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Medical Forum / Diseases and Disorders / Prostate BPH / October 2007

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Green Light Laser will replace TURP as surgical management of BPH in the not too far distant future?

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Researcher - 14 Aug 2007 14:55 GMT
Give your opinion at http://www.urosource.com/home/
raj - 19 Aug 2007 01:54 GMT
> Give your opinion athttp://www.urosource.com/home/

Many thanks to all of you who shared so selflessly about your personal
medical experiences.  When I was scared and ignorant and searching for
information to help me understand what was wrong with me, what could
be don't about it, and what others have done in similar circumstances,
this group was invaluable... Thank You.

CAN WE TALK?
This is NOT the Reader's Digest version...
This is what I experienced... for what it's worth...

In Oct 06, bph shut down my urinary tract.  After months of slow-flow,
one Saturday, I couldn't pee a drop.  (Boy, THAT was a bummer...) Off
to the emergency room... drained 600ml... sent me on to urologist on
Monday who first got painful infection under control (took about two
weeks).... put me on Flowmax and Avodart for 30-days... but I still
had not established any acceptable working-order for my natural
urinary functioning...

I went through a variety of interesting and I'm-told necessary tests
including a computerized-flow-test that was really ingenious, almost
fun, and told my doctor that I hadn't damaged my bladder even though I
had allowed the pee-flow to stop completely...So, guys, whatever's
going on with you now... if you can avoid it DON'T LET THE PEE-FLOW
COME TO A HALT AND DON'T LET YOUR BLADDER MUSCLES BECOME DAMAGED...
apparently slow-flow isn't good if it causes permantent damage...but
let me go on....

I had researched the internet by this point and reviewed 7-8 possible
"treatments" but to me only PVP promised to be a reasonable,
sufficiently-controlled weapon of obliteration that I'd even consider
allowing another person to thread one up my penis and incenerate the
offending tissure of my prostate  ... (I had an obstacle in the pee-
flow that had to go!) Now the way I saw it, the "treatment" COULD NOT
be wildly unpredictable in what other major destruction it would
wreck:  like long-term incontinence or loss of my ability to get hard
and have fun... (I'm sorry guys! I'm being "dead serious" here:  I
just rely too much on my personal pleasure from masturbation NOT to be
worried about losing a nerve or two that would make life unbearable--
life is already "f.cked" having to deal with exhorbitant medical
costs--really nasty hospital company in Kentucky that owns the
Southern California facility I used, nasty lab that did assorted
urinalyses and threatened to send my account to collections on the
FIRST BILL--I didn't even KNOW that I HAD an account with those
bastards.... Thus I wrote back to them that I'd pay asap but if they
were so hung up--in the future-- just PLEASE SEND MY PEE BACK TO THE
DOCTOR! I'm sure I can find somebody else .... AND I DID!... Sorry
guys... but I digress....)

After the 30 days of treatment with pills, I told my urologist that I
had screwed my courage up sufficiently to accept a go-in-and-remove-
the-offending-tissue-kind-of-treatment like Greenlight PVP, to which
he replied that he would suggest microwave!   I'd been reading LOTS on
the net, all the groups, etc. and I'd concluded that that microwave is
BAD sh.t!  Even the FDA has a bold WARNING out on the net telling you
that guys have lost the use of their peni (what IS the plural of penis
anyhow???) and that DOCTORS are supposed to know of the microwave
risk... The FDA went on to say that during the microwave procedure it
is NOW MANDATORY that a cooling probe be placed in the rectum to keep
the temperature down so as not to damage the wrong tissue!

Now pardon my "French" but THAT'S f.cked!  And I couldn't believe
that "my" UROLOGIST would even MENTION such a procedure much less
RECOMMEND IT!  What kind of nutball was I dealing with??? Well, back
to the net I went.  (Thank GOD for the net!)  I found a urologist in
New Jersey who was up to speed on PVP, who blogged with a lot of guys
like me, and who told me that I was right in realizing that PVP would
be perfect for my condition--prostate size is NOT an issue for PVP--
PVP is now available in 80watt version (I used a 40watt unit), and "in
confidence" that the "vendors" of the microwave offered doctors "BIG
BUCKS" to peddle the microwave... (Is that what MY UROLOGIST WAS
DOING, I thought???)  Boy was I worried big time!

I returned to my urologist's office to schedule PVP, and he asked me
what I had against microwave....@! (Can you believe that???) Well, I
gave him a run down on the relative control of the destruction from
microwaves compared to laser; I told him about the FDA warning I'd
discovered; and I said that if he'd need to put a refrigeration unit
in my rectum just to be sure he didn't destroy my penis too, that THAT
procedure was just too fraught with uncertainty for my taste... (I
TRIED to be polite and clinical, but this was MY DICK & PROSTATE on
the block here; so I was ready to explode if some guy wanted to blast
me with death rays!)  He never replied to me, and he scheduled PVP
immediately... Oh, yeah!  I told him that the literature that I'd read
gave me only a 37% chance of coming out of the "surgery" without
retrograde ejaculation/my nerves in tact/mechanism-to-get-hard in tact
(i.e. have an erection). But even THAT low number was better than the
microwave... I'd take my chance with Greenlight PVP, I thought... I
really NEEDED to be able to PEE; so what else could I do??? God, life
is f.cked sometime!

Let me "cut to the chase" here, for you guys who are annoyed with my
wordyness...

The PVP went off without a significant hitch.
The "recovery" lasted a full 30 days for me...
I WAS incontinent for 2-3 DAYS right after the surgery!
(That scared the sh.t out of me; HOW COULD THAT HAVE HAPPENED, I
THOUGHT??? I don't want to wear diapers! God!)
But, in a couple more days I got control of my system.  I didn't just
EMPTY every time a little urine collected in my bladder, as I did
immediately after surgery. (I'm not religious, but I was damn thankful
for my good fortune even acquiring the Greenlight PVP and in NOT being
without pee-control anymore...)
Now, as for the IMPORTANT parts: I COULD urinate LIKE A COW PEEING ON
A FLAT ROCK! Whoppie!
It was truly marvelous!  A miracle! :-)

What about getting hard and.... you know.... getting off????
BINGO!  I still did both--- really well and FORWARD TOO :-) , I might
add.  More semen (or whatever comes out) ejaculated now than before
the obstruction was removed. And it felt GREAT!

Oh, yeah!  Another thing REALLY SCARED THE sh.t OUT OF ME....
I accepted complete anesthesia (I'd have liked a spinal, but since I
was "pushing" the doctor already by insisting on Greenlight PVP, I
just went with his wish for me to be completely out.... hummmm??  I
wonder what he wanted me NOT to see???.... I've become suspicious...)

When I woke up from the anesthesia, blood was dripping out of my penis
urinary tract opening...

WHAT HAD THEY DONE TO MY PENIS!
According to the Greenlight PVP material/website/etc. they said that
the laser would cauterize the remaining prostate tissue and there
would be NO BLEEDING!  (Well, don't you guys believe THAT one at all!
Although I'd kiss the President Of Greenlight Laser Corp for how
wonderful his machine was, how effective his Tech Rep must have been
-- the Tech Rep was actually IN THE OPERATING ROOM WHILE my prostate
WAS INCINERATED-- and even how well my urologist must have done (even
if I am still suspicious of his motives for suggesting microwave)...
Yep! I bled like a stuck pig and peed pink.... for days!
Finally the pink pee too stopped.
I kept peeing and having sex... it was wonderful.

Well, I am a little ashamed that I couldn't wait for a full 30 days
after "surgery" to resume masturbating...  The doctor nearly had a cow
when I confessed that one to him.  I told him that I'd really TRY to
AVOID doing it again...

(At that point I felt that I'd perhaps encouraged the bleeding after
the first 3 days by masturbating... You see, I DID avoid masturbating
for THREE WHOLE DAYS!..)

Ok.  You may have a complete disapproval of me and of the personal
innerworld that I've shared, but I want all of you who might be as
scared as I was, that if you can get Greenlight PVP, have a "decent"
doctor (whatever THAT is), and have insurance and the fortitude to
deal with the a.sholes in the medical-insurance world, I think you'll
have an acceptable outcome--even a TERRIFIC outcome, as I did... BUT
DON'T THINK YOU'LL BE TYPICAL... I've discovered that I sure wasn't
typical... also, stay vigilent for "curve balls" from the medical
establishement...

Later, as I thanked my doctor for doing such a great job on me--he was
happy too--I asked him, "Say, I was just wondering.... why DID you
recommend microwave for me?"  He said, "It's standard practice to
recommend the least invasive treatment first, and microwave is less
invasive...."  Duh!?   Well, why make an issue?  I am just ecstatic to
be able to pee like a cow, ejaculate frontward like a teenager, and
get on to the next problem....

Life's a bitch@!

Only one strong lingering concern remains...
I REALLY want to know whether it smells awful in the operating room
with all that smoke from burning human flesh.... gees!.... What do you
think?
I forgot to ask my doctor...
Good Luck.
p marcus
Rich256 - 19 Aug 2007 02:34 GMT
> > Give your opinion athttp://www.urosource.com/home/
>
[quoted text clipped - 168 lines]
> Good Luck.
> p marcus

The early microwave was cited by the FDA for possible damage to the
body.  However, later ones have received approval.  They work in a
different way.  And PVP is not all that safe either.  Be certain to
find someone who is well experience.  That beam can vaporize a lot
more than just the tissue the doctor is trying to vaporize.

I made certain I had an experience doctor before I proceeded with the
PVP.  Just watch the videos of PVP.  One little flash and a section of
tissue is gone.

As some one else on this site recommeneded.  I would rather have a
doctor experienced with TURP use that procedure than to have an
inexperienced one use PVP.
Al - 19 Aug 2007 04:45 GMT
> As some one else on this site recommeneded.  I would rather have a
> doctor experienced with TURP use that procedure than to have an
> inexperienced one use PVP.

Rich,

I have noticed a few times that you made reference to something I once
said.  The post was Nov 20, 2005, and I was attempting to respond to two
discussions that were going on at the time - 1) that there was nothing
wrong with waiting, and 2) that PVP was automatically 'better' than TURP.

I personally had rejected TURP recommendations by two uro's and traveled
to have a PVP by the premier PVP surgeon in the US, Dr. Te.  My PVP, Dec
2003 was and remains successful beyond my wildest expectation.     I
beleive PVP is the best tool available today, however it must be used by
a skilled surgeon, and merely doing a lot of procedures doesn't mean the
guy is any good.  Much more important is who trained him, and what is
his track record - talk to ten guys that he did surgery on 90 days ago.
 It's also critical that appropriate testing be done to determine if
the problem is actually one that PVP (or TURP) can alleviate.

Al

excerpted from my Nov 20, 2005 post:
If left untreated, BPH can do permanent damage to your bladder and even
kidneys.

I believe that the reason some guys have continuing problems after PVP,
and some other procedures, is because things above the prostate have
become damaged by neglect.  Clearing the passageway cannot restore a
bladder stretched and weakened by years of retention.  Good Doctors
explain what you can reasonably expect, based on the tests and
evaluation they have performed on you, before scheduling surgery.

My advice is to thoroughly evaluate through urodynamic tests,
cystoscopy, blood work, PSA (with biopsy if indicated) what and where
the problem really is.  If you indeed have BPH - fix it.  I am among
those extremely satisfied and grateful for my PVP - but I would add that
I would rather have a TURP by the best TURP surgeon in the country than
a PVP by the worst PVP surgeon.  The skill of my surgeon fixed my BPH.
cjhelp - 19 Aug 2007 18:42 GMT
>> As some one else on this site recommeneded.  I would rather have a
>> doctor experienced with TURP use that procedure than to have an
[quoted text clipped - 36 lines]
>I would rather have a TURP by the best TURP surgeon in the country than
>a PVP by the worst PVP surgeon.  The skill of my surgeon fixed my BPH.
Is there a urologist in Orange County, California that anyone has used for
PVP?
Rich256 - 19 Aug 2007 19:51 GMT
> >> As some one else on this site recommeneded.  I would rather have a
> >> doctor experienced with TURP use that procedure than to have an
[quoted text clipped - 44 lines]
>
> - Show quoted text -

There are a lot of them listsed on the Laserscope site.  Obviously
some good ones.  We don't seem to be getting the number of visitors
that we used to a couple years ago.

There is always Dr. Reiter at UCLA who is a pioneer and author of PVP
articles in the medical journals:

http://www.uclaurology.com/physicians/Reiter_25.cfm
Ed - 19 Aug 2007 18:51 GMT
>I personally had rejected TURP recommendations by two uro's and traveled
>to have a PVP by the premier PVP surgeon in the US, Dr. Te.  My PVP, Dec
[quoted text clipped - 7 lines]
>
>Al

I'm gradually coming to the conclusion that I need to have surgery for
my BPH, after years of avoiding it by "watchful waiting" and meds. I'm
in western Canada, and there is no Greenlight Laser machine here.

So I am thinking about going to Dr. Te. I wanted to ask how you did
this, since you also travelled. How was it determined that your case
was even suitable for PVP? How many trips did it take for all the
examinations and procedures? What's the lead time needed? (I mean, if
I want the PVP in January, say, when should I first contact him?)

Also I'm curious how he pronounces his name: Tee, Tay, or Teh??

And finally, when you came home, how did you deal with care
afterwards? Did you have go to back to NY? Any sign of rejection by
your home uro because you went to the competition, or because he did
not want to deal with after-effects of someone else's work?

Ed
Rich256 - 19 Aug 2007 20:04 GMT
> >I personally had rejected TURP recommendations by two uro's and traveled
> >to have a PVP by the premier PVP surgeon in the US, Dr. Te.  My PVP, Dec
[quoted text clipped - 26 lines]
>
> Ed

I thought I read where PVP was now available in your area.  Perhaps
under the national healt service.  Curious I did some searching.
Didn't find much.

Pay for service in Vancouver:
http://www.nationalsurgery.com/FCSC/procedures-greenlightpvp.php

There may be others.
Ed - 19 Aug 2007 22:47 GMT
>> >I personally had rejected TURP recommendations by two uro's and traveled
>> >to have a PVP by the premier PVP surgeon in the US, Dr. Te.  My PVP, Dec
[quoted text clipped - 35 lines]
>
>There may be others.

Yes, there is a clinic in Vancouver that does PVP. I contacted them a
couple years ago and they told me they did not do prostates bigger
than 50 or 60 g. I guess since they are just a clinic they do not have
the resources to deal with complications that could arise with big
prostates. That left me out.

There are a couple of locations in Ontario near Toronto that do PVP. I
visited one of these (Dr. Baldwin at the Scarborough Hospital) but
they also declined me owing to the size of my prostate... which was
about 150 g at the time.

Maybe things have changed since then, you never know....

But I don't see how I could do better than Dr. Te, who has done so
many and who has a stellar reputation.

Ed
Al - 20 Aug 2007 00:32 GMT
> snip

> I'm gradually coming to the conclusion that I need to have surgery for
> my BPH, after years of avoiding it by "watchful waiting" and meds. I'm
[quoted text clipped - 14 lines]
>
> Ed

Ed,

I hope I wasn't being overly dramatic in saying I "traveled" - I live in
southern NJ, so for me this was 90 min by car plus 1 hour on a ferry,
and 30 terrifying minutes in a NY taxi.  I dislike, fear and never go to
NY so for me this was a big undertaking.

I think the time from my first call till the surgery was about 3 months.
 It's been 4 years, things may be different now, but my experience was
an initial visit, then two more (one for uro-dynamic testing - one for
cystocopy) then the surgery.  I went to one follow-up about a month
later, but it was so uneventful that I never went back. I returned to my
2nd uro afterwards, he had a little attitude on the first visit, but got
over it.  I go once a year but have no issues.

Tay is the correct way to say his name.

The NY hospital has an arrangement with a hotel across the street that
you should inquire about.  Look around in their site:
http://www.cornellphysicians.com/  Also tho, consider Dr Lin at the
Flagler Hospital in St. Augustine Florida.  A few from this group
traveled there and all were thrilled with the procedure and
arrangements, they were very accommodating of travelers.  The NY
location of Dr Te can be daunting. Dr. Laub in Santa Barbara, CA has
also been raved about by guys that had to travel.

Al
Ed - 20 Aug 2007 02:32 GMT
>> snip
>
[quoted text clipped - 44 lines]
>
>Al

Thanks, Al! Very good points. I should look into those other doctors
too then. Santa Barbara sounds like a nice place to recuperate for a
few days... St. Augustine too, actually.

Ed
Prairie Spirit - 18 Oct 2007 04:21 GMT
Will a doctor give out the names of his patients?  Or, how would I find
these people?

>> As some one else on this site recommeneded.  I would rather have a
>> doctor experienced with TURP use that procedure than to have an
[quoted text clipped - 38 lines]
> I would rather have a TURP by the best TURP surgeon in the country than
> a PVP by the worst PVP surgeon.  The skill of my surgeon fixed my BPH.
 
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