MGL59,
I had similar issues. Had a Green Light Laser (120Watt - two tips used up) in June 2012 to remove 70G of a 120+ g prostate with a large median lobe protruding into the bladder, which was left mostly untouched. A year and a half later in Dec., 2013 I had emergency surgery after 3 days of gross hematuria to cauterize three bleeders (one on the prostate and two on the bladder neck) and clean out blood clots which had completely covered the inside walls of my bladder. It was only while cleaning out my bladder after the cauterization of the bleeders and resectioning of the bladder neck (and shaving off some of my median lobe while he was there) that my uro discovered bladder stones (he said it was like a bunch of bb's) and used the cystoscope tool to crush and remove them.
Prior to my GL I had MRI's, CT scans, Ultrasounds and cystoscope exams and no one ever discovered the bladder stones. During the GL, my uro was in the prostate, not the bladder, so he wouldn't have seen them. It was only while cleaning the clots off of the whole inside of my bladder that he saw them.
My uro was never able to pinpoint what caused the hematuria. He said it might have been a vein weakened during the GL, or it might have been the result of cathing. I don't recall whether he mentioned it might have been the bladder stones that caused it.
Last night, (15 months after my last surgery) I peed blood on three occasions over two hours for no reason (not the gross hematuria spaghetti sauce, just the burgundy wine or grape punch variety). Then it stopped. That was how my hematuria started last time. Peed blood, then two nights later started bleeding frank blood uncontrolably. So I'm thinking, maybe more bladder stones. I looked it up online and sure enough a symptom of bladder stones is more frequent urination (especially at night - which has been my problem for 6 months now) and gross hematuria! My uro had no idea why I was urinating more at night the last 6 months, said he couldn't help me with that. So I'm thinking, why didn't he recall the bladder stones, and consider that as a cause of the increased frequency at night?
Bottom line, these doctors aren't spending a lot of time being diagnosticians. It's pretty much all trial and error with them. They follow their cookbook, and if things don't work the first time, they try the next step in the cookbook. Ultimately by the second or third try they get it right for most of their patients.
If I have to have another procedure I would try to get the holep rather than the GL. I only got the GL instead of the holep because my uro didn't do the holep, just the GL. Also, he said I wouldn't get retro and I didn't. He preserved some tissue above the ejaculatory duct in the prostate which acted like a backboard to direct the semen down and out instead of back into the bladder. But if I need another procedure, I'll look for a doctor to do the holep, only because it does a better job of removing more tissue, and it can analyze that tissue. I'll live with the retro, rather than face additional repeat problems with my prostate.
.......
Addendum:
After posting the abvove I did some more research on Holep and on the Button Turp. It seems there are people not happy with their results from those procedures either. One post said that the holep removes the internal sphincter at the bladder neck and in his case it took 8 months for his external sphincter (at the end of the prostate furthest from the bladder) to be strong enough to end his incontinence. Hmm, not sure if I want that.
And removal of the internal sphincter leaves the prostate and bladder
open to each other, what is what causes retro. Normally the internal sphincter is closed except when urinating, and that is why semen goes back down and out. In my case, I had the GL, and also the bladder neck (internal sphincter) resection or widening, but never got retro, so it must still be closing after I urinate. It may also be responsible for my moderate rather than firehose stream. Especially at night that sphincter must be slow to
open because my stream is often weakest when I wake up during the night to pee.
Another poster who had a button turp had difficulties very similar to mine in the growth of membranes or scar tissue a few months after his procedure, that had to be removed, and he needed to start cathing again (both things happened to me after my GL).
Now I can't honestly say what I would do if I needed another procedure. The holep and button turp, wile superior in theory, look less like a silver bullet. My uro has been inside twice, plus inside with a cystocope to remove scar tissue once, so maybe I would stay with him and a GL after all. Add to it the fact my uro and hospital are 15 to 30 minutes from my house, and it becomes less attractive to start considering travel to get any procedure done.
Having been involved in this quandry for more than 4 years now, having done all the research I could do, having been involved in two surgeries and a cystocope removal of a membrane, having been on and off flomax, and trying all sorts of approaches with diet, supplements, etc., I've come to the conclusion there are no sure fire solutions. What works for one person may or may not work for another. There are a few procedures that seem to not work very well at all, but the rest seem to work for most people. That leaves those for whom they don't work back searching for the next step. The model we as patients are presented with is that we have an enlarged prostate that is closing off the urethra, and when xyz prodeure or medication reduces prostate size we will be cured. But for many people that's only part of the problem.
Bob
MGL59 said...
Just a quick update. I am around 4.5 months post GG. Still no improvement. I am actually up to 6 mg/day of Cardura from 4 mg.
I just had a cystoscopy from my urologist last week because he saw a bladder stone on the ultrasound I had prior to the GG. I am a little surprised/unhappy that Dr. Gat did not tell me that I had a bladder stone. Did he even look at the ultrasound that I sent him prior to the GG? As soon as my urologist saw the picture he immediately said, "Did you know you have a bladder stone?" I also had blood and crystals in my urine which suggests a stone as well. Dr. Gat should have seen that in my urinalysis (I am not sure that I did a urinalysis prior to GG actually). So, does Dr. Gat even look at any of the tests he wants done prior to GG?
Anyway, during the cystoscopy the doctor also looked at the prostate of course (not sure how they see that through the urethra). He said that it looked huge and inflamed (I was 118 g at the time of the GG). I had lots of blood in my semen about a week before that. The urologist did not seem to be concerned. He said that sometimes the blood vessels in the prostate can break when it is that large and inflamed.
I need to have the stone(s) removed by laser. I could have stones and prostate lasered at the same time with a Holmium laser I think. However, I think I'll just have the stone removed and give the GG some more time.
If my BPH does not improve I am thinking of PVP Green Light. Every study I read says that only 1/3 end up with RE, but my urologist said that that's bunk (he says most have RE). Then again, my urologist thinks everything's bunk (including GG although he knows nothing about it).
Does anyone know which is best, ablation or enucleation? Can either be done or does it depend on the size of the P or other things? Can Green Light PVP be used for both?
Thanks!
Post Edited (Bob_NJ) : 3/27/2015 5:34:16 PM (GMT-6)