Mel,

Here's my 2c on the matter after having went to two uros and enduring
a variety of "diagnostics" to include rectal ultrasounds, flexible and
rigid cystoscopes, digital exams, etc...

I was originally slated for a Thermatrx microwave, but after lurking
in this group, I left my uro and went to Dr. Wen Lin in St. Augustine
and couldn't be happier with the decision to go with a "top guy".  Dr.
Lin performed a PVP on me and my flow is much better and my voiding
volume is almost double.  It's only been one day since the procedure,
but I wish I had done it a long time ago instead of being such a
"tough guy" and "dealing with it", since now I have a thickened
bladder and kidney trouble as a result.  Hopefully without the back
pressure things will slowly get better.

In regards to your proposed questions, some thoughts:

Question 1: This is clearly the biggie and probably has the most to do
with your ultimate outcome, all else being equal; assuming PVP is the
only option on the table after ruling out the other choices.

Question 2: This is asking to be sent to male hell.  I was on Flomax,
and other than being dead tired all the time, having no sex drive
whatsoever, becoming impotent, stopping exercise due to inability to
generate enough energy, and feeling like an old porch dog (at 42), it
was great :) .  Only problem:  after all that, it still didn't do jack
for the bph symptoms.  If you're getting too much exercise and sex, go
for it.  Otherwise, run like hell.

Question 3:  If he tells you the answer to this, look for his crystal
ball.  Not having the back pressure to fight against can only help in
time.  Frankly his will only be an educated guess, which is better
than a wild guess, but by how much?

Question 4:  A flexible cystoscopy is more tolerable than the rigid
kind, but my experience is that unless he has a really good eye and a
better memory, then having the rigid kind with a camera taking
pictures is the way to go.  My experience here is that the first uro
used a flexible scope (and no anesthesic) in his office, plumbed
around for a while and pronounced that my prostate was swollen.  He
had me planned for a Thermatrx microwave that in retrospect would not
have solved my problem (overgrown and prolapsed median lobe), but
rather caused a whole set of new problems.  Dr. Lin on the other hand,
told me in his office what he thought was wrong with me considering my
age and problem description (and he was right) and scheduled a rigid
cystoscopy to confirm it in a hospital setting.  The rigid was less
comfortable, even with a little numbing gel smeared on it, but it was
a whole lot more informative to see on the TV screen exactly what he
had described in the office, then to have pictures for him to plan his
procedure from, was an added plus.

Some additional questions you might consider:

5.  How skilled are you at preserving the muscle that prevents
retrograde ejaculation?

6.  How long do you estimate that the procedure will produce
satisfactory flow before a reoperation will be necessary.

7.  If I'm not passing clots, can I go home the same day?  

8.  And if so, do I have to wear the catheter home, or can you take it
out before I leave?  The catheter is really the worst part of the
whole thing, the operation is a breeze compared to walking around with
a hose in you.

9.  Since the Cipro XR and/or Levaquin is so expensive ($10/pill and
not covered), can you give me enough samples for the post-cysto and
post-op?

10.  Can I have pictures of the before and after states?  These are
great to show your primary doctor and in doing so, helping other men.
Not to mention, they are pretty dramatic evidence of an effective
solution to the problem.

11.  If a diagnostic transrectal ultrasound is ordered, ask if it's
absolutely necessary based on some other suspicion of cancer.  A TRUS
is like having a Louisville slugger rammed up your a.s and turned into
a paint stirrer for a half-hour.  If absolutely required, then by all
means, demand some good tranquilizers or something.  I was WIDE awake
for mine.  Btw, Dr. Lin didn't request it, the first uro did,
apparently the Thermatrx procedure requires a prostatic length
measurement that the TRUS can provide.

12.  In confirmed BPH, have you ever seen "watchful waiting" work?

13.  Without surgery, and including medical therapy, what is the
ongoing prognosis for my condition and along what timeline?  With PVP?

14.  Is there any circumstances that might apply to me, where I will
be better served by an alternative therapy, and if so why?

These aren't in any particular order and certainly isn't an exhaustive
list, but ones that you may wish to consider.  I'm sure others can
post improvements to it.

Randy