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Medical Forum / Diseases and Disorders / Prostate BPH / July 2007Which way to go?
Hi, I've been having probs peeing for ages and finally decided to do something about it. Yesterday I went to the hospital to see a consultant and he tells me I need a TURPs operation. Suddenly in 24 hours I've become a prostate obstruction expert thanks to Google and consequently am aware that since about 2005 theres another treatment called PVP not to mention medication that can help increase the flow. I live in the UK and broadly speaking its mainly TURPs that is available on the NHS. If I want PVP then I'd have to go private or be lucky enough to live in an area where PVP is available on the NHS; sadly I dont. Anyway I have a number of questions that I'd be grateful for some help/ advise/information on: 1. I've read that once I've had the op the condition can return some years later; is TURPs or PVP reckoned to be the better for delaying the return of the condition? 2. Is PVP really the best way to go? I've read what I can, but its seems because its a relatively new treatment there's no real clear indication. 3. What are the likely costs of PVP treatment? 4. Would ongoing medication be a suitable longterm solution to avoid the op? 5. Which works best; TURPs or PVP .. silly question probably but I just wondered what people's experiences of each are (pain, after effects, time to recovery etc.) Probably loads more questions, but thats mostly whats on my mind now. Thanks for your help. 1. PVP vapourises tissue by use of a laser, TURP removes tissue by means of an electrical cutting loop. It is difficult to say which procedure last longer as PVP is still relatively new, however, some Uros suggest that TURP is the longer lasting of the two procedures. 2. PVP seems to have certain advantages over TURP in terms of operation and recovery time as well as perioperative and postoperative complications. However, like all prostate surgery, it is by no means risk free. 3. Nothing if you get it on the NHS, about ?4-5,000 if you have it done privately without insurance. 4. The general consensus is that medication will only treat symptoms, not the underlying cause. If your surgeon feels it's time for surgery then it probably is. You could, however, try a course of alpha blockers (such as Hytrin, Flomax or Cardura) first to see if they will relieve your symptoms. 5. I can't comment on this as I have had neither (I had a TUIP). From the published research papers, PVP appears to have the edge over TURP in terms of recovery time and lack of discomfort. That said, the difference in relief of symptoms appears to be fairly minimal from the patient's point of view. It appears that PVP is the superior treatment, however it is important to remember that PVP is an evolutionary development rather than revolutionary one. Neither is it a panacea for all prostate conditions although it does seem to have an advantage when it comes to very large glands. TURP, however, is far from the butchery that some posters would have you believe and is still a relatively safe operation. It will, however, almost certainly be phased out by PVP given time. > Hi, > I've been having probs peeing for ages and finally decided to do [quoted text clipped - 33 lines] > Probably loads more questions, but thats mostly whats on my mind now. > Thanks for your help. You are entitled to ask your urologist to refer you to a hospital in another health area that does PVP. I lived in Edinburgh and had my PVP in Newcastle. Derry who often posts here lives in the Highlands and had his PVP at Kings College in London. I'm sure that other determined people have done the same. I personally phoned the Freeman in Newcastle and asked if they would accept me as a patient if I was referred to them. That was in October 2004. I had an initial appointment in January 2005 and the procedure in June of that year. The fuddy duddy urologist in Edinburgh said that "PVP is just a TURP performed with a laser and that I was looking at the situation through rose tined spectacles" He also would not prescribe Avodart as it "has not been proved to be better than other products on the market" If you contact Mike Degun michael.degun@americanmedicalsystems.com (the company that took over laserscope) he will give you a list of hospitals that do PVP. Also consider hospitals that use the Gyrus system. http://www.gyrusplc.com/ Derek. Thanks guys that's really helpful. I think I've read enough to conclude that PVP is the way to go accepting that no treatment is 100%. I had been worried too about the 'sensation' loss downside of TURPs and whilst it seems PVP also carries that risk it doesn't seem quite as pronounced. I'm prepared to fight to get refered to a hospital that gives PVP and in fact theres one just 25mins drive away but although in the same county it's in another health trust; hopefully that won't be a problem. It does seem crazy that TURPs appears to be used more often when it has longer hospital stay times and carries more downsides clinically; still lets see how we get on. If anyone's interested I found a couple of useful videos about BPH and its treatment. They're relatively recent and accepting that they do have a bias towards PVP and have an American slant, I did find them interesting. http://www.healthscout.com/video/1/14061/main.html (general) http://www.healthscout.com/video/1/14062/main.html (specific to PVP) > Thanks guys that's really helpful. > [quoted text clipped - 18 lines] > > http://www.healthscout.com/video/1/14062/main.html (specific to PVP) Have a look at this site. You should be able to see video of Dr Sancha doing a procedure. Which county are you in ? http://drgomezsancha2.blogspot.com/ Derek. Time for an update, though not what I thought I might be writing next. The story so far: In a nutshell I'd been having trouble passing water, got referred to our local hospital where the consultant examined me and said I needed a TURP. Handed me a leaflet on it, was a bit brusque (actually very brusque) and told me he'd put me on the urgent list but it would still be about 3 months. Time moves on. I went back to my GP, said I'd like to look at a PVP option. He said fine, I'll refer you to a hospital that does PVP but lets wait for the consultants letter from your hospital visit. To my surprise 2 weeks later I get an admission form for a TURP operation in a few weeks time. That set the pulse racing slightly. So a few days ago I returned to my GP who showed me the letter which had arrived from the consultant, and here's where it gets confusing. The letter confirms there is a problem with micturation and retention. Then it says the prostate is small and flat and recommends I have a cystoscopy and bladder neck incision and that this was explained to me (first I'd heard of it). Total confusion. The consulltant told me I would have a TURPS, gave me a leaflet and everything, then his letter to my GP says he's explained I probably need a cystoscopy and bladder neck incision; something totally different. Result. Complete loss of confidence in the consultant and I'll now happily go to the other hospital for a second opinion. Watch this space! > Time for an update, though not what I thought I might be writing next. > The story so far: In a nutshell I'd been having trouble passing water, [quoted text clipped - 26 lines] > > Watch this space! Good plan Phil...I don't know about the UK, but here in the states I believe it would be standard procedure to perform a cystoscopy (to get a first hand look at the prostatic urethra, bladder neck and bladder) before pursuing a TUIP, TURP, PVP, or whatever else. Maybe I am all wet (no pun intended). Good luck on your second opinion, and let us know what happens...Pete >> Time for an update, though not what I thought I might be writing next. >> The story so far: In a nutshell I'd been having trouble passing water, [quoted text clipped - 33 lines] > intended). Good luck on your second opinion, and let us know what > happens...Pete Did I ever tell you that the first urologist who did a cystoscopy on me was a Miss Waterfall. She told me to keep an eye on my prostate as it was slightly enlarged. That was in 1983, I watched and waited until 2005 when I had a PVP. Derek. >>> Time for an update, though not what I thought I might be writing >>> next. The story so far: In a nutshell I'd been having trouble [quoted text clipped - 38 lines] > until 2005 when I had a PVP. > Derek. I think you may have :-) ...Pete > Time for an update, though not what I thought I might be writing next. > The story so far: In a nutshell I'd been having trouble passing water, [quoted text clipped - 26 lines] > > Watch this space! You would probably find that the consent form allowed him to do any necessary treatment during the procedure, you would them awake TURPED. Derek. >> Time for an update, though not what I thought I might be writing >> next. The story so far: In a nutshell I'd been having trouble [quoted text clipped - 30 lines] > necessary treatment during the procedure, you would them awake TURPED. > Derek. That's what the uro who did my TURP did (sorry for the repetition for people who I told long ago). He said he was going to clean up the old scar tissue from the previous TUIP. I noticed the permission to do the TURP on the form just before the procedure, and asked the male surgical assistant about it, and he said don't worry, it was standard stuff - da da da da. When I woke up, I was TURPED, just like you said Derek :-) . All this was done in ambulatory surgery in the uro's office and I went home, with the dreaded 22 French catheter in me. Later...Pete >> You would probably find that the consent form allowed him to do any >> necessary treatment during the procedure, you would them awake TURPED. [quoted text clipped - 6 lines] >and he said don't worry, it was standard stuff - da da da da. When I woke >up, I was TURPED, just like you said Derek :-) . Well, Pete, was this a GOOD thing or a BAD thing? Ed >>> You would probably find that the consent form allowed him to do any >>> necessary treatment during the procedure, you would them awake [quoted text clipped - 11 lines] > > Ed Ed...I wasn't mad about the TURP, I just wish he cut the median lobe as much as he cut the lateral lobes (see my post to Dean dtd 7/3/07, 11:40 pm, in the long "Prostate Problem" thread by nala which started on 6/30/07). I consider it a botched job, and I am sure I will have to have another TURP or PVP (if I can find someone to do it) sometime in the future (which will be the third procedure on my prostate/bladder neck) - I have no doubt...Pete >>> Time for an update, though not what I thought I might be writing >>> next. The story so far: In a nutshell I'd been having trouble [quoted text clipped - 40 lines] > All this was done in ambulatory surgery in the uro's office and I went > home, with the dreaded 22 French catheter in me. Later...Pete When I had my PVP the consent form allowed for them to do a TURP but I trusted them as they were so pro PVP. I am now two years and one week post PVP. Derek. Thanks for the heads-up on consent forms. By coincidence I had asked my GP if the surgeons could do anything they wanted once they had me under and he said, 'no', you have to sign a consent form first. I then returned home, read a lot more carefully all the paperwork I'd been sent and lo and behold in the small print is a catch-all statement that allows them to carry on doing whatever they want. So, my nightmare scenario is I go in for a bladder neck incision and, as Derek said, wake up having had a TURP. I also noticed the admissions form clearly says I'm to have a TURP and that the consultant has explained and discussed all options with me. Utter nonsense I'm afraid. He told me I'm to have a TURP, failed to mention the existence even of PVP or any other treatment, filled in the form confirming he's told me everything then, as I said before, writes to my GP saying the prostate is small and flat and recommends a bladder neck incision <sigh>. Sorry to go on about this but having had time now to sit back and reflect on it I'm mad as hell about the sheer incompetence of it all. It even makes me wonder if they've somehow got two different patients mixed up. Roll on the second opinion, but sadly that won't happen for another 2-3 months so I'm told. > Thanks for the heads-up on consent forms. By coincidence I had asked > my GP if the surgeons could do anything they wanted once they had me [quoted text clipped - 19 lines] > mixed up. Roll on the second opinion, but sadly that won't happen for > another 2-3 months so I'm told. Welcome to the world of medicine Phil. I have been to 75 doctors in my life - this is nothing - lol . But it is still very real, like you have picked up on...Pete > Thanks for the heads-up on consent forms. By coincidence I had asked > my GP if the surgeons could do anything they wanted once they had me [quoted text clipped - 19 lines] > mixed up. Roll on the second opinion, but sadly that won't happen for > another 2-3 months so I'm told. The consent form will also warn that you could end up incontinent, with retro, impotent or dead, they have to cover all the bases. In the UK the best way to get a PVP is privately. In less than a month it could be done. Forlorn Hope who used to post here had his initial consultation with a London Urologist on May 22nd 2005 and had his PVP on June 15th. Six weeks later he was trekking in the Himalayas. Derek. I think it's also fair to say that you can end up incontinent, with retro or dead with PVP. Perioperative and post operative complications are reduced with PVP, they are not eliminated. As for your treatment, if your prostate is small and flat then a TURP or PVP probably will not help you a great deal as there won't be any overgrown tissue to remove. The reason your consultant is suggesting a BNI is because your problem appears to be located around the bladder neck rather than the prostate, however if during surgery it transpires you need further action the TURP form permits this. This isn't incompetence, it's foresight. My comment on incompetence was really aimed at their inability to explain things clearly and most definately the option of PVP was not discussed with me even though the consultant happily went ahead and filled in the form saying he had. The world of PVP was only revealed to me through our good friend Google later on. I take your point Patrician but it scared me silly to hold two pieces of paper in my hands that, in effect, contradicted each other; both from the hands of the same surgeon! Anyway, having told you only yesterday I was told there'd be a 2-3 month wait, this mornings post brings me an invite to an appointment in 9 days time. Granted that doesn't mean I'm going to be operated on immediately but its good all the same. Ah, I see. Fair enough then. At least you only have 9 days to wait for the second opinion though. Make sure you ask him about the options (BNI, PVP, TURP) and his reasoning for recommending any particular one. > Ah, I see. Fair enough then. > > At least you only have 9 days to wait for the second opinion though. > Make sure you ask him about the options (BNI, PVP, TURP) and his > reasoning for recommending any particular one. Patrician...as I alluded to earlier in this thread, I seriously doubt any competent uro can (or will) address any one of the options you mention, without first doing a cystoscopy, to see what everything looks like. And I also doubt they will do a cystoscopy on him during his first (history) visit to the second opinion uro (ie he will probably have to make a separate appointment for the cysto)...Pete It depends. The NHS Uros will usually review the cystoscopy notes of the previous surgeon and discuss the options based on those. If another cysto is required then this will have to be requsted and will indeed take time. > It depends. The NHS Uros will usually review the cystoscopy notes of > the previous surgeon and discuss the options based on those. If > another cysto is required then this will have to be requsted and will > indeed take time. But I don't think Phil has had a cysto yet, at least not by reading his post regarding the letter to his doctor, ie, "Then it says the prostate is small and flat and recommends I have a cystoscopy and bladder neck incision and that this was explained to me (first I'd heard of it)". Capice :-) . And I am not Italian...Pete Ah, I see. Strange that they're recommending an op without having a look first then. Doesn't exactly inspire confidence. > Ah, I see. > > Strange that they're recommending an op without having a look first > then. Doesn't exactly inspire confidence. You got that right :-) . > Ah, I see. > > Strange that they're recommending an op without having a look first > then. Doesn't exactly inspire confidence. Fortunately BPH is not something that demands immediate surgery. My first URO recommended TUMT and or TURP. About that time I discovered this group and Forlorn Hope was starting his search for a cure. I asked my URO and he said TURP and PVP were the same. True to a point as they both essentially result in the same end. A friend of mine had just spent three days in the hospital with severe complications of bleeding after TURP. A new URO who does PVP also suggested trying TUMT. I went ahead with his recommendations. Nothing loss except more time and the pain of the procedure. Another year and a second cystoscopy before getting to the PVP. Without a doubt when I need treatment again I will go for PVP (Hoping I live that long). It's obviously not a permanent cure. The prostate continues to grow. Be certain that the Dr. has extensive experience (100 PVPs recommended) before proceeding. The anesthesia is the dangerous part of the procedure. I never heard of anyone dying from either PVP or TURP. Because of the anesthesia danger my URO refused to do PVP on a 90+ year old man but he was willing to try TUMT. Sorry, I've been away a few days. Re the cystoscopy, no I haven't had one. I had a flow test, an ultrasound scan to measure retention (at least I think that's what it was for) and the slightly embarrassing but inevitable prostate anal examination. He was in and out in about two seconds but if thats all it takes to conclude the prostate was 'small and flat' then so be it. I forgot to mention that the consultant prescribed some meds for me; Xatral (Alfuzosin hydrochloride). I felt they helped a little (certainly in the first day or two). Having said that, when I told my GP I was nearly out of them, he asked if I thought they were benefiting me. Thinking about it, I told him I thought they did for a few days but not much after that, so he said "well, see how it goes and if you need to start them again let me know". Within two days of stopping them I was having quite severe difficulty passing water again; it took a huge effort of will to start and then not much came out. So, I'm back on it again and things seem better - whether there's any placebo effect going on here I have no idea. Now, my understanding was that something like Alfuzosin relieves the muscle of the prostate gland widening the urethra and so making it easier to pass water. If there's nothing wrong with my prostate (small and flat remember) then how come I feel better for taking the drug? I suppose it could work to relax the muscle of the bladder neck too so maybe thats the answer. A few more questions while I'm at it: I know what a TURP is and PVP, but I've see some people here talk about a TUIP and a TUMT. Can someone tell me what these are please. Oh and finally, the risks of retrograde ejaculation are pretty high from what I've read with a TURP; is this also true with a PVP, and what about with a BNI? >From what I'm reading I figure I should ask for a cystoscopy before giving any consent to an operation, but having said that, I guess if something needs doing then it needs doing. Thanks for all your comments btw, it all helps. > Sorry, I've been away a few days. Re the cystoscopy, no I haven't had > one. I had a flow test, an ultrasound scan to measure retention (at [quoted text clipped - 33 lines] > > Thanks for all your comments btw, it all helps. A small prostate can still be a problem, it depends where it's pressing ( from the shape ? ) My one was big 72gr and according to the urologist was shaped like a floppy/saggy bottom. Most problems seem to be caused by the median lobe pressing against the bladder. In my case the lateral lobes were pressing against each side of my bladder. Retro is normally less with PVP provided that the bladder neck area is spared as much as possible. TUIP and TUMP are No 'No's to UK urologists. I tried for TUMP a long time before PVP came along, even writing to the Royal College of Surgeons to try to trace some one doing it. The nearest I found at that time was in Switzerland. TUMP: http://tinyurl.com/2vq76z TUIP and others: http://www.suncoastmedicalclinic.com/description.php?service_id=25 Derek. > Sorry, I've been away a few days. Re the cystoscopy, no I haven't had > one. I had a flow test, an ultrasound scan to measure retention (at [quoted text clipped - 33 lines] > > Thanks for all your comments btw, it all helps. Phil...I will try to address some of your comments/questions below. - First, I would absolutely ask for a cystoscopy before agreeing to any type of surgery. I consider that a must. Is the consultant in the hospital that you referred to a urologist, or just some king of generalist. He or she doing a digital, and flow test, and a ultrasound for retention, is not enough to warrant surgery IMO. Furthermore, I do not believe a urologist would perform surgery on you without a cystoscopy being performed first. - TUIP (Transurethral incision of the prostate) and BNI (bladder neck incision) are basically the same thing. Don't forget you can always google anything (TUIP, TURP, TUMT, PVP, etc) - it is usually best to start with google first :-) . TUIP is kind of like cutting a couple of slices in a large rubber band when it is stretched - imagine that, and how the slices would create a relief mechanism (so to speak), and open things up. I remember the old timer who did my TUIP in 1995 told me something like that, and I thought it was a good analogy - lol . - If the alpha blocker (Uroxatral) helps you, and you don't suffer side effects, then you may want to just stay on them, and forgo the surgery (but it may be better to get it over with and avoid the meds - that has been discussed at length in here in the past - you must decide of course). I don't know why they helped for a few days and then seemed to abate, but then they helped again after you started them back again after quitting them. They will relax the bladder neck muscle also, like you surmised. - May I ask how old you are. I don't recall you telling us. Derek has addressed some of your questions also. Please keep us informed as things develop. I wouldn't worry about getting a TURP or TUIP if that is all you can get. Pete >> Sorry, I've been away a few days. Re the cystoscopy, no I haven't had >> one. I had a flow test, an ultrasound scan to measure retention (at [quoted text clipped - 67 lines] > > Pete Pete, I went back and forward to the same Edinburgh hospital over eleven years seeing four different urologists. The first one retired with a bad back and then two short lived consultants before the fourth one settled in... that's how the NHS gets by. I had DRE's, PSA tests and two biopsies but never the suggestion of a cystoscopy, just you need a TURP. The very thorough consult in Newcastle who eventually did my PVP did not suggest a cystoscopy either. It is obviously not the British way:-) Derek. >> Pete >> [quoted text clipped - 6 lines] > eventually did my PVP did not suggest a cystoscopy either. It is > obviously not the British way:-) Derek. Thanks Derek...So I guess he did a cysto on you at the same time he did the PVP. Let me clarify that for you. You were on the table and they put you under with anesthesia. Then the uro did a cystoscopy with a cystoscope to take a look around (and maybe put some water in your bladder), before actually starting the PVP. Then he pulled out the cystoscope and put in a Resectoscope (not a cystoscope) to perform the PVP. Is that approximately correct. If you have your procedure notes, it should describe all that. I would be curious about that. Maybe your uro just went directly to the resectoscope - dunno - I'm sure it was never described to you - they won't tell you anything unless you ask for a copy of the procedure notes - lol . The surgical notes for my TURP I had in 2005, stated approx what I just said (about the cystoscope versus the resectoscope), but I also had a cysto prior to ever making the appointment for the surgery if you follow me. I guess you guys are different over there, but that is not to say that some uro's may do the same thing in the U.S. I am speaking from my personal experiences. I also had a cysto prior to scheduling my TUIP in 1995 (different uro in a different county in Maryland). I hope that wasn't too confusing :-) ....Pete >>> Pete >>> [quoted text clipped - 36 lines] > were no bladder mucosal lesions identified. The procedure was then > initiated. Dean, >>>> Pete >>>> [quoted text clipped - 36 lines] >> be in their normal position on the trigone. There were no bladder >> mucosal lesions identified. The procedure was then initiated. Dean, Thanks Dean...I know that Dr. Sancha specifically made reference to a resectoscope (that he used for his PVP's - I believe it may have been 23 French), and he used to have a picture of it in his blog long ago (I'll have to check his posts - I have saved most of them to my hard drive). This is interesting. The uro who did my TURP used a 22 French cystoscope (then pulled it out after he did some looking, and injected some water in my bladder), and then he immediately put in a 26 French (ouch - but I was asleep) resectoscope. In other words he looked first with the smaller scope, and then put the bigger resectoscope in after to perform the surgery....Pete >>> Pete >>> [quoted text clipped - 14 lines] > cystoscope and put in a Resectoscope (not a cystoscope) to perform the > PVP. Is that approximately correct. I would assume so. If you have your procedure notes, it should describe all that. I > would be curious about that. Maybe your uro just went directly to the > resectoscope - dunno - I'm sure it was never described to you - they won't > tell you anything unless you ask for a copy of the procedure notes - lol . This is UK, NHS, you don't get notes. They did not even send a letter or a copy to my GP, probably because it was done in a different Area Health Authority. My uro was pretty good as he knew that I had sought out a PVP and was interested. He did describe what he had done, drew digrams on my newspaper!! and answered questions. I twice later asked them to send the results of the ECG and echo cardiogram they had done to my GP.... Zilch, . > The surgical notes for my TURP I had in 2005, stated approx what I just > said (about the cystoscope versus the resectoscope), but I also had a [quoted text clipped - 5 lines] > > I hope that wasn't too confusing :-) ....Pete You, confusing, Never. Derek. >>>> Pete >>>> [quoted text clipped - 24 lines] > > This is UK, NHS, you don't get notes. I don't think you understand Derek. You don't get notes here either unless you ask for them. All doctors (I assume - unless you people are that different) do some sort of dictation after they perform a procedure and a medical transcriptionist types it. Are you following me. It is similar to the one Dean just posted. You will not get a copy of anything from any kind of doctor or laboratory or scan center unless you ask for it. It is that simple. I have a copy of every surgical procedure, scan, and blood test that has been done on me since about 1992, when I started going downhill - lol . Maybe the UK has different ways of doing things, but I would almost bet my house that the uro who did your PVP has some typed up surgical notes describing the procedure. Later...Pete They did not even send a letter > or a copy to my GP, probably because it was done in a different Area > Health Authority. [quoted text clipped - 14 lines] > You, confusing, Never. > Derek. >>>>> Pete >>>>> [quoted text clipped - 36 lines] > but I would almost bet my house that the uro who did your PVP has some > typed up surgical notes describing the procedure. Later...Pete The same here.We are now legally entitled to get copies of our medical records. But no doubt they make it difficult to get them. Derek. > They did not even send a letter >> or a copy to my GP, probably because it was done in a different Area [quoted text clipped - 15 lines] >> You, confusing, Never. >> Derek. When I had my TUIP a cystoscope was done at the same time. My initial cystoscope was done about six months previously and showed high bladder neck and prominent muscles, the cysto at he TUIP showed "significant overgrowth". I guess it depends on who you get or how things develop over time. >- First, I would absolutely ask for a cystoscopy before agreeing to any type >of surgery. I consider that a must. Is the consultant in the hospital that >you referred to a urologist, or just some king of generalist. He or she >doing a digital, and flow test, and a ultrasound for retention, is not >enough to warrant surgery IMO. Furthermore, I do not believe a urologist >would perform surgery on you without a cystoscopy being performed first. Pete, What's the purpose of a cystoscopy? I have never had one. What am I missing? Ed >> - First, I would absolutely ask for a cystoscopy before agreeing to >> any type of surgery. I consider that a must. Is the consultant in [quoted text clipped - 10 lines] > > Ed Ed...You are quite knowledgeable and I have been reading your posts in here for at least two years, and I believe you have a large prostate and live in Canada. Are you serious in asking what the purpose of a cystoscopy is (it's basically an endoscopic procedure that uro's use to inspect the prostate and bladder). We talk about them in here all the time, and of course there's google. If you have read my posts (I read all posts) I have made references to getting a first hand look at the prostatic urethra and bladder (via cystoscopy) to see what is going on. It's similar to an EGD to inspect the upper GI tract, and a colonoscopy to inspect the lower bowel, and then there is the bronchoscopy for the pulmonologists. I have had all these procedures, and have yearly EGD's. I wasn't trying to be smart - I guess I was just surprised that you asked. Apparently the docs in Canada and UK are not as big on doing cystoscopies as they are in the USA. Hell, I asked for my last two (flexible scope) out of desperation (and they are not without pain if you are conscious). I have had three cysto's, and my first one was done by an old timer with a rigid scope (ouch). Do you remember any of that from my old posts - lol . I thought most uro's would do a cystoscopy (at least in the US) before proceeding with a TURP or PVP, but apparently that is not the case in Canada and the UK. I believe a cysto will definitely give the uro a better idea of what kind of blockages are in the way and also check for any kind of bladder disease processes. And a flex scope will certainly allow better pictures of the bladder (by retroflexion). If you have a TURP or PVP using a rigid resectoscope (with no previous cystoscope), then there is no way to get retroflexion. Sorry, I am starting to ramble. Anyway, IMHO I think it would be advisable to have a cystoscopy before agreeing to any kind of surgery. Hope this helps...Pete >>> - First, I would absolutely ask for a cystoscopy before agreeing to >>> any type of surgery. I consider that a must. Is the consultant in [quoted text clipped - 42 lines] >to have a cystoscopy before agreeing to any kind of surgery. Hope this >helps...Pete Thanks... of course I hear talk about cystoscopy all the time here, but I don't think anybody ever explained why they are done. Your explanation helps a bit. Still isn't very convincing... I mean, there is not enough there for me to justify approaching my uro and ask for one. Yeah, I could do Google.... Ed >>>> - First, I would absolutely ask for a cystoscopy before agreeing to >>>> any type of surgery. I consider that a must. Is the consultant in [quoted text clipped - 69 lines] >and the cystoscopy doesn't need to be done until under anesthesia and >immediately before turp, PVP or whichever procedure is to be done. Dean, >>>>> - First, I would absolutely ask for a cystoscopy before agreeing >>>>> to any type of surgery. I consider that a must. Is the [quoted text clipped - 71 lines] >> anesthesia and immediately before turp, PVP or whichever procedure >> is to be done. Dean, Dean...I read your PVP report earlier in this thread, and it makes reference to a 23 French cystoscope. Did it also say later on that the uro pulled out the cystoscope and put in a resectoscope to perform the procedure (like in my TURP - ie cystoscope to examine first and instill water in bladder, and resectoscope to pass instrumentation for the actual TURP). Or was your 23 French cystoscope also the resectoscope (so to speak), and it is a wording thing, and you only had one scope. Regardless, I also had a separate cystoscopy prior to the TURP, that precipitated the scheduling for the TURP. I am hearing that is not necessarily the norm, but I still think it would be the proper way to go...Pete >>>>>> - First, I would absolutely ask for a cystoscopy before agreeing >>>>>> to any type of surgery. I consider that a must. Is the [quoted text clipped - 84 lines] > go...Pete >Pete, Your right, I think it would be better to have this done in advance so they could plan for any events that might show up in the cystoscopy but the patient might have to endure more pain. I also think that the reason for this is simply to appease the insurance companies. My operative report, which I tried to post a copy of it, but couldn't get it done doesn't mention resectoscope. It says after inspection with the cystoscopy the procedure was initiated and then goes on to explain the procedure. If I ever figure out how to do it I'll post a copy of the report. Dean, >> Dean...I read your PVP report earlier in this thread, and it makes >> reference to a 23 French cystoscope. Did it also say later on that [quoted text clipped - 17 lines] > goes on to explain the procedure. If I ever figure out how to do > it I'll post a copy of the report. Dean, Dean...no need to send anymore stuff. You paraphrased your report well - I just thought you may have left something out. My point is I believe you need a resectoscope to do the surgeries (versus a cystoscope - and most cystoscopes are flexible). Perhaps your uro uses the two terms interchangeably. I know Dr. Sancha used the term resectoscope, and I know my TURP was done with a resectoscope. Maybe I am wrong...Pete Pete, It would be my guess that when the procedure was initiated, just previous to that he pulled the cystoscope out and inserted the resectoscope but don't know for sure and I haven't had any recent contact with him so it would be hard to find out. Wishing you good health in the future. Dean, >>> Dean...I read your PVP report earlier in this thread, and it makes >>> reference to a 23 French cystoscope. Did it also say later on that [quoted text clipped - 24 lines] > interchangeably. I know Dr. Sancha used the term resectoscope, and I know > my TURP was done with a resectoscope. Maybe I am wrong...Pete > >>>>>> - First, I would absolutely ask for a cystoscopy before agreeing > >>>>>> to any type of surgery. I consider that a must. Is the [quoted text clipped - 96 lines] > > - Show quoted text - And the cystoscopy is really enjoyable!! The last time I had it done when finished the Dr. said "All through, you can start breathing again". How to proceed is a quality of life issue. When I got to the point of getting up every hour at night and spending five minutes dribbling out an ounce or so I knew it was time to do something. First time I tried Flomax I almost fell on my face on the way to the bathroom. All that type of medications affect me that way. >>>> - First, I would absolutely ask for a cystoscopy before agreeing to >>>> any type of surgery. I consider that a must. Is the consultant in [quoted text clipped - 55 lines] > > Ed I guess if you can pee good enough by taking meds then it doesn't matter...Pete:-) > Sorry, I've been away a few days. Re the cystoscopy, no I haven't had > one. I had a flow test, an ultrasound scan to measure retention (at [quoted text clipped - 34 lines] > > Thanks for all your comments btw, it all helps. I forgot to get back here too. TUMT is the microwave treatment. Didn't do a thing for me but apparently does help some. Normally done in the Doctors office http://www.urologix.com/pat_aboutEP.html OK, so big day today; my 'second opinion' visit to a different hospital. Here's a flavour. The first consultant at the first hospital gave me all of 7-8 mins (seriously!), was horribly brusque and keen to apply the knife. Today, what a difference. I had about 40 mins with the consultant during which time he gave a very thorough outline of what causes my symptoms, what the options are and plenty of time for questions. I guess I could wax lyrical forever, but the bottom line is he's suggested I go on watchful waiting, take the meds for 6 months and go and see him again then. No pressure to have any form of operation but happy to PVP me if I wanted. His outlook seemed to be the retention was not severe nor was I at risk from infection and if the meds helped the flow then go with that. Having said that, if I felt I could not live with the inconvenience/frustration any longer then he'd arrange for a PVP; my choice! "Take your time and if during the 6 months you want to go for the PVP just contact my secretary and we'll book you in". That's got to be about as close to private as you can get on the NHS. Whether I last 6 months or longer is of course the big unknown, but I'm prepared to give it a go. So anyway guys, thanks so much for all your comments and helpful advice. I certainly went along this time far better armed with background and questions than before. Consequently I feel I've been able to make a more informed decision than I would have without your input. :) > OK, so big day today; my 'second opinion' visit to a different > hospital. [quoted text clipped - 26 lines] > able to make a more informed decision than I would have without your > input. :) Bravo Zulu Phil :-) >> OK, so big day today; my 'second opinion' visit to a different >> hospital. [quoted text clipped - 28 lines] > > Bravo Zulu Phil :-) Phil...Damn it I almost forgot. So you still haven't got a pre cystoscopy yet, and he will do the PVP without one - good for you...Pete > OK, so big day today; my 'second opinion' visit to a different > hospital. [quoted text clipped - 26 lines] > able to make a more informed decision than I would have without your > input. :) A good result, we still have a few good guys around:-) Was this at the same hospital? What meds did he prescribe and if you decide PVP will it be at that hospital or elsewhere and what waiting time do they have for PVP? Derek. > > OK, so big day today; my 'second opinion' visit to a different > > hospital. [quoted text clipped - 33 lines] > > - Show quoted text - Different hospital. Seemed happy that I stayed on Xatral. Op would be at this second hospital, no idea about waiting times but I got the impression it would only be a few weeks. Re the cystoscopy, I asked him about that and his view was they would do one when it at the time of the operation. Basically his view was that all a cystoscopy would show was that there was a blockage. That being the case best to do it at the time of the operation. I'd have to say he seemed to have a very relaxed and simple outlook on this condition: If you can live with it, live with it. When it gets to the point where you want it done that is the time when they'll look around, decide what needs burning/cutting and just get on and do it there and then. This is pretty much in line with what Dean said in one of these posts. >>> OK, so big day today; my 'second opinion' visit to a different >>> hospital. [quoted text clipped - 40 lines] > Re the cystoscopy, I asked him about that and his view was they would > do one when it at the time of the operation. Phil...this seems to imply (they never explain any more than they have to) that the cystoscopy is separate from the resectoscope (which is used for the surgery). I still think that is true (ie two different scopes - put the cystoscope in to look around, and pull it out and then put the resectoscope in to do the surgery). Do we have a consensus on this or not - lol . Dr. Sancha could answer this in a heartbeat, but he has gone on to bigger and better things :-) ...Pete Basically his view was > that all a cystoscopy would show was that there was a blockage. That > being the case best to do it at the time of the operation. I'd have to [quoted text clipped - 4 lines] > there and then. This is pretty much in line with what Dean said in one > of these posts. > My comment on incompetence was really aimed at their inability to > explain things clearly and most definately the option of PVP was not [quoted text clipped - 9 lines] > in 9 days time. Granted that doesn't mean I'm going to be operated on > immediately but its good all the same. What tests did he do at your earlier appointment. Did he do a rectal ultrasound scan, flow test and scan for retention? Derek. |
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