Good news for BPH sufferers.

[xylophone]

Having suffered from BPH and then having a Turp, which was not that successful, and which was followed by a bladder neck operation, and then the fear that another prostate operation might be necessary because symptoms of BPH returned, I was overjoyed to get this podcast from a friend!!

 

It is a new prostate operation which is not like the steam process Rezum, but involves a stent being inserted in the prostate, then removed about a week later.......all done as an out-patient, with no cutting/stitching, just an insertion of something akin to a catheter, then removal.

 

The procedure stretches the prostate and has had very good results in Sydney (OZ). Please listen to this podcast (link) for more info from the pioneering surgeon.

 

If I do need this then I will certainly be over to OZ as soon as flights allow.

 

Groundbreaking prostate surgery to change lives of Australian men.......

 

Dr. Ross Walker speaks with Professor Henry Woo, urological surgeon at Sydney Adventist Hospital 

https://www.2gb.com/podcast/groundbreaking-prostate-surgery-to-change-lives-of-australian-men/  

[GarryP]

Interesting, but I wonder how long it lasts. From the little I have read on the subject, there would be up to a 30 percent chance of narrowing happening if the stent is not permanent (like a balloon), which seems to be the case with this treatment. This is unlike procedures that result in the removal of tissue. Having said that, I would like to avoid TURP, for a number of reasons, including those just touched on in the podcast.  

 

In the meantime, I will continue to look into Rezum in Australia, which seems to be the most cost effective place to do it. Hopefully, sometime next year travel will be possible.   

[Susco]

When I do a Google I find results as far back as 2011.

 

Why this is promoted only 9 years later?

[xylophone]

6 minutes ago, Susco said:

When I do a Google I find results as far back as 2011.

 

Why this is promoted only 9 years later?

Seems like the earlier versions needed testing and improving, so perhaps this is where we are at now??

 

Worth keeping an eye on anyway.

[RichCor]

also an "iTIND" article in the Sydney Morning Herald

 

EXCLUSIVE | NATIONAL | MEN'S HEALTH
'Incredible urge to pee': new prostate treatment saving sex lives

Sydney Morning Herald | By Kate Aubusson | October 12, 2020 — 12.01am

 

In the past, men in their 70s were less concerned about the risk of erectile and ejaculatory dysfunction that came with traditional treatments, Professor Woo said.  “Now we’re seeing increasing numbers of men over 70 who are seeking out treatments that preserve their sexual function because they’re much fitter and healthier than they were years ago,” he said.

 

 

[Sheryl]

This is a very new treatment so far done only four patients and being done by only one doctor.

 

It is a very long way away from an approved or widely available treatment.

 

In particular the duration of its effect is unknown and would logically be expected to be not very long.

 

There are other minimally invasive treatments that are further along and better tested, see https://cadth.ca/minimally-invasive-therapies-benign-prostatic-hyperplasia-bph

 

Even those have no data yet in long term outcomes (i.e. more than 2-6 years).

[xylophone]

2 hours ago, Sheryl said:

This is a very new treatment so far done only four patients and being done by only one doctor.

 

It is a very long way away from an approved or widely available treatment.

 

In particular the duration of its effect is unknown and would logically be expected to be not very long.

 

There are other minimally invasive treatments that are further along and better tested, see https://cadth.ca/minimally-invasive-therapies-benign-prostatic-hyperplasia-bph

 

Even those have no data yet in long term outcomes (i.e. more than 2-6 years).

Was interested in the Urethral lift before this latest procedure, then looked at Rezum, however there have been some adverse reactions to this, so looking at this new one as potential for now or the future.

 

When compared to the TURP with all of its potential downsides, then personally I would not be worried if this procedure had to be repeated every few years as it is quick and relatively painless. Anything to dodge having another TURP, hence my enthusiasm for something like this, whether approved now or later, because it gives hope for someone like me who had a bad experience (many actually) with the TURP...........and still suffering some 11 years after the operation.

 

PS. A study published in early October by the Nature journal Prostate Cancer and Prostatic Diseases reported a significant reduction in symptoms and no complications or sexual dysfunction among 81 iTIND patients up to three years after their procedures.

Edited October 27, 2020 by xylophone

[GarryP]

15 hours ago, xylophone said:

Was interested in the Urethral lift before this latest procedure, then looked at Rezum, however there have been some adverse reactions to this, so looking at this new one as potential for now or the future.

 

When compared to the TURP with all of its potential downsides, then personally I would not be worried if this procedure had to be repeated every few years as it is quick and relatively painless. Anything to dodge having another TURP, hence my enthusiasm for something like this, whether approved now or later, because it gives hope for someone like me who had a bad experience (many actually) with the TURP...........and still suffering some 11 years after the operation.

 

PS. A study published in early October by the Nature journal Prostate Cancer and Prostatic Diseases reported a significant reduction in symptoms and no complications or sexual dysfunction among 81 iTIND patients up to three years after their procedures.

What were the negative outcomes from Rezum apart from the need to use a catheter for a few days (they often failed to mention this when this treatment started to take off), potential higher risk of infection due the the presence of dead tissue while the body has not yet absorbed the same, and the small risk of retrograde ejaculation or erectile disfunction (much smaller than TURP and GreenLight laser).  

 

Must admit that I have not looked into aquablation as a treatment.     

[xylophone]

1 hour ago, GarryP said:

What were the negative outcomes from Rezum apart from the need to use a catheter for a few days (they often failed to mention this when this treatment started to take off), potential higher risk of infection due the the presence of dead tissue while the body has not yet absorbed the same, and the small risk of retrograde ejaculation or erectile disfunction (much smaller than TURP and GreenLight laser).  

 

Must admit that I have not looked into aquablation as a treatment.     

From what I recall Garry, it was the fact that sometimes the catheter use was for a lot longer than a few days, and sometimes the dead tissue took a lot longer to be absorbed/discarded by the body and some men found quite a bit of discomfort for even a few months afterwards.

 

I've got to say that this did put me off a little, however I can't find my original article on it due to a few computer problems over the past month or three!

 

Actually I hadn't heard about Aquablation, so have looked it up and that also seems promising.

 

Urolift was another procedure of interest, see: https://www.urolift.com/physicians/results 

 

At least there are a few choices now and although progress needs to be made on some of them, it gives someone like me hope for the future if I have to have another operation/procedure, as very often even after a TURP, prostatic tissue can grow back and that's where I believe I am currently – – promising/exciting times in the medical treatment arena.

[Lacessit]

I'm hoping the combination of doxazocin and finasteride will control my BPH until I have shuffled off this mortal coil. To me, any form of surgery is a last option.

[BritManToo]

11 minutes ago, xylophone said:

as very often even after a TURP, prostatic tissue can grow back and that's where I believe I am currently –

One of my neighbours had a TURP at McCormick hospital in CM.

His doctor told him to take finasteride 5mg, every day for the rest of his life or the prostate would just grow back.

[Lacessit]

2 minutes ago, BritManToo said:

One of my neighbours had a TURP at McCormick hospital in CM.

His doctor told him to take finasteride 5mg, every day for the rest of his life or the prostate would just grow back.

Such a shame it doesn't happen with another body part.

[xylophone]

12 minutes ago, Lacessit said:

I'm hoping the combination of doxazocin and finasteride will control my BPH until I have shuffled off this mortal coil. To me, any form of surgery is a last option.

If it works for you, then stay on it, as until new/newer procedures are in place for BPH, some of us are up the proverbial creek without a paddle.

 

I underwent surgery in the Epworth hospital (Melbourne) around 11 years ago (maybe 12) and was assured that this top-notch surgeon and hospital would do a good job. So for the benefit of other folks considering something along the lines of a TURP, I will give the lowdown on my experiences.

 

– TURP procedure carried out at the hospital and hospital stay was for three days which included a full time catheter in the penis, and attached to a bag.

 

– Sent home after three days, but two days later I was rushed back into emergency because I couldn't pass water and I was on the point of passing out with the pain. The emergency nurse hurriedly inserted a catheter (a little painful) and drained 1.5 L of urine from me.

 

– A specialist then suggested that I should learn to self catheterise and I went through the procedures in a little medical room with a nurse, and I wasn't happy about having to squirt jelly up the eye of the old fella and then carefully insert a catheter until it reached the bladder. It wasn't painful, but it was uncomfortable, so off I went home with a few catheters, some rubber gloves and numbing gel.

 

– I self catheterised myself three times a day for about 10 days and then had to see if I could pass water without the catheter, which I did, albeit not a brilliant stream I must admit. However, kitted out with all of the items above I then travelled back to Patong to try and resume a normal life.

 

– I had some urethral pain for a while, which seemed to come and go and also gave me symptoms of a UTI, however tests at Bangkok Phuket hospital showed no infection, so I reckoned it was a side effect from the operation.

 

– I had suffered from prostatitis in the past and the symptoms were coming back again, as were the UTIs, so after about five years I went to Bangkok Phuket hospital to seek out some advice as the urine flow was very poor again and no amount of doxazosin or anything else seemed to work. Not only that doxazosin also lowers blood pressure and when I took it I became a bit of a zombie with a very low blood pressure.

 

– A urologist there decided to have a look at the prostate and bladder and decided I needed a cystoscopy, which I duly had and the verdict was that I had a problem with my bladder neck (stenosis) which can occur after a TURP when scar tissue interferes with the normal operation of it.

 

– About a week or so later I had a UTI and as the urologists at the hospital were being changed, I saw one particular urologist who prescribed antibiotics for two weeks. That did nothing to improve the situation, so he prescribed me another antibiotic for two weeks, and that did nothing. So he prescribed me another two weeks of antibiotics, and then another, and I then asked him if he could do a culture to see exactly what was going on because I was in a bit of pain and not feeling very well at all, and when I suggested that the antibiotics were not working he told me to leave his office, basically threw me out!!!!!

 

– Fortunately a new urologist had just started and I quickly saw him because I was feeling very unwell at the time, and he took a specimen and got a culture from it and it turns out I had E. coli ESBL, which is a form of E. coli that is just about resistant to most antibiotics, and of course the other urologist who had prescribed all sorts of antibiotics didn't help the case at all. I most likely got it from the catheter procedure (hospital acquired, as there was no other way I could have caught it).

 

– I had to see another specialist and was put on an antibiotic called Carbapenem which had to be delivered intravenously on a daily basis for between 14 and 16 days, so daily visits to the hospital and all paid for out of my own pocket as it was an outpatient procedure and it cost over 50,000 baht.

 

– Luckily enough that cured the infection, but then something has to be done about my bladder neck, so I underwent another operation from a visiting urologist and when I asked if there would be any side effects like retrograde ejaculation or dribbling, he said no, and he would do a good job to ensure that.

 

– So I underwent that operation and was in hospital for three days in Phuket and discharged a little later, only to find out that I couldn't pass water again and I had to get back to the self catheterisation as well as taking a medicine called Ucholine, which helps the bladder function.

 

– After that operation and the three times daily catheterisation for about two weeks, I was able to discontinue that, but despite the last surgeons promises that there would be no side effects, retrograde ejaculation is something I have to live with now, as is a feeling of having a constant UTI because the urethra is painful/inflamed.

 

– I was at my wits end with this pain and wasn't sure what caused it, however I contacted two professors, one in London and one in Sydney, who were working on this very subject and they put me onto how they treated patients with similar symptoms, and I was able to find one of the old antibiotics which they used (and I'm not even sure I had an infection but I was going to try it) and use it in conjunction with doxycycline, and it worked to a great extent, and for that I will be forever grateful and when I got back in touch with them to say that I had also used it with doxycycline, they commented that this was a great result, and they often did the same!

 

So I'm at the stage where I do suffer a little urethral pain, but not as much as I did before and something which can be mitigated with a few Nurofen tablets and Xylitol sugar replacement.

 

Hopefully any reader can see why I would be totally against having another TURP, because it was the start of a downward spiral, as it was related to/interconnected with all of the ongoing problems since that day.

 

So looking at new/newer procedures, is the way to go as far as I am concerned, but then other folks have to make their own choices.
 

[GarryP]

A very interesting article: https://wjmh.org/DOIx.php?id=10.5534/wjmh.190076

[Lacessit]

3 hours ago, xylophone said:

If it works for you, then stay on it, as until new/newer procedures are in place for BPH, some of us are up the proverbial creek without a paddle.

 

I underwent surgery in the Epworth hospital (Melbourne) around 11 years ago (maybe 12) and was assured that this top-notch surgeon and hospital would do a good job. So for the benefit of other folks considering something along the lines of a TURP, I will give the lowdown on my experiences.

 

– TURP procedure carried out at the hospital and hospital stay was for three days which included a full time catheter in the penis, and attached to a bag.

 

– Sent home after three days, but two days later I was rushed back into emergency because I couldn't pass water and I was on the point of passing out with the pain. The emergency nurse hurriedly inserted a catheter (a little painful) and drained 1.5 L of urine from me.

 

– A specialist then suggested that I should learn to self catheterise and I went through the procedures in a little medical room with a nurse, and I wasn't happy about having to squirt jelly up the eye of the old fella and then carefully insert a catheter until it reached the bladder. It wasn't painful, but it was uncomfortable, so off I went home with a few catheters, some rubber gloves and numbing gel.

 

– I self catheterised myself three times a day for about 10 days and then had to see if I could pass water without the catheter, which I did, albeit not a brilliant stream I must admit. However, kitted out with all of the items above I then travelled back to Patong to try and resume a normal life.

 

– I had some urethral pain for a while, which seemed to come and go and also gave me symptoms of a UTI, however tests at Bangkok Phuket hospital showed no infection, so I reckoned it was a side effect from the operation.

 

– I had suffered from prostatitis in the past and the symptoms were coming back again, as were the UTIs, so after about five years I went to Bangkok Phuket hospital to seek out some advice as the urine flow was very poor again and no amount of doxazosin or anything else seemed to work. Not only that doxazosin also lowers blood pressure and when I took it I became a bit of a zombie with a very low blood pressure.

 

– A urologist there decided to have a look at the prostate and bladder and decided I needed a cystoscopy, which I duly had and the verdict was that I had a problem with my bladder neck (stenosis) which can occur after a TURP when scar tissue interferes with the normal operation of it.

 

– About a week or so later I had a UTI and as the urologists at the hospital were being changed, I saw one particular urologist who prescribed antibiotics for two weeks. That did nothing to improve the situation, so he prescribed me another antibiotic for two weeks, and that did nothing. So he prescribed me another two weeks of antibiotics, and then another, and I then asked him if he could do a culture to see exactly what was going on because I was in a bit of pain and not feeling very well at all, and when I suggested that the antibiotics were not working he told me to leave his office, basically threw me out!!!!!

 

– Fortunately a new urologist had just started and I quickly saw him because I was feeling very unwell at the time, and he took a specimen and got a culture from it and it turns out I had E. coli ESBL, which is a form of E. coli that is just about resistant to most antibiotics, and of course the other urologist who had prescribed all sorts of antibiotics didn't help the case at all. I most likely got it from the catheter procedure (hospital acquired, as there was no other way I could have caught it).

 

– I had to see another specialist and was put on an antibiotic called Carbapenem which had to be delivered intravenously on a daily basis for between 14 and 16 days, so daily visits to the hospital and all paid for out of my own pocket as it was an outpatient procedure and it cost over 50,000 baht.

 

– Luckily enough that cured the infection, but then something has to be done about my bladder neck, so I underwent another operation from a visiting urologist and when I asked if there would be any side effects like retrograde ejaculation or dribbling, he said no, and he would do a good job to ensure that.

 

– So I underwent that operation and was in hospital for three days in Phuket and discharged a little later, only to find out that I couldn't pass water again and I had to get back to the self catheterisation as well as taking a medicine called Ucholine, which helps the bladder function.

 

– After that operation and the three times daily catheterisation for about two weeks, I was able to discontinue that, but despite the last surgeons promises that there would be no side effects, retrograde ejaculation is something I have to live with now, as is a feeling of having a constant UTI because the urethra is painful/inflamed.

 

– I was at my wits end with this pain and wasn't sure what caused it, however I contacted two professors, one in London and one in Sydney, who were working on this very subject and they put me onto how they treated patients with similar symptoms, and I was able to find one of the old antibiotics which they used (and I'm not even sure I had an infection but I was going to try it) and use it in conjunction with doxycycline, and it worked to a great extent, and for that I will be forever grateful and when I got back in touch with them to say that I had also used it with doxycycline, they commented that this was a great result, and they often did the same!

 

So I'm at the stage where I do suffer a little urethral pain, but not as much as I did before and something which can be mitigated with a few Nurofen tablets and Xylitol sugar replacement.

 

Hopefully any reader can see why I would be totally against having another TURP, because it was the start of a downward spiral, as it was related to/interconnected with all of the ongoing problems since that day.

 

So looking at new/newer procedures, is the way to go as far as I am concerned, but then other folks have to make their own choices.
 

A fairly horrific sequence of events, surgical events sometimes don't go as planned. While I have never had to self-catheterise, I can relate partially due to having BCG treatment six weeks in a row.

My own surgical disaster was my first TURBT for bladder cancer. At that time, I was taking Diclofenac for chronic osteoarthritis, not knowing it also acts like warfarin as a blood thinner.

I was sent home the same day after the surgery, and woke up in the middle of the night with a painfully distended bladder. Could not pee, rushed back to hospital. The wound site bled freely without clotting, the blood  then apparently collected at the bottom of the bladder and blocked the exit. Five days in hospital, the first two I could not stop bleeding until one of the medical staff twigged I was taking a medication that thinned the blood. The surgeon certainly did not know.

While I have a lot of respect for the medical profession, they can't get it right every time.

Antibiotics are like surgery, I try to avoid them unless absolutely necessary.

 

Edited October 28, 2020 by Lacessit