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

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AUR/BRP Surgery Over--Concerns Remain

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Michael - 20 Sep 2007 22:16 GMT
Starting a new Thread (last one ended right before the September 11th
open Benign Retropubic Prostatectomy Surgery after a failed attempt to
use PVP technique on me).

Surgery occurred as planned on September 11th, renowned surgeon and
(by reputation) fine Philadelphia teaching hospital (Pennsylvania
Hospital). Prostate was to be gutted/cored with an additional biopsy
performed on the huge amount of reduced tissue (my prostate was as one
of the docs stated "world championship size" at 158 grams).

Best news was that cancer was ruled out (I had assumed it had already
been ruled-out during the failed PVP surgery but the docs said "we had
much more tissue to check and we weren't going to waste it"). Thank G-
d for that of course.

Gameplan had been do surgery, stick catheter back in, stay in hospital
until 3 days after surgery, remove catheter at Midnight, take 5-6
hours to pee w/o catheter. Out came cath at Midnight of the 3rd day;
3:00 AM I got out of bed and gravity produced a non-voluntary gushing
of uring. I was given a urinal and a decent but not massive amount of
blood-red "red"" emerged. Two hours later I again passed a decent but
not massive amount of blood-red urine. A few minutes after "urination
#2" along came the medical team, heard my story of two "mixed" results
and immediately said the surgery was a success despite my very large
prostate (it had also been wrapped around my bladder) . Discharge
papers were igned at about 6:00 AM Friday Sept. 14th.

Now the horror resumes. After the docs left I again felt the urge to
pee, tried to do so, but NOTHING but drops of blood. Ditto with about
3 subsequent efforts over the next three hours. I called for a nurse
in panic (remember I had been "discharged") and sweet little
bureaucrat thet she was she said very unsympathetically "what do you
want me to tell you the doctors have discharged you". I insisted on
her getting a urologist down to me "stat" 'like that was going to
happen).

About two hours later--I was beyond panic-- a younger doc on my
medical team finally appeared and they did a bladder scan. I was
retaining everything, passing nothing. The young  doc insisted the
surgery had gone well but that perhaps I had extra scarring//swelling
because of the size of my (ex) prostate had made it a little "longer"
after the removal of the catheter to successfully pee. He suggested I
stay "one more night" in the hospital OR see the lead surgeon  in the
doctor's office five days later (catheter back in of course). I chose
the 5 day later option.

Side note: i came into the hospital breathing fine, since the surgery
and continuing until today (September 20th) I've had a hacking dry
cough when I speak and more shortness of breath than I can recall (I'm
a reasonably in shape tennis player) . Things with cough have improved
a bit over time (lead doc prescribed a steroid, Prednisone, to
"address"  the breathing/coughing issue; he never said what caused it
or even what it might be).

5 days after my discharge from the hosp and reinsertion of the
catheter I go to the docs office, catheter removed and again gravity
alone produces a strong leaking to the floor. I make it to the doc's
bathroom and a MASSIVE amount of urine by force, volume and
circumference gushes forth. In the urine was a very large piece of
tissue. The doc says go eat breakfast, drink water/coffee and come
back 90 minutes later to urinate again. At the restaurant I urinate
again (decently, not massively). When I try to go for a Third Time, as
in the hospital, nothing. I'm ready to cry.

I walk back to the docs office, tell  my tale (two good then nothing)
and they do a bladder scan. The doc comes in and says the scan showed
that my bladder was virtually EMPTY and he said go home, be patient
you're doing fine. Home I go.

But when I get home I feel no urge and do not urinate for hours
despite fluid intake. By 8:00 PM in again panicking (no urge but no
output either). At 10:00 PM (12 hours after catheter was removed at
doc's office) I urinate decently. During the night I urinate decently
2 times more. I'm getting a bit encouraged. I should have known
better. It has been 11 hours since my last decent urination.

Though much urine is passing involuntarily through incontinence--oh
yes that comes with the "territory" too--I have had nothing but
dribbles when I try to go. Drinking some water. I feel good (except
for the lingering cough) but until I can urinate three days in a row
in even a semi-normal manner  I know/fear that since more is going in
than coming out it's ony a matter of time until......

Doc's office says we'll watch this until Friday (Sept 21st) then come
in for another bladder scan. I am again ready to cry (I had been
wearing a catheter for 7 weeks up to and after the two surgeries). Any
words of encouragement will be cherished but I just want to pee.....

And that was the short version.
Peter - 21 Sep 2007 02:36 GMT
> Starting a new Thread (last one ended right before the September 11th
> open Benign Retropubic Prostatectomy Surgery after a failed attempt to
[quoted text clipped - 85 lines]
>
> And that was the short version.

Michael...I feel for you so much and I wish I could help.  It sounds like
you are making some progress.  I am having serious problems with my stomach
and above and I am screwed, and it is hard to go on, and I don't know what
to do - docs can't help - and I don't have anyone to help me.  I know how
you feel and my heart is with you.  Do you know if the lead surgeon did the
surgery or just oversaw the resident or fellow.  Not that that matters now.
I mentioned this before if you recall.  I was wondering why you didn't write
earlier and have been waiting for your post.  I wish you the very best and
hope you improve soon.  Please keep us informed.

Pete
Michael - 22 Sep 2007 16:31 GMT
> > Starting a new Thread (last one ended right before the September 11th
> > open Benign Retropubic Prostatectomy Surgery after a failed attempt to
[quoted text clipped - 97 lines]
>
> Pete

Pete--The Magic of These Boards????

First I'm so sorry your medical situation is not good. At this most
sacred time of my own religion my prayers will go out for you. I want
to say that soon after I typed the long, semi-desperate message above,
I got up, went to the loo and was (finally) able to urinate. Though
I'm still not pronouncing myself "cured" in the subsequent 40+ hours I
have urinated reasonably consistently.

Peter in a prior Thread I responded that I have no idea who--the lead
surgeon or a resident--performed my surgery. I will ask for the
surgical notes from the doc at some point (not that I expect the notes
to say a "junior associate" gave it a try!!!)

I attribute my improvement to (in order of course) G-d and to the good
wishes present in this Message Board community. May those powers
somehow improve your situation too Peter.

The problem now is that the Prednisone (steriod) that the doc
prescribed for my coughing/breathing problem (somehow contracted in
the hospital) is making my ankles and knees swell noticeably.

To summarize: (1) failed PVP surgery (after general anesthesia, wasted
night in the hospital "recovering"); (2) three weeks later (catheter
in at all times, 7 week in toto) back for open abdominal benign
retropubic prostatectomy surgery; (3) wake up with lingering, ongoing
severe breathing/coughing issues;(4) doc prescribes steroid
(Prednisone) to "address" those issues;  (5) prednisome creates severe
swelling of lower-mid legs (and lord knows what else) while somewhat
assisting the coughing/breathing problem(s) and (6) I call the doc who
says (via his nurse--no time for him to speak directly to me of
course) "take 2 more Prednisones then stop and see either a
cardiologist or my family doctor ASAP". Appointment with family doc on
Monday.

And yet I still feel grateful.

Everybody be/stay/get well.
Peter - 22 Sep 2007 19:42 GMT
>>> Starting a new Thread (last one ended right before the September
>>> 11th open Benign Retropubic Prostatectomy Surgery after a failed
[quoted text clipped - 139 lines]
>
> Everybody be/stay/get well.

Michael...that is great news and I am so glad for you.  Prednisone is a
nasty drug with many side effects but I am surprised the swelling in your
legs has occurred so soon (people also get "moon face" but it usually
doesn't occur until after prolonged use).  I assume he gave you some kind of
"blast dose" with decreasing dosages each day for 7 to 10 days.  I would be
curious as to what the Rx says as far as the mgs per day etc.  Hope you keep
"peeing" better each day.

Pete
Ed - 23 Sep 2007 05:06 GMT
>> > Starting a new Thread (last one ended right before the September 11th
>> > open Benign Retropubic Prostatectomy Surgery after a failed attempt to
[quoted text clipped - 136 lines]
>
>Everybody be/stay/get well.

Hi, Michael!

Thanks so much for posting your experiences and not forgetting us. You
have had a very hard time, but I really think the worst is over.
Others in this NG have also reported problems post-op. It seems that
some of this is to be expected. You might still have some reversals
and scary moments ahead of you, but from now on I'm guessing it will
be mostly steady improvement.

I am impressed that you still have good spirits and a sense of humor.

Please let us know how you progress. I want to know when you are able
to drink a couple of beers with impunity!

And when you get to that stage, I might feel such jealousy that I will
sacrifice my body up before my uro for whatevery operation he wants to
do.  

Ed
Michael - 23 Sep 2007 16:20 GMT
> >> > Starting a new Thread (last one ended right before the September 11th
> >> > open Benign Retropubic Prostatectomy Surgery after a failed attempt to
[quoted text clipped - 156 lines]
>
> Ed

Ed, Peter, Everyone Else:

I feel it is important whether our outcomes are good or bad( relative
terms to be sure) that we remain accessible--ANYONE, always may
contact me directly via e-mail even if I eventually visit this Board
less frequently, but I'm still not pronouncing myself "cued"-- to
fellow sufferers old and new.

Peter I did not get a blast dosage from the uro of Predisone (10 mg 2X
per day for about 6 days). Pending my visit Monday to my family doc, I
cut the dose in half to 1 10 mg tab per day--down from 2 per day).
Swelling is still noticeable in ankles/knees, cough still there but
slightly improved. I am stunned the uro simply attacked the (relative)
fly of my hacking cough with a non-specific pharmaceutical "A-bomb"
like Prednisone. As you may have perceived, renowned or not he
basically plays the percentages--e.g., my failed PVP surgery without a
prior test for prostate size--without delving too deeply into the
"specifics" of his patients or their symptoms..

Another issue (sorry to do this to you guys I'm not usually a whiner,
I promise) is significant Incontinence.

I am forced to wear what they now call "adjustible (lined/absorbent)
underwear"--yes kinda like diapers but designed with leg openings like
underwear!!----but to my horror as they expand with "absorbed urine"
over the course of a few hours I cannot fit everything in to my dress
pants (underpants, undershirt, shirt, etc.).

I have had to wear my shirts out --not looking too good
professionally--thus I am now soliciting fashion tips cause I must get
everything properly tucked in and (hopefully) soon. Not sure how long
the Incontinence will persist but I know that  comes with the
territory. I vowed never to complain about too much "output" as my
complaint has been far too little output for years now.

Beer with "impunity" sounds nice--beers with any of you guys if you
get near Philly sounds better.

Everybody be/stay/get well.
Michael - 23 Sep 2007 16:25 GMT
> > >> > Starting a new Thread (last one ended right before the September 11th
> > >> > open Benign Retropubic Prostatectomy Surgery after a failed attempt to
[quoted text clipped - 176 lines]
>
> read more ?

[for some reason the rest of this post did not display here....if not
bored press the read more option]. Thanks to all.
Peter - 23 Sep 2007 20:53 GMT
>>>> Starting a new Thread (last one ended right before the September
>>>> 11th open Benign Retropubic Prostatectomy Surgery after a failed
[quoted text clipped - 161 lines]
>
> Ed

The TURP will be good enough Ed.  Go with it, and forget all that crazy
stuff about traveling thousands of miles to get a PVP...Pete :-)
Rich256 - 23 Sep 2007 23:23 GMT
> >>>> Starting a new Thread (last one ended right before the September
> >>>> 11th open Benign Retropubic Prostatectomy Surgery after a failed
[quoted text clipped - 166 lines]
>
> - Show quoted text -

Ed stated that with a 150 g prostate he may also be faced with open
prostatectomy.

I remember Dr. Sancha saying on his blog that one of his patients had
a prostate of that magnitude.  The remark was about the time it took
and the number of expensive fibers that were needed.   That may have
been with the older machine.  The newer more powerful machine can do
it faster with and perhaps with less fibers.
Ed - 24 Sep 2007 19:45 GMT
>> And when you get to that stage, I might feel such jealousy that I will
>> sacrifice my body up before my uro for whatevery operation he wants to
[quoted text clipped - 4 lines]
>The TURP will be good enough Ed.  Go with it, and forget all that crazy
>stuff about traveling thousands of miles to get a PVP...Pete :-)

He was talking TURP a couple months ago at my regular 6 month visit.
But my prostate must be around 150 g... and the uro told me a year ago
there is a time limit of about 1 hour to do a TURP, and 150 g is
probably not doable in 1 hr.... so, like happened to Michael, once
they get me in there, they might just exclaim, this is too big, we
have to do an Open! That increases the ante a bit.

Ed
Rich256 - 24 Sep 2007 21:09 GMT
> >> And when you get to that stage, I might feel such jealousy that I will
> >> sacrifice my body up before my uro for whatevery operation he wants to
[quoted text clipped - 13 lines]
>
> Ed

Ed,

Did you happen to see this one?

http://tinyurl.com/36cxre

I forgot if you said what town you lived in.
Ed - 24 Sep 2007 22:59 GMT
>> >> And when you get to that stage, I might feel such jealousy that I will
>> >> sacrifice my body up before my uro for whatevery operation he wants to
[quoted text clipped - 21 lines]
>
>I forgot if you said what town you lived in.

Thanks, Rich! Hadn't seen that.

This is definitely progress. They are buying several of the high power
PVP machines. Depending on what happens, I may be under one of those
one day.

The inclusion criterion of <100 cc for prostate size leaves me out of
the proposed study, though.

I'm in Calgary, Alberta. (Do you know where that is?) ... but have
family in Ontario, so it would not be so hard to go there for this
procedure... assuming it would be suitable for my king-size prostate.

Ed
Rich256 - 25 Sep 2007 04:45 GMT
> This is definitely progress. They are buying several of the high power
> PVP machines. Depending on what happens, I may be under one of those
> one day.

Dr. Sancha refers frequently to working on greater than 100 cc.  And
comments on how much faster it is with the 120 watt unit.

> I'm in Calgary, Alberta. (Do you know where that is?) ..

Sure, I am in the Denver area.

I would expect that you should be getting PVP into your area, perhaps
Edmunton, before long.  I happen to note not long ago that a hospital
there was using the Di Vinci Robot for cancer surgery.  A neighbor had
his removed with that machine not long ago.  Marvelous results.  Back
at work in just a few days.

Fortunately waiting with BPH is usually just a quality of life
decision.  As long as the "C word" doesn't show up it can usually be
put off at least for a while.  I was getting tired of getting up every
hour and spending five minutes or more to "dribble" out an ounce or
two.  I still am getting up more a couple times a night, more often
than I like, but don't stay up very long!!

Sure not the quantity of viewers on this site that there was a year or
two ago.  Apparently most that have a successful  PVP go on with their
life and quit visiting.  Only ones left are those that are still
looking and us old guys that find it to be a way to pass the time:-).
Peter - 25 Sep 2007 00:51 GMT
>>>> And when you get to that stage, I might feel such jealousy that I
>>>> will sacrifice my body up before my uro for whatevery operation he
[quoted text clipped - 20 lines]
>
> http://tinyurl.com/36cxre

I wonder why the exclusion criteria excludes chronic urinary retention -
huh?  That is one of the main problems associated with BPH.  Oh well...Pete
:-)

> I forgot if you said what town you lived in.
Peter - 25 Sep 2007 00:54 GMT
>>> And when you get to that stage, I might feel such jealousy that I
>>> will sacrifice my body up before my uro for whatevery operation he
[quoted text clipped - 14 lines]
>
> Ed

Ed...do you know what the one hour time limit to do the TURP is based on.  I
hope it's not the uro's personal time limit and it is more scientific...Pete
Ed - 25 Sep 2007 01:49 GMT
>>>> And when you get to that stage, I might feel such jealousy that I
>>>> will sacrifice my body up before my uro for whatevery operation he
[quoted text clipped - 17 lines]
>Ed...do you know what the one hour time limit to do the TURP is based on.  I
>hope it's not the uro's personal time limit and it is more scientific...Pete

They irrigate the prostate when doing the TURP to help keep the area
clear so the surgeon can see. That liquid gets absorbed by the body,
though. By about 1 hour, the amount gets to be excessive, and can
cause serious effects. This is called TURP syndrome. And that's why
there is a time limit on the TURP procedure.

http://tinyurl.com/yqr3hk

Ed
Peter - 25 Sep 2007 04:16 GMT
>>>>> And when you get to that stage, I might feel such jealousy that I
>>>>> will sacrifice my body up before my uro for whatevery operation he
[quoted text clipped - 28 lines]
>
> Ed

Thanks Ed...I just learned something...Pete
Derek F - 25 Sep 2007 20:31 GMT
>>>>> And when you get to that stage, I might feel such jealousy that I
>>>>> will sacrifice my body up before my uro for whatevery operation he
[quoted text clipped - 29 lines]
>
> Ed
The Uro who wanted to TURP me said that the fluid used was changed some
years ago. It did not eliminate TURP syndrome but the patients are evidently
no longer in increased danger of suffering heart attacks in the next five
years.
Derek.
Ed - 25 Sep 2007 20:55 GMT
>The Uro who wanted to TURP me said that the fluid used was changed some
>years ago. It did not eliminate TURP syndrome but the patients are evidently
>no longer in increased danger of suffering heart attacks in the next five
>years.
>Derek.

Wow, I didn't know that there was an increased risk of heart attack
spread over such a long period of time. Do you have more info on this?
And on the improvement given by the new fluid?

Ed
Michael - 25 Sep 2007 23:00 GMT
> On Tue, 25 Sep 2007 20:32:35 +0100, "Derek F"
>
[quoted text clipped - 10 lines]
>
> Ed

Ed, Everyone:

I have cut the Prednisone to 1/2 of 1 10mg tab per day. Only one tab
to go. Cough virtually gone. Still very tender around the still-
stapled incision site and Incontinence remains an issue (any clothing
alternatives absorption wise would be appreciated).

Remember, please feel free to e-mail me directly--Ed and others past
or future--in sorting out options. I still can't get completely over
the fact that they put me under a General and started the PVP "before"
realizing my 158 gram prostate was too large for the Philly
technology. A simple Ultra-sound for size would have/should have
removed me as a candidate without having to (eventually) go through 2
procedures (the second of which was quite severe/invasive).

But as the old Chicago (group not city) song/sang:" feelin' stronger
every day". Finally. Post-surgical visit to uro on September 28th. If
no complications I assume my surgical staples will be removed and he
will pronounce me (for now) fine. We'll see. Always skeptical.
Ed - 26 Sep 2007 05:53 GMT
>Ed, Everyone:
>
[quoted text clipped - 10 lines]
>removed me as a candidate without having to (eventually) go through 2
>procedures (the second of which was quite severe/invasive).

I agree with you. But as you also suggested in one of your posts, (not
your words)... the famous Dr. Malloy uses the same hit-and-miss
methods as other docs. Anyway, why does he have such a good
reputation? Probably because he publishes. That makes him a great
researcher, but not necessarily a better surgeon.

My uro is pretty off-hand too... recommended a TURP at the last visit,
but did not measure prostate size or do any other tests and (as
mentioned in another post) it may not be the right option considering
my prostate size.

Still, I'm sure you're in good hands there at Philly. The medical
system just doesn't work the way we expect.

>But as the old Chicago (group not city) song/sang:" feelin' stronger
>every day". Finally. Post-surgical visit to uro on September 28th. If
>no complications I assume my surgical staples will be removed and he
>will pronounce me (for now) fine. We'll see. Always skeptical.

Is the incontinence an improvement over the catheter for now?

Good luck, take it a day at a time.

Ed
Derek F - 26 Sep 2007 10:22 GMT
>>The Uro who wanted to TURP me said that the fluid used was changed some
>>years ago. It did not eliminate TURP syndrome but the patients are
[quoted text clipped - 8 lines]
>
> Ed
I first read of this effect in this book by Henry Salcedo an American Navy
urologist.
http://tinyurl.com/3az49l
He said that in the five years after having TURP Syndrome a larger than
expected number of patients had heart attacks.  I was
already concerned about having a TURP because of the other possible after
effects at that time (1995) and wrote to him with my symptoms and asked
about progress on TUMP and laser surgery. He sent me a hand written reply
advising me not to have a TURP and to wait for improved laser treatments to
be approved. I took his advice but it was a long wait for PVP to get to the
UK.
Other TURP syndrome references without the heart attacks.
http://tinyurl.com/2qk647

http://medind.nic.in/iad/t02/i6/iadt02i6p441.pdf

http://www.nda.ox.ac.uk/wfsa/html/u16/u1608_02.htm

After my PVP in June 2005 I came round in the recovery room shivering and
had to be covered in heated blankets. The anaesthetist later said that
during the procedure my heart rate had gone very low and he had to
administer something to speed it up. I don't know whether either symptom was
caused by the fluid used.
Derek.
Ed - 26 Sep 2007 15:36 GMT
>>>The Uro who wanted to TURP me said that the fluid used was changed some
>>>years ago. It did not eliminate TURP syndrome but the patients are
[quoted text clipped - 32 lines]
>caused by the fluid used.
>Derek.

If it is correct that there is a long term heart risk after TURP, then
that is scary. How does Salcedo know it's due to the fluid? If it is
the fluid, you gotta wonder what long-lasting damage it does to you.

Well, I guess those days are behind us, if they have now improved the
fluid.

Ed
Derek F - 10 Oct 2007 12:03 GMT
>>>>The Uro who wanted to TURP me said that the fluid used was changed some
>>>>years ago. It did not eliminate TURP syndrome but the patients are
[quoted text clipped - 45 lines]
>
> Ed
I will check to see if I still have the book but I think it went in the
clear out when we moved house last year. The heart attack theory was not his
but evidently from published statistics.
Derek.
Rich256 - 23 Sep 2007 16:28 GMT
Michael,

Perhaps improvement is in sight.  Obviously after such surgery it will
take some time.  We who just had them blast out a new channel got by
pretty easy.  Mine as I remember was only about 60 gr.

And having picked up additional problems in the hospital only makes it
worse.  Just noted the announcement that Doctors will be doing away
with lab coats and ties in UK:

http://www.star-telegram.com/279/story/238920.html

I am still puzzled over the description of the Prostate "wrapped" (or
something to that effect) around the bladder.

I never heard of Prednisone.  Looked up the side effects and can only
say "WOW".  I thought the dizzyness from Flomax was bad!!

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601102.html

Problem is that many of us are at the point in life where everything
is wearing out.  Just hope to keep functions like  the water works
flowing before the heart stops!!
Peter - 23 Sep 2007 21:09 GMT
> Michael,
>
[quoted text clipped - 12 lines]
>
> I never heard of Prednisone.

Rich...how did you get to be your age without ever hearing of the dreaded
Prednisone - lol - or for that matter never taking it.  It is probably the
most prescribed drug in the world for it's use as an anti inflammatory drug,
and it interferes with the production of and activity or your lymphocytes,
and lowers your immune system, and opens you up for infection (great stuff).
They also use it for transplants to lessen the effect of the body trying to
reject the new organ.  Take care...Pete

Looked up the side effects and can only
> say "WOW".  I thought the dizzyness from Flomax was bad!!
>
[quoted text clipped - 3 lines]
> is wearing out.  Just hope to keep functions like  the water works
> flowing before the heart stops!!
 
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