Best laser for prostate surgery while on Eliquis?

[mirtilla]

Has anybody had any experience with a laser Turp while on Eliquis?

I had a prostate resection 10 years ago, ( no PAF then) and it was a quite bloody affair, with 4 days of catheterized bladder washing. I filled tens of colored water bags with the draining of my blood loss.

Now I have to do a Turp again, because my prostate keeps growing, but recently I have been put on Eliquis for my PAF..

Fortunately today a laser technology is available, with reduced blood loss, but which laser is best with a person on Eliquis? I see around hospitals with Olmium, Tullium or Green Light lasers, but it is difficult to get information on the technique with a minimum hemorrhagic risk.

Can anybody help me?

[beardy_chris]

I had a HoLEP (Holmium Laser Enucleation of the Prostate) resection of the prostate while on Eliquis. I think they recommended I stopped taking it for 48 hours beforehand but it wasn't very bloody at all. Normally the only keep you in for one night but they kept me in for two nights just to be sure.

I can't comment on the other procedures.

[mirtilla in reply to beardy_chris]

Thank you. Very useful

[seasider18]

I had Thulium/Holmium laser similar to HoLep in 2013 while one Warfarin. I just had to stop it for two days. I had previously had GL some years before when not on Warfarin and it too was practically blood free.

[mirtilla in reply to seasider18]

Thank you. It coincides with Seasider18, so I assume it is a standard procedure

[BobD Volunteer]

You might try the Prostate section of HUL with this question as I am sure they will have more experience. I had radical prostatectomy in 2011 and had to stop warfarin five days before but once the drains came out there was no blood. (catheter for 14 days normally)

[mirtilla]

Thank you for the suggestion

[seasider18]

There are some other new procedures PAE done by a radiologist where veins feeding the prostate are shrunk to cut off some of its blood supply to make it shrink. Urolift where the prostate is pushed back and held in place with three or four metal bands and Rezum the latest favourite of NICE. Rezūm uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms.

[MarkS in reply to seasider18]

That's very helpful, Seasider, I had read about Rezum but couldn't remember the name and couldn't find it googling!

[seasider18 in reply to MarkS]

There are many that come up with Google

This is the company itself.

rezum.com/the-rezum-system/

If you Google 'NICE REZUM' or NICE with any of the other procedures you will get more info than you need. I'm presuming that you are in the UK.

From my personal experiences I favour Laser procedures to any other. Hopefully you don't have a big median lobe as that is when problems can occur. You also want a Uro who does a bladder neck sparing procedure so that there is less chance of RE...Retrograde ejaculation where your semen goes into the bladder.

Which part of the country are you in?

I had the original version of GL they are now on version three at least.

I had it done at the Freeman in Newcastle on a Friday afternoon and the catheter out on Saturday morning and expected to go home to Edinburgh that day. As I was not fully voiding they kept me another night in case of any problem. I went home by train on the Sunday afternoon and on the Monday went to the races and was out for over six hours and drinking a lot of coffee had to remind myself to go to the toilet before going home. Previously I would have been in and out of the toilet all afternoon.

[MarkS in reply to seasider18]

Thanks very much for that, Seasider. I've been through the NICE stuff and there are some good stats there. I mentioned to my GP about the steam process that was hugely spouted last summer and he hadn't a clue. I'm seeing a Uro in a week about my slightly raised PSA though I think that's simply due to my BPH. I don't think it affects my median lobe too much as my symptoms are mainly around a reduced volume and having to get up 3 times a night, which affects my sleep and can induce ectopics.

I live in Hampshire and there's a good centre apparently in Basingstoke. But I'm just starting down this road. Did you find drugs had any effect?

[seasider18 in reply to MarkS]

There are still backward parts of the country that only do TURP or variations of it. Southampton was one of the hospitals that did initial trials of PAE. Many URO's will put you on drugs to save their area health authority money. Drugs come off your GP's budget. Drugs in the long term have bad side effects. Avodart that is expensive and the cheaper Finasteride are the ones to reduce prostate size but it takes months for them to work. Alpha blockers like Tamsulosin help the flow fairly quickly but have side effects. Tamsulosin can give you Floppy Iris Syndrome and make future cataract surgery difficult. It also causes RE and other sexual problems. Speaking to the nurse at the surgery I once asked her what was the most complained about drug and that was it. I said Yes by men but she replied No by their wife’s  One a day Cialis is a much better alternative.

GP’s know little about new procedures. My PSA was initially 5.0 when my BPH was first diagnosed in 1995 and I had two negative biopsies. By the time I had GL in 2004 it was 9.8. Big prostate it was 75grms = high PSA. It came down to 5.0 again after GL. My prostate regrew to 135grms by 2013 and my PSA was then 7.8. After Thulium/Holmium Laser it came down to 0.74. It and HoLep save tissue for histology but GL does not have that option. He removed 80grms of tissue and sent 37 grms for testing. That procedure took nearly three hours he said but my GL only took 57 minutes of lasing time.

In the early days of GL I knew someone from Basingstoke who went to Haywards Heath to have GL. Home by train the next day and playing Pool the next night.

[MarkS in reply to seasider18]

That's most helpful, Seasider. I think I'll try to avoid drugs and surgical treatment for now. My symptoms are manageable and treatment options seem to be storming ahead. I might get an MRI or ultrasound as a base to compare any changes in the future against.

The urology department at Basingstoke Hospital does seem to be in the forefront of developments:

hampshirehospitals.nhs.uk/n...

This article is 3 years old. In the meantime they have been involved in the Rezum trial. Richard Hindley seems to be the man.

[seasider18 in reply to MarkS]

Nothing wrong with watchful waiting if your symptoms are not too severe. Do you know the size of your prostate yet although it is where the gland is putting pressure on the bladder that is the problem ? A friend's prostate was only 33grms and his problems were far worse than mine.

The Uro's finger tests have always been accurate in my case and confirmed by TRUSS or cystoscopy. Beware though of the finger stimulating your Vagus nerve. A colonoscopy stimulated mine and put me back into AF as did the last DRE. Each time I had been back in sinus rhythm for way over a year. I had the DRE in the afternoon and went to see the out of hours doctor at the hospital later in the evening.

With the colonoscopy I was watching the procedure on the screen with little sedation and quite alert. I suddenly noticed that my BP and heart rate were rapidly dropping. BP to 40/29 and heart rate 30 bpm. I think are they going to do something about this? With an oxygen mask on it was difficult to speak. They suddenly panicked. They pumped drugs into me and attached me to a drip and kept me until evening. They either did not notice or bother that I was in AF and I didn't feel it until later when waking up a slight hill. 

[MarkS in reply to seasider18]

That must have been very alarming! GPs have checked with their fingers before now and I haven't had a problem - but that's a new one on me! I don't know the size of my prostate yet (but I probably will by next week) and will most probably do the watchful waiting. Thanks for all your comments that have been most useful!

[seasider18 in reply to MarkS]

With the colonoscopy their other suggestion was dehydration after the laxatives but I had been drinking a lot after it.

Another urologist who later did a cystoscopy said that he had heard of cases after a DRE but had not personally come across one. I must have a very sensitive vagus nerve or else once having been in AF one is more likely to easily go back into it. My AF started after having my aortic valve replaced in 2012.

[seasider18 in reply to MarkS]

Hopefully your hospital will be up to date and have a Urology Suite where all the tests (DRE, two Flow Tests and a scan for retention) are done t the first appointment before you go in to see the urologist. Many hospitals use a nurse practitioner for the initial tests. If so be prepared to be there for a long time.

[MarkS in reply to seasider18]

Thanks!

[seasider18 in reply to MarkS]

Have they told you to go with a full bladder ? It can save a lot of time if you can make it. First time I went an hour early and took a two litre bottle of water with me.

[MarkS in reply to seasider18]

No they hadn't told me. I'll do that and hope the appointment is not prolonged!

[mirtilla in reply to seasider18]

Interesting precedure. Hope they become available in my area. Molte grazie