BPH

[hrosensweig]

Hello,

My father is 79 and was recently diagnosed with BPH He has been on Flomax and Vesicare for a long time and now he must use a catheter to urinate as these meds are no longer providing much relief. The urologist advised him to go on Proscar (finisteride) to see if it can shrink prostate. Urologist advised that it could take 4 months to know if Proscar will work or not. He said if it didn't then we could consider laser (green) surgery.

Does this sound like a reasonable way to go? He is very upset and uncomfortable with the catheter and bags. He goes from a leg bag during the day and a larger bag at night and needs assistance changing these. The leg bag is hard because it has these small buttons you must thread through a slit. I wish they had velcro straps. Anyone know of bags with velcro or should I just make some for him?

many thanks,

Harris

[mrcoyote]

Harris>
I sympathize with him about the leg bag and the larger one at night. I know they aren't comfortable, but you should be able to do it with velcro provided you are able to make the velcro pads stick to the elastic straps. That's going to be the tricky part. Just use a tiny velcro piece....otherwise, it will just pull off the strap. Somebody with a sewing machine could do it easily and it would work, but that seems like Plan B and not the easy way. Your urologist was right. It takes time for the Proscar to work....IF it's going to work. Same thing with Avodart, but if your urologist suggests Avodart....confront him about using a laser for the surgery after a person has started taking that drug, because my urologist told me it's a big no-no to try to use the laser in that case since the Avodart shrinks the blood vessels in the prostate and the prostate doesn't respond well to laser turp then. Yes, they can always revert to the old-fashioned roto-rooter non-laser method but for your dad, I suggest the laser if he's gonna do it. Quicker heal times and less bleeding. There's quite a bit of blood in the urine with the laser anyway. If it comes to it, go with the surgery and give your dad the relief he so desires. It will just a week or so with a catheter, maybe less, and then no catheter and you can urinate like a race horse compared to before the surgery.
Any more questions, feel free to ask.

[hrosensweig]

thank you so much for the response. I can see us going in the direction of the laser surgery. It's becoming clear that he is not able to change the bags from the day one to the night one independently and it is causing great stress for my sister and myself. We have companions coming to assist, but they are not completely reliable.

take care,

Harris

[mrcoyote]

Harris> You're absolutely right. The different bags, especially switching them, can be a bit of a chore as it was even for me after a while. Consider this: if it's bad now, another four months of dealing with it, which he isn't going to like at all, and then unreliable help will make it even worse if the people you use are not timely and comforting. Even after only one week it was driving me nuts! I'm not a doctor, but my guess is that at his age and the way things are, the Proscar isn't going to be enough to give him the results you are looking for, but I really don't know. You're going to have to be aggressive the next time you go in to talk with the urologist about this if you really want to proceed with the surgery. He may be trying to avoid the surgery in his case for some reason. Now, I have to tell you, the surgery itself isn't that bad. But you DO wake up with a pretty big catheter (to drain blood and all the junk in your bladder from the resection, blood clots, etc.) and it has to stay in for a while. So you would have that to deal with for a while. But.....the result would be (probably) no meds anymore and no catheter or any bags, and he would be able to urinate freely on his own and be so much more independent. I'm sure of that.
There IS some pain, but it's a dull, "bruised" kind of pain in the prostate area. Kind of hard to describe.
But it's normal. And you get pain meds if you need them. And there is bleeding from the surgery into the urine. It looks pretty bad in the bag, but it's normal too. Eventually, it clears and the pain subsides. I'm telling you all this because somebody is going to need to be there with him for the surgery and after. I'm positive about that. Same old bag changing thing and all. But you have to focus on the outcome and the eventual freedom from it all. It feels so great to be done with it now I can't tell you. It's all about being comfortable in your daily life, and sometimes you just have to go for it.
Right? I don't see any other way around it for your dad. This, I'm sure, will not only give him relief, but will make a new person out of him as far as his outlook on life and temperment. It did me.

[hrosensweig]

thanks again for the honest response. It's comforting to hear from someone who has been through it. I've been sharing these responses with my sister. We've moved up his next urology appointment and will be pushing the surgery issue.

many thanks,

Harris

[mrcoyote]

You're most welcome. I try to tell it like it is. I probably don't have to tell you this, but if you do decide to have the surgery done, it is most important that you have a BOARD CERTIFIED urologist with lots of experience do it. And he must be on top of his game. You want somebody that has done this surgery, laser and otherwise, for years and isn't afraid to tell you so. For me, that's the most important thing. You want the best result possible for your dad and you'll only get one shot at this thing. The success rate is extremely high for this procedure and you only want to put him through this once. All blood thinners, like aspirin or prescription drugs that might thin blood and all herbal supplements have to be discontinued weeks before the surgery so everything can heal properly. They will probably require a blood test, an EKG, and a chest X-ray as routine pre-op procedures just to check and be sure there won't be a problem with the general anesthesia. I'm sure there won't be, but they have to do it anyway. Anesthesiologists get nervous if there are heart problems with their patients, so they have to clear you.
I'm sure you know about all this and they tell you anyway. Basically, then you're good to go. I'll be interested to hear how your urologist feels about doing the surgery at this point. Let me know. And my
pleasure to try to comfort you and help you out.

[hrosensweig]

Many thanks! Based on the content of your posts, my sister and I are better armed when we go into his next urology appointment. We've also been spurred on to find the best doctor we can for dad who has as you say done many of these. We're currently looking at a guy at Jefferson Hospital in Philadelphia.

Keep you posted,

Harris