"Gat-Goren" - like procedure to cure BPH? My diary

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On May 2nd I will be undergoing a bilateral embolization (or sclerotization) of my internal spermatic veins ( gonadal veins ) in an attempt to cure my BPH disease. So I just wanted to start a record here of my experience.

Here is some background.

Drs. Gat and Goren are interventional radiologists in Israel who have been treating infertility in men for many decades. They noticed over the decades that when they embolized incompetent internal spermatic veins (ISVs) which caused the varicoceles in these men, that many men who had BPH were also cured of their BPH symptoms.

They noticed that every man who had BPH also had varicoceles in one or both testes. They theorized that the high back pressure from these very long (35cm) failed veins which drain the testes and the prostate was causing very high concentrations free testosterone to bath the prostate. This growth hormone they claimed was the cause of the hyperplasia of the prostate. So by sealing these long veins the "fuel" that is driving the prostate "fire" will be cut off and the prostate will return to normal.

I have some papers on this procedure and some clinical trials and I will list them later on. If anyone wants them PM me with your email and I'll send them to you.

So there is another forum started in 2012 which documents at least 18 men from around the world who went to Israel for this procedure. Most had their BPH cured. Of course it was very very expensive.

That is the beauty about the GG procedure - it offers a cure for BPH and not just symptom relief. BUT it is considered very very experimental. Even the interventional radiologists (IR) do not believe in it. So here is the point of all this. The GG procedure is just the basic treatment for varicoceles. So if you have been diagnosed with these awful things then a good IR can emolize them with a few caveats (like sealing any collaterals that opne up during the procedure) and the procedure is covered by insurance.

So last month I decided to get checked out for varicoceles. I had a scrotal color doppler bilateral ultrasound nd sure enough there were 2 big honkers there. They have been bothering me for years - I have to sit on soft pads all the time and pull up my scrotum frequently. Apparently varicoceles increase the weight of the scrotum because of blood pooling which causes the "balls to drop".

Here is my brief bio: I am 68 with BPH for over 20 years. I am on alfuzosin and dutasteride these past 13 years. I had a PAE last summer which was a huge technical success but a clinical failure as my IPSS score has remained at 30. I learned intermittent self-cathing from jimjames here (CIC) last Fall and perform it 4 times a day. My natural voids are 150ml and the cathing voids are 250ml. If it weren't for CIC I would have had my 180 gm prostate out a year ago. I have no bladder neck obstructions or other complications. The PAE did reduce my prostate from 280 to 180 gm but all the tissue reduction was away from the urethral constriction where i matters. I have been tested for prostate cancer many times and am ok.

So that's it. Please feel free to post any comments or questions. If the GG procedure works then it takes from 6 months to a year to see results. That is why I am grateful for CIC to keep my bladder/kidneys healthy in the meantime. If GG fails after a year then I will likely try FLA with Dr. K in Houston.

Take care

Neil

 

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  • Posted

    Best of luck to you neil. I have been reading a little the links you sent me via PM. I think one person on there mentioned seeing results in 2 months or am I mistaken? Also what is the cost? Seems to me this procedure might be covered by insurance since there is discomfort involved if you don't get treated. 

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    • Posted

      Thanks unclefester for the wishes. There were a couple of guys from Australia I think who went together for the treatment and saw a very fast improvement but most guys saw a more gradual and I should say durable improvement in that it has lasted for several years.

      You are correct that the cost is fully covered by Medicare B plus my supplemental since I have been diagnosed with painful varicoceles.

      Hope it works!

      Neil

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  • Posted

    Good luck to you. I hope I don't need to go this route, as I recently had FLA. But who knows how long that will last.

    Do you know what the cost is, assuming insurance does not cover it? 

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    • Posted

      Thanks Motoman - how is your FLA working out?

      I don't know the cost w/o insurance for mine but there was a fellow in Florida who had the same procedure performed by his IR. Since he only had one varicocele his insurance would not pay for the other ISV to be embolized. He said that one cost him $2,200.00 so not too bad. He also said his BPH was cured after about a year.

       

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    • Posted

      I think my FLA is working just fine at this point. It's been 9 weeks. But I always wonder when or if I am gonna need something else done, especially since I had the Itind procedure done a year ago. So something that gets to the root cause is interesting, but I hope I never need it. 

      The cost is reasonable compared to FLA as well. 

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    • Posted

      I've had it done (not in Israel/Cyprus) & it hasn't helped my BPH at all. You need to check round those people who have had the procedure & find out if it has helped them before you go ahead.

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    • Posted

      Hi Peter where did you have it done and how long ago was it done? Have done another procedure since G-G
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    • Posted

      Motoman and Neil3149

      I agree with you Motoman, we both had good results with FLA and I am very happy but I live in fear of when it will come back. I can't take living that way again especially after a taste of the great life I now have without it. Noone knows about how long this will last, and we could be good for 5 maybe 10 years, but if this GAT procedure or another comes to light as a real cure for the issue, we need to be ready to followup with that. We both understand the need to cure this condition permently.

      I am very proud and impressed with Neil. He researched hard and did his homework, he found a way to get this done in the U.S. and better yet near his home. He verified the Doctor he will use with another IR Doctor he believes in and recieved great reviews. I think he is good to go on this. He even found a way to get this covered by insurance in a proper manner. IMPRESSIVE to say the least!!

      We are all pulling for him. Thank you Neil for what you are doing 1st for yourself and second for sharing this experience and knowledge with all of us. I have gotten a lot of wonderful insight and information off of this site. But your new diary is the most exciting thing to come across in a long time. I have my calendar marked and will be waiting for your reports.

      Sincerely I feel confident and very hopeful you will have a good experience.

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    • Posted

      Thanks so much John for your kind thoughts. I wish you would not worry so much about your old condition returning. Even if that happens several years down the road you still have good options - but why worry now? Worry will just tense up your pelvic floor muscles and sphincters and bring about the very restricted flow you are worried about!!

      Thanks again. I sure hope it works for all our sakes - we need a cure and not a bandaid!

      Neil

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  • Posted

    I had it done in the UK by an IR over a year ago. The procedure took under an hour to perform as it is a much simpler & less invasive than PAE.  I am now in contact with doctors re. FLA which would appear to kill two birds with one stone.

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    • Posted

      Hi Peter

      Thank you very very much for sharing your experience here. I am sorry it did not work for you. This stuff is all experimental and we are the guinea pigs.

      Could you please provide a little more info about your BPH? Do you have any type of bladder neck obstructions like a large median lobe? I know Dr. Gat refused men with bladder neck obstructions like stones, median lobes and abnormal constrictions.Also do you take medications,have you had previous procedures like TURP and can you natural void on your own ok? I think all this relevant to what we can expect with this "GG-like" prcoedure.Sorry for all the questions but your experience is very important. Did you have bilateral varicoceles and were they both embolized ok along with collaterals that may have opened during the procedure? I asked my IR if I can be awake during the procedure and he asked me why. I told him I want to make sure he seals any collaterals that open up. His response was he was changing my conscious sedation to unconscious!Anyway, thanks for chiming in. Please add anything else you consider relevant. I will still get it for my painful varicoceles regardless.Neil

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    • Posted

      Hello Peter, I'm considering pros and cons of PAE and FLA and have had initial contact with two sites in the UK carrying out PAE. Interesting to read here about Neil's PAE technical success and clinical failure (with no change in IPSS) and coming to the view that PAE is a bit hit and miss and not the preferred first line of intervention that FLA could be. Are you in contact with UK or US practitioners about FLA?

      My background:

      71 year old with some 10yr history of BPH without prior treatment. As well as nocturia now suffering with daytime urgency/immediacy, and following on from recent GP discussion now trying to ascertain which route to pursue.

      Best wishes to Neil for May 02 and will be following your progress.

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    • Posted

      Been in touch with 2 Interventional Urologists in the US, can't seem to find anybody in the UK. A Dr Spirling in Florida & a Dr Karamania in Texas. I'm just sounding them out at the moment.

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    • Posted

      Dr Karmanian is very accessible and wonderful. I had 3 lengthy phone conversations with him, the third even when he knew that I would be choosng PAE rather than FLA.
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    • Posted

      Yes, I sent him my MRI's which he looked at & we had a long chat on the tel which was ver useful.

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