Re: Tests for blockages after PVP

I guess dilatation could break adhesions inside the prostatic capsule.
These could form postoperatively and impair voiding. There is a report
in the mayo clinic series of soft bladder neck contracture that was
balloon dilated with success. I guess it is not unreasonable to try
dilatation if voiding does not improve after PVP. I prefer to do a
flexible cystoscopy rather than a blind dilatation, to assess what
could be the cause of the impaired voiding. I had once a patient in
whom I left a bit of tissue at 11 o´clock that acted as an embolus and
impaired voiding. I performed a rigid cystoscopy under sedation and
vaporised it in 10 minutes, he was sent home three hours later and the
patient is now very happy. If cystoscopy is OK, then a urodinamic study
would be indicated, to find out why voiding is not improving. Some
patients have weak bladders and this explains the low flow in absence
of obstruction. Dr. Lin seems to be a good guy, stick with him and he
will solve the problem.

I hope you will get better, Buford.

Fernando Gomez Sancha
http://drgomezsancha2.blogspot.com

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