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Medical Forum / Diseases and Disorders / Prostate BPH / November 2006PVP - back again!
Hi Everyone, I had a PVP in December 2003 without problems. Unfortunately, I was left with retro but everything else was OK. Well, I am now back to square one and did not expect to be back on this newsgroup. Recent tests revealed that my prostate is now bigger than it was before PVP! The problem I am now having is getting my local surgeon (Inverness, Scotland) and the surgeon who did the PVP (Gordon Muir, King's College, London) to communicate with each other. So far, I have been polite but as my flow decreases my patience also evaporates. I am still on the NHS (state health service) which probably accounts for the slow progress. I've done a search on "Repeat PVP" and I gather having to have a second one done is not unusual. My local surgeon is trying to talk me into a TURP which is nothing unusual either. Derry > Hi Everyone, > [quoted text clipped - 17 lines] > > Derry Sorry to hear that, you were the first British success story, mainly due to your own determination in getting a referral to Gordon Muir. Have you thought of contacting him directly and telling him of your problem. He will remember YOU ! Another thought would be to contact Mike Degum of Laserscope for advice of other NHS hospitals doing the procedure, there must be many more by now. As You know I referred myself to the NHS hospital in Newcastle. Once they said that they would see me I asked the consultant in Edinburgh to refer me... he was very keen to get a troublemaker like me off his books. Derek. >> Hi Everyone, >> [quoted text clipped - 15 lines] >was very keen to get a troublemaker like me off his books. >Derek. Derek, You are right!<g> I am very patient, up to a point, but started politely agitating ealrier this week -- Recorded Delivery letters, emails marked URGENT, phone calls, etc. (Thy don't like it!<g>). Spoke to someone in the local hospital yesterday and was assured that things are happening as my medical notes have been recovered from storage! I have put myself back on Flomax so all is ok in the short term. Mike was informed a while back that things were going down hill and he was as helpful as usual. I expect a mention here did not go unnoticed either. Derry > Hi Everyone, > [quoted text clipped - 17 lines] > > Derry > Hi Everyone, > [quoted text clipped - 17 lines] > > Derry Hi Derry, I am back to square one as well. I had a PVP in August 2003 with Tim Larner at Princess Royal. I posted about it under the username William and you did reply to the postings at the time. My flowrate improved and I was able to go off Flowmax after the PVP but my frequency stayed the same. My flowrate has now decreased to 11 mls/sec and I get up every 2 hours at night. I am going for a repeat PVP with Gordon Muir at King's College on 4 Dec. He will use the new Greenlight HPS machine. I am going privately, the all in cost is ?4560. I thought that PVP was a permanent fix. It is surprising that we both need repeats after 3 years. Will keep the board posted of the results. On 11/17/06 3:18 AM, in article 1163762326.651085.235750@j44g2000cwa.googlegroups.com, "blkwhite123@aol.com" > I am back to square one as well. I had a PVP in August 2003 with Tim > Larner at Princess Royal. I posted about it under the username William [quoted text clipped - 7 lines] > I thought that PVP was a permanent fix. It is surprising that we both > need repeats after 3 years. Will keep the board posted of the results. After the glowing reports here on PVP, I thought that I had wasted my time and pain on TUMT. Off hand, it now seems that TUMT works as well. Three years after a second treatment my flow rate is about the same as yours. I am posting on my recovery from my latest TUMT. This time, I was cooked to a higher temperature than before. Bill -- Fermez le Bush > On 11/17/06 3:18 AM, in article > 1163762326.651085.235750@j44g2000cwa.googlegroups.com, "blkwhite123@aol.com" [quoted text clipped - 19 lines] > Bill > -- Fermez le Bush There are a couple of us here that tried TUMT without any success. It did absolutely nothing for me. But I figured it was worth trying. A URO said he has had about 50% success with it. I wonder what the difference is with different patients? > On 11/17/06 3:18 AM, in article > 1163762326.651085.235750@j44g2000cwa.googlegroups.com, [quoted text clipped - 21 lines] > Bill > -- Fermez le Bush Personally I would rather have three PVP's than one TUMP :-) It does not matter which treatment you have the prostate is still going to grow unless you have the radical prostatectomy. It would appear that some prostates are more aggressive than others. I had read some experts who expected the PVP effect to last for about ten years. Derek. Hi again, Dick, thanks for your message inviting me to comment on this issue. I see that two group users have to go to a repeat PVP after three years. I will comment on this. You must know that there is no BPH operation that guarantees freedom from reoperations. With TURP, 10% of patients need a reoperation in five years. PVP does the same as TURP, but with less bleeding and risks than TURP. I think, but this is only my opinion, that there is a very good correlation between removal of tissue and durability of the operation. I know Tim Larner started doing very fast operations, just carving a tunnel from the bladder neck to the veru montanum, I watched the videos he posted in the internet and I did not like that way of performing PVP. Later on he changed his mind because he was seeing patients coming back, he recognized this during a European Congress. Gordon Muir was more agressive than him, but still he did not think that complete removal of tissue was so important. I have discussed this with Gordon Muir many times, I have always thought that the chances of reoperation will be less if you are agressive with PVP, that means using a lot of energy, spending as long as it takes (I have operated patients with big glands for up to 4 hours with the 8 watt laser) and removing as much BHP tissue as possible. The new HPS makes that task easier for the surgeon, because it vaporizes much much faster, and halves the surgical time. Mr Muir got the first HPS laser in Europe, I got it after him and I really think that this device allows us to perform a better job in a shorter time If you read my posts some months ago, I was insisting in finding an aggressive surgeon... I have always been convinced that to reduce the chances of reoperation the initial operation has to be very aggressive. I would recommend discussing this with Mr. Muir, there might be another reasons for this early need for a reoperation, you did not tell us your original prostate size... it will be very interesting to know what is his opinion for the need for a reoperation in your cases. After all, he is the most experienced surgeon in Europe. Best regards to all, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com > Hi again, Dick, thanks for your message inviting me to comment on this > issue. [quoted text clipped - 42 lines] > Fernando Gómez Sancha > http://drgomezsancha2.blogspot.com Thanks for your input. A number of us who had PVP more recently (May 5, here) were getting concerned. Dick >Personally I would rather have three PVP's than one TUMP :-) >It does not matter which treatment you have the prostate is still going to >grow unless you have the radical prostatectomy. It would appear that some >prostates are more aggressive than others. I had read some experts who >expected the PVP effect to last for about ten years. >Derek. I think a lot depends on how much prostate tissue is removed. I was insistent that I didn't want retro so I would guess a minimal amount of tissue was removed. My local urologist (a confirmed TURP advocate) remarked that Muir had not removed much, but I do not know how he knew that although I did go for a thorough checkup after some bleeding. Anyway, it seems logical that if not much tissue is removed and the prostate is still growing, the problem will re-occur. A few years ago I had a good friend who was professor of urology at Prague University. He assured me that none of these treatments "work" (presumably meaning that they do not have a 100% success rate) and he recommended surgical removal of the prostate. He even arranged for me to go over there and he would do the operation, but I was not keen for obvious reasons. He sent me a copy of an article he had written for an international medical magazine (I forget which now) which roundly condemned everything except surgical removal. But I understand that is quite a tricky operation as the surgeon is working in a confined space. Anyway, PVP was such a dawdle, I am quite happy to have another and take my chances. Muir said he would do it, but things then went silent, hence my current stirrings!<g> Derry Derry If you did not want retro that might explain the short duration of the benefit. I never try to preserve ejaculation, it can compromise urinary results... still about 40-50% of patients preserve ejaculation. Fernando G?mez Sancha http://drgomezsancha2.blogspot.com Derry ha escrito: > >Personally I would rather have three PVP's than one TUMP :-) > >It does not matter which treatment you have the prostate is still going to [quoted text clipped - 27 lines] > > Derry These fascinating and informative exchanges can be read in precisely the opposite way: tell your urologist that you want a less aggressive PVP, avoid retro, and gamble that you won't have to be reoperated on too soon. This route would preserve sexual function: bringing on retro is not to be taken that easily, especially if, as some argue, "retro" is a misnomer, and that, at least in the case of Flomax, what you get is in fact anejaculation. I offer this as a friendly comment and wonder what those who argue for an aggressive approach make of this alternate interpretatiion. Jesse > Hi Everyone, > [quoted text clipped - 17 lines] > > Derry Jesse, Well said. I was thinking the same thing. If I had to go back a few years later, but spent that time with full sexual function, I wouldn't complain. Jackie > These fascinating and informative exchanges can be read in precisely > the opposite way: tell your urologist that you want a less aggressive [quoted text clipped - 8 lines] > > Jesse > These fascinating and informative exchanges can be read in precisely > the opposite way: tell your urologist that you want a less aggressive [quoted text clipped - 8 lines] > > Jesse You are fortunate that Flowmax worked for you. Didn't do a thing for me except make me dizzy and sick. With the prostate continuing to grow eventually something more aggressive may have to be done. But at least you can hope that something even better comes along. >These fascinating and informative exchanges can be read in precisely >the opposite way: tell your urologist that you want a less aggressive [quoted text clipped - 3 lines] >is a misnomer, and that, at least in the case of Flomax, what you get >is in fact anejaculation. I very much doubt that the retrograde ejaculation resulting from PVP has anything to do with the anejaculation caused by Flomax. As I understand it the retro caused by PVP is because of damage to the bladder neck. On emission the prostatic urethra remains open at the bladder end allowing the ejaculate to flow backwards into the bladder. The Flomax problem is because the drug interferes with the D2 (dopaminergic type 2) receptors which are responsible for triggering ejaculation. The reports of this problem don't say exactly what it does to the D2 receptors (probably a competitive antagonist--my guess) nor where these receptors are located. Since they're also involved in parkinsonism, my guess is that they're in the brain and not local to the prostate at all. I agree with you as to the seriousness of each though. |
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