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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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Hello Dr Tharun - you were very helpful towards me last year

Resolved Question:

Hello Dr Tharun - you were very helpful towards me last year and developments have taken place since.I need sometime to put my question(s) to you. Please tell me how long you expect to be on line as I have just 'gone on line' as I need at least one hour to revise and compose my questions.
Submitted: 2 years ago.
Category: Urology
Expert:  Dr. Tharun replied 2 years ago.
Hi
I Will be online for some time. You can get your question ready and ask it here. I will get back to you for sure.
Dr.Tharun
Customer: replied 2 years ago.

Sorry to be a bother but I have just spent one hour editing the message. When I went to save it it said: Access denied. And showed a plumbing page! I am so upset by this! Where did all my work go? It seems that now have I have to start all over again. It's not your fault but I am the one who has to tolerate and suffer this stupid action . All I did was edit it and attempt to save what I edited. Why did it deny access instead of saving and allowing me to forward the completed question to you? Please forward this to the web master and I will start again in an hour or so?

Expert:  Dr. Tharun replied 2 years ago.
Hi

I cannot assure you a quick answer for the technical trouble, but I will try to convey the problem to the administrator.

Dr.Tharun
Customer: replied 2 years ago.

Urology question(s)

My urology condition is complex because it has three elements associated with it. The first is stenosis of the bladder (a high necked bladder that has narrowed) and appears to be the reason for a) the very weak stream that I have been experiencing b) the inability to ‘thread’ the cystoscope )for urodynamics) via the penis without recourse to a general anaesthetic. Secondly I also have BPH (though the prostate gland is not overly large). Thirdly I have also been diagnosed with IC/PBS and now have an SPC insertion as retention occurred after the attempted urodynamics failed.

I am expected to undergo an operation to rectify the stenosis of the bladder that will permit a stronger flow. I accept that this ‘obstruction’ needs to be removed by an incision (or two) to widen the bladder neck. My principle QUESTION is this: It is my understanding that while undergoing the laser technique there will be a simultaneous (and parallel) operation to reduce the prostate gland’s size. Can I request that this not be done?

I also understand that I would experience retrograde ejaculation and I do not want this to happen. Is it mandatory, or unavoidable, when doing a bladder neck incision to ‘interfere’ with the prostate gland?

I do not wish to lose the little bit of libido that still remains and find that once this operation is carried out this may well happen. I also understand that orgasm is still there but it would be a dry one.

This why I have delayed any operation in the urogenital area and why I do not want my prostate gland to be touched; QUESTION is that at all possible or is the laser treatment such that it is inevitable?

The IC/PBS is a separate issue and will require other kinds of intervention. I wish to use alternative/natural dietary methods to try and relieve the awful pain and discomfort associated with this latter condition. I therefore wish to retain the SPC as it affords me the relief I need when voiding via the bladder into the leg bag. According to the consultant I will have to have this SPC removed at some stage as it inhibits treatment of IC. But as already mentioned I much prefer to ‘experiment’ with a dietary regime.

Ideally I really would like to have stem cell treatment which I understand is being carried out in several countries China, Japan, South Korea and in the USA in California. The latter is still too regulated with regards ***** ***** Yet I am keen to avail myself of these newest scientific advances. Can you put me onto the right track Dr Tharun?

Sincerely

Michael Sheldon

Expert:  Dr. Tharun replied 2 years ago.
HI Michael,

Usually the principal treatment for high bladder neck with not so enlarged prostate is just bladder neck incision without ablating the prostate gland. Removing an already small gland is not going to benefit you much. So in the first place they may not do the prostate ablation or you can always ask your doctor to avoid it if it is planned.

Our bladder neck involves the funnel shapped end of the bladder and the prostate. Incision just on the bladder would not flatten the high bladder neck and so the problem will persist. So the incision has to be on the prostate too for it to be effective. One option is to do the bladder incision only in one side as it decreases the chances of retrograde ejaculation, but the smae time it also increases the chances of treatment failure.

Bladder neck incision does not interfere with your libido. Libido is something to do with your age and testosterone levels. So BNI should not affect your libido as such.

Once you have retention of urine due to this problem, it is always better to correct it. You can opt to live with it but you have to be ready to face the persistent slow urinary flow and future risk of further retentions.

I am not very much aware of the stem cell therapy for IC as I have less experience in treating this pathology.

I hope this helps you.

Regards

Dr.Tharun.
Customer: replied 2 years ago.

Dear Dr Tharun

Thanks for your explanation and sorry to seem obtuse but something you said is confusing me.

I believe there will be two incisions on the bladder itself to create a widening of the bladder; one incision would not suffice. But you are implying that this incision would not “flatten the high necked bladder”. So does it not widen the bladder entrance then? Why else would one do such an operation? Even more confusing is your explanation “the incision has to be on the prostate too for it to be effective”. Is that ablation of the prostate or TURP or something else entirely? It seems from your explanation that I am obliged to have a further incision on the prostate, is that right?

Regards

Michael

Expert:  Dr. Tharun replied 2 years ago.
HI

The incisions are at 5 and 7 o clock which will widen up the bladder neck. But sometimes one incision is preferred in males who want to retain their fertility especially younger age bracket.This is where this procedure is recommended.

Bladder neck incision is a linear incision which opens the bladder base and the prostate gland up to its capsule. There is no ablation or removal of the prostate tissue involved in incision. Bladder neck incision by default involves the prostate also and it is different from the TURP or prostate ablation.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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