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Medical Forum / Diseases and Disorders / Prostate BPH / March 2004PVP + 20 hours
written live from Haywards Heath hospital 10 am Wednesday Next morning. I've had no pain at all, just a mild ache in my wrist where I had the tube for the drip! Actually, I didn't get full feeling around my abdomen until 6 am this morning, which left me mistakenly thinking my catheter wasn't working. Now everything is out. The last bag of urine had only a slight pink tinge, so clearly no significant bleeding. I'm anxiously waiting to be able to pee. Then I'll have an ultrasound scan of my bladder and if it is less full than the amount I peed, I'll be free to go home. I was **very** nervous yesterday, but the whole think actually was really easy. Nothing at all has been more than mildly uncomfortable. I'll report more over the next few days, when the real test of how much better I am becomes clear. Regards, Gary > written live from Haywards Heath hospital 10 am Wednesday > [quoted text clipped - 17 lines] > Regards, > Gary Thanks Gary for your honest and factual reporting. For one of us still not sure which way to go re TURP or PVP in the UK,I look forward to your next bulletin. Good wishes for the future. Pete Gary, Well done! Hope things continue to progress well. Did you go private or NHS? What tests did you have in the run up to PVP and did Tim Larner do the cystoscopy you refer to in another post?? Regards, Magna > Thanks Gary for your honest and factual reporting. For one of us still > not sure which way to go re TURP or PVP in the UK,I look forward to your > next bulletin. Good wishes for the future. > Pete Hi Pete, For me, their is no choice between TUPR and PVP. One of the nurses was telling me about TURP. She said they more or less needed to have a constant nurse on a TURP patient to keep watching and changing the bottle or whatever it that was flushing out the blood, clots and other residue. It takes four or five days in hospital for that to settle down. They don't tell you the worst about the TURP when they are trying to get you to have it. With the PVP I've had almost no bleeding, perhaps a drop or two at the beginning of a pee. No pain and minimal discomfort. I was peeing with a good stream within about 6 hours of the catheter being removed. (That was yesterday, Wed., at 8 am, when the op was Tuesday at 2:30 pm.) I was pretty well in tears with the relief of it. No more trickling out, divided stream, no feeling that I still have to pee when I've finished. No bladder spasms. Today, I feel nearly normal, and it is only a day and a half after the op. Yesterday I felt very spacey, but I think that was mainly from the anaesthetic. I had this op done privately, for a cost of about £3,500 which is most of my savings, but well worth it. Once I had made the decision, I couldn't bear to wait for a year or more while the NHS got its act together for me. I presume that in a few years PVP will be much more available. Mr. Larner said that one reason PVP is expensive is that you need a new fibre for each patient, at a cost of £750, but he thinks the overall cost, including hospital, nursing, etc. is lower with PVP. If you count the benefits to the patient (not measurable in money) the case is overwhelming. In the run up to the PVP I had a flow rate and a very detailed PSA test through Mr. Larner and then blood tests with my GP. The cytoscope was a couple of years ago in a local hospital. Regards, A very happy Gary > For me, their is no choice between TUPR and PVP. One of the nurses was > telling me about TURP. She said they more or less needed to have a [quoted text clipped - 3 lines] > down. They don't tell you the worst about the TURP when they are > trying to get you to have it. I had a traditional TURP in 98. Was in the hospital approximately 20 hours. I didn't have any nurse more or less around the clock. People shouldn't post something as fact when they don't know what they are talking about. Don Hi Don, I also had a regular TURP , even earlier than you, 8 years ago in '96. My experience was much closer to yours than to the crazy ramblings of this Gary Hysterical - oops sorry - Alexander. Like you , I certainly neither had, nor needed, a continual nurse. I guess that the nurses in some private hospitals are not always as professional as they should be - which probably expalins the 'stories' which she fed to poor gullible Gary. My op took only half the time that Gary's took. And I didn't even have to have a 'general' ! I had total relief from my BPH symproms and, most importantly, I had the satisfaction and reassurance, from the biopsy of the prostate which was removed, that I had not got Prostate Cancer . Poor Gary has not got that reassurance.. I hope that he is not among the 1 in 10 who, after undergoing a TURP, are found to have Prostate Cancer. Correction, after suffering a laser TURP that should be 1 in 5. I also agree with you Don when you say " people shouldn't post something as fact when they don't know what they are talking about" This is particularly despicable when it causes unnecessary anxiety in people who are waiting such procedures. My message to them is - 1 Ignore the nonsense of 'Garys' 2 Follow the advice of your Urologist, if necessary getting a second opinion. 3 If you are advised to have a regular TURP then be thankful - it is simple, straightforward, painless and effective. 4 If you are advised to have a laser TURP , after a second opinion, then be sure that it probably fits your particular situation. 5 If you are offerred the choice between general and spinal anasthaesia, choose spinal. Mark ( 8 years post regular TURP and still 100% ) >> For me, their is no choice between TUPR and PVP. One of the nurses was >> telling me about TURP. She said they more or less needed to have a [quoted text clipped - 10 lines] > >Don I would like to weigh in on the pros and cons of TURP vs. PVP. I'm a urologist in eastern North Carolina who has done roughly 60-70 PVPs, and probably 300-400 TURPS. I posted a few times several months ago. There's no question that a TURP is a great operation, that's why it's been referred to as the "gold standard" for 30 years. "simple, straightforward, painless " a TURP is not!!! It is a technically demanding, and difficult operation. Bloody TURPs can be extremely stressful. For the urologist, it's hard work. TURPs on small to medium glands are generally pretty straighforward. TURPs on larger glands are quite difficult. As a resident I witnessed a patient suffer from TURP syndrome (from the absorption of irrigating fluid)and go on to die--extremely rare, but can happen. Fortunately, I've never had a patient have a serious complication from a TURP. Yet, bladder neck contractures, urethral strictures, impotence, and incontinence, need for transfusions,etc. do occur with TURPs. Patients generally need to stay in the hospital hooked to irrigation for 1-2 days. Also it's generally not considered safe to do TURPs on prostates larger than 100 grams. This is not a problem with PVP. A TURP cannot be done as an outpatient. Also 10 years ago 500,000 TURPs were done every year; now it's less than 75,000. Therefore, urology residents today are not learning how to perform TURPs. There's no question that learning how to perform a good PVP is much easier and less risky than learning to perform a good TURP. Urology residents today are going to want to learn how to perform PVP. Without a doubt, a TURP in a well-trained urologist is a great operation, with a low risk of serious complications. There's also no doubt that PVP achieves the same open outlet and great flow rates with significantly less morbidity. "I hope that he is not among the 1 in 10 who, after undergoing a TURP, are found to have Prostate Cancer." The above is simply not true. Prior to PSA testing 1 in 10 men may have had prostate cancer diagnosed from a TURP. In fact of the 150 or so TURPs I've done in private practice I cannot not remember one having had a serious cancer. The vast majority of prostate cancers are in the peripheral zone, which is not sampled during a TURP. Most cancers found on TURP specimens are incidental/low volume cancers that don't need to be treated. Transition zone cancers occur but are much less common. With PSA testing and digital rectal exams, prostate cancers are diagnosed at an earlier more curable stage. Men having a PVP laser instead of a TURP do not need to worry that a significant prostate cancer may be missed. Sincerely, Richard M. Hughes, M.D. Kinston Urological Associates Question, if 500,000 TURP's a year were being done and it is now less than 75,000 what is happening to the other 425,000 BPH sufferers? We know that only 11,000 PVP's were done last year. Has America now gone for watchful waiting. Derek. > I would like to weigh in on the pros and cons of TURP vs. PVP. I'm a > urologist in eastern North Carolina who has done roughly 60-70 PVPs, [quoted text clipped - 45 lines] > Richard M. Hughes, M.D. > Kinston Urological Associates No Derek, those others are managing their BPH with medications that have come on the market in the past 10 years. > Question, if 500,000 TURP's a year were being done and it is now less than > 75,000 what is happening to the other 425,000 BPH sufferers? We know that [quoted text clipped - 50 lines] > > Richard M. Hughes, M.D. > > Kinston Urological Associates The drug companies must be doing very well. Unfortunatly they did not work for me. Flomax put by heart rate up to a dangerous level and Proscar gave me a headache (by constricing blood vessels?) Than goodness for Saw Palmetto and Nettle Root. Derek. > No Derek, those others are managing their BPH with medications that have > come on the market in the past 10 years. [quoted text clipped - 53 lines] > > > Richard M. Hughes, M.D. > > > Kinston Urological Associates > I would like to weigh in on the pros and cons of TURP vs. PVP. I'm a > urologist in eastern North Carolina who has done roughly 60-70 PVPs, > and probably 300-400 TURPS. Is there anyone for whom you would recommend TURP instead of PVP? Specifically, I've been in nearly full retention and self cath-ing for months. Would that be a consideration? Stuart > > I would like to weigh in on the pros and cons of TURP vs. PVP. I'm a > > urologist in eastern North Carolina who has done roughly 60-70 PVPs, [quoted text clipped - 5 lines] > > Stuart Doing PVP on patients with large median lobes that protrude into the bladder (ie. intravesical median lobes)that cause obstruction in a ball-valve fashion can be more difficult to do. In one patient I had to convert to a TURP to stop the bleeding by resecting the bleeding prostatic median lobe. Generally, I try to do PVP, because of less bleeding, and convert to TURP if necessary. Also a patient with a high PSA and negative transrectal biopsies, may have a transition zone prostate cancer. There's a lot of controversy in this area about what PSA level requires a TURP to diagnose a transition zone prostate cancer. Therefore, a TURP which cuts out the tissue has an advantage over PVP which vaporizes the tissue,in terms of diagnosing prostate cancer. Sincerely, Richard Hughes, M.D. > Doing PVP on patients with large median lobes that protrude into > the bladder (ie. intravesical median lobes)that cause obstruction in a [quoted text clipped - 12 lines] > > Richard Hughes, M.D. Uh oh!! I'm afraid I might fall into the first category. Would this be determined by cystoscopic exam? Am I to understand that it would be sensible to begin with PVP, even under the above circumstances, then convert to TURP, if necessary? Many thanks for your generous and expert response. Stuart > Uh oh!! I'm afraid I might fall into the first category. Would this be > determined by cystoscopic exam? Am I to understand that it would be [quoted text clipped - 4 lines] > > Stuart You should probably see an experienced PVP urologist and be evaluated. An office cystoscopy and ultrasound should be able to diagnose a large median lobe, though sometimes it's not so obvious. It's easier, in my opinion, to remove all intravesical prostate tissue (prostate tissue that has grown into the bladder) with a TURP. It's harder with PVP to remove all the tissue, but I think one can safely create a channel to void through with PVP. Prostate tissue, probably has a higher chance to grow back in this special situation, because not as much can be safely removed with PVP, in my opinion. Sincerely, Richard Hughes, M.D. > > Uh oh!! I'm afraid I might fall into the first category. Would this be > > determined by cystoscopic exam? Am I to understand that it would be [quoted text clipped - 18 lines] > > Richard Hughes, M.D. Dr. Hughes...With a large median lobe protruding into the bladder, I was unaware that the TURP is more effective than the PVP in removing the excess tissue grown into the bladder. Why is the TURP better in that situation? I thought that the PVP laser can be positioned to target that tissue that has bulged into the bladder with less risk of complications. Thanks. Al > Dr. Hughes...With a large median lobe protruding into the bladder, I > was unaware that the TURP is more effective than the PVP in removing > the excess tissue grown into the bladder. Why is the TURP better in > that situation? I thought that the PVP laser can be positioned to > target that tissue that has bulged into the bladder with less risk of > complications. Thanks. Al To a non-urologist, it will be difficult to try to explain this to, but I'll try my best. The most critical thing to worry about when doing either a TURP or a PVP on a patient with an intravesical prostatic median lobe is the ureteral orifices -- the openings where urine drains from the kidneys. The ureteral orifices can be cut, cauterized, or damaged with the cautery loop or the laser beam if one is not extremely careful. The intravesical prostate lays on top of these orifices. With the cutting loop used during a TURP it's easier to not damage the orifices, in my opinion, than with a laser fiber. Therefore when doing a PVP, so as to make absolutely sure I don't damage these openings ( which can lead to blockage of the kidneys and require further operations), I personally won't be as aggressive at trying to vaporize all the tissue lying in the bladder. Yet, I still believe I can create a good channel to void through, and still get good results. Dr. Hughes I've had 2 PVP's. It's 3 months post 2nd PVP. The 1st was 14 months before that. I now have a consistently strong stream. But I still have overwhelming urinary urgencies, and a higher frequency of pees than I expected (more of both than after my 1st Op). I also have sexual side effects of 2nd PVP - extremely reduced orgasm (if you can call it that) - unsatisfying. No semen ejaculated, and possibly no semen or sperm in urine after orgasm (I'll be getting a lab test). I can only assume that these varied side effects were caused by the PVP work at the mouth of the bladder, but I'm not sure. Maybe there's a blocked duct (from laser) preventing sperm release & maybe not enough prostate gland to produce the semen. I would like prospective PVP customers to be aware of side effects before they make their choice. Keep informed, looking at pros & cons at newsgroup. Ron > From: hughesgr@earthlink.net (Richard Hughes, M.D.) > Organization: http://groups.google.com [quoted text clipped - 24 lines] > > Richard Hughes, M.D. > You should probably see an experienced PVP urologist and be evaluated. > An office cystoscopy and ultrasound should be able to diagnose a [quoted text clipped - 9 lines] > > Richard Hughes, M.D. Thanks again for your valued opinion. I wish seeing an experienced PVP urologist were easy. According to the Laserscope site there isn't a single practitioner in the state. I'd have to fly 2500 miles just for an office visit. Maybe you would be interested in practicing in Hawaii? <g> It's quite beautiful here on Maui. Stuart I've been to Maui. Sure is a beaut! > From: szinner@maui.net (Stuart) > Organization: http://groups.google.com [quoted text clipped - 23 lines] > > Stuart Thanks for another good informative post Gary. A couple more questions: You mention bladder spasms - did you get these prior to PVP? If so what are they like? (I think I had one a while ago & described it to my uro who didn't comment. I had a very full bladder and had been hanging on for a while and when I got to the loo the pee came out in short high pressure squirts with a terrific feeling of pressure in the bladder only settling down about half way through the pee.) How soon did you go home on day 2? Did Tim Larner give you specific instructions on what to do if you went into retention and what were they? How far away from Haywards Heath do you live and how did you get home? Hope the good progress continues. Magna Glad to hear how well it went. I am sure that you will continue to regard it as money well spent. Derek. > > Thanks Gary for your honest and factual reporting. For one of us still > > not sure which way to go re TURP or PVP in the UK,I look forward to your [quoted text clipped - 35 lines] > Regards, > A very happy Gary >>>Thanks Gary for your honest and factual reporting. For one of us still >>>not sure which way to go re TURP or PVP in the UK,I look forward to your [quoted text clipped - 36 lines] >>Regards, >>A very happy Gary Gary Thanks again for the useful info on your successful PVP. I have been thinking along the same lines re going private, and the price seems reasonable for the relief that must come afterward. I too have heard frightening reports about TURP, without the extra time spent in hospital connected to all those pipes (ouch!). I'm not desperate at the moment, as the pills seem to be working, but for how long? I shall certainly take on board your comments in the coming months, and hope you continue with your improvement. Pete |
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