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

Thanks arlington.  I do not have any median lobe obstructing the bladder neck opening. That was based on a cystoscopy last year. But I do have two huge side lobes in the periurethral zone that clamps down on the uerthra where the prostate starts. It takes forever to get through that region with the catheter.

I know that Dr. Gat refused men with any type of bladder neck obstruction. I followed 18 guys on another forum who had the procedure by Dr. Gat since 2012 and all were helped except for one who had a large median lobe.

But I can tell you that I would try this procedure regardless of general conditions because we are all very different and you never know how it will turn out. Even Dr. Gat cannot say for sure how it works in detail.

Thanks for the good wishes.  I hope it works.

Neil

Thanks a lot, Neil.

At the very least it will clear up your varicoceles.

That's an interesting point. I could imagnie some connection. I will mention it to my IR just before he puts me out.

There is another procedure similar to the GG embolization that is performed by urologists. It is called a microsurgical varicocelectomy. This procedure just goes in and severes the base of the gonadal veins and ties them off. Then there is no way for these longs veins to create a high back pressure to the prostate and spray it with free testosterone. It is a more direct procedure and does not have the difficulties associated with embolizing the right gonadal vein that GG has. It is used to treat really bad varicoceles but when I reviewed it it seemed like a vasectomy. I didn't elect it because it requires a general rather than conscious sedation.

I wonder though if  a vasectomy might help prevent BPH if the GG theory is correct since it would prevent Free T from ever leaving the testes? I will ask about this.

I wrote my urologist and asked him your question. He said he was not aware of any link, but of course that does not mean there isn't one.

Why don't you post your question on a new thread here? I'm sure there are lots of men out there who have had vasectomies that would respond. I find the only place to get to the truth on these issues is forums like this one.

Neil and Glenn, 

I had a vasectomy 25 years ago when I was 40 years old. That was 1991. I dont know what this means for BPH or back flow of Free T., but I know it worked as advertised and I know I later had BPH which developed enough for me to realize it by the time I was 56 years old. I lived with it until 65 when I then had the Focal Laser Ablation done and it greatly improved all my symptoms. So as far as I know the vasectomy did not help in preventing BPH at least in my case. 

John

FWIW - just looking at the anatomy of the vas deferens vesicle and its accompanying blood supply/drainage vessels, I would think that a vasectomy would reduce the chances of getting BPH if the Gat-Goren model is correct.

The reason is that the veins which drain the vas deferens (which is severed in a vasectomy) carry some of the excess pressure due to the valve failures in the gonadal veins to the prostate. So if the arteries and veins are cut along with the vas deferens during the vasectomy procedure then the high pressure would not be transmitted to the prostate which GG say is partially repsonsible for BPH.

But the main problem arises in the veins themselves according to GG and it is the blood draining the testes that carry the high concentrations of Free T back to the heart and the main circulation under normal conditions when the gonadal veins are working ok.

The vas deferens are tubes carrying just sperm but they do form another link between the testes and the prostate so maybe it should help having them cut.

Just talking here - the plumbing in that area is so complicated - the best way is to just gather statistics of which you are the first John! Thanks.

Hi Jim,

The IR who will be performing my embolization is aware of the Gat-Goren procedure and its history. He is interested in it but I had to show him I had bilateral varicoceles before he would agree to the procedure. The scrotal ultrasound he did confirmed it for him but I knew I had them anyway because of the discomfort I have had sitting for many years.

The Gat-Goren procedure is basically the same as the sclerotization procedure for sealing varicoceles. I guess " the devil is in the details" and Dr. Gat has many tricks up his sleeve when it comes to doing it but other IRs have done it for BPH with great success.

I recall from another forum where the guys who had Dr. Gat do it that one of them had had PAE earlier which failed while GG worked ok.

The main difference is that PAE embolizes arteries leading into the prostate while GG embolizes veins which drain the testes and prostate. So relatively speaking it is a much safer procedure than PAE.

The two procedures are very different. PAE tries to cut off normal blood flow while GG tries to restore normal blood flow by emboloizing incompetent veins.

Here are 2 papers you might like. The German paper did their own study to confirm GG on men with BPH. If you have trouble getting them PM me with your email and I will send them to you.

Thanks for your good wishes. And thanks for teaching me CIC - otherwise I would not have a prostate now to still play with!

1. " Treatment of Benign Prostate Hyperplasia by Occlusion of the Impaired Urogenital Venous System - First Experience", H. Strunk et al 2015.

2. "Reversal of benign prostate hyperplasia by selective occlusion of impaired venous drainage in the male reproductive system: novel mechanism, new treatment", Y. Gat et al. 2008

Jim - I forgot to mention that there may also be an edema component to BPH in general if the GG model is correct. Edema is often casued by impaired fluid drainage out of tissues by the venous and lymph vessels.

So if GG is correct then the prostate tissues may be expanded by excess fluids since the main drainage veins from the prostate (the gonadal or internal seprmatic veins) have failed.

This edema can cause tissue irritation and inflammation which could be BPH. So sealing these big incompetent veins and their high back pressure may relieve the prostate edema and the BPH ... or maybe not.

Neil

Neil,

Just curious if you have discussed this with Dr. K? I thought you said you went to him for a procedure. Since he is an IR, and seems open to finding a cure for BPH, wondering what his thoughts were?

Hi Motoman,

Yes - I did discuss this procedure with Dr. K at length when I went to him for my biopsy in Feb. In fact he was the one who used the term "GG". He also thinks it is experimental but he was willing to set up a scrotal ultrasound for me while I was in Houston to see if I really did have varicoceles. But I couldn't do it then because of time restrictions.

I have kept him in the loop on my procedure. He knows Dr. Vartanian and highly recommends him. Dr. K wrote "Excellent" when I told him I was going to try it.

But Dr. K just wants to focus on FLA (no pun intended) for cancer and BPH and does not want to look at other methods like PAE and GG which he considers indirect and experimental compared to FLA.

Hi Neil,

Do you CIC during the night.  I've started doing that.  It at least ensures that I'm only going to have to get up once!

I also CIC about 4 times during the day - but the first 2 volumes are usually about 500ml.

What is your daily liquid intake?

Best of luck!

Hi arlington - thanks for the good wishes - I am getting nervous with all these procedures - maybe this one will work and that will be that!

I do CIC at 7 am; 2pm and 11pm. The ones at 2pm and 11 pm and pretty good. First I NV about 150 to 200ml and then CV about 200ml. I used to do one at 4 am and will have to restart that one because my 7 am NV is maybe 100 ml but my CV ranges from 500 to 700ml which is way too high. Also I tend to wake at 4am anyway with a lot of pressure in my abdomen but I don't want to get up and CIC because once the lights come on I cannot get back to sleep. But I don't sleep well anyway after 4 am so I will add that CIC back in tonight as these volume are much much too high.

I drink about 1500ml each day - mostly water and cranberry juice. So with 300ml from food and 200ml from the metabolization process I think it is ok.

Also between my CICs I NV about 3 times ok between 150 and 200ml each NV.

Take care.

Neil

 

Thanks Neil.  I've had exactly the same experience during the night - but take some comfort in knowing once I CIC I'm good 'til morning.

My NV/CIC ratio was about 1/1 for 2 years (one before and one after my PAE).  Then, about 9 months after the PAE, My NV has dropped off to the point where it is almost nonexistent (maybe 30cc's per week!).  Very discouraging. 

I'm looking forward to hearing your good news!

Can you tell me the size of your prostate and whether you have an enlarged median lobe?

Thanks arlington. I do not have a median lobe at all - thankfully. I just have 2 huge side lobes that cause my problem.

In 2011 my prostate was measured by a transrectal u/s to be 150gm. Then in 2016 it was meausred the same way to be 280gm!  That was when I had PAE done (last Aug). Then in Nov. last year it was measured at 180 gm by MRI. And just 2 weeks ago it was measured by an abdominal u/s to be 200gm though that one was not accurate.

I found that if I take 2 tylenols after CIC at 3 or 4 am then I can get back to sleep but it is so hard to get out of bed after being awakened from a deep sleep but I guess we have to do it!

All the best to you.

Thanks Neil.

Agreed about getting up, but, as you said, if we don't, then the rest of our sleep is p*ss poor anyway!

Neil, whats a median lobe, and how is it determined if you have one?

Hi uncklefester,

As I understand it the median lobe is just a normal part of the prostate structure like the side lobes. But the problem with the median lobe is that it is located near the top of the prostate under the bladder neck region so when we get BPH and the prostate grows this part can do the most damage in restricting the bladder neck opening to the urethra.

It tends to grow up into the floor of the bladder and lift the bladder wall up and twist it causing all sorts of restrictions to urine flow.

Only about 10% of men do not have a median lobe so I was very lucky in this regard since with my condition it would have been game over a long time ago.

The best way to determine for sure if you have a median lobe is by a cystoscopy done by a uro. One of my uros told me I had a large median lobe based on a transrectal ultrasound but then I had a cystoscopy by another uro who directly viewed the urethra and into the bladder and he said I had none.

So I guess in some ways I am lucky. Kind of like winning the lottery and then having it all taxed back!

Thanks neil. My last ct scan stated my prostate was pushing against my bladder wall. The uro that did my cystoscope said this as well. He didn't clarify what it meant. He tried to rush me into turp. Glad I left him.