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Medical Forum / Diseases and Disorders / Prostate BPH / August 2007AUR Has Struck--What Next Medically?
Long time BPH have been prescribed Flomax but do not take it every day as recommended. Most days difficult urinating in the morning by night very comfortable. Sleep interrupted an average of 1-3X per night over about an 8 year period. High PSA, monitored for prostate cancer via Ultra Sound/Biopsies every 18 months or so. Earlier today for the 3rd time in the past 30 days I could not urinate at all upon awakening While the previous two episodes of AUR resolved themselves in about 4-6 hours (and by night I was comfortable) this morning's after 8 hours of intense urge, maximum push and dribbles, I got myself to the ER. I was catheterized. told to see my uro within a few days (it was on a Saturday of course). They ruled out a UTI and were concerned that white blood count was high (13,000 ??). But otherwise I was sent home w with a leg bag in and out of ER within 2 hours. My basic question is what to next expect both over the next few days until I get to the uro . and what the alternative scenarios/diagnostic and treatment might be once he sees me. Of some concern as I sit here basically comfortable but very catheterized--13 hours and counting-- are 2 things. First, the nurse said I'd not have any urge to urinate while the catheter is in and that has NOT been so. Though the urges are not nearly as bad or as frequent as they were this morning they have occurred (usually when I shift positions, get up etc.) and they are intense (but brief 5 -8 seconds, every 20-25 minutes or so but usually when I change positions). Here comes the gross(er) part: first two leg bags urine very yellow but normal otherwise (warm). Bags 3 and 4 definitely red (from medium red to a paler but still distinctly red color) . Other than worry-- I was not "warned" about this in my discharge instructions from the ER-- I feel decent (good appetite neither too hot not too cold only minor irritation where the catheter was inserted; moving around slowly and being careful not to jolt the catheter the bag or anything connected thereto). The red color is alarming of course so any theories would be greatly appreciated even if it means I should run back to the ER. It's now Sunday of course. Thanks. > Long time BPH have been prescribed Flomax but do not take it every day > as recommended. Most days difficult urinating in the morning by night [quoted text clipped - 37 lines] > > Thanks. I expect some bleeding can be expected. I don't want to rule out a ER visit especially if the color in the tubes is a deep red. I assume you are seeing a Uro. Any discussion about PVP or TURP? Where are you located? >Long time BPH have been prescribed Flomax but do not take it every day >as recommended. Most days difficult urinating in the morning by night [quoted text clipped - 35 lines] >any theories would be greatly appreciated even if it means I should >run back to the ER. It's now Sunday of course. When the bladder is overfilled to excess, the stretching causes many tiny blood vessels in the bladder wall to burst. The bleeding discolors the urine. Depending on how full the bladder was, there might be lasting effects. Next time, get to Emerg sooner. Check with the urologist, obviously. The immediate cause might be infection which might resolve... and/or he might recommend a procedure like TURP or PVP. In the meantime, intermittent self-catheterization might be useful for you... ask him about it. Good luck Ed > >Long time BPH have been prescribed Flomax but do not take it every day > >as recommended. Most days difficult urinating in the morning by night [quoted text clipped - 51 lines] > > Ed Rich and Ed... Thank you very much for your feedback. I expect the urologist will call me back on Monday (july 30th) the Answering Service did not feel it warranted an emergency callback (this was after ER had catheterized me, made me more comfortable, so I agree-- not a true emergency. I reside in South Jersey (near Philly). Is there any standard way a uro approaches diagnosis treatment (from least severe to most severe) or do most of them just "cut" right to surgery (pun intended) option. Are there any meds (again I sporadically take Flomax and am about ready to also start with Avodart or Procar too) which if effective would obviate the need for TURP or other surgery? Oh...last two bags (slept reasonably well on my back of course!!) most//all of the reddish color has disappeared. Back to yellow urine color. Last question: may I shower as usual (not concerned about the bag as much as where the catheter was inserted into the penis). Again thanks so much to both of you. Michael >>> Long time BPH have been prescribed Flomax but do not take it every >>> day as recommended. Most days difficult urinating in the morning by [quoted text clipped - 76 lines] > > Michael Michael...A couple of things. First of all the nurse was absolutely WRONG saying you would not have the urge to urinate while the catheter was in. I had a catheter for 3 days after my TURP and I couldn't stand it - the urge to urinate was incredible and non stop and drove me crazy. Boy did she blow that one - furthermore the nurse after my TURP told me just the opposite - ie that you would have the urge because the catheter was keeping the sphincter open - oh well, so much for consistency in the medical world. Secondly, didn't they give you a night time bag (a big bag) to use at night so you wouldn't have to keep getting up and changing the small one on your leg. And did they tell you how to remove the catheter in case you couldn't see your uro right away - or were you just supposed to leave it in until you saw him - sounds like shitty instructions. Also, they should have told you how to take a shower. You simply pull the catheter off the bag and take the bag of your leg and let the catheter drain in the shower. I have to have my daily showers, although I have been in medical situations which precluded them. Good luck with the uro. If he does PVP, I would recommend that over TURP. Pete > > >Long time BPH have been prescribed Flomax but do not take it every day > > >as recommended. Most days difficult urinating in the morning by night [quoted text clipped - 77 lines] > > - Show quoted text - My experience is that flomax just puts off inevitable surgery. It does not shrink the prostate. What's your age? Be certain you URO offers PVP and that he has lots of experience. That is has performed at least 100 of them. Maybe someone here can recommend a good one in your area. Have you followed Dr. Sancha's blog? http://drgomezsancha2.blogspot.com My experience with Flomax is that it stops the bladder from going into spasms when you try to urinate. Previous posters right about it not affecting size of prostate. When after almost 6 years of treatment I had 2 ER visits for acute urinary retention within a month, I was finally advised to have surgery. I had laser surgery which I would advise rather than the TURP. My opinion is that the 2 operations are similar but the laser coagulates when it cuts and bleeding should be a non-issue. Bleeding is a major issue with a TURP. Incidentally, if you ever have eye surgery the opthomologist needs to know if you have ever taken Flomax. Fred On Jul 31, 6:34 am, f...@westchestergov.com wrote: > My experience with Flomax is that it stops the bladder from going into > spasms when you try to urinate. Previous posters right about it not [quoted text clipped - 11 lines] > > Fred Similar experience here. No side effects from the surgery. Wore a catheter the first night. Quite disappointed when I didn't get the "Gusher" described by Forelorn Hope and others. Instead it was worse than before. By evening I thought I was going to have to go back and have the catheter put in again. But by morning the flow was back to where it was before the operation and by the end of that day it was back to where it had been 20 years before! Everyone gets different results. I was also going to comment that surgery normally just puts off more surgery. The prostate doesn't quit growing. We were not supposed to live so long!! Unless something even better comes along will have no problem with another PVP. > On Jul 31, 6:34 am, f...@westchestergov.com wrote: > [quoted text clipped - 27 lines] > live so long!! Unless something even better comes along will have no > problem with another PVP. Rich, Pete, Fred: Ongoing thanks. Was most relieved to hear my ongoing, but basically bearable, urges to urinate were not a sign of trouble. I was given a larger night bag option but it's darn big/bulky I can easily time the 1 or 2 trips needed to empty the smaller leg bag. every night. Catheter still in (day 5) and have been told by 2 uros (or their nurses, including mine with whom I have an appointment next Tuesday on Day 10) that 7-10 days after AUR is the usual recommended catheter in time. I was dismayed at first but I'm halfway there. Major pain is after walking--my maximum is about 200 yards and at a very slow pace--at the insertion point. Sleeping, sitting fairly comfortably but I've had to cancel business/social things requiring walking. I told my uro's nurse (I have lydocane at home) she said it would be ok to put some on catheter and slide it (gently) into the tip of the insertion point to numb pain. I still haven't tried that (no balls to do so I guess!!). I can't see to agreeing to anything BUT PVP surgery (not TURP) if that is the recommendation on Tuesday, ( the day the catheter comes out I hope). Will I be forced to urinate on my own//immediately at the uro's office before anything further is done/decided? I don't do too well under that kind of pressure!!! Also my brother who had suffered with AUR had TURP surgery a few years ago, said be reading to be asked to have a cystoscopy (??) at next week's cath removal appointment. Not sure what that entails. Thanks to all fellow sufferers/empathizers. > > On Jul 31, 6:34 am, f...@westchestergov.com wrote: > [quoted text clipped - 65 lines] > > - Show quoted text - If you don't already know, check the laserscope site to see if your URO does PVP http://www.greenlighthps.com/consumers/index.html > > > On Jul 31, 6:34 am, f...@westchestergov.com wrote: > [quoted text clipped - 70 lines] > > http://www.greenlighthps.com/consumers/index.html Rich..Followed the link unfortunately not too many Uros in my area use this approach and not the guy I have the catheter out appointment with on Tuesday. 1.Is there a difference between greenlight laser and bluelight laser treatment or have I confused my colors? 2.What is likely to transpire as/ immediately after the catheter is removed on Tuesday (both from my perspective and from the doctor's, especially what are the options if I can quickly urinate again on my own vs. great difficulty in doing so?). Ongoing thanks. I've actually gotten semi-used to "catheter" comfort and maintenance issues here on Day 8 not that I'm volunteering to do this again!!!! At the risk of sounding cynical, would a uro make more money performing a TURP as opposed to a PVP? I'd also be grateful if someone would explain why one procedure would be recommended over another. Thanks in health JD > At the risk of sounding cynical, would a uro make more money > performing a TURP as opposed to a PVP? [quoted text clipped - 4 lines] > Thanks in health > JD I posted something yesterday but for some reason didn't get posted. (Forget to click on send?). I am quite certain one procedure over another does have financial bearings. As for recommending TURP over PVP, I will expect that it is as simple as being that the hospitals they use don't own a PVP machine and the Dr. has never been trained to use one. From what I have seen if the hospital the Dr. uses has a PVP machine, that is what they recommend. Two UROs I went to suggested trying TUMT first. One only used TURP and the other PVP. I switched from the TURP guy to the PVP. Although TURP is less invasive I more suspect that it was because they owned the TURP machine. I never heard of bluelight laser being used for BPH. Thought it was used for some kind of cosmetic thing. I often thought the Holmium was more of a cutting type beam whereas the KTP Greenlight was more for vaporization uses. I have seen it refernced especially when cutting is being done on the bladder nect. Perhaps when the hospital has the Holmium for other surgery procedures and they prefer adapt it for prostate. It may also be faster. I remember Dr. Sancha saying something about PVP on a large prostate could take a couple hours and use two or three expensive fibers. That may have changed as there is now a more powerful machine than was in use at that time. In addition some here have travelled long distances to get PVP. As I recall, a friend of Derek took a train from Northern Scotland to London in order to have it performed by Mr Muir. Had to pay for it himself too. > In addition some here have travelled long distances to get PVP. > > As I recall, a friend of Derek took a train from Northern Scotland to > London in order to have it performed by Mr Muir. Had to pay for it > himself too. Actually Derry claimed his expenses back from the NHS. I travelled Edinburgh to Newcastle for mine and did not claim my train fare back. Derek. >> At the risk of sounding cynical, would a uro make more money >> performing a TURP as opposed to a PVP? [quoted text clipped - 18 lines] > and the other PVP. I switched from the TURP guy to the PVP. > Although TURP is less invasive Rich is this a typo - did you mean less expensive. Turp is generally considered to be more invasive :-) . I more suspect that it was because they > owned the TURP machine. > [quoted text clipped - 10 lines] > may have changed as there is now a more powerful machine than was in > use at that time. > >> At the risk of sounding cynical, would a uro make more money > >> performing a TURP as opposed to a PVP? [quoted text clipped - 42 lines] > > - Show quoted text - Worse than what you think. I meant that TUMT is less invasive and that they push it because they own the machine. > >> At the risk of sounding cynical, would a uro make more money > >> performing aTURPas opposed to a PVP? [quoted text clipped - 42 lines] > > - Tekst uit oorspronkelijk bericht weergeven - Fellas - give your opinion to the poll regarding the topic - Green Light Laser will replace TURP as surgical management of BPH in the not too far distant future? at http://www.urosource.com/home/ |
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