoted text clipped - 87 lines] > > Pete Sorry, I don't remember. Not a lot of retention but flow rate is pretty slow. Really, I have thought that I could live this way but would be nice to get back to somewhere near normal. Been following this group for more than a year now. Probably here more than many because I sort of enjoy looking around the web - and not much anything better to do :-). I don't look forward to the cross town trip during rush hour but it is all suburban driving. Nothing like trying to get to the downtown hospitals. There are some in Denver now. I used Brownrigg in Pueblo when I did mine 2 years ago cuz he was the only one who had done > 100 in Colorado at that time. Now it's all over. I have moved to Brutscher in Ft. Collins for followup. He has a nice style & is good. Don't fear the PVP. Bill Hale Loveland CO > There are some in Denver now. I used Brownrigg in Pueblo > when I did mine 2 years ago cuz he was the only one who had [quoted text clipped - 6 lines] > > Bill Hale Loveland CO Doctors? Yes, there have been 9 listed on Laserscope for quite some time. I think there are even more that are not listed on the site. Of them 3 are with Denver Urology Clinic, 2 Urology Associates and 2 with Colorado Urology Associates. What we were discussing is that Urology Associates uses one of three hospitals, Swedish, Littleton or Sky Ridge. And the option of whether they do PVP or not is obviously determined by which hospital they use and as to if the hospital has purchased the equipment. Or perhaps the equipment is purchased by the doctors but resides at the hospital. For example both Urology Associates and Colorado Urology Associates both use Swedish at a minimum. I expect both of them use Sky Ridge as well as it has all the latest equipment. Urology Associates also uses Porter Hospital which has the Robot machine: http://www.porterhospital.org/index.php?s=optional_2 Aurora Urologists also use that machine at the Aurora Hospitals. I think they may have the greenlight laser too but not listed on Laserscope site. There must be other hospitals that have the equipment for the doctors for the northern part of town. <The lidocaine for the local they put in your penis is a joke. Does nothing <for me at all. I agree. It just doesn't get up in there far enough. It helps some when the scope is first inserted, but just when you're thinking "that wasn't too bad," it goes through the sphincter into your prostate, and whoah Mama! > <The lidocaine for the local they put in your penis is a joke. Does > nothing [quoted text clipped - 4 lines] > wasn't too bad," it goes through the sphincter into your prostate, and > whoah Mama! You got that right Temjujin. I believe the key for the pain is the sphincter, and depending how long the uro looks around inside the bladder, it can be a son of a bitch. Some people in here have reported it doesn't bother them too much. I don't like it, and consider it extreme pain, but nowhere near as bad as when I had the rigid scope by the horse doctor in 1995. :-) ...Pete |
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