GreenLight™Laser PVP Surgery for BPH
One Patient's Experience
On Wednesday, September 21, 2011 I underwent GreenLight™ Laser PVP surgery for BPH. The surgery was performed by my urologist, Dr. Seth E. Lerner, at Metropolitan Lithotriptor in White Plains, NY. What follows is a diary of my personal experience.
In summary, I am very happy with the results. If you suffer from BPH and are considering PVP surgery, read my story. If you have any questions, please feel free to email me and I will try to help. My name is Jim and I am a fellow patient, not a doctor. I am not affiliated with, nor am I reimbursed in any way by doctors, medical facilities or equipment suppliers.
Here is some general background information on BPH and the GreenLight™ PVP procedure:
GreenLight™ Laser PVP (Photoselective Vaporization of the Prostate) is a procedure used in the treatment of Benign Prostatic Hyperplasia (BPH), an enlargement of the prostate gland, resulting in urethral restriction. BPH is an overgrowth of prostate cells occurring in nearly 50% of men over age 55 and 80-90% of men by age 80. As the prostate grows, it begins squeezing the urethra creating uncomfortable and inconvenient urination problems, such as frequent urination, especially at night, a hesitant and intermittent flow, urgency, dribbling, and a feeling that the bladder is not emptied.
GreenLight™ Laser PVP is an out-patient procedure performed by a urologist. The anesthesia can be general, spinal, or nerve blocking along with sedation. The surgeon inserts a cystoscope (a tube equipped with a light) through the urethra to the prostate gland. A thin fiber is run through the cystoscope and placed in the urethra adjacent to the obstruction. Pulses of light radiate from the end of the fiber as the surgeon directs them towards the areas of overgrowth. The light is easily absorbed by the blood which becomes heated to the point that nearby tissues are vaporized. The doctor continues applying this laser light until the destruction of tissue reduces the restriction on the urethra. As the tissue is being vaporized the heat seals off the blood vessels, resulting in less bleeding than in other treatment options. A temporary catheter is often inserted to allow urine to drain from the bladder. The procedure takes approximately sixty minutes.
A Brief Personal History
In 2011 I turned 55 years old. I had been suffering from symptoms of an enlarged prostate for at least ten years. I was having difficulty urinating, starting and straining, and had to urinate often, at least a couple of times per hour. I would frequently have to excuse myself during meetings at work for a quick bio break. It got to the point that I could not go out someplace without knowing where the nearest men's room was. Hiking in the woods was no problem, but trips to the city or the zoo with the kids became for me a series of stops at one men's room after another, and made me the subject of much teasing. Car rides longer than a half hour were problematic, and more than once while stuck in traffic I had to pull off to the side of the road desperate for relief. It was a frustrating and humiliating experience.
I was also getting up several times each night to visit the bathroom. As a result I was often tired during the day from a lack of sleep, a problem which also affected my wife. She is a light sleeper and my frequent bathroom breaks were actually disrupting her sleep more so than mine. My urinary symptoms got progressively worse, and in 2009 I made an appointment with Dr. Seth E. Lerner, a urologist, after hearing him speak about prostate cancer and BPH at a local community forum on men's health issues.
Dr. Lerner is a member of Westchester Urological Associates, located on Maple Avenue in White Plains, NY. After a thorough examination, Dr. Lerner diagnosed BPH and said I was a perfect candidate for Flomax. He prescribed Flomax (Tamsulosin) 0.4 mg. daily. Flomax is what is known as an Alpha blocker. Other Alpha blockers include terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral), and silodosin (Rapaflo). These medications work by relaxing bladder neck muscles and muscle fibers in the prostate, making it easier to urinate. Alpha blockers work quickly. Within a day or two, most patients have increased urinary flow and need to urinate less often.
There is another class of medications called 5 alpha reductase inhibitors. These medications shrink the prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before improvement is noticed. Unfortunately, these medications can also cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation. Because of these potential side effects, Dr. Lerner felt that it would be best to start me on Flomax, and if that worked, then there would be no need for me to use one of the 5 alpha reductase inhibitors.
Flomax worked better than I could have imagined. Within a few days it had eliminated nearly all of my symptoms and I felt like a new man. I was still getting up once or twice per night, but this was far better than the five or six times previously. However, there were minor side effects such as sleepiness and stuffy nose, but I felt these were a small price to pay for relief of my urinary problems. I initially saw Dr. Lerner every month or two, but when it became apparent that Flomax was working for me and there were no adverse effects, we cut it back to an annual follow up exam.
After being on Flomax for two years, I began to feel that it was not as effective as it had once been. There was also a new problem of leakage, just a few drops here or there. I'm not sure if Flomax, by relaxing the smooth muscles in my prostate, contributed to this or if the leakage was just the latest symptom of BPH, but it had never happened before. Wearing dark pants made any small accidents less noticeable, but it was still disgusting and unacceptable to me.
In July, 2011 I decided to make an appointment with Dr. Lerner to discuss my latest concerns. He had mentioned surgical options to me in the past, but we both agreed that as long as the Flomax was working, taking medication and adopting a wait-and-see attitude was the best solution. At this point, however, I felt this approach was no longer viable.
Prior to my appointment I had used the internet to research the various surgical procedures for BPH to become familiar with the pros and cons of each. I came to the conclusion that the GreenLight™ Laser PVP surgery, one of the newest surgical treatments for BPH, would be best for me. In the course of my research I found very little information such as the detailed patient experience you are now reading, so I decided to keep a journal of my own experiences for other men suffering from BPH who may be contemplating surgery.
Wednesday, July 6, 2011
I had my appointment with Dr. Lerner today. He agreed that of all the surgical options, the GreenLight™ PVP surgery would be the best option for me given my relatively young age, the size and growth rate of my prostate, and my symptoms. Since it is non-emergency elective surgery, he said to consider it as a lifestyle decision. Even minor surgery has its risks, not the least of which is related to anesthesia. If your lifestyle can tolerate the symptoms of BPH, and Flomax (or some other medication) is working, then don't have surgery. However, if BPH is impacting your life, then why suffer the symptoms?
I felt strongly that the latter now described me. Did I really want to live like this for the rest of my life? No. And if I were eventually going to need to have surgery anyway, why not have it sooner rather than later. As a younger, healthy man I would recover faster, and then I would have that many more years to enjoy my life without suffering from BPH.
In the end I simply decided to have GreenLight™ PVP surgery because I did not want to be dependent on medication for the rest of my life. I did not want to get started with higher doses of Flomax or additional medications. I believed that I literally could not live without Flomax, and frankly I was very concerned about what would happen if for some reason it were unavailable. I thought of scenarios from the probable to the unlikely, including such things as financial hardship, disruption of the drug supply chain because of economic or social upheaval or wide scale natural disaster, or my simply running out or forgetting to pack my medication while travelling. Surgery would eliminate my dependence on daily medication, hopefully forever.
Once the decision was made to have the surgery I felt relieved. Now the question became when to do it. My initial reaction was as soon as possible, and Dr. Lerner said he could typically schedule it with two weeks lead time. However, there is the issue of post surgical recovery to consider. Although the surgery is minimally invasive, meaning they do not make any extra holes in my body and use one of the ones I was born with rather than make an incision somewhere, it still requires four weeks healing time during which I am not supposed to exercise or strain myself in any way. No bike riding. No swimming. No heavy lifting. No sex. Nothing that could cause undue internal pressure. I could walk and after a day or two, drive. Since I work on computers in an office, I would be able to go back to work immediately, but if I did some sort of physical labor for my job, this would mean four weeks of disability.
I decided that to minimize the impact of the recovery on my life, I needed to fit the surgery in between summer and winter sports seasons. My primary exercise is road cycling. I typically ride about 3,000 miles per year. I ride year round, but obviously a lot more in the summer. July or August would be a bad time to have surgery. Winter would be better, but I am also a skier and a USA Hockey certified Level 2 ice hockey referee and hockey season runs from October through March. Thus it became apparent that some time in September would be best, when cycling season is winding down but before hockey season starts. Dr. Lerner does surgery on Monday and Wednesday mornings, and I chose Wednesday, September 21 as my date for surgery.
Wednesday, September 7, 2011
I saw my primary care physician, Dr. Jonathan Rie, for the required pre-surgical exam. I had just seen Dr. Rie three months earlier in June for my annual physical and had passed with a clean bill of health. This did not matter because the pre-surgical exam needed to be done within two weeks of surgery. It included a general exam, full blood work, and a chest x-ray. As expected there were no problems and I was cleared for surgery. I was also instructed to call Metropolitan Lithotriptor to speak to a nurse about advance preparation for surgery.
Wednesday, September 14, 2011
Metropolitan Lithotriptor sent me an information packet including among other things a long list of medications and supplements to avoid consuming commencing one week prior to surgery. This included most pain medications such as aspirin and acetaminophen, some vitamins, notably vitamin E, and basically anything that would thin the blood or contribute to bleeding. There were additional instructions for patients on daily heart or cholesterol meditation, but I'm not so I did not pay attention to these restrictions. To keep it simple I decided to forego any vitamins and if I were in any pain, just tough it out without any supplemental pain killers. Better safe than sorry.
Most importantly, because I would be having general anesthesia I was advised to not eat or drink anything including water, candy, or gum, after midnight the night before my surgery. Also, because of the anesthesia, I would need to have someone drive me to and from the surgical center, and wait there during the surgery, which they said should only take about an hour. My wife was volunteered for this assignment.
I was a little apprehensive about the events of the next day, so I had an early dinner and was in bed by 11:00 pm.
Wednesday, September 21, 2011 -- Surgery Day
Before and After pictures.
This is me at home before surgery getting ready to go to Metropolitan Lithotriptor. I was nervous but I managed a weak smile for the camera.Here I am again a few hours later back home after my surgery. It looks like the same picture, but it's not. I don't look much different, maybe a little relieved and tired, but certainly not in any pain.
We got the kids off to school, and then my wife drove me to Metropolitan Lithotriptor. It is a small facility only three miles from our home. Going there is much more convenient than going to a big hospital, struggling to find a parking spot, then being lumped in with a million different people having a million different things done. Metropolitan Lithotriptor is a standalone, dedicated medical facility on Westchester Avenue with a large, easily accessible parking lot right in front.
We arrived at 9:00 am as instructed. My surgery was scheduled for 10:00 am but there was some prep work to be done first. The waiting room was empty and the administrator processed me immediately. I signed the required medical forms and gave her my credit card for my insurance co-pay. I had barely sat down before I was called up by a nurse.
Nurse Jean took me in promptly and brought me to a changing room with a locker for my stuff. She had me take off all my clothes and put on a hospital gown open in the back and little slipper socks. She then took some medical history and inserted an intravenous line into the back of my left hand.
I was nervous about the entire experience and Jean did her best to reassure me that everything would work out fine.
She explained that I would be going home with a catheter in me, and she brought out a demo catheter to show me how it works. I asked her why I needed a catheter since I read online that some urologists send patients home without one. She explained that sometimes there can be swelling which can block the flow of urine, necessitating a trip to the emergency room to have a catheter inserted. Better safe than sorry again. I agreed that this made sense, but I had no idea how unpleasant that catheter would be.
Next Dr. Ed the anesthesiologist came in to talk to me. He also asked about my medical history and asked me when I last had anything to eat or drink. It was the previous evening, ten hours before surgery, which he said was more than sufficient. He said it should be a minimum of six hours, but that if he were having surgery he would refrain from eating or drinking for fourteen hours.
He admitted that this was certainly overkill, but he understands the reasons behind having an empty stomach before anesthesia and the repercussions of vomiting while anesthetized. In the future I think I'll take his advice and wait even longer. Better safe than sorry for that too.
Finally Dr. Lerner came in and asked me how I was doing. Fine, I said, let's do it. I asked him about the catheter and he said they would remove it on Monday. Monday! Today is only Wednesday! I was expecting it would be removed on Friday! No, Monday, he said definitively. There would be no argument and no discussion. Now I was thinking I should have scheduled the surgery for a Monday rather than a Wednesday because then they probably would have removed the catheter by Friday and at least I would not have to wear it over a weekend. When he said "a couple of days" I had interpreted this to mean two, not five. Oh well, at this point there was no turning back.
I also asked him about the Flomax. He told me to continue taking Flomax daily until the catheter is removed, and then stop and evaluate my situation.
They walked me into the operating room with the IV anymore in my hand and had me climb up onto a table, lie on my back, and position myself where they wanted me. When I was in position they covered me with blankets and made me quite comfortable.
There were four people in the room: two nurses, the anesthesiologist, and Dr. Lerner. Dr. Lerner was seated down near my feet. The others were standing around my head on both sides. There was a clock on the wall and I noted that it was just before 10:00. Right on schedule. Then one of the nurses took my glasses off and the world dissolved to a soft blur.
They put a mask on me with pure oxygen to breathe. I suspect the anesthesia was already flowing because rather than feeling nervous I was feeling quite relaxed despite the circumstances. They asked me some basic questions: my name, date of birth, doctor's name, where I live, why I was there, and then, who is the president? Someone quickly added "who do you wish was the president?" and everyone laughed. I smiled but I was too tired to answer and the next thing I knew I woke up someplace else.
I was very groggy and just wanted to be left alone to sleep. It was weird. I was sitting up in a bed with no recollection of how I got there. The clock on the wall showed that it was a little after noon. I later learned that the procedure itself took an hour as planned, but I had been asleep for almost an additional hour.
The anesthesiologist said I might have a sore throat afterward but I did not. However I was hungry and thirsty, and still very tired. Nurse Jean gave me a little juice to drink and some cookies to eat but all I really wanted to do was sleep. All they really wanted to do was get me out of there, but they were gentle about it. At some point my wife came in and spoke quietly with the nurse and gradually the anesthesia fog began to lift.
My wife and Nurse Jean helped me to my feet and to walk back to the locker, and I got dressed by myself. I had a catheter in me and a urine bag strapped to my leg, so it was a little clumsy but eventually I managed to get my clothes on. If I had been in a hospital I'm sure they would have put me in a wheelchair, but I was not, so I was able to walk myself out the door which I actually did without difficulty. Even so my wife held my hand as we walked across the parking lot to the car, and then she drove me home. We were back home a little before 1:00 pm and I asked her to take my picture, the after photo that you see above. She prepared a light lunch for me, and then I sent a couple of emails to family, work, and friends to let them know the surgery was over and I was home and resting comfortably.
I was instructed to drink 8-10 8 oz. glasses of water a day to flush my system and keep the catheter running clean. I took my regular Flomax pill just before bedtime.
For some reason I could not sleep Wednesday night. I must have gotten up 5-6 times to empty the catheter bag. I was amazed how full that bag would get. I was lying on my back in bed but even though I was tired, sleep would not come.
Thursday, September 22, 2011
The catheter is very uncomfortable but I got the hang of emptying it quite easily. You just bend forward at the knee with the bottom of the spout over the toilet, and then lift up the blue plastic lever. The urine drains out, and when it stops, just lock the lever down again. The lever is secure and it does not leak. At first my urine was pumpkin orange. It stayed this way for nearly 24 hours, and gradually lightened. Dr. Lerner said this is normal.
Thursday night I was exhausted and went to bed around 9:00 pm.
Friday, September 23, 2011
I have been constipated. This is a mystery since I eat a high fiber diet and this is normally never a problem. I don't know if this is somehow related to the surgery or the anesthesia. The good news is my urine is running nearly clear, which is desirable.
If it weren't for the catheter I'd be feeling 100% back to normal. There is no pain inside of me, just a burning or stinging sensation from the catheter leaving my body. If I sit still and watch TV or read I'm fine, but if I try to move it hurts, so I try to move as little as possible. I am not planning to drive or even leave the house until it is time to go to Dr. Lerner's office Monday morning to have this hideous catheter removed.
I'm trying to work from home so I don't burn up all my vacation days. Thankfully, my boss is very understanding and told me to take care of myself and not worry about work, just work on getting better. I don't want to take advantage and I'm able to do emails and make phone calls, which is enough for now.
Saturday, September 24, 2011
The good news today is the constipation problem went away. Other than that, not much new to report. I'm just moping around the house, reading, watching a little TV, and resting. Waiting for Monday morning.
Sunday, September 25, 2011
Surgery was four days ago. I haven't left the house since I returned from the surgery. All I am thinking about is today it is Sunday and the catheter is going to removed tomorrow morning. It won't be soon enough. I'm really tired of it. It is irritating. I am looking forward to being able to urinate normally and take a regular shower without a bag strapped to my leg. I think wearing this catheter is worse than my Efudex treatment, but not as bad as a broken collarbone.
Monday, September 26, 2011
Monday morning. My wife drove me to the doctor's office at 9:00 am. I probably could have driven myself but it is just annoyingly uncomfortable wearing this catheter and it is much better to be able to sit quietly without moving. After a brief wait the nurse brought me in and had me drop my pants. I didn't even have to remove my clothes. I asked her if removing the catheter was going to hurt and she said no. I asked her how long it would take and she said two seconds. She was true to her word.
She did something with a syringe to the catheter, and then told me to turn my head (i.e. look away) and cough. I felt a brief pulling sensation but nothing worse than I've been feeling for the past five days, and it was done. She threw the catheter in the garbage, gave me a prescription for an antibiotic just in case, and sent me on my way. Oh happy day!
I am scheduled to see Dr. Lerner today at 3:00 pm. One more day of working at home between visits to Westchester Urological.
Monday afternoon. I just saw Dr. Lerner. I drove myself over there which was the first time I drove a car since my surgery. It made me feel normal again. Dr. Lerner asked how I felt and I said 100% better since the catheter was removed. I asked him how the surgery went and he said very well. He examined me with the ultrasound machine and said my bladder was completely empty. Dr. Lerner said I may still experience some pain and bleeding, but everything will resolve itself in time. He seemed genuinely happy and proud of his handiwork. He told me to stop taking Flomax, no exercise for four weeks, and to make an appointment to see him again in a month.
Tuesday, September 27, 2011
I still got up three times last night to go to the bathroom. There is a slight stinging sensation which Dr. Lerner explained would go away as the prostate relines itself. The antibiotic was unnecessary as there were no complications from the catheter.
Today was my first day back in the office since my surgery. Another small step back to my normal life.
Today is also the first day in several years that I have not taken Flomax. I still have a full bottle of pills, but I'm not going to throw them out. I really don't think I'll ever need them again, but time will tell.
Wednesday, September 28, 2011
My surgery was one week ago today. Urination has improved dramatically. It hurts but is not really painful. It feels more like the sting of an injury that is healing and reminding you that it is there. I am still having urgency but no straining and no hesitation. My stream is strong.
Today I noticed a small raised red bump the size of a bug bite on the back of my left hand where the IV was. This is something new. I am going to call the nurse tomorrow morning and ask about that. It is very itchy so I put some hydrocortisone cream on it. Also some jock itch that may be related to wearing the catheter?
I rode my bike to work today. I normally commute year round in all weather by bike since it is less than one mile to work by bike on a path through the woods, or three miles by car. I could walk, but the bike is faster. In fact it is faster by bike than by car. It takes me less than five minutes by bike, and I feel good about leaving the car home, getting a little exercise, and saving a tiny bit of gas. However the bike path is bumpy and I felt a little tender on my seat so I tried to ride standing up. Maybe biking so soon after surgery isn't such a good idea after all. Dr. Lerner did say no exercise for four weeks. But riding less than a mile on flat ground is hardly exercise; at least that is what I am trying to convince myself.
Thursday, September 29, 2011
I am feeling good. Urine is clear and my stream is strong. I called Nurse Jean this morning about the bump on my left hand. She recognized my name but didn't really remember me. I was a little surprised by this, but it was a week ago and I guess they see a lot of patients for the same thing for only a short period of time and they probably all start to blur together after a while. But OK, I'm not looking for a new friend and she did her job well and made me comfortable while I was her patient and that is all I can ask for. Anyway, she said that if it gets worse or if I have any signs of infection to come in immediately. She even offered to have me come in right then for a quick look, but I did not think that was necessary. In the end she felt sure that it would go away on its own in a couple of days. The itching is driving me crazy; it is like a mosquito bite that won't stop itching. She said to continue with the hydrocortisone cream for that.
I rode my bike to work again today but sitting on it was really uncomfortable and I stood up most of the way. I think this was a bad idea and I am going to leave my bike alone for the next few weeks and just drive my car to work like everyone else.
Friday, September 30, 2011
Surprisingly I had some bleeding today. My urine looked like pink lemonade. Then I passed a clot. Gross. That was a little unnerving. Now every time I urinate it starts out pink for a half second or so. I called Dr. Lerner and once again he said this is completely normal and it's a part of the healing process. He has been very patient with me but I think he is getting tired of my questions. He might do this every day but it's all new to me. He said not to worry and to expect some bleeding and clots for up to three weeks.
Sunday, October 2, 2011
I skated tonight which I probably should not have done. As I said, I am an ice hockey referee, and I was a last minute emergency substitute for my son as a linesman in a Midget 18U game. Being a linesman is much easier (and requires much less skating) than being a referee, and I tried to take it easy as much as possible and still do my job. As luck would have it, there was a fight at the end of the game, and part of the linesman's job is to separate players during an altercation. Despite what you see in the NHL, fights rarely occur in youth hockey games. I can count on one hand the number of fights I've seen. There is a good reason for this: penalties for fighting in youth hockey are severe. I don't mean just the 5 minute fighting major penalty and being thrown out of the game. I'm talking about the additional multiple game suspensions tacked on by the league. If the fight occurs during a high school game, the school district's Athletic Director gets involved, and this can result in additional suspensions including possibly even being suspended from school or being kicked off the team.
Oops, I went off on a tangent there, but we got the players separated and threw out the guilty parties. After the game I was a little tired but I felt OK and I don't think I did myself any permanent harm. However, I am not going to push my luck and I will not skate again until after I see Dr. Lerner again. I'm not going to tell him I skated either.
Monday, October 3, 2011
It turns out Nurse Jean was right; the bump on my hand is gone. Also, some anti-fungal cream took care of the jock itch. I'm still not sure if it was related to any of this.
Friday, October 7, 2011
One week later and I am still bleeding a little bit when I start to urinate. It still hurts a little. I am still having urgency. The good news is my stream is strong. No hesitation. No straining.
Monday, October 10, 2011
In two days it will be three weeks since my surgery. I am still bleeding. It seems to be a little less today, but maybe I am imagining it.
Wednesday, October 12, 2011
Well now it is exactly three weeks and I am still bleeding. If it is any less than two days ago I really can't tell. I'm still trying to drink lots of water to keep flushing my system.
Saturday, October 15, 2011
Dr. Lerner told me no sex for three weeks, and I dutifully complied. Today was a big milestone. My wife and I tested out my male reproductive system for the first time since my surgery. I was a little nervous, but there was no problem with ED (erectile dysfunction) and there was no pain. Actually I did not expect either, and everything worked like it is supposed to. Dr. Lerner had told me to expect retrograde ejaculation but I am happy to report that this did not occur, and all male functionality is as it was before, though a little pink like my urine. I guess this will pass too. Since this is a family website, I won't give any more updates of this nature unless there is a problem.
Sunday, October 16, 2011
I think the bleeding is diminishing. It is still there but noticeably less. I'm still drinking lots of water. My insides still feel a little tender but I think I'm 90% back to normal and in terms of urination, better than I've been in 20 years.
Wednesday, October 19, 2011
It has been four weeks since my surgery and I think I have finally completely stopped bleeding. Up until the last couple of days I was seeing a noticeable decrease in blood at the start of the stream. By yesterday I could barely see any change in color, and today, none at all.
Thursday, October 20, 2011
I rode my bike to work today for the first time in a couple of weeks. There was no discomfort and I think I will go back to my regular routine of bike commuting.
Monday, October 24, 2011
I saw Dr. Lerner today for my four week follow up. The nurse had me empty my bladder, and then the doctor checked my bladder with the ultrasound machine. He cheerfully pronounced my bladder completely empty. He cleared me to resume all normal physical activities and asked me to schedule a follow up exam in four months. I mentioned that I was still having problems with urgency and he said that this is always the last thing to resolve itself. He said that since I had been suffering from BPH for so long, it just takes time to retrain my bladder. He said this could take six months or more. He has been right about everything so far, so I have no reason to doubt him now.
He asked me if I had sex and if I had any problems or if I had experienced retrograde ejaculation. He was surprised when I told him I do not have retrograde ejaculation; he said something like 80% of patients do experience retrograde ejaculation. Well, I suppose I'm one of the lucky 20%. I guess it would be a little weird to have retrograde ejaculation, but it doesn't really matter to me since I'm not planning to have any more children anyway. However, I'm happy everything works the way I'm used to it working.
(October 21, 2012 update: I received an email from a fellow patient who is experiencing retrograde ejaculation. He said his orgasm feels the same as it always did, but it's just a little unnerving that nothing comes out of his penis. He went on to say that his wife doesn't mind, because "she never liked the mess anyway." He is happy with the results of his surgery, and he called the retrograde ejaculation "a non-issue.")
Friday, October 28, 2011
When I woke up this morning I realized that I had not gotten up in the middle of the night to pee for the past two nights. Wow, I can't remember the last time that happened!
Friday, November 11, 2011
It has been two weeks since my last update and I could not be happier with the results of my surgery. The past two weeks it has become normal for me to sleep through the night without having to get up at all unless I drink something right before bed. I used to be afraid to drink one beer in the evening, but no longer. I am still having some urgency but it is not as bad as before, and I can often suppress the urge with just willpower.
Monday, November 21, 2011
I have been sick all weekend with a bad cold. Another benefit of the prostate surgery is that now I can take over-the-counter and prescription cold and sinus medications that contain decongestants or antihistamines such as pseudoephedrine (Sudafed or Contac) without worrying that I will not be able to urinate. I had a scary experience with this about 5-10 years ago where I woke up in the middle of the night in extreme pain with a strong urge to urinate but was unable to do so. Since then and until now I had not taken any of these medications, and just suffered the cold symptoms, but now this is no longer an issue. I know these medications don't cure the common cold, but they do relieve the unpleasant symptoms and make me feel a whole lot more comfortable.
I still have some urgency but I think it is less than it was, though it could just be my imagination. Dr. Lerner said it would take about six months to resolve. At least now I am able to sit through my son's concert at school or his hockey game without running to the men's room mid-way through. I am still in the habit of using the bathroom before leaving anyplace where there is a bathroom handy, and especially before going anywhere in a car, but I no longer have the terrible desperation to urinate upon arriving at my destination that I used to have. I am embarrassed to admit that more than once I had to jump out of my car and urinate in the bushes beside my house because I knew that I would be unable to unlock the doors and get inside the house fast enough to avoid an accident. Thankfully this is no longer a problem.
It has been exactly two months since my surgery and I feel great (except for this cold!).
Thursday, November 24, 2011
Thanksgiving Day. Just when you think that everything is fine and all your troubles are behind you, life sometimes throws you a curve. Just after turkey dinner with my family, I went to the bathroom to urinate. Everything felt normal up to that point, but when I attempted to start my stream I felt a blockage, not like I had before surgery but different. Then very suddenly there was an intense pain that actually made me gasp. It only lasted a second or two before I felt something large pass out of me. Apparently it was another clot. After that my stream was strong but the pain persisted in a stinging sort of way rather than the sharp pain I had just experienced. There were also a couple of drops of blood at the end of my stream..
Fortunately I had no more problems urinating that evening, I saw no more blood, and thankfully the pain gradually diminished. When I undressed for bed I saw that there were a couple of spots of blood in my underwear, but I was able to sleep normally. I will see how I'm doing this weekend and call Dr. Lerner on Monday if I'm having any more difficulties.
Tuesday, November 29, 2011
I had no further problems since last Thursday. No more bleeding and no more clots. The pain went away after a day. I did not bother calling Dr. Lerner.
Thursday, December 1, 2011
I have been taking saw palmetto extract daily for the past five years. I decided when I had my surgery that I would use up what I had left in the bottle, and today I took my last pill. I don't think it is necessary for me to take it any longer so I don't plan to renew it.
I was using a brand called Prostate Rx. It is a one-a-day soft gel pill containing 320 mg. 100% pure saw palmetto extract. The ingredients say it is Standardized Premium Liquid Extract 93% to 98% Fatty Acids (Serenoa repens berry). No other ingredients. No fillers. No stretchers. No sugar, caffeine, or artificial additions.
I think that it helped me, and the company was easy to deal with and the price was reasonable, but my urologist seemed to think it was nothing more than a placebo. He told me when I first saw him back in 2009 that if it made me feel good to take it, then I should continue, but he felt that I was just wasting my money. I didn't listen to him on this and I did continue to take it because I felt that if it was doing any good at all, it was a positive thing; plus it was cheap enough that I didn't worry about wasting that amount of money.
However, now it is clear that a sixty minute surgical procedure did more good than five years of saw palmetto extract, so in the end maybe Dr. Lerner was right about this too.
Saturday, December 24, 2011
Christmas Eve. I got a letter in the mail today, a bill from Metropolitan Lithotriptor. A rather large bill. I was surprised because I had confirmed with the surgical coordinator at Westchester Urological and double checked with my insurance company that the procedure would be covered except for my co-pay. I don't understand why I received this bill. Unfortunately because of the Christmas holiday I won't be able to call anyone about it until Tuesday. I hope its a mistake, but now I'm a little worried. Merry Christmas.
Tuesday, December 27, 2011
I called Metropolitan Lithotriptor first thing this morning. They said all charges were submitted to insurance. Why then, I asked, did I get this bill? She said it was for the anesthesiologist. OK fine, but I argued that it was supposed to have been covered by insurance. She checked a few things and then said, "Oh, wait, it looks like this was double billed. Let me get back to you on that. I'll call you back by the end of the day." She never did. If I don't hear back, I'll assume no news is good news.
Friday, February 17, 2012
Fast forward almost two months. I never did hear back from Metropolitan Lithotriptor so I guess my account is paid up. The entire procedure, including surgeon, anesthesiologist, nurses, and facility use cost me only my specialist co-pay. My health insurance paid the rest. That's a hell of a deal in my book!
I have had no problems with my prostate and everything has been working better than ever. Well, at least better than it has worked for the past twenty years. I NEVER get up to pee during the middle of the night anymore. NEVER. It's really incredible. In fact I have gotten so used to sleeping through the night that I hadn't even thought about this until I updated this website tonight. I actually forgot that I used to get up 4-5 times per night. Now I am able to take long car rides, sit through a two hour meeting at work, and do other things that would have required one or more bathroom breaks six months ago. What a pleasure! I am scheduled to see Dr. Lerner next week for a follow-up exam. I expect it to be uneventful, but I'll update this diary in any case.
(September 22, 2012 update: A fellow patient recently sent me an email and asked why did I opt for the surgery rather than try Avodart? Here is my answer regarding Avodart (Dutasteride) and other medications. Avodart was just the next step down a road I didn't want to travel. I do not like the idea of being on a daily medication for the rest of my life. I thought of a lot of what-if scenarios where I couldn't get the medication, or if I lost my insurance and prescriptions became very expensive. I didn't want to worry about any of that. Actually, I decided to have the surgery because I had health insurance. With the job market the way it is, who can say when one might be laid off, and then it's goodbye health insurance. That was actually a big part of the reason I decided to have the surgery when I did, plus the feeling that why should I continue to suffer these embarrassing and painful issues which are so easily and hopefully permanently corrected.)
Monday, February 27, 2012
I had a four month follow up appointment with Dr. Lerner today. They took blood and urine samples, but they did not have me do the urine volume test that I've done in the past. Dr. Lerner looked at my bladder with the ultrasound machine and said it is completely empty. That's good news! He asked me how I felt and I said "like a new man." It may be a clichй, but it is true in my case. I have had no problems at all either urinating or with sexual function. He did a DRE (digital rectal exam -- and in this case the digital has nothing to do with computers or electronics. Digital refers to digits i.e. fingers, and if you haven't figured it out by now, a DRE is done by the doctor inserting a lubricated, gloved finger into the patient's anus and palpating the prostate to check its size and to feel for lumps.). This DRE was the first one since my surgery (with all my prostate issues, I've had many others in the past) and he and seemed satisfied with the results. It was no more uncomfortable than it ever was. (Actually, Dr. Lerner has small hands and thin fingers.) He said he'd like to see me again in six months.
On an unrelated note, I had some pain in my lower left groin area. He checked me for a hernia and said I felt a little weak there, but nothing that needs surgery to correct. I did have a hernia operation when I was a very small child, too young to remember it actually. He said try to rest it and it should start to feel better. If not, call him.
Saturday, March 31, 2012
It's been a month since my last update and a little over six months since my surgery. There is not much new to report. I actually forgot about the pain in my groin until I read the February 27 update above. I'm happy to report that this groin pain is gone.
We went to the movies last night (Hunger Games) and not only did I not run to the men's room before the movie, I didn't have to get up during the movie to run to the men's room. I did have to visit the men's room at the end of the movie, but so did my kids and I think every other man in the theater. I had no sense of urgency and everything was normal. I think the urgency issue may be resolved too. Dr. Lerner said it would take about six months, and it appears he was right about this too. I have not gotten up in the middle of the night to urinate in so long I can't remember. When I wake up in the morning that's usually the first thing I have to do, but I think that is fairly normal, and I don't have to run and sometimes I can even wait a bit.
The 2011-2012 hockey season is over, and now I look forward to having more time for cycling. I haven't ridden much since my surgery. It used to be that on any ride lasting more than an hour or two, I'd have to stop by the side of the road to pee. This was a minor inconvenience when riding alone, but was a real problem on a group ride, especially when riding with a large, fast group that doesn't stop. Basically it meant I got dropped and rode home alone. With smaller, more friendly groups, we could wait and regroup, but I'd suffer a fair amount of teasing about having a small bladder, which wasn't really the problem at all. This is yet another lifestyle issue that will no longer be a problem for me.
Monday, September 10, 2012
I had a six month follow up appointment with Dr. Lerner today. The nurse took a blood sample to check my PSA level and had me do the urine volume test. Dr. Lerner looked at my bladder with the ultrasound machine and then did a DRE exam. Everything was normal.
My only complaint is that occasionally I still have a feeling of urgency. It is nowhere near as bad as it was, but sometimes I suddenly feel a desperate need to pee. I can usually suppress this feeling, but it is uncomfortable. The difference is that now when I do urinate, the stream is strong and I usually have some volume, not just a few dribbles like in the past. I asked Dr. Lerner about this and he said that this feeling of urgency is the last symptom to resolve itself, and it can take years to do so. This was discouraging news, but it really hasn't been a problem, more of an occasional annoyance. He explained it like this: if a body builder suddenly stopped lifting weights, his biceps wouldn't immediately shrink and weaken. They would eventually weaken, but it would take time. Likewise my bladder. He said my muscles had become used to straining to urinate. This caused them to strengthen, as if I were exercising them. Now I no longer strain, but the muscles are still strong, and they will take time to weaken. I'm not sure I understand the analogy, but that was his explanation. The bottom line was he said to be patient. He's seen this before and it takes time to resolve itself, and it eventually will. He said he'd like to see me again in six months, and then we will cut back to an annual visit.
Friday, September 21, 2012
Woo hoo! It has been exactly one year since my surgery. I consider the surgery to have been a total success. The surgery itself was painless, and there was no post-operative pain since they used an existing hole in my body and did not create a new one. Wearing a catheter for five days was uncomfortable, but not really painful either.
My urinary problems resolved themselves quickly and completely. I can ride in the car for two or three hours without having to stop for a bathroom break. When I do stop for a bathroom break, it is planned in advance at a rest area and not in desperation in the woods on the side of the road. I can sit through long meetings at work or a two hour movie without having to run to the men's room. Best of all, I sleep through the night without having to get up to pee. My wife is happy about this too because she would wake up when I got up. Since I have been sleeping through the night, I am no longer exhausted during the day from lack of sleep.
Unless I have something interesting to report, I'm not going to continue with regular updates here. However, I will continue to monitor my email, so if you have any questions, feel free to ask me. My name is Jim.
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