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The prostatic urethra

Grinder
Posts: 437
Joined: Mar 2017

Will someone please educate me on the prostatic urethra and TURP?

This is a membrane that passes from the bladder neck through the prostate, where the ejaculatory ducts and prostatic ducts empty into the membrane, the membrane then joins the urethral membrane at the base of the prostate.

But what happens in TURP?... I can only assume the prostaric urethral membrane is removed, leaving only prostatic tissue exposed to urine, semen, and worse, catheters of various sorts.

That membrane is there for a reason. It is part of what is called the "innate" immune system. The other is called the "adaptive" immune system.

All membranes and blood borne immediate defenses such as leukocytes comprise the first line of defense against bacterial infection... "innate defense mechanisms" .

 "Adaptive defense mechanisms" instead adapt to a particular pathogen and "learn" how to deal with it.

How can removing the first line of defense against pathogens in the urinary tract end well if there is any possibility of a catheter infection.  I am guessing that infection transmitted through the prostatic ducts is also possible... but to remove the entire membrane?

What forms in place of the membrane? Does it grow back over time? Does fibroid tissue grow in place and form a hardened barrier? Or is the channel through the exposed prostate tissue the new urethra?

Imho TURP should only be considered if there is no chance of future pathosis... and probably not a good idea on AS.

MK1965
Posts: 164
Joined: Jun 2016

Proces called rapid wound  re-epitalization happens in prostatic urethra as resected area is healing.

Re-epitalization is preventing fibrous tissues to develop which helps prevention of later complications.

That is defense body mechanism which starts right after resection and makes fairly similar look of prostatic urethra cystoscopicly 6 months after TURP. In some patients this process might be delayed for unknown reasons and that is when fibrous tissue starts forming which will lead into further problems.

Does it sounds reasonable Mr. Grinder?

MK

VascodaGama's picture
VascodaGama
Posts: 2966
Joined: Nov 2010

Your "Mr" made me laugh.

I want to add that the re-epithelialization takes action immediately when a membrane (or the group of cells forming it) gets ruptured. The healing process or restoration of the affected area is complete once such membrane is formed back. Oxygenation is required so that blood vessels for the supply at the area are formed naturally if none existent. Hyperbaric treatment is the best for fast healing of inner wounds. The blood transports the reconstruction materials to the site but blood thinners can delay the healing process (lesser number of materials reaching the place). Those with cardiovascular problems are more in risk of local infections till healing, taking longer for full restoration. These guys that usually are on thinners need to carefully chose the type of medication (inhibitors) and should consider to take it intermittently (on/off medication) during this period, to balance the requirements (this may answers Grinder's inquire in his other post in another thread).

Another issue that so often is commented in this forum is the problem of radiotherapies done while the healing process is underway. The radiation destroys/deteriorates the DNA (micro-RNA) which wellbeing is essential in the re-epithelialization for avoiding the formation of chronic wounds. Some doctors do radiation in PCa patients without proper exams to look for existing ulcerative colitis, urethritis, cystitis or proctitis. We become the responsible ones that should care on such a possibility because we are the ones to agree in relieving the physician from any wrong outcome in the therapy.

Please note that I am not a doctor. My above opinion regards my experience in dealing with the bandit along my sequential therapies and investigations done in my 18 years of survival.

Thanks for bringing the issue to this discussion board.

VGama

  

Grinder
Posts: 437
Joined: Mar 2017

Having looked at diagrams and images of the amount of prostatic tissue removed during TURP, I find it astonishing that membrane tissues can reform so rapidly.

If I was to cut a sizable chunk out of my arm, the  re-epithelialization process to repair the epidermis would be long and difficult.  And would require a great deal of artificial assistance, such as a tourniquet, bandaging, antibiotics and antiseptics, and long term care of the wound.

Yet in that deeply buried gland, the body can reform a membrane that covers a much larger area than its original area... How does it know which cells form the tissues of the Prostatic Urethral membrane and where they go, since the likelihood of damage to that membrane is highly unusual under normal living circumstances , but for recent TURP procedures? 

My wife has always made the observation that the miracle of our bodies seems commonplace only because of the element of time. She states that a wound that heals under time lapse photography would appear to be a marvelous supernatural miracle, yet the only variable in that healing is... time.

I wonder if we have become callous to the intricate molecular mechanisms that are taking place by the millions in our bodies every day that we would be foolish enough to suggest this happened by a series of fortuitous accidents and random chance. Because it appears commonplace, we are not stunned when the body can repair and replace deeply located membrane tissues inside the prostate.

Irreducible Complexity.

So, thank you for that answer... but now I am back to the  riddle of TURP procedures limiting the availability of treatments for future pathoses. Judging from the experiences of others in this forum, I would still be reticent in jumping to a TURP unless I was absolutely sure there was no danger of other pathosis.

Or , in light of what Vasco said about the time required to regenerate membrane tissues, the treatments for other pathosis happen too soon before the membrane has healed properly, which can also be affected by other variables, such as age, circulation impairment, etc.

I am still of the opinion that a biopsy should precede a TURP procedure, unless the urologist  can absolutely convince the patient there is 0% danger of cancer or other pathosis. And I am guessing  in most cases they cannot.

C'mon guys...  think about this. Following a TURP with  Prostate removal... whether by RP or Cyberknife or laser ablation?

WHAT IF you had a car with a locked up engine and took it to the mechanic. The mechanic says "Well, we can rebore your piston chambers and put new piston rings in, and charge you $5,000 for that, and then in three months, bring the car back and we will take that engine out and put in a new one for $10,000."

 How many of us would elect to spend all that money and go through all that grief to get our "piston chambers bored out" only to have  that engine removed anyway with more added expense and grief. Personally I would skip to the engine removal, but that is only because the mechanic in this analogy told me.  

But if he did NOT tell me, and I did both... I would say, in the Network words of Peter Finch... " I'M MAD AS HELL AND I'M NOT GONNA TAKE IT ANYMORE! "

But that's not all... as  has been discussed recently by some of the guys in this forum, TURP can limit the treatments available to you in the case of cancer and future pathoses.

I am not getting down on TURP... it has been a wildly successdul procedure judging from the numbers... but like all treatments, I think it gets overprescribed... and should not be employed until future pathoses are convincingly ruled out.

And judging from the gruesome looks of the procedure... I dont think TURP is going to be a ride at Disneyland anytime soon.

VascodaGama's picture
VascodaGama
Posts: 2966
Joined: Nov 2010

I agree with your wife's observation. Our systems are prepared fully to repair and substitute the building blocks when most needed. What leads to its failure is when a certain material is required and it is not locally available or it cannot reach the affected area via the traditional means. The typical route is the blood circulatory system and nerve networks but these may have been damaged or accidentally cut off.

The repair system enters into action immediately but time is required to get all pieces in place and assembled. It all evolves in the principle of "Irreducible Complexity" or "Darwin's theory".

(I am a civil engineer by profession, I like the building blocks) Lol

VG

Grinder
Posts: 437
Joined: Mar 2017

"What leads to its failure is when a certain material is required and it is not locally available or it cannot reach the affected area via the traditional means."

 I think I get it... if diet does not supply necessary "materials"... or manufacture of building blocks is disrupted or impaired by organ malfunction failing to convert materials , or the supply line to the repair site , the circulatory system, is inhibited,  injury repair can be slowed or retarded.

That would explain why the original design of the human body is near perfect, but all of us have genetic imperfections that are far removed from perfect design, and our accumulated adverse environmental influences take us that much farther away from the original design.

VascodaGama's picture
VascodaGama
Posts: 2966
Joined: Nov 2010

Yes, it is as you say. As far as I know, cancer derives from a genetic imperfection that can have origins in an hereditary matter, adverse environment and aging. 

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