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Medical Forum / Diseases and Disorders / Prostate BPH / January 2004PVP-Day +10
Well, finally things seem to be going well. When I saw Dr Paibul again on Monday, the flow rate was back up to 21, and I'd guess it's still in the 20s - so as long as it stays there, that's fine. What the problem was last week no-one really knows; I suspect the biopsy three days before the PVP probably *was* a factor. Dr P OKed flying back to Singapore (about a two-hour flight) on Monday evening as scheduled - no problems with that, though I did get some help at both ends on lifting my quite heavy suitcase. (Somehow I've never mastered the art of travelling light!) I still had some annual leave, so I took Tuesday off; we were only working half the day yesterday, and today is the New Year holiday, so I'll only have one more working day before the weekend - a nice gentle reintroduction to work! Apart from that I'm back to normal life, though trying to avoid any heavy lifting. I'm still noticing minor bleeding when peeing, especially at the beginning and end, but rereading the reports in the Google archive that seem quite normal at this stage, I think? (Especially since I also had a biopsy and rigid cystoscopy within the same week.) There's a small amount of discomfort - soreness rather than pain - in the prostate area immediately after peeing, going away quickly; but it's nothing like as bad as after the TUIP. (That went on for several weeks, I remember; I'll hope for a quicker end to it this time.) Otherwise my main complaint at the moment relates to having to get up twice or so in the night to pee. Join the club, I hear other people on this group muttering! However, I was lucky never to have any major urgency or frequency problems with BPH, so the current broken nights are an unwelcome change! Only a temporary one, I trust. I do have some pills to reduce bladder overactivity, but I'm not sure they are having much effect. One small surprise was being kitted out with a month's supply of antibiotics (ciprofloxacin) before leaving Bangkok. It seems a long time to continue them; but I think that may relate to the biopsy as much as to the PVP itself. (Certainly the biopsy procedure inevitably releases a lot of undesirable organisms into the bloodstream immediately afterwards, and I suppose there are still some minute holes between the rectum and the prostate area, which itself is currently more vulnerable than usual. But that's speculation - I didn't ask Dr P himself, though perhaps I should have done.) In due course I'll try to find time to do a more organised write-up both of my PVP procedure itself and of the biopsy. I've found that one of the virtues of this group is the opportunity to get an idea of what the procedures are actually *like* - and the range of experiences people can have with them. There are some good websites on the technical aspects, but this group supplements them very usefully. So it's only fair that I in turn should make a small contribution to the store of information! Happy New Year. Richard Slessor Big snip: > In due course I'll try to find time to do a more organised > write-up both of my PVP procedure itself and of the biopsy. > I've found that one of the virtues of this group is the > opportunity to get an idea of what the procedures are > actually *like* - and the range of experiences people can > have with them. Richard, Since I have been researching for the proposed newspaper articles, I have come to realize just how enormously valuable this newsgroup is. If I were a surgeon or a manufacturer of equipment to deal with BPH, I think I'd try to get it banned! It is only when you start to read the web sites again after accessing this group daily that you realize what propaganda there is out there. No wonder there are still urologists who are sceptical. If you want to know how good a restaurant is, do you ask the chef or the customers? Please keep your reports coming, Richard and others. Another excellent post for which we are all grateful. Derry Richard, Pleased to hear all is going well! Thanks for another informative post! You refer to a rigid cystoscopy. Is this the PVP or did you have a cystoscopy in addition? If so why was it a rigid as opposed to a flexible and did you have a general or local anesthetic?? My understanding is that if a cystoscopy is needed it is carried out as part of the pvp using the pvp scope? Did you have ANY urgency or frequency pre PVP or were the symptoms as Derry's ie just poor flow? Interesting to see that Derry has a bit of Urgency now. It seems to me , from reading posts in this group that Urgency/Frequency post PVP is worse for those who had them significantly before PVP and not so bad for those who didn't have much pre PVP. Anybody agree with this theory?? Richard & Derry, - keep up the informative posts. It is great to have non USA experiences to add to the database of info. Derry do let the group know when your article will be published. Will you post it here? Regards, Magna > Derry do let the > group know when your article will be published. Will you > post it here? Modern journalism via email allows for the shotgun approach, i.e. if I can arouse their interest, I will send an article on the same subject, but different copy, to every newspaper that responds positively. It will then be up to the editor of each publication to accept or reject. I will of course be pleased to publish references here for anything that gets into print. Derry > Richard, > > Pleased to hear all is going well! Thanks for another informative > post! [Snip] > Did you have ANY urgency or frequency pre PVP or were the symptoms as > Derry's ie just poor flow? Interesting to see that Derry has a bit of [quoted text clipped - 4 lines] > significantly before PVP and not so bad for those who didn't have much > pre PVP. Anybody agree with this theory?? Not me, I had severe urgency almost to the point of incontinence, there was dribble if I couldn't find a urinal within five minutes. The frequency was every hour to hour and a half prior to the PVP some seven months ago now. Now there is no urgency and the trips are two to three hours apart, depending how much I've had to drink. Nights are just about 50-50 not getting up at all or getting up once. However, my urinary problems were caused by a large medial lobe protruding into the neck of the bladder. Two uros described as a cork in a bottle. Jack Jack, Pre pvp was there any post voiding residual urine? Sometimes, a few drops at best were voided. I believe it was 25 to 35 % of the time. However, there was 40 to 50% retention in the bladder. That number now is <10%. Jack > Jack, > > Pre pvp was there any post voiding residual urine? I'll say, I'm 6 weeks out of PVP and having major urgency issues during the day including severe pain at the end of some short streams. At night, everything calms down and stream is good. Seems to be related to morning bowel movements and ensuing irritation. Urologist wants to do a Cytoscope but I am wary of another invasive procedure in that area. Unless they can rectify the problem (no pun intended) it just seems like more agony. Anyway, the hype about PVP needs to be addressed. This is no walk in the park. Laserscope ought to be sued for misrepresentating the REALITY of this surgery. It may be the best thing out there, but hey, that's what they say about American Democracy. Marcus > Big snip: > [quoted text clipped - 23 lines] > > Derry Oh come off it ............theres loads of people who have been delighted with PVP and have recovered as per text book No one regrets rejecting the horrors and risks associated with TURP me especially I know someone who had a TURP day before I had PVP on July 24th .......he is still very ill and in hospital thanks to damage and infection Of course there will be differences in response ,,,,,we are all individuals Some get retro with PVP others dont Some get pulling at end of urination for a while Some get urgeny for a while but ALL get immediate speedy relief from the misery of BPH without the need for 4 or 5 days hospital stay and stiff catheters etc that are associated with TURP Retro ,incontinance and impotence are all recognised side effects of TURP > I'll say, > [quoted text clipped - 41 lines] > > > > Derry I think we need to be measured and reasonable when discussing the possible outcomes of a PVP procedure. PVP is surgery and there is a recovery time. Not everyone gets immediate miraculous relief. For those who do get a miracle, I'm glad for you and I wish everyone could get that miracle. As I've said before, I think that we should not be perceived as merely a rooting section for PVP. If we do that, then the benefits of using this NG are greatly diminished. I chose PVP, but not solely based on the Laserscope Website info. I chose PVP because; I did not want a TURP, I trusted the accounts of BPHers on this NG, and because the projected bad effects of an unsuccessful (or partially successful) PVP were not all that bad. By that, I mean that for those people who have an experience with PVP that is less than they had hoped for, they will probably be no worse off than they were before the PVP. To go through the misery and agony of a TURP and still have BPH would be too much to expect anyone to go through. I had a TUNA and a TUIP, both of which were unsuccessful. If the PVP had been available, I would have gone directly to it and avoided the TUNA and TUIP. My PVP has been mildly but not wildly successful. I am definitely better than before the PVP, but I did not get immediate relief and at no time have I experienced a fire hose type of experience. I am optimistic and I believe that things will continue to improve. I would recommend that BPH sufferers choose PVP over the other available options, but I would not promise them a miracle or immediate relief. -- Come off it? I'm sure as this procedure becomes more prevalent there will be many more experiences that don't corroborate the "walk in the park" scenario that Laserscope is promoting. I'm not doubting the superiority of PVP to TURP and some of the alternatives. But the medical industry has a responsibility to the patients who may not have such an easy time of it. They need to be REALISTIC and prepare patients for the more difficult experiences as well as the quick success stories. I was not given any written information whatsoever about what to expect. In fact, I went into acute retention the next night and had to be taken by ambulance to the hospital to get re-catheterized. Since then, I've learned that urinary retention happens in 5-10% of the time, post-surgically. Where was that on the Laserscope site? If I had more complete information I could have been aware of the signs and gotten myself to a hospital hours earlier! Today I was told that the surgery destroys the uretha and it takes up to 3 months for the uretha to repair itself. In another words, even if only 10% of PVP patients are likely to experience a prolonged recovery, they should be told that this possibility exists. I didn't see anything about this in the literature either. For Christ sake, they are boiling human tissue in a strategic and delicate area! If marketing and medicine are to coexist, then the marketers should own up to the real world... not the convenient fantasy-land of best case scenarios. I'm sure those success stories exist, but this is human health we're dealing with, not choosing a house painter or a television. Marcus > Oh come off it ............theres loads of people who have been delighted > with PVP and have recovered as per text book [quoted text clipped - 58 lines] > > > > > > Derry Marcus, Everyone who has ever had a Laserscope PVP has received a huge improvement in their overall well being than they would have recieved with either a TURP or an open prosectomy. That is a fact. Does Laserscope PVP remove the bladder outlet obstruction in the most patient friendly way: absolutely yes. Does it instantly restore the bladder to it youthful functioning: absolutely not. The healing process is individual and variable. Take your case, in particular. Could you have continued with your BPH causing obstruction without surgury? For how long? Were you a month or a few months away before going into retention? Wasn't surgury in your case, inevitable? Were you not damaging your bladder everyday by not having the obstruction removed? PVP removed the obstruction in a much better fashion that TURP or open prosectomy. Better than TUNA, TUMT, or medication which do not physically remove the obstruction. But PVP does not fix the damage that has been done by years of an obstructed bladder. Once the obstruction is removed it will take time for the bladder to heal. In your case, your bladder responded to PVP by going into retention. This probably would have happened with a TURP or any other prostate procedure because of the years of bladder damage caused by BPH. As I have said many times, PVP offers the best solution to BPH when done early. Before bladder damage, before the prostate gets to be over 100 grams! It is my strong belief that every man should be examined and tested in their late 40's for decrease flow rate and post void residual. Two simple and meaningful tests (along with PSA). If flow rate begins to diminish year after year, it is time for tests to see if BPH is involved. But once BPH begins to have a measurable impact on flow rate, or symptoms like increased frequency or urgency begin to appear, it is time for a PVP. The true benefits of PVP will be realized when thousands of men have PVPs before their symptoms get severe. Looking at my own history and yours, we both should have gotten PVP done at least 10 years ago (if it were available). The material on the Laserscope is accurate and based on experiences of over 11,000 men. PVP does provide the best option available today to get rid of a bladder outlet being obstructed by an enlarged prostate. Patrick > Come off it? I'm sure as this procedure becomes more prevalent there will be > many more experiences that don't corroborate the "walk in the park" scenario [quoted text clipped - 91 lines] > > > > > > > > Derry "The material on the Laserscope is accurate and based on experiences of over > 11,000 men." Not completely accurate, and in fact, misleading. But I agree. PVP is likely the best surgical approach available. Again, more realistic preparation for the patient is crucial! Marcus > Marcus, > Everyone who has ever had a Laserscope PVP has received a huge improvement [quoted text clipped - 148 lines] > > > > > > > > > > Derry Please tell me what you found on the Laserscope site that you think is misleading. Copy and paste it here and let's discuss. Patrick > "The material on the Laserscope is accurate and based on experiences of over > > 11,000 men." [quoted text clipped - 177 lines] > > > > > > > > > > > > Derry Please tell me what you found on the Laserscope site that you think is > misleading. Patrick I would say it is a matter of a several outright misleading statements as well as a general impression. The suggestion that "Some men may experience more severe symptoms, which can be easily treated by your doctor." is simply not true. There is nothing easy about recovery for some of us. There is no mention of the possibility of going into urinary retention. There is no mention that the urethra is destroyed during PVP (or any BPH laser surgery) and that it can take up to 3 months or more to repair itself. Say, anyone can figure that an eviscerated urethra is likely to cause pain. The video showing the happy camper with the stream of bloodless urine right after surgery may be accurate for some, but how many patients get off this easy. The statement that you will not need to take your prostrate meds after the procedure certainly did not hold true for me. "Will I still need to take my prostate medication following the PVP procedure? --No. Your doctor will tell you when you can stop taking these medications." I went off the Flomax, as instucted and experienced so much urgency that I had to go back on it. If Laserscope was more realistic it would help patients understand that they will be undergoing an invasive procedure and not to necessarily expect things to get back to normal in the week or so that they imply. This would help keep the expectations reasonable and the anxiety level down. I think medicine, more than any other business, has a responsibility to avoid the hype of modern marketing. Laserscope should re-write their web-page. I'm sure they'd still be on the cutting edge of the market. Despite my post-surgical problems, I would still recommend it, only with a much greater sense of reserve and caution. Marcus > Please tell me what you found on the Laserscope site that you think is > misleading. [quoted text clipped - 211 lines] > > > > > > > > > > > > > > Derry I have watched the laserscope website evolve over the past 2 years. Compared to what it was when I first heard about it in Nov 2001, it is now much more informative and I don't think it is the least bit misleading. Everything on the website is based on factual and typical results now of thousands of successful procedures done by hundreds of doctors. The things you are blaming on PVP have nothing to do with PVP, i.e. your bladder going into retention. The PVP opened a channel through your prostate in a way unmatched by any other technique. If you watch a video of PVP and compare it with a video of a TURP you would see the vast differences. Nobody says PVP is a walk in the park. It is prostate surgery. But it is much much better than any other prostate sugury you can have and the literature shows that it does a better job of getting rid of BPH symptoms than any other procedure or medication. As for the urethra being destroyed and needing 3 months to repairing itself. Well this is an oversimplification. The PVP like the TURP creates a large wide open channel through the prostate. The walls of this channel do need time to heal. This does take several weeks, that is why your doctor tells you to take it easy. But realize that this is the whole point of the prostate surgury, to open up a urethra that has been essentially closed by BPH. Frankly, the things you are blaming on PVP are not warranteed. PVP did not cause your BPH symptoms, nor your bladder problems. PVP is the tool that was used to open up a channel through your prostate without you bleeding profusely, or needing a catether for several days or having to stay in the hospital for several days or having a long recovery. Even in your case, PVP is alot better than what would have happened to you had you had a TURP. For me, PVP has been an enormous quality of life enhancer. More than any medical treatment or procedure that I ever had. WIth time, I believe that you will say the same thing and realize that you waited too long to have a PVP. But for anyone in misery with BPH, PVP is better late than never. Patrick > Please tell me what you found on the Laserscope site that you think is > > misleading. [quoted text clipped - 277 lines] > > > > > > > > > > > > > > > > Derry You miss my point.....I'm not blaming my problems on PVP. I'm saying that there is an overly optimistic approach that is taken by Laserscope and perhaps its surgeons that does not reflect the reality of prostate surgery. Like you say, it is prostate surgery. Not discussing the damage to the urethra, suggesting that any complications can be easily dealt with is, indeed, MISLEADING! Again, I'm not doubting PVP's superiority, just the integrity of the marketing. Marcus > I have watched the laserscope website evolve over the past 2 years. > Compared to what it was when I first heard about it in Nov 2001, it is now [quoted text clipped - 351 lines] > > > > > > > > > > > > > > > > > > Derry I think you folks are coming down way too hard on Sasha. He is reporting his experience. His reports are less than glowing. I think we need all the impressions of the participants! Mel > I have watched the laserscope website evolve over the past 2 years. > Compared to what it was when I first heard about it in Nov 2001, it is now [quoted text clipped - 351 lines] > > > > > > > > > > > > > > > > > > Derry I think the disagreement is not about Sasha's experience (which is less favorable than most have reported) but rather his contention that the Laserscope website is misleading and/or paints an overly optimistic procedure. My only comment is that one should ask lots of questions of one's urologist and get the results of his experience. If he's done a lot of PVPs, then he is likely to have a range of experiences to report. I agree with you in that we need to hear from everyone, whether they were satisfied or not. It's also important for those whose immediate success is not great to keep us informed of their progress. Some people take weeks or months to see the full benefits. > I think you folks are coming down way too hard on Sasha. > He is reporting his experience. His reports are less than glowing. I think [quoted text clipped - 7 lines] > > Everything on the website is based on factual and typical results now of > > thousands of successful procedures done by hundreds of doctors. This thread illustrates what I like about the BPH group - sensible (and where necessary sensibly critical) discussion without descending into the 'flames' of silly name-calling and dialogues of the deaf! I've been critical here in the past of 'walk in the park' marketing of newer approaches to BPH treatment - mainly in connection with some sites dealing with Targis TUMT, which promised an experience during actual treatment which was very different from (and much pleasanter than) the one I actually had. In due course the Targis website itself changed to a much more balanced presentation - I take no credit for that, but was nevertheless pleased to see it! Having read the comments by Sasha and Marcus I had another look at the Laserscope website. On the whole I think it is relatively honest; it mentions the possibility of 'slight burning during urination and/or a little bit of blood in the urine for a couple of weeks', and adds that 'some men may experience more severe symptoms'. (I agree with Marcus that if the incidence of retention is as high as 10% or even 5% - source for that? - the possibility should specifically be mentioned.) The site also says that 'Retrograde ejaculation, or "dry climax" following treatment, may occur.' And it actually repeats the warning abour RE later on the same page - one wonders whether Haditdone ever looked at the website! My main criticism would be that it compares 'minimally invasive' PVP with 'invasive surgery', by which I'm sure we are intended to understand TURP. Have a look at the Laserscope video and I think you'll agree there's nothing very minimal about PVP's invasiveness - and indeed if it were, it would probably be less effective! It's the wrong way to sell it, I think; it just gives the lazier urologists an opportunity to put PVP straight into the same 'tried that, didn't really work' pigeonhole as other earlier alternatives to TURP. But I come back to the point I made at the beginning of this thread: the value of seeing a range of actual experiences reported on and discussed in this group. Like James I decided to go for PVP not because of any hype - from the manufacturer or anyone else - but because monitoring this group over more than a year convinced me that, compared to a TURP (which I think was by that time my only realistic alternative) it was likely to be less unpleasant, less traumatic and quicker to recover from. Despite the fact that my early post-op experience has been a little less straightforward than some people's, I think those advantages have by and large been delivered so far. I had a catheter for less than a day, did not have to go through the rather unpleasant process of continuous bladder irrigation, was out of hospital in little over a day, and am back at work which I certainly wouldn't have been after a TURP. My flow, while not in the 'fire hose' category (yet, at least!), is now very satisfactory. Yes, I had unexplained slow flow for a while after the op, I do still have some bleeding and a little (very short-term) discomfort at the end of urination, and I'm getting up more at night than I did before the op - though it was down to once last night, so here's hoping! (I confirm, incidentally, that like Derry my main problem has always been slow flow, with relatively little urgency or frequency.) So PVP is certainly *not* a 'walk in the park', and we should not expect that of something replacing a major operation (which TURP is). If you watch your own procedure, as I did, or even watch the streaming video on the Laserscope website, you are unsurprised that the result is not (for most people at least) an *instant* total cure. A lot of damage is being done in there! If you add to that my biopsy three days before the PVP, and the cystoscopy four days afterwards, Derry and others are probably right that I should expect my course to be a little less smooth that some other people's - though if retention really is a 10% possibility, my 4 ml/sec becomes substantially less surprising anyway. By the way, the cystoscopy was to try to discover why flow was so low, and a rigid instrument was used because it would give Dr P more choices (I nearly said flexibility!) in dealing with anything he might find. The point, surely, is that while PVP is definitely not an instant panacea or any kind of miracle, it appears to offer as good a final result as TURP does, with less short term downside. Only time will tell if the promise of durability proves true. However, having had two earlier procedures which removed less tissue and fairly quickly stopped working, I would not have gone for yet another alternative to TURP if I hadn't felt the odds were good that it would be as effective as the traditional operation, and last as long. Richard Slessor > They need to be REALISTIC and prepare patients for the more > difficult experiences as well as the quick success stories. You signed a consent form before the operation, right? That surely tells you that you might not even wake up from the anaesthetic. We've had these arguments here before. Life is a risk. Haditdone complained that he had retro after PVP. A percentage will get retro with PVP. He could have cut the odds by having a TURP. If he'd done that he could have been near 100% sure he would have got retro and removed all possibility of being surprised. Derry > I know someone who had a TURP day before I had PVP on July > 24th .......he is still very ill and in hospital thanks to > damage and infection I have not told my story of when I went into the local hospital for my biopsy which was done under a general anaesthetic. I was in two nights. I have wondered if I ought to tell about the filthy conditions. I arrived the morning of the first day and left late afternoon on day three. In that time the toilet serving six patients with urinary problems was not cleaned nor were the waste containers emptied. There was a log on an A4 sheet for the cleaner to complete on the back of the door. It stated that the toilet should be cleaned three times a day and the log completed each time. The last legible entry was six months previously. A 92 year old man urinated on the floor of the toilet and that remained until it dried up. One of my fellow patients sat on his bed attempting to clean this urine off his slipper with a Kleenex... Any procedure that will get me in and out of hospital as quickly as possible has my vote. I have no wish to go into hospital with one complaint and come out with another. I should perhaps add that King's College Hospital in London was spotless. And, yes, I did check the schedule behind the toilet door. No nurse came near a patient without first donning a fresh pair of surgical gloves. Give me that over a TURP in the local hospital any day. One question: What do I do about my experiences? Should I complain? Write it up and publish? Or what? Derry > > I know someone who had a TURP day before I had PVP on July > > 24th .......he is still very ill and in hospital thanks to [quoted text clipped - 32 lines] > > Derry > > I know someone who had a TURP day before I had PVP on July > > 24th .......he is still very ill and in hospital thanks to [quoted text clipped - 32 lines] > > Derry I was speaking to a lady the other day who is waiting to into Edinburgh's (much criticized) state of the art new Royal Infirmary for a knee replacement. She had just been to see her doctor for a cortisone injection. He had said to her "Sooner you than me. I would rather be operated on in a dirty cellar than in that place" Derek. > I was speaking to a lady the other day who is waiting to > into Edinburgh's (much criticized) state of the art new [quoted text clipped - 3 lines] > dirty cellar than in that place" > Derek. It is the system that is wrong. No matron to check. BTW, I still have not been seen by my doctor since I had PVP. It is clearly the people at the top who need an application of boot leather to the anal area and not the poor over worked staff. The nurses are very caring and do a great job, but they are not cleaners. Derry > One small surprise was being kitted out with a month's supply of > antibiotics (ciprofloxacin) before leaving Bangkok. It seems a long [quoted text clipped - 5 lines] > currently more vulnerable than usual. But that's speculation - I > didn't ask Dr P himself, though perhaps I should have done.) Richard-- This point seems to have been lost in the subsequent discussion about LaserScope's marketing methods. As I understand it, a month on cipro is unusually long. Ten days or two weeks is usually the prescribed duration for such an antibiotic. More than that may have counterproductive results, as you may lose the needed beneficial bacteria as well as the unwanted detrimental bacteria. Good luck. Dick > As I understand it, a month on cipro is unusually long. Ten days or two > weeks is usually the prescribed duration for such an antibiotic. More > than that may have counterproductive results, as you may lose the > needed beneficial bacteria as well as the unwanted detrimental > bacteria. Yes, it is long - though I believe that with prostatitis you can be on it for quite a number of weeks. I suspect even a short course (five days, say) can kill off a lot of the beneficial bacteria in the colon. I remember once when I consulted a dentist in France for an infected tooth, I got not only antibiotics but lactobacillus tablets to counteract the effect on the colon. There may be a case for that, I guess. For the moment I'm going on with the ciprofloxacin; I always feel antibiotics - of more or less any kind - take the edge off your energy, but at the moment I can cope at work without too much problem. Maybe I'll get some lactobacillus to take when the course is finished! (No obvious digestive effects at the moment.) Two weeks in, I'm still getting some blood especially at the beginning of urination, and soreness as I finish (lasting less than a minute, though). I'm also still getting up at night more than I'm accustomed to. I mentioned the bleeding to Dr P when I e-mailed him to confirm a followup appointment - interestingly, he said he finds bleeding after PVP is often more noticeable in the second post-op week than the first. Richard Slessor |
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