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Urology/BPH with LUTTS

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QUESTION: I was diagnosed with BPH with Lutts. Because of this I have recurrent Urinary tract infections which recur after antibiotics are stopped.  This has gone on for 1 year.  I have a normal size prostate apparently with some swelling around a "long" bladder neck. I have very bothersome symptoms including burning, and nocturia X6 which leaves me tired and sleepy.  My PSA bounces between 3.2 and 2.3.  My Baseline before these infections was 1.0.  My free PSA is 30% and my PCA3 is 8.  My DRE is "completely benign" .  
I am taking an alpha blocker which I do not think works well.  I also take saw Palmetto and zyflamend which don't seem to work either.  I am considering a TUIP to try to stop some of the symptoms.  I would like a single incision TUIP which I have read may be just as effective as  multiple incisions but with less side effects.  I have retrograde ejaculation which is very uncomfortable and I would like to avoid this as a result of surgery.  I want to know if I should have a biopsy and if you think that a single incision cut could help me?  The surgeons here typically do not do a single incision. Is there a med center where this is practiced?

ANSWER: Dave:

With any kind of unusual prostate anatomy, there is a greater result of an insufficient result with TUIP compared with a standard TURP.  Your PSA is not high enough to warrant a biopsy.  If you want tissue for review, then you will need either a TURP or a separate biopsy procedure.

Your retrograde ejaculation may be related to your alpha blocker medication.  However, after a prostate surgery, permanent retrograde ejaculation is expected.

Single incision TUIP surgery is not rouitine done because of the relatively high failure rate.  I am not aware of any center that specializes in TUIP.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your response.  Do you think that Proscar or a similar drug could help me?  Also, if my PSA returns to normal is there any harm (such as increased risk of cancer or urethral stricture) if I just ignore the LUTTS?

Answer
Dave:

Proscar might help, but it usually takes 6 months or longer for a full effect.  However, it has the advantage of not causing retrograde ejaculation.  Proscar will lower PSA levels by about 50% so we like to be sure there is no cancer before starting it.  The decision should be up to you and your local urologist about how to proceed.

There is no risk of urethral strictures or cancer if you choose to ignore the LUTS, but there is a risk of increasing bladder and urinary symptoms, urinary retention and bladder damage.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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