25 - PSA & DIAGNOSIS .... IS IT CANCER?

Many of the questions most asked by men on prostate related platforms relate to a PSA (prostate specific antogen) reading they have received. Their concern is often about whether it is a sign of cancer.

A rise in your PSA level is not an indicator of or proof of any condition including cancer. It just indicates some anomaly in your hormone levels - testosterone and androgens. There can be many causes of this so you should not jump to conclusions or self-diagnose whilst you are waiting for further tests to be carried out. It won't help!

Normal PSA levels generally range from 0 to 4 ng/mL, though what is 'normal' varies significantly based on age, prostate size, and other health factors. PSA levels typically increase with age, with many doctors using lower thresholds (e.g., 2.5 ng/mL) for younger men and higher thresholds (e.g., 6.5 ng/mL) for men over 70. 

Whilst I was in the medical system moving towards TURP surgery my highest PSA reading was 8.5. That was high enough for my consultant to decide do some tests but he urged me not to be unnecessarily concerned and never even talked to me about the results!

Many of those posting about their PSA have levels under 10 ng/mL. It is useful to know that PSA can go into the thousands or even tens of thousands. Reading about levels on the internet it seems to be generally agreed that a level greater than 20ng/mL indicates a higher probability of cancer. It's worth knowing however that levels over 10 ng/mL carry a greater than 50% chance of being cancer ... if you can work that out in percentage-terms I take my hat off to you! A level greater than 50 ng/mL is a very strong indicator of cancer. You can however have a low PSA level AND have cancer and that's why you should not trust your reading to prove anything other than that you should get further help and advice. Here's what AI says about that:

'Studies show that approximately 15% of men diagnosed with prostate cancer have PSA levels of 4.0 ng/mL or less. While higher PSA usually indicates a greater risk, low-PSA cases can sometimes involve aggressive, high-grade cancers that do not produce much PSA'. So whilst you/ your doctor should act on a high PSA reading and seek further tests you should not panic. There are numerous possible reasons for your elevated PSA amongst which are - prostatisis, a simple urinary tract infection (UTI) and of course Benigh Prostatic Hyperplasia (BPH)

(BPH) and prostate-Specific Antigen (PSA) levels are closely connected, primarily because an enlarged prostate (BPH) is one of the most common non-cancerous causes of elevated PSA levels in the blood. Here's AI again:

Key Details on PSA and BPH:

• Typical Elevated Ranges: For BPH (Benign Prostatic Hyperplasia), PSA is often moderately elevated, frequently falling in the 4–10 ng/mL range.
• Significantly Enlarged Glands: Very large prostates (e.g., 80 cc) can produce a "normal" PSA for that size that is much higher than 4 ng/mL.
• Higher Potential Readings: Although rare, BPH, especially when combined with inflammation, can drive PSA levels significantly higher, with some case studies showing levels well above 10 or 20 ng/mL due to severe enlargement, before a biopsy rules out cancer.
• Cancer Risk Indicators: Generally, as PSA levels increase, the risk of prostate cancer rises. PSA levels over 10 ng/mL, however, carry a greater than 50% chance of being cancer.
• Age Matters: Normal PSA ranges increase with age (e.g., up to 5.5 ng/mL for men 70–80). 

If you are presently worried about your PSA test reading I hope this gives you a little bit of peace of mind whilst you wait for further investigation.

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24 - SNAKE OILS & PLACEBO EFFECT

Modern day snake oils and their purveyors deserve a post all to themselves - they can cause much unnecessary suffering.

Whilst there is clearly merit to dietary adjustments not just for people with BPH, but with other health problems, there is no merit to pretend-cures packaged to look like legitimate medicines. This practice needs to be called out. Profiting from sickness and misery of others knowing your product is untested and ineffective is about as low as you can go.

Yadda yadda yadda

SNAKE OIL - THE ORIGINS

Medicine made in C18th China from Chinese water snakes (Enhydris chinensis or Myrrophis chinensis) was a legitimate and effective treatment. It had known medicinal properties. The oil was rich in anti-inflammatory omega 3 fatty acids and could reduce joint pain, inflammation and other symptoms. It really worked!

Its reputation was tarnished when brought to America by Chinese railroad workers. There unscrupulous drug store owners, quack doctors and hucksters took advantage of its reputation replacing the Chinese water snake oil with low-omega 3 rattlesnake oil, adding fillers - mineral oil, beef fat and even turpentine -and selling it fraudulently to unsuspecting buyers. With no medicinal value whatsoever 'snake oil' then grew a reputation for being a fake-cure. It has kept that reputation to this day, now being a colloquial term implying uselessness. At least the Chinese water snakes got a break!

Cod liver oil has since replaced snake oil as an equally effective source of omega 3 and is still taken not as a 'medicine' but as a dietary supplement. It too really works!

Clark Stanley - 'Rattlesnake King'

We tend to think of 'snake oil salesmen' as a thing of the past - respectable looking but unscrupulous old fashioned men touring rural markets and fairgrounds on horse drawn carts filled with cure-all tinctures and potions.

A Huckster

They haven't gone away though. In fact they are more numerous today than they have ever been. These days however they don't drive around in horse drawn wagons, and the suits & ties have been replaced by lab coats. In an age where the cost of medical treatment can be far out of the reach of many people even in the richest countries 'snake oils' are very big business. Glass tincture bottles with beautiful labels have been replaced by plastic blister packs and packer bottles. Today's snake oils are manufactured in sprawling factories on industrial estates and sold globally on the internet 24 hours a day - still to unsuspecting, desperate and sometimes just gullible customers. The unscrupulous men behind the businesses drive expensive cars and live in big houses. Just like the C19th hucksters they profit off the misery and desperation of others. 

As I discussed in my last post (#23) I do not believe anyone who claims they have found a cure for BPH. There is evidence to back me up. Apart from the ears and the nose the prostate is the only male organ that keeps on growing as we age - yes ears and noses are organs! That growth is unstoppable. It is 'dialled in' to our DNA by way of growth hormones - the same growth hormones that make a baby grow into a child and a child into an adult. Unstoppable prostate growth serves no physical purpose. It just happens as a result of age related hormone changes, primarily the conversion of testosterone to DHT (dihydrotestosterone) which stimulates prostate cell growth alongside a relative increase in estrogen as testosterone levels decline (this is the bit that causes BPH) As I said in an earlier post the flawed prostate organ contradicts  the idea that some sort of 'intelligent design' played a part of our 'creation'. Evolution just got it a bit wrong - that's all.

Clinically proven modern medicines (5-alpha-reductase inhibitors like Finasteride) can have an effect in TEMPORARILY reducing the size of the prostate but they cannot permanently arrest the growth and eventually they stop working. There is extensive research and clinical trials that prove their efficacy.

Dietary alterations in early stage BPH can also have an effect in TEMPORARILY reducing its size but there is no clinically proven test information for this (see post #23) When you start experimenting with dietary alterations you are going off the beaten path and you are in the darl vis a vis efficacy. If you find something that works for you, you can say no more than that it works for YOU - for YOUR body with YOUR metabolism with your stage of BPH.

When you start paying hundreds of pounds for alternative 'medicines' and untested concoctions that are claimed to contain effective herbal compounds you are in the hands of by businessmen 'guides' who have no idea where they are taking you - except to a click of a purchase button.

They have no idea what works for YOU. Their products have no regulatory body to oversee their claims. This means that consistent ingredients, purity and quality are all UNcontrolled - you literally don't know what's in the tablet.                                                                                                                                        

"Just trust us!" they say. "Take our word for it!" is their motto. That's all they can say because they usually have no evidence at all to back up their claims.                                                                                                                                                                                                                                                                    

Saw Palmento is often referred to in prostate posts. Lots of sufferers swear by it saying it helps them with their symptoms. However, many studies have been conducted on its efficacy in the treatment of urinary tract symptoms and prostate enlargement and they are not encouraging. The conclusion by NIH itself (National Centre for Complimentary and Integrative Health) was 'We know enough to conclude that Saw Palmento is probably not helpful for this purpose."  

Saw Palmento

Have you ever heard of Gokshuru Extract, Putikaranja, Akik Pishti, Shatavari Extract or Puga? 

Akik Pishti

Of course not, yet one herbal remedy manufacturer assures you that they are "the best prostate supplements" .... what even is 'a 'prostate supplement ffs!?  These organic compounds do all have basic anti-inflammatory properties but that's as relevant to the symptoms of BPH as it gets. Where is the proof that they work on the prostate?                                                                                                                                                                                                                                                                                        Shatavari is primarily used for menopausal symptoms including hot flushes!                                                                                                                                                                                                                      Puga or 'Betel nut' is widely used for digestive health and related conditions.                                                                 

Reducing a load of herbs with vaguely anti-inflammatory properties into a powder or paste and flogging it to blokes with enormous prostates and blocked pee pipes is absurd and scandalous. However, sensible grown men who are so desperate to relieve their UR symptoms that they'll try anything will part with hundreds of pounds a month in a misguided hope of relief.

The American Urological Association (AUA) states that evidence of the efficacy of alternative medicines is mixed and that "While some small trials show promising results in symptom relief, larger, more robust clinical trials often find no benefit over palcebo."

Herby stuff

THE PLACEBO EFFECT

A placebo is anything that seems to be a "real" medical treatment but isn't. It could be a pill, a shot, or some other type of "fake" treatment. What all placebos have in common is that they do not contain an active substance meant to affect health.

My first experience with the placebo effect was through a video posted on YT by a quack American doctor - one of those charismatic types who's energy is a little bit infectious and makes you WANT TO believe what they say. My UR was getting worse but I was unaware that my problem was shared by other men around the world. This video came like a bolt out of the blue - I WAS NOT ALONE!. The 'doctor' promised that eating flax seed would cure my UR in just a few days. 

In the world of those who are sceptical about using modern medicine intelligent people can be too willing to trust the claims of fellow sceptics regardless of any proof. This can be due to a combination of personal beliefs, a desire for control over their own health, perceived positive experiences, and dissatisfaction with conventional medicine. Rejecting medical advice and conventional medicines is of course a choice we all have and if it makes us 'feel better' then who can judge? In the case of serious medical conditions it does however leave the door open to people being ill-advised, misled and needless suffering. 

In every walk of life there are people who lack scruples and do not care how they make money or if someone else is harmed in the process. Some of the worst of these people that society has to offer are the modern day snake oil merchants. They are plain con artists.

https://youtube.com/shorts/D-fc_U4KYcY?si=cG9c3ArOqEipp9qS

Con artists don't just sell herbal potions. They flog us all sorts of goods that aren't what they are promised to be - cars, dishwashers, soap powders, clothing, foodstuffs - all sub-standard and not fit for their promised purpose. When it comes to the business of medical cures we need to be very conscious of the fact that there are Clark Stanley the Rattlesnake King types waiting to take our money at every turn in the road.

This practice of a con artist selling fake cures is timeless. As long as there has been humanity there has been deception and greed.

.                                                          

In the C14th the writer Geoffrey Chaucer expertly captured the conman in the character of the "Pardoner' in the Canterbury Tales - a peddler who travels the land selling false hope and fake religious relics to gullible customers.  

Chaucer's character perfectly illustrates that there are no depths some people will not plumb in order to satisfy their greed.

As you've probably already worked out I'm not a big fan of homeopathy either. This comedy sketch sums up why:

https://youtu.be/HMGIbOGu8q0?si=nieqN6Aq_ZX3uqOW

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14 - A TAMSULOSIN MAN!

DRUG FREE!

I believe in conventional drug treatments. They've benefited me from time to time through my life. They save lives. I probably wouldn't be here today without them. I loathe big pharma and the huge profits made off the back of other's misery but that's not a fight I've chosen to take on.

I know many people for whom prescribed medicines are mistrusted and misunderstood. They don't want them in their body. They don't even believe them to be necessary. Homeopathy is their chosen course of treatment. However the older they get the more I find their course changing as growing infirmity tests their slowly waning good health and strength. You just can't beat hard (pharmaceutical) drugs when the shit really hits the fan!

 I started using prescription drugs for urinary retention on March 22nd 2010. I was 44 years old - too young I thought to be heading in to daily tablet taking, but needs musted. Propranolol is a beta blocker used for reducing high blood pressure in people with heart problems. It works by relaxing the body's blood vessels and so reducing the heart rate. Great drug! The thing is - there is no record online for its efficacy as a treatment for urinary retention. That nevertheless is what my doctor ordered and what I dutifully took twice daily for years. I definitely wasn't going to have a heart attack during that time but I might as well have been eating chalk tablets - aka homeopathics - for my piss problem. 

Neither Propranolol nor any of the drugs prescribed for me by my doctor in the subsequent 10 years helped with my symptoms in any noticeable way. Why? Because they were the wrong drugs. My doctor repeatedly prescribed me the wrong f***ing drugs! I'm still trying to gather the strength to question/ confront him on this. I'm so embarrassed - for him. How could he have got it so wrong for so long?

I was finally prescribed the right medications - Tamsulosin and Dutasteride - 2 years before my TURP surgery. That's 11 years after the first "I'm having trouble peeing ..." consultation with my doctor. That switch only happened because he was on holiday when I attended an appointment and the locum spotted his error. I choose to see this from a glass half full perspective in an otherwise glass very half empty scenario. Family and friends say I need to change my doctor. They say I'm too forgiving, but what's to be gained by causing a scene now?

Though they were the right meds Tamsulosin and Dutasteride did no more than ease the severity of my condition a little - maybe 30%. I think that by the time I made the change my prostate was too large to be significantly affected by them. 

They were no overnight cure for my symptoms. I still suffered from regular and urgent need to pee but the edge was definitely taken off. I found that out when I neglected to take them - when I'd run out or forget to bring them with me on work trips. After a couple of days my pee-pain and the urgency increased noticeably and I desperately regretted not having my 'thirty percenters'.

Most people with BPH seem to be prescribed these meds. There aren't many alternatives. They work well for those in the earlier stages of prostate engargement but not for men like me with an already very enlarged prostate. After growing to 50cc or more you're really beyond effective drug treatment from what I've read. You need surgical intervention of one type or the other - hoLEP/ TURP etc.

My TURP surgery was on July 25th 2023 - 12 weeks ago. It wasn't an overnight cure-all and over the intervening months I've continued to experience significant retention issues - to which has been added daily incontinence (now ended) and what's unpleasantly but aptly called 'leakage'. My surgeon prescribed the drug Vesomni for all of that - a combination of Solifenacin and Tamsulosin. It's a bladder muscle relaxant that's supposed to help the muscles stop tightening - the thing that causes urinary retention. I don't know why I wasn't being prescribed that before my surgery when I had just the same symptoms. 

It has taken a long time for these to reduce, but they have and as of last Friday, not having renewed my prescription for Vesomni I'm drug free! I'm still 'leaking' and still urgently need to pee comically small amounts but that's now at a level I consider tolerable. It's so much better than it was - though might be considered a nightmare to others!

Getting off medication is a big deal for me - a major turning point. 

It only takes a few seconds to pop a pill. Doing so has been a minor daily inconvenience yet after just a couple of days, no longer having to has left me with a powerful sense of liberation that should really only come after being released from under a much heavier burden.

The daily taking of medication forms a part of your life routine - slotted in alongside coffee breaks and tooth brushing. Your psyche adjusts to that. The 'brand' you take defines you especially when those around you don't use your brand or don't use at all. Their ingestion makes them a little part of you; a part of your physical makeup and your identity - how you see yourself in the world. I was a Tamsulosin man for years. Now I've kicked the habit! 

For some time I've seen my medication as an invisible crutch providing hidden support where my broken body hasn't been strong enough to hold itself together on its own. No one sees the crutch, but I'm always mindful that it's there. 

I no longer need that support. I'm standing on my own two feet again and that really is a shagging big deal.

Whilst I expect to be munching pills for all sorts of ailments in later life, for now pill-taking is an unwelcome reminder of the frailty and vulnerability of my body at a time when I should still be feeling healthy and youthful. It may not be long before I need to go on some other lab produced cocktail so I'm going to fully enjoy this moment and this time. 

Last Saturday night, to celebrate this milestone I filled the fridge with 16 cans of beer and sat down to drink ALL of them during the rugby world cup final (All Blacks vs Springboks) Of course that was never going to happen - especially because Ireland ☘️ (my team) weren't on the pitch, but it was an amusing, laddish and satisfying thing to do.

I managed 4 beers. Their unstoppable flow through my renal system resulted in 7 trips to the loo. Thank dog for the 'pause' function on the TV (the one that's still faulty in my bladder) and the nearby under-stairs toilet closet I constructed a couple of years ago for just this sort of occasion! I have a very long way to go before I'll be able to match my peers in their drinking prowess, but on the plus side I'm a very cheap date!!

23 - PHARMACEUTICALS, DIETARY SUPPLEMENTS & ALTERNATIVE MEDICINE ... IMO

CAVEAT: 

I am neither a clinician nor a dietitian so the comments and observations below are entirely personal and should not be used as guidance for your decisions on treatment.

I've been a member of the Prostate Health Awareness and support group on Facebook for the last couple of years. It's a real mine of information with contributors offering up their experiences of many different prostate related issues - Prostatisis/ BPH and also cancer. I highly recomment you join this and other support groups.

TREATMENTS

A subject that frequently comes up in these groups is treatments. Men want to know how they can relieve their pain. After several wasted years of trying out 'alternative medicines' and dietary alterations I chose the drug/ medication route and I have no regrets. Others however want to avoid taking chemicals into their body so here's a bit of info about both options:

THE PHARMACEUTICAL ROUTE

There are relatively few drug treatments available for benign prostate hyperplasia (BPH) and whilst I've heard of them having had a significant and very beneficial effect on some patients none has resulted in anything more than a small improvement in my acute condition. My prostate was already very enlarged so the small amount of shrinkage the drugs caused wasn't enough to be effective. The flow of pee through my urethra remained restricted.

Tamsulosin appears to be the market leading drug for BPH. It is primarily sold under the trade name Flomax but is also sold under license with other names -

Contiflo XL - Farmasil MR - Parmsvaz XL - Tabphyn MR - Bestflo - Mecir LP - Urimax - Pradif

THE EFFECT OF THE TWO MAIN TYPES OF DRUGS

1 - Alpha inhibitors:

These meds work on shrinking the prostate by reducing hormone levels in the body. They are: Finasteride & Dutasteride

2 - Alpha blockers:

These meds work by relaxing the smooth muscles in the neck of the bladder and in the prostate making it easier to pee. They are: Tamsulosin (aka Flomax), Alfuzosin, Doxazosin and Silodosin

Both types of meds can be prescribed in combination for greater effect.

Unfortunately there is no miracle cure-all drug or treatment for BPH. Their efficacy depends on a number of physical variables in each patient relating specifically to their own physical and genetic position.

I was prescribed Tamsulosin, Dutasteride and Finasteride over a number of years before surgery. Their effect on me was minimal due to the late-stage uptake. Patients who's condition is diagnosed in its early stages will probably respond better and I am confident that they would get noticeable relief from using them.

I frequently come across facebook posts from men asking for contributor's advice on treatments. Often there will be responses from contributors who swear by 'alternative' methods, these usually being in the form of dietary alterations and supplements. Whilst I have no doubt that dietary alterations may have some effect on early-stage BPH I have found no 'gotcha' clinical trials or published research on any of them. That means that these contributor's comments and recommendations are based solely on a "you just have to believe me" promise. They just insist that such-and-such worked for them and often promise it will work for you. I believe that doing this is wrong and unethical. Men with BPH are in great pain. They are desperate and so more likely follow unsubstantiated claims. They will readily 'try anything'. To steer these men away from clinically proven medication and towards here-say remedies can needlessly prolong their suffering and that is both cruel and potentially harmful.

Some messenger posts on alternative treatments:

I occasionally respond to these posts by offering reasons why presenting false hope is wrong. 

I have no way of knowing that the Saw Palmento or turmeric they took didn't help them so I never argue about that. What I do is to ask them to offer me proof that it will work for others; that it is a tried and tested CURE. Of course they can't do that and what often comes back at me is a diatribe about how corrupt big-pharma is - how the pharmaceutical industry has a stranglehold on alternative medicines and are hiding research in order not to lose profits from the sale of their own patented medications. Other contributors state that it is the food we eat and pollution in the environment that have caused the BPH condition so we just have to eat organic and shit seed husks. These arguments are ridiculous - totally and utterly ridiculous - for the following reasons. 

1 - MODERN DIET/ ENVIRONMENTAL FACTORS - POLLUTION

As I have covered in my posts about the history of the catheter - BPH/ UR is as old as homo erectus (upright man) and probably older. The reason we know this is that there are records going back 4000 years of makeshift catheters being used by man. That means that for at least 4000 years men have been finding ways to alleviate their suffering from urinary retention.

Why else would they have been sticking bamboo leaves and hand crafted leather tubes up their cocks!? It is highly unlikely it was for pleasure or some sort of ceremonial decoration!

Four thousand years ago mankind did not have any of the chemical and environmental pollution we have in today's world and they had much healthier diets - no processed foods or refined sugars etc. For all that time we have eaten meat, grains and plants. There is therefore no tenable argument for our modern diet to be having a profound effect on urinary retention especially bearing in mind the fact that the prostate grows naturally and with age. It is an inevitable part of the ageing process.

2 - ALTERNATIVE MEDICINES

It is common knowledge that the Chinese were practicing sophisticated medicine thousands of years before any western civilisation. The evidence goes back at least 6000 years. The Chinese were using medicinal herbs by 2000BC. They weren't just doing this in the privacy of their own homes. They were trading their medicines abroad. There was a market for them which suggests that their medicines worked.

There is no physiological difference between the prostate of Chinese men and any other men. They suffer from exactly the same levels of UR/ BPH as men in the rest of the world. It therefore stands to reason that their ancestors suffered too. As pioneers of herbal medicines it can be assumed that the pharmacists who were developing treatments for diseases and illness included efforts to find a treatment for BPH. Just like everywhere else in the world men across China were suffering the same excruciating pain and dying from the condition so it is unthinkable that BPH was not a focus of their attention. Hence the Chinese have had 4000+ years to find an effective 'alternative medicine' treatment for BPH/ UR .... AND THEY HAVEN'T. Surely that is sufficient evidence that there is no alternative medical or dietary cure for BPH?

3 - IS BIG PHARMA IS KEEPING A LID ON IT?

A number of prostate group contributors have insisted they have found a natural cure for their own BPH - that they have actually stopped their prostate enlarging. I always suggest to them that they share their discovery and become gazillionaires but that is never offered. 

Big pharma cannot stop anyone from coming up with an effective treatment for BPH. All anyone who does so has to do is PROVE IT - prove that it works again and again in the patients is is given to. With access to the internet this could be done without the need for labs or scientists in white coats or animal guinea pigs in cages. Just et 1000 men together to participate in your own trial and feed half of them Saw Palmento and the rest a placebo in a controlled situation! Job done. At some stage if you wanted to get a license to market your miracle cure you would need more proof than that but if it's just Saw Palmento then you don't need a license!? How come no one has ever done this?

A trial on one person (yourself) is not a clinical trial and it can never be any sort of proof of efficacy. At best your self-trial would convince you that you have found a solution to YOUR condition - a solution that is only relevant to your body at your stage of illness in your physical condition with your prostate and your bladder and your urethra and your metabolism and your age and your genetic makeup etc etc etc etc etc etc etc. That is not how you find cures to illnesses. It is entirely circumstantial. It is not even proof that your 'cure' actually was what cured you. You could have been cured for some entirely different bodily reason unbeknownst to you, it only having been chance that made it happen when you were conducting your one man trial!

In short - every man's prostate enlarges naturally with age. It is pot luck whether yours enlarges to the point where it restricts or even stops your pee-flow. If an effective alternative medical or dietary treatment for UR/ BPH could be found it would have been found so to tell people you've found one is arrogant, selfish and delusional.

I took saw palmento, nettles, flax & pumpkin seed, ground cumin and turmeric until they were coming out my backside. I drank every herbal tea known to man. I stopped eating fatty foods, sugar, pepper and loads of other delicious things but apart from the placebo effect that I occasionally experienced they did nothing at all for me.

If none of this convinces you and you still want to try reducing your BPH by dietary means here are a few suggestions all of which I tried without results: 

Other dietary ingredients that are supposedly effective are:

- Lycopene rich foods - tomato, apricot, grapes, peaches, cranberries, apricots

- Beta-Sitosterol rich foods - rice bran, soybean, wheat germ, peanut 

Cumin

Flax seed

'PROSTATE HEALTH SUPPLEMENTS'

A number of companies offer supplements that they say contribute to 'prostate health'. These include:

PROSTAGENIX

PROSTACOR

PROSTATE SUPREME

ULTRA PROSTAGEN

PROSTATE FLO

PROSTATE FORTE

My advice is - do your research before trying these and don't expect them to work miracles.

My next post will be about snake oil merchants.

PLEASE FEEL FREE TO COMMENT

21 - POST-OPERATION UPDATE ... INCONTINENCE & ALL THAT JAZZ

I had my TURP operation in July 2023. Two years and 4 months have now passed since I started to get my life back. When I say 'started' it's because it took time for my system to adjust to a sort of pee-normality and even more time to get back to the life I'd had before UR had taken it away. In facebook prostate groups the question is often asked - "How long will it take to get back to normal?". There is no standard answer to that because every individual's experience is different. Hence all I can do is describe my own post-op experiences and hopefully give others an idea what they may have to look forward to.

POST-OP IN-PATIENT RECOVERY

Even the length of the hospital stay seems to differ between TURP patients. I have read many online posts in which the patient said they were released the same day as or the day after surgery. This never fails to surprise me because although the surgery is not highly invasive and the post-op pain level is minimal the patient does waken up fitted with a catheter linked to a drainage bag strapped to their leg or hanging at the end of the bed. This is needed to prevent their newly cored out urethra from coming into contact with their urine, allowing it to heal. It's also needed to provide unimpeded irrigation of the bladder as well as to reduce the possibility of post-op swelling and bleeding.

Patients who are sent home soon after surgery leave hospital fitted with a catheter which then has to be removed by their doctor or a nurse in a medical centre.

I spent 4 days as an in-patient. I was treated privately which perhaps explains the duration. On the day after the op I was told to drink as much fluid as I could and to exercise as much as possible. Nurses regularly did the rounds changing our water jugs and encouraging us to drink drink drink. I took to walking the ward three or four times a day. In the corridors I came across other patients doing the same. With all of us hauling a catheter stuck up our dicks we walked with a bit of a waddle and must have looked like blokes in the early stages of transitioning to be penguin.

I wasn't in a hurry. The chafing of my penis and the catheter tube against the inside of the nylon hospital gown saw to that! I had no pain, just a bit of discomfort but the thought of making the wrong move was constantly on my mind. I looked at the doctors and nurses hurrying around freely and felt very self conscious. Even in a prostate ward that felt a wee bit awkward.

On day three I was told to remove my catheter by myself after breakfast. That happened in the ward toilet. I have described the experience in the post titled '2 - PEE AT LAST'. It was an extraordinary experience! The pleasure I felt from that first pee is still with me to this day.

From then on I was directed to drink as much water as I could in order to flush the bits of my post-op urethra out of my bladder. Each pee brought new bloodied lumps but they quickly reduced in frequency. The only issue subsequently was that I wasn't always making it the 4 metres from my bed to the toilet in time. Incontinence had become an issue. I'd never experienced that before but my surgeon who did the rounds every morning assured me this was normal and it would soon stop.

On discharge from hospital I walked out the revolving door into the fresh air and sunlight with some  trepidation. How could I already be free to go? My incontinence hadn't stopped and I was facing a two hour bus ride home. I hadn't planned ahead for this by bringing incontinence pads with me so it was going to be pot luck whether my bladder would keep its mouth shut .... and I was wearing light tanned trousers!

My bladder did its own thing and I was leaking within 20 minutes of getting on the bus. I used an abandoned newspaper as a makeshift incontinence pad and so avoided leaving my cushioned seat drenched for the next unsuspecting occupant. By the time I'd arrived home I was soaked. 

The experience of incontinence is strange and un-nerving because it comes not from a bodily feeling but from lack of feeling where you have always been used to one. There is a specific but subtle 'sensation' of peeing that comes from the process of allowing your bladder muscles to loosen to allow pee flow. It is a satisfying feeling. There is no such sensation with incontinence. You don't 'decide' to pee -  to relax your muscles. They do that all by themselves without warning. The result is that your urine flows into your crotch unannounced. Suddenly it's there following gravity and the line of least resistance and you are warm-wet.

Going from full urinary retention to incontinence in the space of four days is a lot to deal with and I got very confused.

INCONTINENCE VISUALISATION ....

Think of your crotch as a dry river bed in the desert. It is parched but somewhere out of sight and sound a dam has been opened. You have no knowledge of it. Suddenly out of nowhere a fast moving wall of water appears and fills your river bed with an unstoppable flow of water. The bone dry desert landscape has become a flood plain. That's incontinence. 

In the following days there was no improvement. I wet myself several times a day and didn't leave the house. I stifled the thought that this might be my new reality by reminding myself that my surgeon had promised it would "come right" as he put it. Permanent incontinence can be a side effect of TURP so I focused on the idea that it would be so much better to be peeing myself uncontrollably than not being able to pee at all. With the choice between wearing incontinence pads for life and self-catheterising, incontinence was an infinitely preferable terrible state to be in!

The follow up appointment with my surgeon took place two weeks later in his Dublin 'rooms'. I had peed myself on the way there. This time my jacket had to replace newspaper on the seat of the bus - I'm a slow learner. Thankfully it was a warm day so I had no need to wear it. The meeting lasted less than 15 minutes. He asked me how I was and I brought up the incontinence to which he replied "Nooooooo!?" in a slightly patronising tone with a look that suggested he didn't believe me. I lifted my damp jacket off my crotch to reveal my 'pissy pants'. It was a 'slam-dunk'. With more assurances from him I left the consultation and have never seen him since.

Thankfully in the end he was right. The uncontrollable gushing slowly reduced and then stopped and within a month I was fully in control of my bladder. It took around six more months for my pee-flow to become balanced and predictable. One thing however never got back to normal.

As we blokes know - two fluids flow out of our penis. The main one - pee/ piss/ urine - is a daily norm. It contains all the waste from our food and drink intake - urea, uric acid, sodium, potassium, salts and hormones. Getting rid of that is vital for our health. The other fluid is the stuff of procreation - full of life giving properties .....