I Have Had BPH Issues For Years And Can You Address The Irreversible Bladder Damge Issue

Posted on Thu, 9 Aug 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 9 Aug 2018 Answered on

Mon, 16 Jan 2023 Last reviewed on

Question : I have had BPH issues for years. Recentlt they've become more bothersome. My IPSS is now at 24 and I am in a state of constant discomfarnt. My psa is 1.19, and I'm a 66 yr old male in otherwise good health. I had a CT of the abdomen in XXXXXXX saying i had "coarse calcifications in the prostrate gland. The urinary bladder wall is relatively thickened and tribiculated. An ultrsound I had 1 yr ago indicated "equivocal mild bladder wall thickening circumferentially. Mildly enlarged prostrate gland @ 4.7 cm and demonstrates some internal calcifications, mildly impressing upon the posterior bladder Prevoid volume=109ml and 24ml postvoid". My retention US showed 42ml on 8/7/18. Cystoscopy on 7/31/18 showed large lateral lobes(estimate 55-60) and recommending Urolift. I take 5mg of Cialis daily, as well as well as 10 mg Alfuzosin and 5 mg Vesicare for past 6 days. The doctor I saw on Tuesday rec urodynamics, TRUS, cystoscopy and DRE. which I'll have over next 3 wks with Urolift procedre in 5 wks. This doctor is highly recommended and i trust him but as always he's very busy and unable to address some concerns I have post appt. I am worried about irreversible bladder damage as my BPH has been going on for a decade although only recently @ IPSS of 24 for approximately 1 month. Prior to that my IPSS was approx 14. Another doctor who has done alot of these procedures as well could do the procedure in 12 days but I don'tb know much about him other than his clinic is considered a Center of Excellence by UROLIFT as he has done 120 of these procedures over 1.5 yrs. What gives me pause is his only wanting a cysto and a visual on my peeing in a cup with no need for urodynamics or TRUS. I like the doctor I just saw but there will be an additional 3 week delay. My concern is with irreveversible bladder damage that might happen if I wait. I have never had retention but had extreme difficulty last night(up half the night). Can you address the irreversible bladder damge issue and 3 wk wait? Also the TRUS and Urodynamics difference between these 2 physicians. Also I don't know if Vesicare is helping or hurting. Thanks for all you do.

Follow up: Dr. Anders Mark Christensen (5 minutes later)

I really like the physician who will be 3 wks longer but I'm concerned about irreversible bladder damage and retention.

Answered by Dr. Anders Mark Christensen (1 hour later)

Brief Answer:
Irreversible damage unlikely, TRUS and urodynamics a question of preference

Detailed Answer:
Hi Dmorrissey37,

I can certainly understand your concerns and thank you for the elaborate history. First of all, a three-week wait is worthwhile, if this is the doctor you trust the most and feel most comfortable with. The waiting time will not cause irreversible damage to anything.

The question of whether TRUS and urodynamics are indicated is mostly a question of preference. With a recent scan of your prostate and normal PSA level, since you do not have any prostate cancer, TRUS will not add diagnostic value.

Urodynamics may help diagnose an overactive bladder, for which Vesicare is used. If you do not feel that Vesicare has helped, you probably do not have an overactive bladder.

I hope this helped. If you have additional questions, do not hesitate to contact me.

Kind regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Anders Mark Christensen (3 hours later)

Thank you so much! Do you have an opinion on Urolift vs Rezum? Urolift sounds easier but it leaves inserts on the prostrate which compromise further imaging of the prostrate 1.5ml from the urethra. Would the XXXXXXX 2018 w/wo-contrast ct be definitive for prostrate cancer? Thanks again. XXXXXXX

Answered by Dr. Anders Mark Christensen (12 hours later)

Brief Answer:
That depends on the expertise of your urologist

Detailed Answer:
Hi,

Urolift vs. Rezum depends on the preference of your urologist. The CT scans in addition to your normal PSA are enough to rule out prostate cancer.
Thanks.

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Above answer was peer-reviewed by : Dr. Kampana