8 week post-op RP follow up. Meet the Cystoscope.

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Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/2/2009 2:08 PM (GMT -6)   

 Went to see the Uro/Surgeon today for post-op follow-up, and to get results from a 2-month psa test. Good news in that the psa remains undetectable at <0.01. yeah [Crowd Noise] The intake nurse updated my history, and asked if there were any complaints. I told her that within the past week my night-time urination stream got very weak, and had a burning in the head of my unit. She ordered the urine tested for infection. When the Uro came in I repeated the complaint, and he said we’d better have a look.  So, checking my modesty at the door, the nurse had me remove my pants and get on the table, and cover with a drape.

 

She then lowered the table down, raised the drape, grabbed my unit with one hand and a large syringe with the other, and pumped a load of local anesthetic into the urethra. Then she clamped off the head, and said we’ll be back in a few minutes.

 

The Uro came back in with the nurse, and poked a cystoscope up my unit. When he got to the spot where the urethra was sewn together, he said, yep, scar tissue was bridging in there, and causing partial blockage. The nurse opened a package of 18” long plastic straws of varying diameters, and the Uro selected one, then inserted that in me, to try and rod me out. That hit a stop, so he withdrew, and took another that looked like a long needle and pushed that in. That one I could feel! He worked it around for a bit, withdrew it, then reinserted the cystoscope for another look. He withdrew that one, and told me to get up and take a leak.

 

Wow, what a difference! I passed some blobs of tissue, a little blood, but with the most powerful stream I have had since pre-surgery.

 

I am back home, 4 hours later, and in that time I don’t think I have leaked at all!

 

I report this to encourage you to have yourself checked out for blockage if you are experiencing difficulty with urination. The discomfort was well worth it.

 

All the best.

Roger


 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage pT3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 

Post Edited (Opa N) : 11/3/2009 2:15:39 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/2/2009 2:12 PM (GMT -6)   
Roger, your story made me cringe a few times. I know first hand what you went through, but several times over in the past year. Glad they were able to clear you out that easy. I have had 3 corrective surgeries since last Nov, and it still keeps scarring back closed. That's why I am still with a catheter while undergoing radiation.

Good luck, hope you stay flowing. Despite all these corrections and cath time, my natural flow at best, is just a tiny amount of pre-surgery flow.

Hope you continue to do well.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 11/2/2009 2:37 PM (GMT -6)   
Roger, congrats on the zero club and wishing you a lifetime of them. Not gonna comment on the other part of your story...ouch!
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/2/2009 3:47 PM (GMT -6)   
James, I may get to push that scent block yet!

Roger

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage T3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.

10/21/09          First Lupron injection. 30 mg dose (4 month)

11/2/09            PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night.

 

 

 


pigeonflyer
Regular Member


Date Joined Nov 2009
Total Posts : 85
   Posted 11/6/2009 6:45 PM (GMT -6)   
been having cather in for 5 weeks now. have some kind of blockage. will get cystoscope on nov. 10 09. hope i dont have to get the reem job without painkillers. hade my surgery on sept 28 2009. hade cather out three times. just a dribble and severe pain in head of penis. hope this gets solved. sorry david i emailed you today with some insignifictquestions comparied to what your going through. that was before i knew. keep up your great spirit pluged up

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/6/2009 7:16 PM (GMT -6)   
plug, got and answered your questions, write again if you need to. there are no insignificant questions in the PC world, they are all important to someone.

trust me, you do not want to be dialated through the scope without being heavily sedated. I had that done as an emergency procedure back in july, and it was one of the most painful events in my life. My doctor was one step away from calling an ambulance to get me into a real OR, when at last he was able to break through the blockage. So don't let them talk you into it with proper sedation.

Also, make sure they are using a flexible scope on your, probably 99% of the time they would anyway ,but some smaller and older practices still use the rigid scopes, they work alright with a woman''s body, but you don't want one as a guy.

If you need anything, just ask away, we are here to help you.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


pigeonflyer
Regular Member


Date Joined Nov 2009
Total Posts : 85
   Posted 11/7/2009 5:43 PM (GMT -6)   
hey david the doctor did not say she was going to dilliate but said ill get the scope. ill be watching out for the diliating proceder.thanks for the warning.if i can get this cather out and work on urinating things may look better up the road. neil picayune ms

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/7/2009 6:05 PM (GMT -6)   
I thought the biopsies were a little uncomfortable, but nothing I couldn't handle. I've had the cystosope for a look see, but that didn't seem so bad. Even had a scope into my kidney with a little lidocaine gel.

But if you start dilating my bladder neck, which is a nice way saying we are going tear a little scar tissue here, plug me in and put me out. Willie tries to hide when I think about it.

As another poster said here, doing that without anesthesia is barn yard medicine.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 11/7/2009 6:42 PM (GMT -6)   
Roger,

Thanks for your post. It has helped me understand my own situation better. It's not always easy to be open about such private matters.

For the first couple of weeks after getting rid of the cateters (plural) I had a very strong stream. That's what I expected what with very little left to restrict the flow. Since then it has been very gradually getting weaker, until now when it's little more than a dribble most of the time. I was thinking it wasn't a big deal, but your post has convinced me to check with my urologist. Maybe a little procedure is called for.
Living in the northern Atlanta suburbs.
Good health and no symptoms when my annual physical uncovered an elevated PSA.
Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.
open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.
Pathology report after surgery showed negative margins, cancer contained in capsule
(60 gram sample, Gleason 3+3=6, T2c N0 MX).
PSA at 4 months after surgery <0.1 (all other problems are minor considering being cancer-free).
Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.
Anal fissure due to trauma to rectum from biopsy, surgery, and antibiotic-induced diarrhea.
Scheduled for repair of Spigelian Hernia due to tearing of abdominal muscles during RRP.
Using 1 pad during the day for occasional stress incontinence, dry at night (18 weeks after surgery).
Taking Cialis for ED with no joy so far.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/7/2009 7:27 PM (GMT -6)   
Oyster, you need to go before you have total retention, then you will end up needing an emergency dialation like I had done in July, will not be fun for you. Sounds like you may have some scarring over at your bladderneck/urethra junction.

david in sc
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/8/2009 9:37 AM (GMT -6)   
It's well known that different folks have different threshholds of pain. I guess I am one of the lucky ones with a fairly high threshhold. In my description of the process, I was trying to keep things light and find some humor in the procedure.
 
The nurse was very professional; the syringe with the local anasthetic did not have a needle to inject me, rather was pressed against the tip of my unit, to fill the urethra with the local, then a clamp was placed at the tip to keep the liquid from flowing back out. All painless to me.
 
The doctor used a flexible cystoscope, and it was only somewhat uncomfortable when it went in. Felt more pressure than anything else. I did feel the second device he inserted, because he was able to cut away at the scar tissue with it. That lasted about ten seconds. The whole procedure from start to finish was under 10 minutes. If I start to plug up again, I will go back for more without hesitation.
 
All the best.
Roger

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 11/8/2009 9:45 AM (GMT -6)   
Roger, I am glad it went that easy for you. In theory, that is how it should be. If they use enough lydacaine gel, it makes it much easier. Also, gets a bit more complicated if you are not circumsised, but since most men are, its not usually a big issue.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 11/8/2009 10:18 AM (GMT -6)   
Roger,
Sorry you had to go through that, but it sounds like it turned out for the best. I was just wondering if the blockage came on slowly or if it happened all of a sudden. My stream is weaker than before surgery, but is acceptable, just hoping it doesn't get any less (I'm 7 weeks out).

crew
Age 44 (43 at diagnosis)
5/6/2009 1st ever PSA 4.3
Referred to Urologist
DRE: Nodule felt on left side
6/19/2009 Biopsy done, 10 samples
6/25/2009 All 5 left side positive Gleason 3+3=6 40-60%
RRP performed 9/17/09 Catheter out 9/22/09
Final path: Tumor involved 20% of gland, PT2c Nx Mx, Gleason 6, Organ Confined, Clear Margins
Continence since cath out, viagra works pretty good for ED
6 weeks post OP PSA <0.1


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 11/8/2009 3:24 PM (GMT -6)   
Crew,
It came on relativly slowly. Remember, I was 8-weeks post-op, 6 weeks post-catheder (in for 12 days). I started out with a good stream at night, never great during the day. At night, I could kegel while urinating at stop the stream. Then at about 6-1/2 weeks post-op, or about 1 month w/o catheder, it started slowing down, until it would dribble off my fingers. Also had some pain in the head of my unit, and a cloudy urine, very smelly.
 
What I failed to update, is that the Uro's office called me last Friday to let me know I also have a bladder infection, and started me on a course of Keflex.
 
Hope this helps. If you have similar, please have it looked at. I still feel and pee really great today.
 
All the best.
 
Roer

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/8/2009 5:41 PM (GMT -6)   
The question of urinary stream after surgery can take many turnings. I add mine not to diminish the seriousness of the problems of others, but to add perspective.

Shortly after catheter removal my stream was about 25% of pre surgical normal. Now at six months I am up to about 50%-60%. Last week my doc did some urinary flow tests – you pee into a funnel and a detector measures the result. He also did a bladder ultrasound. He said that while the flow was light, the pattern – starting low, building to high and then tapering off (the bell shaped curve) was good and not indicative of a serious constriction. The ultrasound showed that my bladder was completely emptied which is also good since if urine was left it could lead to infection.

He suggested that I keep a “pee journal” He noted that during recovery there is a tendency to go more often to compensate for lack of control and that if I was still emptying frequently this could account for a low stream.

He said that corrective action could be taken but there was always some risk of opening things up too much and increasing incontinence. We left it for now and will revisit the issue in three months.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


pigeonflyer
Regular Member


Date Joined Nov 2009
Total Posts : 85
   Posted 11/10/2009 6:05 PM (GMT -6)   
had cystascope today. doc said i had a small hump where bladder neck was connected to urethea but said it was so small she didnt think that was stoping me from urinating. she believes that the pain from spasms are making me tense up and stoping the flow. and they will make you tense up. will get cather out friday.and will be taught to self cather. do yall think this is a good idea?she thinks i will not have to self cather and i will be good to go. self cather is so i will not have to go to er.also had another procedure called flurourodynamics study. said all that was normal. when i went to empty the contrast i had a stream as goog as when i was 18. by the way in 49. things might go my way.i hope. neil
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