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Medical Forum / Diseases and Disorders / Prostate BPH / July 2004Thanks, Lee!
First, thanks Lee for coordinating this poll. It's most helpful because no peer-reviewed journal or publication has yet published on the efficacy of PVP. Secondly, for the umpteenth time (that I've posted these here) let me reiterate that U.S. Government statistics are and have been available on TURP, a procedure which has been around for at least 30 years. A free booklet issued by the National Institutes of Health in Washington, D.C., several years ago reported that the chances of impotence following a TURP were one in five; that the likelihood of permanent incontinence was 1 in 20 and that the risk of mortality was 1 in 250. Given these numbers, why would anyone nowadays want to consider TURP? To date, I haven't seen a message on this board that reports anyone dying after PVP or anyone reporting incontinence or impotence. The worst scenarios seem to be retrograde ejaculation and increased urinary frequency. I, myself, am still waiting for some improvements in PVP, as my situation is not critical. However, if I should someday find myself blocked, I would submit to a PVP procedure in a moment. Rob, Something about those numbers you report sounds wrong. I cannot imagine that hundreds if not thousands of Urologists have been performing TURP's that are leaving 20% of their patients permanently impotent or causing 1 in 250 to be incontinent for the rest of their lives. What is the exact name, source and publication date of the "booklet" you refer to, and how old is the data used to support its conclusions. Thanks, Bob > First, thanks Lee for coordinating this poll. It's most helpful > because no peer-reviewed journal or publication has yet published on [quoted text clipped - 19 lines] > situation is not critical. However, if I should someday find myself > blocked, I would submit to a PVP procedure in a moment. > Rob, > [quoted text clipped - 33 lines] > > situation is not critical. However, if I should someday find myself > > blocked, I would submit to a PVP procedure in a moment. They are the exact same figures any decent uro in the UK will give you if they are pressed for the info plus they will tell you that retro is a high % too if a TURP is done First, you didn't answer my question. Second, I don't believe these numbers because they defy credibility. Twenty percent permanent impotency from a TURP makes no sense since the nerves that control an erection are on the outside of the prostate nowhere near the area operated on either by a TURP or PVC. By the way, I recently had a TURP and am not impotent or incontinent. Bob > > Rob, > > [quoted text clipped - 37 lines] > they are pressed for the info plus they will tell you that retro is a high % > too if a TURP is done I found this on Medline. It shows 15.6 percent. I did quite a bit of web searching and the numbers, as bad as they seem, appear to be correct. Burr [Reevaluation of impotence following TURP] [Article in Italian] Grasso M, Castelli M, Lania C, Scattoni V, Radice F, Rigatti P. Divisione di Urologia, Istituto Scientifico H San Raffaele, Milano. Impotence following transurethral prostatectomy is one of the main complications that still has a controversial origin. Many authors, reporting their experience, have demonstrated that this complication is due both to psychological problems and to organic causes. We review retrospectively 68 patients submitted to TURP. All patients (53 to 65 years old) were asked about their sexual efficiency before and after TURP, 6-12 months after surgery. Those who complained of erectile failure have been studied using this diagnostic protocol: plasmatic dosage of FSH, LH, Testosterone and Prolactin; penile Doppler ultrasound, polysomnographic recording of nocturnal tumescence test (NPT Test); angiography of the pudenda arteries has been performed in only one patient with pathological penile Doppler ultrasound (IPP < 0.7). The examinations demonstrated an organic impotence not secondary to vascular damage in 10 patients following surgery (incidence 15.6%). Our high incidence of this complication is, according to us, significant even if it should be considered in excess since in our study we used anamnestic criteria alone in the evaluation of sexual efficiency before surgery. In 1984 T. Lue demonstrated, through accurate histological preparations, that cavernous nerves run contiguously to the prostatic capsule at 5 and 7 hours in correspondence of the glandular apex. He suggested that impotence following TURP is due to iatrogenic lesions of these nervous structures during endoscopic resection. Similarly, we have conducted an anatomopathological study on prostate specimens taken from autopsies. We demonstrated the presence of nervous structure contiguously to the prostatic capsule in correspondence with the glandular apex. Thus, impotence following TURP probably occurs after an iatrogenic heat lesion of the periprostatic plexus caused by resection.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 8278875 [PubMed - indexed for MEDLINE] > First, you didn't answer my question. Second, I don't believe these > numbers because they defy credibility. Twenty percent permanent [quoted text clipped - 46 lines] > > they are pressed for the info plus they will tell you that retro is a high % > > too if a TURP is done Here's my problem: If Turp's cause 15.6 percent impotence, how come this information (based on a really small study of 68 patients) is only available in some obscure Italian publication? The other question that occurs to me is why should the results from PVP's be any different? Both TURP's and PVP's involve large tubes pushed up the penis into the bladder to facilitate a constant irrigation during the procedures. If there is any solid statistical support for these high numbers, I would think the cause would be all the stretching caused by the irrigation tubing. I also note that apparently the Italian article does not claim TURP's cause incontinence. Bob > I found this on Medline. It shows 15.6 percent. > [quoted text clipped - 101 lines] > high % > > > too if a TURP is done Hi again I searched Google for web sites using key words "TURP mortality" and this was at the top of the list. I could have read the thousands that followed but since you are the one who is interested why not try it yourself. I saw several that mentioned the 0.25 percent death rate and none were below the 1 in 20 incompetance rate. Just go to www.google.com and you will find more verification than you can read. Hope this helps Burr > Here's my problem: > [quoted text clipped - 116 lines] > > high % > > > > too if a TURP is done SNIP >To date, I haven't seen a message on this board that reports anyone >dying after PVP or anyone reporting incontinence or impotence. I myself suffered incontinence and impotence after PVP before I died. SNIP >I, myself, am still waiting for some improvements in PVP, as my >situation is not critical. However, if I should someday find myself >blocked, I would submit to a PVP procedure in a moment. I suggest that, instead of having a PVP, you have a head transplant.. Both you and us would benefit. |
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