BPH, TURPS, and Alternatives |
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- Опубликовано: 4 окт 2024
- BPH Treatments: HoLEP, PAE, Surgical, TURPs, & More | Casey Dauw, MD: • BPH Treatments: HoLEP,...
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0:34 What is BPH and how are TURP's used to treat it?
1:47 Are TURP's usually go-to procedure for treating BPH?
2:30 Is scar tissue a common complication of TURP's?
3:09 What are the recommended alternatives to TURP's?
4:45 What side effects can be expected from REZUM/Urolift/iTIND?
5:56 If TURP is ineffective at first, it is advisable to try it again?
7:17 Is age a risk factor when undergoing one these procedures?
7:51 Are some BPH treatments incompatible with other prostate cancer procedures?
9:35 Alex's conclusions
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Can u do a detailed video on
Prostatitis?
Finally had the TURP procedure in late July, spinal anesthetic, couple of days in the hospital. This after 4-5 yrs. of Active Surveillance; glad to be off the pills and no major issues.
I mention another new treatment below. I'm a posterchild for this video, around the 8:40 mark describes some of my current situation so this is for those to whom it may apply although as we all know or come to find out the hard way the sample size for prostate cancer and BPH is 1. Every case should be looked at individually. I have 3+4 intermediate stage cancer (Decipher) and spent awhile deciding on treatment after biopsy initial diagnosis in March of 21. I also was told I had enlargement in the transitional area of the prostate (mine was considered slightly enlarged 40cc) which is the area of the prostate right around the urethra well away from the cancer in one part of the apex. This was discovered at my first multi parametric MRI in October of 21. BPH symptoms (urgency, some additional nighttime trips to urinate) were mild (and stayed that way a while) while I researched cancer treatment. I also got diagnosed with moderate sleep apnea at this time. ( Age 68 now 70) so I already had sleep issues for at least the preceding 20 years. I decided on MRI-linac (Meridian) hypo-fractionated radiation treatment, 5 treatments. The length of time that elapsed from the MRI that found BPH diagnosis to making my decision about cancer treatment allowed the urgency and frequency to get progressively worse and eliminated any time for treatment since the second MRI showed some cancer progression but still focal and and no ECE but still time to proceed with cancer treatment and not BPH treatment. The normal protocol for MRI-linac was disregarded against my vehement protests. The Doctor in FL (where I travelled for this specific treatment) said it was still safe (very long story). I totally disagreed but already had one treatment so I finished the 5 treatments. I developed a pretty bad case of radiation cystitis at 9 months post treatment. (Thanks Doc for not telling the truth and sticking to the known protocol of treatment of every other day). Lots of blood in the urine, I believe they like to call it gross hematuria, and of course now the BPH symptoms intertwined, so also much difficulty in urinating anyway. This played out over 2 and half months this summer including 1 trip to the ER. Flomax helped somewhat until the cystoscopy showed the damaged tissue from radiation in the bladder. I was prescribed Hyperbaric Oxygen Treatment to stop the bleeding and accelerate the healing process as well as staying on Alpha blocker. I did 57 consecutive weekdays (ending 11/21/23) of 90 minute treatments at 45 feet below sea level at the best facility where I live in Atlanta (They have been in business over 20 years and said they could not recall anyone doing that many treatments without missing a day. I was prescribed 60 at the facility but chose to stop at 57). Bleeding long gone at the moment but radiation poisoning is the gift that can give at any time so will just have to see what happens.(Exactly what I told FL doc I was most worried about and wanted to take all proper precautions to avoid and now at only 9 months it begins instead of the average of 25 months....thanks doc) I'm still on Alpha blocker, I prefer Uroxatral for sustained release and antegrade ejaculation versus retrograde with Flo max. BPH symptoms still present but manageable. I want to get back to Kegels instead of medication but seems counterintuitive to exercise same muscles that the medication is forcibly relaxing, so will wait another 2-3 months before deciding on a next step. I have below low normal free testosterone but very normal total testosterone. No symptoms there though radiation can cause this. I exercise 6-7 days a week with plenty of energy, not overweight, no caffeine almost no alcohol (2 drinks or beers once a week along with large amounts of water, which together (and I guess the medication) have a great relaxing effect and allow the best urination of the week. No incontinence but the brain knows at home it doesn't have to wait so more frequency then when I'm out and about for several hours with no issues. Getting up once a night which is as much (treated and treating) sleep apnea as anything. I hope the radiation will eventually shrink the prostate enough to lessen and maybe even eliminate the urgency and the need for the very few treatments available post radiation as discussed in the video. It's been 13 months, PSA slowly down from 7.6 to 1.4. Never any ED (in fact still the opposite situation which some might call ED ha ha :)) and still not dry orgasms but getting closer to that. Optilume is probably the newest procedure for BPH and the doctor is looking into whether I can do that one. He says I could do Urolift which I am not impressed by so far. Not sure about Itind yet but I like the concept though likely not as effective post radiation. All the others especially TURP are out as mentioned in the video. My doctor in Atlanta where I live is a surgeon doing prostate removal as well as treating BPH. I'm hoping in the months to come to find out more about Optilume.
Good intel. I was given a 3+4=7 by the local lab here in south Florida after my biopsy. [The urologist---of course---recommended surgery immediately]. BTW: I only recommend having a biopsy AFTER the 3T MRI finds/identifies a lesion. Per the advice of this excellent channel, I SLOWED down and had the biopsy slides sent to John Hopkins for a 2nd reading. JH has MUCH more experience in reading Prostate Biopsy Slides; And they came back w/ a 3+3=6. Subsequently, the Proton Institute in Jacksonville also read the slides as a 3+3=6. (Yes, I fired my urologist). Normally w/ a Gleason score of 6, I'd "wait & watch", but my PSA is consistently rising and 1 core sample found 50% cancer. So, after speaking w/ 30 random patients that underwent Proton Beam, I'm opting for the 28 treatments of Proton Beam treatment sometime in the New Year. Best of luck to you!
I am looking at similar situation. BPH (80 cc) and 4+3 GS. Sounds like best to handle BPH first (HoLEP perhaps) then SBRT - 5 sessions after. Will see.
Whichever way you go, I highly recommend "You Can Beat Prostate Cancer And You Don't Need Surgery to Do It" - (New updated 2nd Edition)
by Robert Marckini@@tomjgrant Full disclosure: He's a strong advocate of Proton Beam, however as a MIT trained engineer I really appreciated both his communication style and his analysis. Best of luck!
Aquablation...thoughts ?
I have a question, what about aquablation procedure, is it effective?
When I had Tulsa it reduced the size of my prostate from 160 to 30 and it solved my bph problem.
I though about Tulsa but was going to do focal with laser instead because the BPH and cancer were not close to each other and the laser could zap each one individually. Doc admitted he was probably getting me five years at best before some type of re-treatment for the cancer, and it is not covered by insurance so wasn't worth $15k to me. From my research all focal was very, uh, non-focal in that large numbers of patients were needing retreatment. I found 2 great forums out there to listen and talk with others in similar condition. Inspire and Health Unlocked. Hopefully you will be one of the successful patients.
@@stillaliveandwell5291 tulsa can be either full gland or focal.
Thanks, great video ! If you have a TURP procedure, how long must you wait for it to heal, before undergoing radiation ??? Is there a standard timeframe for the incisions to heal ? Thank You !!
I was having typical urinary symptoms that started my prostate work up. According to MRI nearly my entire gland is a tumor. I am 4+3+7. Just started 6 mos Lupron and will have radiation mid way. If my pre existing urinary issue persist after treatment can/should I consider one of these procedures on my radiated prostate?
As highlighted in the video you have many fewer options after radiation but everyone's condition is unique so at least you should be researching and planning now for all of your options pre and post. Get on the forums I mentioned in this thread.
Why no mention of HOLEP?
HoLEP is mentioned at 09:37 with link to another video dedicated to HoLEP: BPH Treatments: HoLEP, PAE, Surgical, TURPs, & More | Casey Dauw, MD: ruclips.net/video/BDpfkhQvdH0/видео.html
My radiologist demands I have TURP before he does HDR brachy. Something about "otherwise you're gonna wear a catheter for the rest of your life." Nothing else was ever offered. No word on side effects. I am considering to change health systems and try different doctors, or is that a common process when you cannot fully empty your bladder and HDR brachy is on the menu?
Your radiologist? Is he also a radiation oncologist? Why the high dose brachy vs the low dose brachy? There's a radiation oncologist in CA that that will do over 500 + of these procedures, the most in the country, and has refined and developed his procedures. He also travels to Arizona and does these procedures, and collaborates with local urologists and other oncologists in the area. He used to do High dose, now does low dose.
See PCRI video on Brachytherapy for radiation oncologists highlighting LDR seeds.
@@threeftr3349 He is the head of Radiation Oncology at the largest hospital in the state. HDR because I am Gleason 8.
I had a TURP procedure a few years ago. It was straightforward and I was discharged the day after the surgery. It helped somewhat with the urgency, but not a great deal with the frequency. The downside is that I am now impotent and have to rely on Viagra. I also don't like that I can't ejaculate anymore.
What about holep procedure.
Hello Henry, here is a video on HoLEP: ruclips.net/video/BDpfkhQvdH0/видео.htmlfeature=shared&t=1535