Visit to PVP Doctor in Rhode Island

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Uncle - 02 Jul 2003 21:25 GMT

Two days ago (June 30) I visited Dr. Barry Stein at Rhode Island
Hospital in Providence. He took a urine sample, poked my abdomen, and
did a rectal digital exam. I am supposed to go back for an ultrasound
to check the size of my prostate, and also have the urine flow rate
test. If all results indicate a prostate problem, I would have the PVP
on the third visit.

Dr. Stein does PVPs and TUNAs. He used to do TURPs but prefers PVP
now. Here's a summary of Dr. Stein's comments about PVP, as well as I
can remember.

Comparing PVP to TURP:
Incidence of retro ejaculation: TURP 90%, PVP 80%!!! I am sure he
said this. These may be his own results.

PVP advantages are little or no bleeding, short recovery time. He
said that many patients can urinate shortly afterwards and can go home
the same day with no catheter.

In some cases there may be no immediate improvement in urination
because of swelling. Improvement in flow may take several weeks.
Because the inside of the prostate forms a scab, there may be bits of
tissue passed as the scab breaks up.

He said that Laserscope's website and their printed brochure make
overly optimistic statements. A new brochure will be coming out soon
with more realistic statements.

His statement about retro shook me up. I guess at my age I shouldn't
be so concerned about retro.

My own history:
I have been lurking in this group for 6-7 years.
I am retired,70, living alone, and have had urgency problems since
1984. Have been treating the BPH with saw palmetto and other herbs in
various brands and doses since early 90s. Have tried Hytrin, Proscar,
Flomax, and Cardura, all with various unpleasant side effects. Since
1999 I have been taking Cardura 2 mg plus saw palmetto and beta
sitosterol.
The multiple bathroom trips at night and the nasal stuffiness from
Cardura are wearing me down.
I'm retired and living in northern Connecticut so Dr. Stein is the
closest PVP doctor, about 2 hours away.
I haven't made an appointment for my second visit yet. I don't think
Dr. Stein has come up before in any discussions here. If anyone has
any comments I would welcome them.

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Uncle

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Jack - 03 Jul 2003 17:55 GMT

Uncle,

You sound like a good candidate for a PVP procedure. I think that an
80% retro rate is high, but again it depends on the doctor and what
types of prostates they are operating on. The higher the medial lobe
is in the neck of the bladder, the greater the risk of retro, seems to
be the consensus of this group.

I had a PVP six weeks ago with a very large medial lobe in the bladder
and I have retro, yet the doc who did mine had only a 20 % rate of
retros. But he told me that because of the size and location of the
medial lobe there was a better than 50% chance of retro in my case,
that might or might not correct itself in 4 to 6 months.

Can't say how soon I saw improvement in my flow rate, because the
catheter had to be in five days, two of which were because it was
Memorial weekend. The doc wanted the catheter in for 3 days because
of the extensive work he had to do in the neck of the bladder. Anyway
as soon as the catheter was out I was peeing at four times the flow
rate compared to before the procedure.

I would ask Dr. Stein how many PVPs he has done. I wouldn't want to
be one of the first ten he had done. Nor would I want to be the first
or second one he did that had a large prostate size (>75gm) or a large
medial lobe in the neck of the bladder.

Everything he told you is correct, many do go home without a catheter
and many have very little bleeding. However, just remember that
doesn't say all. Today, I would guess that over 90% do not stay in
the hospital overnight. So you had better have someone go with you
when you have the procedure done to drive you home. The procedure
requires anesthesia.

Good luck and I can say that you probably will kick yourself for
waiting as long as you have. I know I did. I waited at least eight
months or so before I had the PVP, when I was sure that was the way to
go.

Jack

> Two days ago (June 30) I visited Dr. Barry Stein at Rhode Island
> Hospital in Providence. He took a urine sample, poked my abdomen, and
[quoted text clipped - 45 lines]
> --
> Uncle

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