Hi everyone,

Damn it, I am rewriting this since I just lost a whole typewritten page
(over a half an hour) due to a power outage [boy does that piss me off - no
pun intended, since I do leak :-)].  So I will have to make this shorter,
without as much background as I had before.

If you have all recovered from laughing after reading my post on the
retrograde (just sent it - and there was no harm intended to anyone -
believe me), here we go.

I had a TUIP in 1995, and TURP last year (4/05) to clean up the scar tissue
from the TUIP.  Haven't been a happy camper since (or before), and asked for
a cysto by one of the partners of the uro who did my TURP (in the interest
of two heads may be better than one - I also see the PA for massages etc).
Most practices don't let you switch doctor's, but this one does, and all the
uro's where I live are in one huge room, with a surgical suite, etc.

My problems go beyond simple BPH if you may recall.  Currently, I can get a
good flow during the day if I drink a lot, but everything shuts down at
night, and I believe my kidneys are not producing as much urine at night,
but I still have a constant urge and get up every hour just to dribble (do
not believe I am retaining, and I don't know where the urge is coming from).
You may recall my kidney post on 2/21/06 regarding this - and I have had
follow up regarding this with our Dr. Sancha.  I also have pain/discomfort
in the perineal area, pelvic floor etc, and a gnawing/eating/urge feeling -
hard to describe and not pleasant to live with.  Antibiotics and massages
don't help.  Basically its non bacterial.  I call it
prostatitis/urethritis/cystitis as a continuum, as I have said in the past.

Okay, at least that lead-in is shorter than the last one I lost :-) .

I had the cystoscopy today, and I was worried if I was going to be able to
communicate with the new doctor I asked for to do the procedure (since you
may recall I don't like doctors too much).  He was okay and I gave him a
"C".  There are no "A" doctors left anymore, except for our Dr. Sancha of
course.

I asked him if he could use the video monitor instead of the eyepiece the
previous uro used last year, and requested that they turn the monitor so I
could see it (its old equipment and they can't print hard copies of the
display).  The nurse told my they weren't going to use it, but she was wrong
(apparently I had to ask the doctor- isn't that great- what the patient
doesn't know won't hurt him philosophy).  I told the uro I wanted to rule
out interstitial cystitis (IC), and it would be nice to see my bladder on
the screen, and would appreciate it if he would describe the anatomical
parts as he proceeded through the urethra into the bladder, and he did, and
I asked questions as I was wrenching in pain :-) .  He had a problem finding
the veru and external sphincter - and was making me nervous - I would think
that would be second nature to him after doing thousands of cysto's.

I was pleased with the way my bladder looked [having seen normal (versus IC)
bladder pics googling],and there was no evidence of IC - no trabeculation,
small blood vessels looked normal, and no ulcers of any kind, and he said
the ureters looked good also.  So I got some peace of mind from that since I
have bladder pain/discomfort all through the night.

However, I was not pleased with the way the median lobe looked in way of the
bladder neck (I just had the damn TURP a year ago, and I think the other uro
may not have taken enough out).  I asked him about the median lobe (he
didn't call it that - I did) obstructing the bladder neck (it was clearly
visible as a "hump" as he called it - we have used the term "ballcock" in
here recently, and Dr. Sancha's recent link he gave us for a dissected
bladder/prostate, also uses the term "ballcock".  The uro also referred to
the "hump" as the floor (ie bottom as you look in).  There is another term
called "elevated bladder neck" that the uro in 1995 used when he did my
TUIP.

Anyway, I could see an obstruction that I thought should not be there
because I just had a TURP a year ago.  I asked the uro if perhaps the other
uro didn't remove enough and naturally he plead silence, and gave me a
wheasly answer.  I told him I could pee during the day but not at night, and
I asked him what percentage of blockage the hump was creating in way of the
bladder neck (eg 10-15%) and he said maybe 15% - but it looked closer to
35-40% to me, based on how much of the "circle" was truncated.  I asked him
how it looked overall and he said it didn't look that bad, but I was
disappointed and did not like what I saw (ie I expected to see more of a
round (circular) opening at the bladder neck.

Dr. Sancha, if you got this far, I would like to ask something.

- After a PVP or TURP, should the bladder neck look round or circular after
the tissue removal, or is there always an inherent flat part at the bottom
or floor (as a chord on a circle in geometry).  I thought your videos showed
more of a round opening after the surgery (ie a big hole).  In other words,
when a uro does a PVP or a TURP, isn't he supposed to remove the tissue in a
360 degree fashion, in order to make it look symmetrical so to speak,
similar to a pipe (ie round or circular).

Last year, I asked the uro who did the TURP if he cut all the way around and
he said yes I believe, but his surgical notes mainly refer to the lateral
lobes, plus a band of scar tissue from the left lobe to the median lobe.  He
also told me the previous TUIP made incisions at the 5:00 and 8:00 positions
and he "connected the dots" as he put it.  I get the feeling that he
connected them by burning off tissue from the lateral lobes going upward to
the 12:00 position, and that he didn't cut much between the two previous
cuts on the "floor" (and thus the hump that we saw today).

- Also, do you think that there could be any relationship to the "hump" that
we saw in way of the bladder neck, and my urge at night, but not being able
to pee, but yet I can go during the day.  I don't see how based on logic.
In other words if a person had a stricture or permanent blockage,  the
blockage would block urine *all* the time, not just at certain times.

- Are the terms "elevated bladder neck" and "hump" and "ballcock", and
"enlarged median lobe" all kind of synonymous.

I welcome any comments you may have.  Incidentally I asked the uro what he
thinks may be causing the urge feelings I have and he said he didn't know,
which is what I always get when I ask most of my doctors questions.  So my
best guess is some kind of inflammatory response, but I am not a doctor :-)
.

Sorry this is so long, but I have a difficult time dealing with all this
crap as you know, and I usually don't bother you guys with my personal
problems that often (ie I comment mostly).

Thanks...Pete