BNI Bladder Neck Incision

[Sleeper Service]

Original symptoms were:

a) A constant urge to urinate localised in the urethra - varied from moderate to horribly intense. I would pee and feel that I needed to go again thirty seconds later. I also felt that I never emptied my bladder although I didn't have much retention.
b) A very weak urinary stream (<10 ml/s).
c) Some pain in the hip region.
d) Some suprapubic burning.
e) Frequency about every 20 mins to half an hour.
f) A little nocturia.

Never had perineal or rectal pain as such.

Now it's:

a) A constant irritation in the urethra. This feeling is mild to moderate and isn't quite the same as before - my bladder feels comfortable and empty although it does burn a little sometimes if I've passed a large volume. This is probably due to my bladder's bad habits which are tough to break.
b) The feeling that I need to make a bowel movement shortly after I urinate.
c) Some burning in the bladder if it gets full
d) A little stinging in the bladder neck or penis tip sometimes.
e) Need to pee every two to four hours unless I have coffee in which case it's every hour to hour and a half until it flushes out.

It's possible that the wound is still healing (can take three months for symptoms to settle) or that the prostate has become irritated post surgery or that it was already and constantly irritated as a result of the blockage - sometimes things seemed to get better then they would worsen. My hope is that now the structural fault that perpetuated symptoms has been removed things will improve over the coming months.

As an example, My AUA score prior to surgery was 16. It is now about 6-8. My QoL has gone from 5 (sometimes 6) to between 2 and 3.

All in all I'm happy with the outcome of the surgery. Whilst I wish my irritative symptoms would clear up soon my life is in no way limited as it was before. When my symptoms are at their worst they're roughly the same as they were at their best pre-op. When they're good they're hardly noticeable if I'm busy.

Patience is they key. Even if it turns out I do have chronic prostatitis / chronic pelvic pain syndrome in addition to LUTS then this board has shown that this ailment can be effectively controlled and even cured. I have my any accredited quercetin product on order and Bill Taylor's number if needed!

[Sleeper Service]

An update, but not a good one I'm afraid.

Had the symptoms from hell today - very reminiscent of pre op. I had also contacted my Uro to seek advice about the ongoing irritation and he feels it's now time to try six weeks of Cipro.

It's possible this may be a fresh case of prostatitis but I think it's more likely to be a continuation of symptoms. Feeling kind of depressed at the moment because of this.

In saying that, since Cipro didn't work the first time round, it could very well be that this is the genuine article. I shall give them a go. You never know.

[carld]

An update, but not a good one I'm afraid.

Had the symptoms from hell today - very reminiscent of pre op. I had also contacted my Uro to seek advice about the ongoing irritation and he feels it's now time to try six weeks of Cipro.

It's possible this may be a fresh case of prostatitis but I think it's more likely to be a continuation of symptoms. Feeling kind of depressed at the moment because of this.

In saying that, since Cipro didn't work the first time round, it could very well be that this is the genuine article. I shall give them a go. You never know.

Sorry to read that update Sleeper.

The Cipro may help with the anti inflammatory effect and you could of possibly contracted an infection from the operation. My concern is many weeks have passed since your operation and an infection would of taken hold of you sooner I would think My gut feeling is you had a two fold situation where you had the high bladder neck which needed to be addressed and from many years of this, the chronic prostatitis / chronic pelvic pain syndrome as an addition to the high bladder neck. So you may be dealing with the second aspect of your case. So I would dive full force into the protocol with PT, stretching, relaxation, possible Elavil( amitriptyline) low dosage, food restrictions like no coffee. ( I know you dig the stuff) prelief before food irratives and Quercetin.

Hang in there you will have the ups and downs...

[Sleeper Service]

True - bear in mind the symptoms I describe have been with me since about four weeks after surgery when the wound was still healing though so it's possible it could be a low grade infection that has kicked off due to a vigorous ejaculation the night before. I have asked my Uro if he thinks it's a new case or a pre-surgical problem. No reply yet.

Can't take quercetin products with fluroquinolones unfortunately as they interfere with each other.

As regards the SP stuff, it's entirely possible that my obstructed bladder neck was the instigator of the problems I currently have. Whilst I understand that Prof Guercini isn't flavour of the month round here he does correctly point out that:

Obviously, prostatitis cannot be cured until the anatomic abnormalities which are the underlying cause are rectified.

which seems a fair enough assumption. Hopefully now the underlying cause may have been removed I can actually start to improve.

[carld]

Ya that's true about the quercetin and Cipro that you can not take them together. I understand that it binds with the Cipro which gets in the way of it's effectiveness.

[Sleeper Service]

My symptoms continue to baffle me.

I'm back to being virtually symptom free until about lunchtime when I have my second pee of the day. After that I get an intense sensation in my urethra near the tip which lasts until I go again. I also feel that I need to make a bowel movement a lot although I really don't and generally the more I feel this the less I feel my urinary symptoms. Urine flow is still good although has decreased to maybe 20-25 ml/s peak over the last few days and amount produced is less.

I'm on the Cipro now. Don't know if it'll do any good but we'll see.

Maybe it's just my bladder recovering after all?

[webslave]

Unfortunately, it is rare for pelvic pain to be cured by surgery. I was hoping your case would be the exception, but don't be too upset if that does not happen.

[Sleeper Service]

Yeah, it seems like this has been the case. However, my flow rate is about two to three times better than it was so that's been a benefit and the fact that the obstruction has been removed will prevent further irritation from happening.

I've stopped the antibiotics at five weeks and moved onto Quercetin, Glucosamine and Chondriton. My next Urologist's appointment is in early August so I'll ask about Elavil then.

Whilst it's disappointing, my Uro did make it clear the operation was to improve obstructive symptoms, not to cure prostatitis, which it has done. Now it's a case of doing what I can to get normality back into my life. There is also the possibility it's just going to take time to settle down - it can take up to a year to do so and I have read the experiences of patients treated with TUIP and TURP for obstruction who have had chronic prostatitis / chronic pelvic pain syndrome like symptoms for many months before finally settling down.

In the meantime I shall practice the SP.

[Sleeper Service]

Had my five month check up today. Talked through the symptoms with my Uro and explained the good and the bad. Next was a uroflow.

Well, my operation has certainly helped my flow - a nice bell curve with a very impressive 40 ml/s peak! Much better than the 7 ml/s to 11 ml/s prior to my operation. Residual urine was about 35 ml. In both cases my Uro noted that because my bladder was very full (520 ml voided) when I did the test (which means that it doesn't work as well as it can under a more normal load) so my flow and retention are likely even better than that. He asked about retro and I said no to which he confirmed that they expect 90% of people to have retro after the op. I asked him, as I didn't have it, if that was an indication that the op hadn't worked and he said he had considered it until he saw my flow curve.

So that was the good.

I explained about the irritation that I still had in the urethra and sometimes the perineum. He feels that this is likely prostate inflammation from either before or as a result of the surgery. The good thing was that he said "We've tried six weeks of antibiotics, haven't we?" and when I said yes he said there was no point continuing as it most likely wasn't bacterial. I've to try six weeks of anti inflammatories next and go back in three months to see what to look at which may be...

Prostate massage. I expressed doubt about that and he asked me what I thought it entailed. I told him stories of the people coming in every week for a quick drainage and he shook his head and said "No, that's the US where it's fee based. It's a nice income for some Uros to do this week after week but it's not what we do as it's a bit dodgy." I asked him what he did and he said "Five minutes of solid work whilst you're under a general anesthetic". Eek!

I mentioned that I was taking Quercetin which he nodded at and I asked about muscular dysfunction. He said that was a possibility so stretching and keeping active may help.

Finally we talked about recovery time in general. I mentioned that I'd read a peer reviewed paper where it showed that recovery from a BNI took up to a year with symptoms improving quite a lot immediately post op and then gradually improving more over the next year. He agreed and said that was the case as the National Audit review of Prostatectomies (TURP, TUIP, BNI, etc) demonstrated this - he said it takes a year before you really know where you are post op.

So pretty positive all round. It's good that my uro isn't one of the reach for the antibiotics brigade - we've tried that, it didn't work, move onto the next thing.

[carld]

Well I'm pleased to read you had a good check up and dialog with your Uro.

What anti-inflammatories are you going to take?

[Sleeper Service]

Just Ibuprofen. 200mg three times a day for six weeks.

[webslave]

"Five minutes of solid work whilst you're under a general anesthetic".

I'm sorry, but run, don't walk. This guy has done all he can for you.

[Sleeper Service]

In fairness, Webslave, it's something that he sees as a last resort and he's not trying to kid me that it'll definitely work. He has improved my condition by correctly diagnosing a physical obstruction so I'm going to stick with him.

Incidentally when he says 'solid' he means slowly and completely. I believe this is the method recommended if massage is going to be used at all - the anesthetic is to ensure compete relaxation so he can work without me twitching or moving around. It's not a case of hammering in with the thumb. After all, you yourself say:

I think it is certainly true that many men receive substantial improvement from prostate massage, without using antibiotics.

To be clear - this is not a Polacheck scenario, it's a standard UK treatment covered by my insurance. If it doesn't work, fine. Nothing lost.

[webslave]

In the quote of mine, was referring to the fact that many men get a massage to the whole anterior pelvic floor during a so-called prostate massage.

The under-anesthetic prostate massage is not a standard treatment, as far as I know. I am not sure how he'll write it up. He'll perhaps describe it as a diagnostic procedure. I just think you're wasting your time with him. I said nothing negative when you went for the BNI, but I had very strong reservations. And the aftermath is not, as I suspected, as good as we may have wished for.

I would hold back from seeing him for at least 6 months to see what your real status is, post-op.

[Sleeper Service]

Yes, sorry - I should have made it clear: My next check up is in three months and nothing major will happen until at least a year post op as - which you correctly point out - we need to give it a year to see where we are after the BNI.

The BNI was successful. Once again, my Uro was clear that it was there to resolve an obstruction, not to clear up any chronic prostatitis / chronic pelvic pain syndrome symptoms - it was me who got my hopes up, not him. The fact that my flow rate is about 4 times better, I would say my symptoms are 50-60% improved and I'm able to go back to work would suggest that it has been, at least to a degree, a success.

So my PBNO has now been resolved. Unfortunately the chronic prostatitis / chronic pelvic pain syndrome that was secondary to this will have to run its own course.

I believe we need to try various methods to get better. Massage has worked for some people and I might be one of them. I won't know until I try but it's a good six months in the future before it even becomes an option but if it remains an option then it's one I will not hesitate to explore.