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Re: PVP yesterday by Dr. Nseyo at McGuire Veterans Hospital
2003-07-09 13:59:16
An interesting write up on your procedure and look forward to hearing how
you progress. Re the irrigant, is that normally used during a PVP and what is it that they use. One reason that I did not have a Turp when advised to abut eight years ago was that the irrigant used then was absorbed into the body and there was a theory that it could cause heart problems about five years down the line. Derek. "Jack" news:bamgfh$ld9$1@bob.news.rcn.net... > Well I bit the bullet and had a PVP yesterday at McGuire VA Med > Center, Richmond, VA. The operation was performed by Drs. Nseyo and > Kleeman, a second year resident in Urology. The day before I had a > pre-op screening, blood work, EKG, chest ax-ray, urine specimens, the > works and it only took two hours to get it all done, the longest wait > I had was the ax-ray, 40 minutes. The urology clinic did a Qmax 6.8 > mL/sec, avg. flow rate 2.7 mL/sec, bladder retention 66%, prostate > size 70 cc with a psa of 4.74. Saw Dr. Nseyo and he told me that the > medial lobe was up in the bladder beyond the neck and that was why all > my numbers except the psa, were so poor. He said I would have dysuria > for up to a week after the operation and because of the retention he > wanted a 22 Fr. Foley catheter in for 3 days after the procedure. > Well 3 days would have been Sunday and since Memorial day is Monday > lucky Pierre gets to have it for 5 days. So far not too bad. Odd when > you know your urinating and there is nothing you have to do. > > I was scheduled for a 9:30 am operation time, The operation started > at 12:40 and ended at 1:50. I thought the delay was because of Dave > deBar and the movie crew. It wasn't till I got home today that I > found out they scrubbed Dave because of an extra large prostate 150 > cc. Part of the time in my operation was used by Dr. Nseyo instructing > the resident, Dr. Kleeman, how to his part. Dr. Nseyo did the medial > lobe and Dr Kleeman did the lateral and anterior lobes. After the > operation, I met a Laserscope representative who was in the OR along > with at least three other voices and he showed me their laser optical > kit. The probe used to do the vaporizing, is only 2 to 3 mm in > diameter and he said that the 80W average power was measured at the > laser port and that there was a total of 30% power lost in the two > couplings, one at the fiber optic bundle connection with the laser > port and the other with the probe. He also said that the max power > was measured at 263 W. Don't hold me to all those numbers because > they gave me a mild sedation in an IV along with the spinal. At the > very end of the operation Dr. Kleeman broke off part of the laser > probe, but they were able to flush it out with the irrigant. > > My urine in the post-op recovery room was colorless and clear, no > blood at all, however when they gave me the leg bag to go back to the > motel, I noticed about 8pm blood in the bag just from the activity of > riding in the car and walking to our room. Overnight the bleeding > stopped, but the drive home from the motel, 60 miles, started it up > again and I had my first bout with dysuria. He gave me Tylenol-3 for > the pain, along with an antibiotic sulfamethoxazole 800 mg with > trimethoprim 160mg. Brand names are Septra, Bactrim and Cotrim. > > It's to early to tell how much good the PVP did, but I should have a > much better idea when they take the catheter out next Tuesday. The > only thing I didn't like was they put a screen in front of me so I > couldn't see what was going on. All I could do was, from the > dialogue, try and determine what they were doing. Every time I tried > to lift my head up to try and see over the screen a nurse said keep > your head still. I finally told her it's not my head they're > operating on. But I did feel silly with my feet in stirrups open to > the world and the voices I couldn't identify, and not feel a thing > from the waist down. > > When I have some more info on the results I'll pass them along. > Hopefully after next Tuesday. > > >
2003-07-09 14:39:59
Derek
That was quite some time ago now, the PVP was done May 22nd. The irrigant was a 5 or 10% saline, NaCl, solution. I'm not sure of the concentration. Actually it is used to flush out the area where they are working.. It's my understanding that after the laser vaporizes the prostate tissue it gets pretty "cloudy" in the prostate so the irrigant is used to clear the smoke so to speak as well as anything else that is there that can be flushed out, such as charred tissue and blood clots. Right now I'm a satisfied customer. I have posted here a few progress reports here, in a nut shell, my flow rate is now 4 times what it was before the PVP. I'm holding the urine much better than before, however I have retro. Since I'm 73, that doesn't bother me. Although I'll admit there are some odd sensations when ejaculating. Jack "Derek F" news:beh3j5$52cg3$1@ID-107529.news.dfncis.de... > An interesting write up on your procedure and look forward to > you progress. Re the irrigant, is that normally used during a PVP > is it that they use. One reason that I did not have a Turp when > abut eight years ago was that the irrigant used then was absorbed > body and there was a theory that it could cause heart problems about > years down the line. > Derek. > "Jack" > news:bamgfh$ld9$1@bob.news.rcn.net... > > Well I bit the bullet and had a PVP yesterday at McGuire VA Med > > Center, Richmond, VA. The operation was performed by Drs. Nseyo > > Kleeman, a second year resident in Urology. The day before I had > > pre-op screening, blood work, EKG, chest ax-ray, urine specimens, > > works and it only took two hours to get it all done, the longest > > I had was the ax-ray, 40 minutes. The urology clinic did a Qmax > > mL/sec, avg. flow rate 2.7 mL/sec, bladder retention 66%, prostate > > size 70 cc with a psa of 4.74. Saw Dr. Nseyo and he told me that > > medial lobe was up in the bladder beyond the neck and that was why > > my numbers except the psa, were so poor. He said I would have > > for up to a week after the operation and because of the retention > > wanted a 22 Fr. Foley catheter in for 3 days after the procedure. > > Well 3 days would have been Sunday and since Memorial day is > > lucky Pierre gets to have it for 5 days. So far not too bad. Odd > > you know your urinating and there is nothing you have to do. > > > > I was scheduled for a 9:30 am operation time, The operation > > at 12:40 and ended at 1:50. I thought the delay was because of > > deBar and the movie crew. It wasn't till I got home today that I > > found out they scrubbed Dave because of an extra large prostate > > cc. Part of the time in my operation was used by Dr. Nseyo > > the resident, Dr. Kleeman, how to his part. Dr. Nseyo did the > > lobe and Dr Kleeman did the lateral and anterior lobes. After the > > operation, I met a Laserscope representative who was in the OR > > with at least three other voices and he showed me their laser > > kit. The probe used to do the vaporizing, is only 2 to 3 mm in > > diameter and he said that the 80W average power was measured at > > laser port and that there was a total of 30% power lost in the two > > couplings, one at the fiber optic bundle connection with the laser > > port and the other with the probe. He also said that the max > > was measured at 263 W. Don't hold me to all those numbers because > > they gave me a mild sedation in an IV along with the spinal. At > > very end of the operation Dr. Kleeman broke off part of the laser > > probe, but they were able to flush it out with the irrigant. > > > > My urine in the post-op recovery room was colorless and clear, no > > blood at all, however when they gave me the leg bag to go back to > > motel, I noticed about 8pm blood in the bag just from the activity > > riding in the car and walking to our room. Overnight the bleeding > > stopped, but the drive home from the motel, 60 miles, started it > > again and I had my first bout with dysuria. He gave me Tylenol-3 > > the pain, along with an antibiotic sulfamethoxazole 800 mg with > > trimethoprim 160mg. Brand names are Septra, Bactrim and Cotrim. > > > > It's to early to tell how much good the PVP did, but I should have > > much better idea when they take the catheter out next Tuesday. > > only thing I didn't like was they put a screen in front of me so I > > couldn't see what was going on. All I could do was, from the > > dialogue, try and determine what they were doing. Every time I > > to lift my head up to try and see over the screen a nurse said > > your head still. I finally told her it's not my head they're > > operating on. But I did feel silly with my feet in stirrups open > > the world and the voices I couldn't identify, and not feel a thing > > from the waist down. > > > > When I have some more info on the results I'll pass them along. > > Hopefully after next Tuesday. > > > > > > > >
2003-07-09 17:19:48
Derek,
Just want to clarify something about the "irrigant" For a standard TURP a fluid is used to flush out the morcelation. This fluid can be quite a problem when absorbed by the body. On the other hand, Greenlight PVP uses regular saline solution for optical reasons. By shining the laser through water gives better absorption than through air. This is another advantage of PVP over TURP. There is no problem of fluid absoption. Patrick "Derek F" news:beh3j5$52cg3$1@ID-107529.news.dfncis.de... > An interesting write up on your procedure and look forward to hearing how > you progress. Re the irrigant, is that normally used during a PVP and what > is it that they use. One reason that I did not have a Turp when advised to > abut eight years ago was that the irrigant used then was absorbed into the > body and there was a theory that it could cause heart problems about five > years down the line. > Derek. > "Jack" > news:bamgfh$ld9$1@bob.news.rcn.net... > > Well I bit the bullet and had a PVP yesterday at McGuire VA Med > > Center, Richmond, VA. The operation was performed by Drs. Nseyo and > > Kleeman, a second year resident in Urology. The day before I had a > > pre-op screening, blood work, EKG, chest ax-ray, urine specimens, the > > works and it only took two hours to get it all done, the longest wait > > I had was the ax-ray, 40 minutes. The urology clinic did a Qmax 6.8 > > mL/sec, avg. flow rate 2.7 mL/sec, bladder retention 66%, prostate > > size 70 cc with a psa of 4.74. Saw Dr. Nseyo and he told me that the > > medial lobe was up in the bladder beyond the neck and that was why all > > my numbers except the psa, were so poor. He said I would have dysuria > > for up to a week after the operation and because of the retention he > > wanted a 22 Fr. Foley catheter in for 3 days after the procedure. > > Well 3 days would have been Sunday and since Memorial day is Monday > > lucky Pierre gets to have it for 5 days. So far not too bad. Odd when > > you know your urinating and there is nothing you have to do. > > > > I was scheduled for a 9:30 am operation time, The operation started > > at 12:40 and ended at 1:50. I thought the delay was because of Dave > > deBar and the movie crew. It wasn't till I got home today that I > > found out they scrubbed Dave because of an extra large prostate 150 > > cc. Part of the time in my operation was used by Dr. Nseyo instructing > > the resident, Dr. Kleeman, how to his part. Dr. Nseyo did the medial > > lobe and Dr Kleeman did the lateral and anterior lobes. After the > > operation, I met a Laserscope representative who was in the OR along > > with at least three other voices and he showed me their laser optical > > kit. The probe used to do the vaporizing, is only 2 to 3 mm in > > diameter and he said that the 80W average power was measured at the > > laser port and that there was a total of 30% power lost in the two > > couplings, one at the fiber optic bundle connection with the laser > > port and the other with the probe. He also said that the max power > > was measured at 263 W. Don't hold me to all those numbers because > > they gave me a mild sedation in an IV along with the spinal. At the > > very end of the operation Dr. Kleeman broke off part of the laser > > probe, but they were able to flush it out with the irrigant. > > > > My urine in the post-op recovery room was colorless and clear, no > > blood at all, however when they gave me the leg bag to go back to the > > motel, I noticed about 8pm blood in the bag just from the activity of > > riding in the car and walking to our room. Overnight the bleeding > > stopped, but the drive home from the motel, 60 miles, started it up > > again and I had my first bout with dysuria. He gave me Tylenol-3 for > > the pain, along with an antibiotic sulfamethoxazole 800 mg with > > trimethoprim 160mg. Brand names are Septra, Bactrim and Cotrim. > > > > It's to early to tell how much good the PVP did, but I should have a > > much better idea when they take the catheter out next Tuesday. The > > only thing I didn't like was they put a screen in front of me so I > > couldn't see what was going on. All I could do was, from the > > dialogue, try and determine what they were doing. Every time I tried > > to lift my head up to try and see over the screen a nurse said keep > > your head still. I finally told her it's not my head they're > > operating on. But I did feel silly with my feet in stirrups open to > > the world and the voices I couldn't identify, and not feel a thing > > from the waist down. > > > > When I have some more info on the results I'll pass them along. > > Hopefully after next Tuesday. > > > > > > > >
2003-07-09 23:18:53
Jack,
The irrigant for a TURP is just plain old glucose solution, or any non- conductive solution. I can't imagine what that business about it causing problems later could be related to... With PVP, since no electrosurgery is used, saline can be the irrigant. At any rate, regardless of the irigation used, it sounds like there are plenty of other reasons to avoid a TURP. "Derek F" news:beh3j5$52cg3$1@ID-107529.news.dfncis.de: > An interesting write up on your procedure and look forward to hearing > how you progress. Re the irrigant, is that normally used during a PVP > and what is it that they use. One reason that I did not have a Turp > when advised to abut eight years ago was that the irrigant used then > was absorbed into the body and there was a theory that it could cause > heart problems about five years down the line. > Derek. > "Jack" > news:bamgfh$ld9$1@bob.news.rcn.net...
2003-07-11 00:36:09
Zeppo wrote:
The irrigant for a TURP is just plain old glucose solution, or any non-conductive solution. I can't imagine what that business about it causing problems later could be related to... Well what about: TURP Syndrome - Mild 2%, Severe 0.5% This is a rare but potentially serious problem Absorption of the fluid used to irrigate during the operation occurs normally to some extent. If the operation is prolonged over an hour or especially difficult, then excess fluid absorption can cause problems. Patrick "Zeppo" news:Xns93B3C47BCBB86zeppojunqueorg@207.69.154.254... > Jack, > > The irrigant for a TURP is just plain old glucose solution, or any non- > conductive solution. I can't imagine what that business about it causing > problems later could be related to... > > With PVP, since no electrosurgery is used, saline can be the irrigant. > > At any rate, regardless of the irigation used, it sounds like there are > plenty of other reasons to avoid a TURP. > > > "Derek F" > news:beh3j5$52cg3$1@ID-107529.news.dfncis.de: > > > An interesting write up on your procedure and look forward to hearing > > how you progress. Re the irrigant, is that normally used during a PVP > > and what is it that they use. One reason that I did not have a Turp > > when advised to abut eight years ago was that the irrigant used then > > was absorbed into the body and there was a theory that it could cause > > heart problems about five years down the line. > > Derek. > > "Jack" > > news:bamgfh$ld9$1@bob.news.rcn.net...
2003-07-11 00:40:34
That TURP Syndrome is a fallacy has long been discarded as a result of
better understanding of the pathophysiology of the disease.1,2 It is now considered as a distinct clinical entity characterized by a constellation of signs and symptoms secondary to neurologic, cardiovascular and electrolyte imbalance resulting from the absorption of irrigating fluid through prostatic veins or breaches in the prostatic capsule during TURP. 3 Mental confusion, bradycardia, hypotension/hypertension, nausea, vomiting and visual disturbances associated with hyponatremia are most commonly observed.4 Although majority are mild in nature and are easily managed with close monitoring and diuretics alone, severe cases may lead to a significant morbidity or even to a preventable mortality which is often attributed to other causes such as myocardial infarction.5 This is one of the reasons why TURP, as the "gold standard" in the treatment of benign prostatic hyperplasia, has become a subject of reappraisals leading to the acceptance of medical and minimally invasive forms of therapy. 6 "Patrick" <303delaware@comcast.net> wrote in message news:Ro6dnb4wm80po5OiU-KYvg@comcast.com... > Zeppo wrote: > > The irrigant for a TURP is just plain old glucose solution, or any > non-conductive solution. I can't imagine what that business about it > causing problems later could be related to... > > Well what about: > > > TURP Syndrome - Mild 2%, Severe 0.5% > > This is a rare but potentially serious problem > > Absorption of the fluid used to irrigate during the operation occurs > normally to some extent. If the operation is prolonged over an hour or > especially difficult, then excess fluid absorption can cause problems. > > Patrick > > > > "Zeppo" > news:Xns93B3C47BCBB86zeppojunqueorg@207.69.154.254... > > Jack, > > > > The irrigant for a TURP is just plain old glucose solution, or any non- > > conductive solution. I can't imagine what that business about it > > problems later could be related to... > > > > With PVP, since no electrosurgery is used, saline can be the irrigant. > > > > At any rate, regardless of the irigation used, it sounds like there are > > plenty of other reasons to avoid a TURP. > > > > > > "Derek F" > > news:beh3j5$52cg3$1@ID-107529.news.dfncis.de: > > > > > An interesting write up on your procedure and look forward to hearing > > > how you progress. Re the irrigant, is that normally used during a PVP > > > and what is it that they use. One reason that I did not have a Turp > > > when advised to abut eight years ago was that the irrigant used then > > > was absorbed into the body and there was a theory that it could cause > > > heart problems about five years down the line. > > > Derek. > > > "Jack" > > > news:bamgfh$ld9$1@bob.news.rcn.net... > >
2003-07-15 22:16:54
Your Uro is just not prepared to take on new ideas
He clearly prefers the "butchery job " of TURP "Bob R" news:15ab0471.0307150949.422f777@posting.google.com... > Zeppo > > Jack, > > > > The irrigant for a TURP is just plain old glucose solution, or any non- > > conductive solution. I can't imagine what that business about it > > problems later could be related to... > > > > With PVP, since no electrosurgery is used, saline can be the irrigant. > > > > At any rate, regardless of the irigation used, it sounds like there are > > plenty of other reasons to avoid a TURP. > > > > > > "Derek F" > > news:beh3j5$52cg3$1@ID-107529.news.dfncis.de: > > > > > An interesting write up on your procedure and look forward to hearing > > > how you progress. Re the irrigant, is that normally used during a PVP > > > and what is it that they use. One reason that I did not have a Turp > > > when advised to abut eight years ago was that the irrigant used then > > > was absorbed into the body and there was a theory that it could cause > > > heart problems about five years down the line. > > > Derek. > > > "Jack" > > > news:bamgfh$ld9$1@bob.news.rcn.net... > Jack, how are you doing now? The last message I saw was 9 July. I am > doing a consult for PVP in St. Augustine on 17 July as there is no > equipment in Orlando. My Uro got all defensive when I aked about PVP. > Actually tried to scare us off with comments like "don't come to me if > you go out of town" and 'don't call me at 2:00AM if you need help".
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