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Medical Forum / Diseases and Disorders / Prostate BPH / October 2004Large Prostate PVP
On 20 August I underwent the PVP procedure with quite satisfactory results. Any remaining problems that I have are fairly obviously bladder related and are slowly improving. I had been "watching and waiting" for many years and seen the growth from 80g in 1999 to 135g last July2004. My symptoms took a sudden turn for the worse in July and I ended up in hospital with total retention, which certainly focusses the mind. My pvp did not go as smoothly as some - not only was the size a problem, it was very bloody and from photos I was shown was an odd shape and malformed in the channel. I had about 70cc removed by pvp but also a small TURP procedure to avoid going too close to the sphincter muscle with the laser. Because of this I was kept in overnight and I elected to stay in a further night as I was in a Hotel anyway. A catheter was left in for 4 days but I was given the option of 3 days if it was a problem. I had a lot of blood loss , about 1 pint during the op but no need for a transfusion. I gather my case was about as difficult as they get. Considering my alternative realistically was a radical prostatectomy, I wasn't complaining. I think this is what the PVP detractors overlook-that the operation does not just replace TURP ,it also replaces RP in most cases of BPH. Because of this we are going to see more outcomes like mine which are not copybook day surgery but they are also not fair comparisons with TURP. I think the 100g+ prostate statistics are going to have to be separated out for a fair comparison. During the 4 day catheterisation I had very bloody urine, slowly clearing. When the catheter was removed I passed a lot of large black chunks of what looked like charred blood and guts followed by a good stream for a change. From that moment on I have had no problems at all. No blood except for odd spots at the start of urination for 4 wks, no pain (I have had no pain at any time right from day 1) and things just keep getting better. I followed orders with 3 litres of water a day,lots of walking and no heavy exertion. I have no incontinence,no impotence. I don't know about retro yet but that has never been a concern. It is now over the 6 week recovery period so things are looking good. Considering the side effect risks with the RP and the increase in risk factor for TURP on large prostates, I think I am lucky to be back to a normal life with no disabilities, thanks to PVP. No doubt some will think I have shares in Laserscope but no such luck. They are saying now that good health and an expert surgeon are the two most important factors in outcomes. I am lucky to have had both, but I think the extra large prostate has to be seen as a major negative. I am 68yrs old and 70kg with no other medical problems. I would be interested to know the maximum size of prostate that can be treated by TURP. I have seen the figure of 100g in various websites, but my GP ,who was and is very dismissive of PVP,is now saying that a TURP would have been just as good even though before the event he agreed mine was too big for a TURP. His attitude is annoying me intensely as he gives no credit to the procedure (he is even older than me! ) and refuses to see the obvious.He also doesn't seem to understand the concept of risk (of unwanted after effects). Daddyo Just curious --- where was your surgery done and who did the surgery? Mel > On 20 August I underwent the PVP procedure with quite satisfactory > results. Any remaining problems that I have are fairly obviously [quoted text clipped - 60 lines] > > Daddyo Hello Mel, My surgery was done by one of the top PVP practitioners....Gordon Muir at Lister Hospital,London. daddyo Dear Daddyo, Your post is right on the mark. I was also in that huge prostate group that PVP helped. Ultrasounds were saying about 70-80grams but during PVP almost 50% of the prostate mass was hidden by the bladder. It was also irregular in shape. After my PVP, Dr. Te said to my wife that, without PVP, a open prosectomy would have been needed. I too am very thankful that PVP became available at the right time for me. I hope you continue to recover quickly and completely. Best wishes for good health, Patrick > On 20 August I underwent the PVP procedure with quite satisfactory > results. Any remaining problems that I have are fairly obviously [quoted text clipped - 60 lines] > > Daddyo Good post Daddyo! Where abouts in the uk are you from? My GP and URO are also dismissive of PVP (High Wycombe area) and say lasers are a fad. PVP seems the intuitive way to go to me and I have the wheels in motion but they turn awfully slowly!. What were your symptoms prior to going into retention? - Just curious. Regards, Magna Hello Magna, I am an expatriate, so I can't be of much help with your GP problem. Going into retention was a complete surprise and could have been avoided. I have always had a small (weak ?) bladder so the slow onset of BPH was not a great difference. I have never been a great drinker but on the odd occasion I did, I had real problems, like every 15mins with slow dribbling.Also getting up at night once or twice didn't bother me much. Last year I discovered that I was better off having a cup or two of tea in the evening because then when I did get up at night the flow was better,without the standing and waiting which sometimes happened without much in the bladder. I felt that things had improved over the previous year. On my annual visit to the Urologist in June he felt the prostate and said it was much bigger and organised an Ultrasound. This showed an increase to 135 cc and it was then I knew that I had to do something.I then corresponded with Mr Muir coincidentally before the retention episode with the view to PVP maybe within a few months or next year. In July the frequency and poor flow became much worse and on the night in question I did something a bit radical. I had been out to lunch with my wife (not a common event ),and had a glass of wine and then a cappuchino at about 4 (I am not a coffee drinker ).So rather than an evening meal we had a sandwich and a cup of tea. The bladder really started to play up at about 7 oclock going every 10 mins with nothing much coming out. It was then I had the clever idea to drink half a litre of cranberry juice and two cups of tea and a couple of glasses of water between 8 and 10 oclock to at least get some flow going.Big mistake. I woke up at 2 am and spent a worrying half hour trying to empty the bladder, walking around ,doing press ups, jogging on the spot eventually feeling empty and going back to bed. Woke again at 3.30 am but this time nothing, and I knew after about 15 mins that this was it.Still kept trying for a few hours but went to Hospital at about 8.30am for my first experience of a catheter. That stayed in for 5 days. I was told that 70% of retention re-occurs within a week, so after contacting Mr Muir with the intention now of getting to London as soon as possible, I adopted the following habits - no alcohol,no caffeine,no liquid after 6pm,A half hour walk before going to bed,going to bed at 12 instead of earlier, setting the alarm for every 2 hours during the night (this sounds an ordeal but I actually slept better).In this way I managed for 5 weeks before my PVP. Hope this is of help. I don't think the retention damaged my bladder; I've not got much retention but not much capacity either.Because I now drink far more fluid than I ever did ,I still pee a lot but much stronger and consistent without the blocked feeling. At night I can last all night if I don't have an evening drink but I usually do (tea or water) and get up once. It is still only 7 weeks and improving. Richie Hello Patrick, Thanks for your post. I owe a lot to your contributions to this group. I started "lurking" many tears ago at the start of my problems, around 1997 when Dr Casey was the main contributor. I came to the conclusion that the Urologist was right...that the gold standard was TURP. I didnt check the Newsgroup again until about 18 months ago and PVP had arrived. It didn't take me long to be convinced. Many thanks for all your info, and Derry Argue and Haditdone,and many others,and I hope I can pass on my experiences to other sufferers. regards Richie >On 20 August I underwent the PVP procedure with quite satisfactory >results. Any remaining problems that I have are fairly obviously [quoted text clipped - 14 lines] > >Daddyo Don't know whether I still hold the title of "King of the Prostates" bestowed upon me by Dr. Alexis Te last year before he operated (PVP). Perhaps now I am merely 20th in line for the throne. When I first saw Dr. Te in 2002, my prostate was about 250g. After almost a year on Avodart, it shrank to about 190g. At that time (Dec. 2003) Dr. Te proceeded to operate--took five hours to clear out the tissue. No pain ever. Feeling better all around. Wouldn't consider any other treatment! You will see continuing improvements over time. Good luck. Dick  SignatureRichard F. Somer I have always made it a rule never to smoke more than one pipe at the same time. (adapted from Mark Twain) Just to keep the terminology straight, I think Daddyo's alternative to the PVP plus TURP would have been an open (probably suprapubic) prostatectomy, in which the prostate's core is 'shelled out' through an open incision - not a radical prostatectomy, done for prostate cancer, where the whole prostate is removed. The open BPH operation is still quite a major one, though, with the pain of an external wound and a longer recovery time than even TURP. If it can be avoided with PVP, even though the latter has to be combined with TURP, I'd judge that a definite gain. Richard Slessor Hello Richard, I never realised that there were two varieties of prostatectomy. That explains something that has puzzled me for a while.I was told that after the open prostatectomy up to 20 g was still left which made me wonder about it's effectiveness in the case of a cancer treatment. A very important distinction , particularly in relation to the risk of impotence caused by damage to the nerves on the outside of the prostate. Richie |
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