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Medical Forum / Diseases and Disorders / Prostate BPH / February 2005What tests are necessary?
I'm 71 and in good health except for high blood pressure (under control with medicine) and BPH symptoms (10-15 years). I have posted a few times to this news group in the past 3 years, mainly about my reaction to alpha blockers (Hytrin and Flomax). They both cause my pulse to race. I finally convinced my primary care physician in a big HMO to refer me to an urologist. Some blood test were done before I went for the appointment such as pH, Sp.Gr., Urine glucose, Urine blood, Nitrates, Ketones, Esterase, U protein, Bilirubin, Urobilinogen and Urine source. All were within normal ranges. Also the last 4 psa results were sent (all less than 0.7) I lucked out and got to talk to the Chief of Urology. He had me take the ASU Questionnaire where I scored 22 mainly because of problems with getting up at night and a weak, intermittent stream. Urgency is not much of a problem. He reviewed the lab tests and the ASU survey. Before he started, I told him I was only interested in PVP. At that time he handed me the brochure "The Greenlight PVP Laser Procedure" and told me he was using that technique. He explained that he would do the surgery in the morning, and that I would go home with a catheter, take it out in the shower the next morning and see him in the PM to make sure everything was OK. He told me my condition was not a medical necessity, but a quality of life issue. He did not buy into the irreversible bladder stretching theory. He said when I decided I was tired of the BPH inconveniences I could simply ask to schedule the procedure. I was so excited to find someone knowledgeable about the technique that I forgot to ask him some questions. I did find out he had done 23 PVP's so far with enthusiastic support from those operated on. He would require me to sign a form authorizing TURP if they encountered complications. I asked him for an example and he told me of a time when the machine malfunctioned and they finished with a TURP. A question I should have asked, "What about tests?" Most of you know how big your prostate was, how fast you voided before and after, and how much urine is retained if you do not void completely. Are these tests used only to decide if surgery is necessary? If this is the only reason, I don't really need to know. I'm guessing he wants to avoid the test costs if they are not needed. This is an HMO so tests subtract instead of add to the bottom line. Are these tests important for other reasons? Hi Aner, A urologist can use ultrasound, a non-invasive test to determine "how much urine is retained if you do not void completely." My uro did a cystoscopy before my procedure. Others do a variety of other tests. Every procedures has its risks, so you and your uro should be convinced that the procedure is required before you proceed. Just my view. Phil > I'm 71 and in good health except for high blood pressure (under control > with medicine) and BPH symptoms (10-15 years). I have posted a few times [quoted text clipped - 39 lines] > > Are these tests important for other reasons? The idea of having to consent in advance to a TURP if they screw up while doing a PVP (see below) seems to me positively grotesque and unacceptable. Is this common? Have others run into this? Jesse He would require me to sign a form > authorizing TURP if they encountered complications. I asked him for an > example and he told me of a time when the machine malfunctioned and they > finished with a TURP. I had a small TURP procedure during my PVP in August. It was explained to me afterwards that this was to avoid going too close to the sphincter with the laser. The problem was caused by my prostate and urethra being very mis-shapen. I was shown photos comparing mine with a normal channel and they were totally different.It did cause much bleeding but the alternative I assume would have been to risk more permanent problems. Surgeons can pretty obviously face the unexpected ( like the laser machine failing ) What do you do ? I had a 135g prostate which would have been considered too big for a full TURP. I am very happy with my outcome 6 months later Richie >The idea of having to consent in advance to a TURP if they screw up while >doing a PVP (see below) seems to me positively grotesque and unacceptable. [quoted text clipped - 6 lines] >> example and he told me of a time when the machine malfunctioned and they >> finished with a TURP. > The idea of having to consent in advance to a TURP if they screw up while > doing a PVP (see below) seems to me positively grotesque and unacceptable. > Is this common? Have others run into this? > > Jesse Dear Jesse, I'm a greenlight laser preceptor in eastern North Carolina. I've done over a 100 greenlight laser procedures, and am extremely impressed with the technology and it's results. In fact, I've successfully treated 5 or 6 men in their 90s who were in urinary retention. My greatest success though was treating a 50 year old man who 2 months previously had a heart transplant-- he suffered miserably from prostatism and got instantaneous relief. I think the words you used to describe Aner's urologist are unfortunate. This kind of animosity towards physicians is sad. Most doctors honestly want to do the right thing. In today's medicolegal environment a doctor would be crazy not to view every patient as a possible lawsuit. Aner's urologist is obviously doing a wonderful job with informed consent, and should be commended. During one case I had to convert to a traditional TURP to control bleeding. I've found as I do more cases--they go more smoothly with less bleeding. Sincerely, Richard M. Hughes, M.D. There's an unhappy logic to what you say: you need to retreat to TURP if there is too much bleeding; as you do more of these surgeries, you produce less bleeding. It seems to me airtight that the retreat to TURP was related to your inexperience. So I'd have to conclude that any doctor who sought prior consent for a retreat to TURP is somebody whose inexperience produces excessive bleeding: I would want to stay away from him. Have others on this list been asked to consent to TURP before undergoing PVP? Jesse > > The idea of having to consent in advance to a TURP if they screw up > while [quoted text clipped - 28 lines] > > Richard M. Hughes, M.D. As a newbie I hope I can shed some light on the possible use of TURP to stop bleeding during a PVP procedure. I am 56 and will probably have to have some kind of surgical intervention due to problems related to BPH this year. I have a prostate that had grown to 108 grams. I spoke with my urologist who wanted to do a TURP and quickly left the office. I then saw one of the urologists at UCLA who does PVP proceedures. He told me that he has done PVPs on large prostates and once had to perform a TURP to stop the bleeding that occurred as a result of an improperly calibrated laser. He has done hundreds of these procedures and actually teaches other doctors (not medical students) the procedure. While I, too, have trouble understanding the logic of using a TURP to stop bleeding, I do trust this doctor and if I do have a PVP I will sign a consent form allowing him to do a TURP if he feels it is necessary to stop any bleeding. I appreciate that he was direct with me. Perhpas he was concerned because of the size of my prostate. To his credit, he put me on both Avodart and Uroxatrol and my prostate is shrinking and my symptoms have improved. I guess we each have to do our research and make our choices. While I would like to avoid even the PVP procedure, I will chose it over the traditional TURP, carefully select my surgeon, and realize the risks I assume. I hope I have been able to shed a bit of light on the subject from the point of view of a layman facing the prospect of a PVP. Outlier48 An ultrasound to determine the size of the prostate, which is done through the rectum with little discomfort. While your PSA values are very good, which is an indicator of a relatively small prostate and unlikely Pca, a DRE should be done to also give an approximate size and determine if there are any abnormalities with the prostate. The ASU value, from your symptoms, indicates a small opening in the urethra. Good luck and hope you have a successful PVP, most are. Jack > I'm 71 and in good health except for high blood pressure (under control > with medicine) and BPH symptoms (10-15 years). I have posted a few times [quoted text clipped - 39 lines] > > Are these tests important for other reasons? |
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