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Medical Forum / Diseases and Disorders / Prostate BPH / May 2006Another Median Lobe Question
Hello group: I've heard that an enlargement of the median lobe of the prostate acts like stopper, and shuts off urine flow from the bladder. I can't visualize this in my head, and was wondering if someone could post a simplified drawing of what this actually looks like. Also would this prevent complete emptying of the bladder each time, or could it be a random event? Thanks, Corky Think of a soft rubber tube through which water is flowing unimpeded. Now wrap a string around the middle of the tube and slowly tighten the string until it shuts off the flow of water. Your prostate grows at different rates...the centre, (median lobe) grows big enough to constrict the flow. Go get it zapped and you put a lot of worries behind you. > Hello group: I've heard that an enlargement of the median lobe of the > prostate acts like stopper, and shuts off urine flow from the bladder. > I can't visualize this in my head, and was wondering if someone could > post a simplified drawing of what this actually looks like. Also would > this prevent complete emptying of the bladder each time, or could it be > a random event? Thanks, Corky The following explanation captures the dynamics of interrupted urination: The effect is likened to a ballcock (no snickers!) valve, such as that which controls water entry into a flush toilet reservoir. When the bladder is full (in fact overfull in advanced BPH), pressure becomes sufficient to prompt bladder sphincter opening and flow lifts the median lobe which was pressing on the orifice. However half way through voiding, even though the bladder is only partially emptied, the median lobe clamps down on the upper sphincter of the urethra and flow prematurely stops. This event is comparable .. by the ballcock analogy ..with the sudden cessation of water entry into the water closet when the critical level is reached. It is the retained volume of urine which leads to the stretched bladder syndrome and resulting urinary frequency. > Think of a soft rubber tube through which water is flowing unimpeded. Now > wrap a string around the middle of the tube and slowly tighten the string [quoted text clipped - 8 lines] > > this prevent complete emptying of the bladder each time, or could it be > > a random event? Thanks, Corky > The following explanation captures the dynamics of interrupted > urination: [quoted text clipped - 6 lines] > the median lobe clamps down on the upper sphincter of the urethra and > flow prematurely stops. Kahan...I like your explanation, but I am just not sure it is accurate (perhaps Dr. Sancha can comment if he is reading this). It is my understanding that the main shut off valve for the urethra is the external sphincter at the veru montanum, and the interior sphincter (or "upper" as you called it), which is at the bladder neck, only assists in the shutoff, but its main function is to prevent retrograde during ejaculation. I am not a doctor or an expert on this, but I am basing this on my studies, and previous posts from our Dr. Sancha. When you said "upper sphincter", did you mean the bladder neck (which I believe is the upper or interior sphincter), or were you really referring to the main sphincter at the veru montanum...Pete > This event is comparable .. by the ballcock analogy ..with the sudden > cessation of water entry into the water closet when the critical level [quoted text clipped - 15 lines] >>> like. Also would this prevent complete emptying of the bladder each >>> time, or could it be a random event? Thanks, Corky You can have a look at this photo I have uploaded to flickr.... it shows a median lobe. You will find this interesting http://www.flickr.com/photos/drgomezsancha/141250419/ I hope it helps.. Dr. Fernando Gómez Sancha http://drgomezsancha2.blogspot.com > You can have a look at this photo I have uploaded to flickr.... it > shows a median lobe. You will find this interesting [quoted text clipped - 4 lines] > Dr. Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com Thanks Dr. Sancha...I guess Kahan was correct in his analogy. So even though the external sphincter is the main shutoff valve (for a normal prostate, and even for a BPH prostate, in the sense of stopping incontinence), it sounds like the median lobe/ballcock syndrome is the main vehicle that causes retention, when you have BPH. In that vein would you please explain some more on the concept of an "elevated bladder neck". Is that similar to the median lobe problem (or is it the same thing). When I had my TUIP in 1995, the uro said I had an elevated bladder neck. And I also remember you using that terminology in your 45 gram prostate PVP video clip. Thanks again...Pete > Hello group: I've heard that an enlargement of the median lobe of the > prostate acts like stopper, and shuts off urine flow from the bladder. > I can't visualize this in my head, and was wondering if someone could > post a simplified drawing of what this actually looks like. Also would > this prevent complete emptying of the bladder each time, or could it be > a random event? Thanks, Corky Think of your prostate as an inflatable ring/donut that surrounds your urethra. When it expands (swells from BPH or inflammation) it expands in all dimensions (not just outward) so that the hole in the middle gets smaller, thus squeezing the urethra closed. (Picture an over-inflated innner tube outside of a tire when it is way overinflated.) This tends to be more chronic than random, until treated. I have the same issue (radioactive seds caused swelling) with the median lobe and am soon to have a laser prostate resection to burn some of that away. Richard > Think of your prostate as an inflatable ring/donut that surrounds your > urethra. When it expands (swells from BPH or inflammation) it expands [quoted text clipped - 9 lines] > > Richard How much trouble did you have? A friend had the seed treatment in January. He has had to use a catheter ever since. Without the catheter he is in severe pain. I was also wondering about the use of laser after seed therapy. What happens if the laser hits a seed? Do you have any sources of information about the problem that I might pass on to him? >> Think of your prostate as an inflatable ring/donut that surrounds your >> urethra. When it expands (swells from BPH or inflammation) it expands [quoted text clipped - 19 lines] > Do you have any sources of information about the problem that I might > pass on to him? Richard, I just sent you a direct email. Looking over your previous posts it is quite apparent the two of you need to get together. His URO is at a loss as to what to do and is contacting others as he had never encountered that problem. I have had severe urine retetntion for 11 months since seeds June 2005. I have had to self-cath daily ever since. The retention has been accompanied by severe bowel and bladder spasms (and a host of other unbelievable complications as welL), and generally I have lived (if you want to call it that) with chronic agonizing pain ever since. The problem with laser after seeding isnt if a laser hits a seed, it is rather that the irradiated prostate tissue doesnt heal well after radiation, and there can be a problem of leftover necrotic tissue further blocking the urethra. Self-cathing is usually the treatment of choice until enough time goes by for things to heal. I have heard of people doing that as long as 14 and 18 months. But if those prostate lobes are still squeezing the urethra, you can cath forever .... So I am taking the risk of the laser TURP. I am sick of being in pain all the time and having no life. I have had a hard time finding good info about all of this. Most Uros know how to do the seed thing, but few have a good plan if complications set in. But sign up for seedpods.org on the Internet. Unfortunately, > > Think of your prostate as an inflatable ring/donut that surrounds your > > urethra. When it expands (swells from BPH or inflammation) it expands [quoted text clipped - 19 lines] > Do you have any sources of information about the problem that I might > pass on to him? > I have had severe urine retetntion for 11 months since seeds June 2005. > I have had to self-cath daily ever since. The retention has been [quoted text clipped - 16 lines] > know how to do the seed thing, but few have a good plan if > complications set in. But sign up for seedpods.org on the Internet. Is that? http://www.prostatepointers.org/seedpods/ Rich -- you have the right address for seedpods. Thanks for posting the correct one. Still haven't heard from your friend. > > I have had severe urine retetntion for 11 months since seeds June 2005. > > I have had to self-cath daily ever since. The retention has been [quoted text clipped - 20 lines] > > http://www.prostatepointers.org/seedpods/ |
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