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

Sorry to hear this neil. Get well soon 

So sorry to hear that Neil. Speedy recovery!

Sorry to hear that, as with a number of illnesses stress can bring them on if you are susceptible. Get well & go again. All the best.

Thanks guys for the good wishes. Got some Macrobid at the ER and am feeling better.

Neil, I had my appointment at Columbia University Hospital IR department on Monday. The IR was totally aware of GG's work and had read all their papers. So I am being tested for varicoceles by way of a pelvic MRI and ultrasound next Thursday. 

Ironically, the following morning I had to rush myself to ER because of AUR. I was completely unable to void. I have made an appointment with Dr. K; it's time!

As for the coils, does Dr. V use them?

The Columbia website says the following about varicocele embolization:

"After you arrive at the interventional radiology suite and change into a gown, you will lie face up on the procedure table. To relax you and block any pain we will intravenously give you a combination of medicines called “conscious sedation.” Using X-ray and/or ultrasound image guidance, we will insert a long, very thin tube called a catheter through a small incision into the femoral vein in the groin or into the jugular vein in the neck. We will then inject a contrast dye through the catheter to make the varicocele and the blood vessels that supply it visible on the X-ray. Using the catheter, we will advance a synthetic material called an “embolic agent” (an FDA-approved polyacrylamide microspheres with a gelatin coating) to the veins, and block them with it. The entire procedure takes about an hour."

Would such an embolizing agent be acceptable?

Ross

Hi Ross,

I am very sorry to hear about your AUR. I went through that last summer/Fall and had to use prednisone to pee until I could get to my uro and learn how to self-cath. I had many surgical opitons available to me at the time to relieve my emergency situation but based on jimjames and others on this forum I opted to learn self-cath (CIC). I am so glad I did. It was a steep learning but with help here I got over it and now I control my bladder instead of the other way around.

Are you sure you don't want to try CIC first before doing FLA? I know it worked well for John and some others but just a suggestion. I can help you if you wish - just PM me your phone number and we can talk.

As for coils - Dr. V does use them. He also has the same description as the one you wrote here which does not mention coils. So you may want to ask then directly if they use them. If not, that is great and I may come over to your doc instead of mine for the procedure.

Dr. Gat does NOT use coils and strongly advises against them. I am putting together a letter to Dr. Vartanian with more info on why Dr. Gat does not use them and I will post this info here later this weekend. Mainly the porblem with coils is that they can move and leak as well as not making it possible to seal the small collaterals that may open once the main veins are closed since the coils block access. When I asked Dr. Gat about why he did not use them his first answer was that "they were not needed".

So I am gald I used the title "GG-like". But the details are different as well as the outcomes.

Good luck

Neil

Neil,

This is great information. I actually had a cath with me on Tuesday morning but had no idea what I was doing and ended up with blood and no urine, which compounded my situation. This was the second such occurence in the last 6 months and while perhaps it would be beneficial to learn how to CIC, I would rather get something done and FLA currently appears to be the safest and best option. I fear long term damage to my bladder and feel it's time to jump in with both feet.

I will be asking the IR at Colmbia on Thursday what they use and report back to you guys here. Meanwhile, I am booked for FLA in Houston on the 18th contingent on my MRI next week. So fingers crossed.

I appreciate the offer for help with CIC but it's not a common occerence for me and I am merely two weeks out from getting this taken care of once and for all. 

I'll get back to you on Columbia and coils.

All the best.

Ross

Ross,

I don't know your background and case specifics but if you're in AUR, that puts you in an altogether different category than the men who have had FLA with Dr. K. 

FLA, while very promising, is only a prostate reduction procedure, so it may not help if your problem is significant to your bladder. 

Do you know what your PVRs were prior to AUR? Have you had a bladder/kidney scan to check both bladder achitecture and for hydronephrosis? Urodynamic testing? TRUS to measure prostate size? Cystoscopy? 

I would have all this information beforehand before even thinking about any sort of procedure or operation including FLA. 

Meanwhile, if you're in AUR and/or have significant retention, you should consider self cathing (CIC) both to protect your bladder and kidneys and also to buy a little time for either additional testing and more investigation into next steps.

Jim

 

Hey Jim,

Thanks for your comments. I am not "in" AUR. It's only happened to me twice in my life and only in the last 6 months. For the most part, I manage to void successfully albeit sometimes slowly and at other times surprisingly well. My problem is the median lobe that obstructs my urethra when my bladder is too full. This is mitigated by going to the bathroom as soon as I feel the slightest urge to. The fact that my flow is on occasion quite good, leads me to believe that my bladder function  is still in tact. But I fear that not acting now as clearly my symptoms are worsening, it may well have a negative impact on bladder function going forward. 

I have spoken to one of the FLA success stores who had a similar size prostate and median lobe and who had also experienced occasional AUR. So I believe I am a strong candidate to benefit from FLA as long as I don't delay and allow things to get any worse.

Back in December I had a cystoscopy and I had a measured PVR of 80ml. I usually only get up once a night and can generally go 90 minutes to 2 hours between bathroom breaks when awake. My prostate size is 125g with a pronounced median lobe. 

I had PAE with Dr Bagla almost 4 years ago which lasted about 2 1/2 years before symptoms began to return. I feel I need to act again and FLA I believe is currently the best option.

Ross

 

I am glad to hear that you are usually not in retention. I don't know when you had your PVR measured, but if not recently then you might want to have it done now. It doesn't require a hospital ultrasound bladder study, most urologists do it right in the office with a portable bladder scanner. Urodynamic testing is also a reasonable step before any prostate reduction surgery. But at least that portable bladder scan.

If I had to guess, sounds like FLA will help you, but why guess when you can take a few simple steps. You might also want to talk to Mike who also had FLA after what I remember to be a similar PAE experience. Not sure if he had median lobe issues or not.

Good luck moving forward.

Jim

These measurements were from 5 months ago.

Ross

But you've gone into AUR once or twice since then and once just recently. Things change!

I again wish you well with FLA but personally I wouldn't be in such a rush.

While less invasive than say TURP, FLA is by no means a non-invasive procedure as attested by the recovery journals here. And, we have at least one of Dr. K's patients still self cathing after 11 weeks post FLA. 

Then again, my whole approach is much more conservative than most, so consider that. 

Jim

Hi Ross,

What is your condition right now at this moment? Are you taking any drugs?

I would just mention that my first experience being shown how to self-cath in the uro's office caused me to cry and faint as blood was spouting out everywhere! The nurse tried to bangthe catheter into my penis past the constriction. I left telling my wife I could never ever do it.

I came back home an posted my experience on this forum and jimjames came to the rescue - literally. I could still NV ok so I took advantage of that and with his help, and others learned step by step what to do under my own control.

I also had a PAE last summer that failed. I thought it would be a panacea for my BPH.

I also am considering FLA with DR. K but self-cathing gives me the time to look at other options and to continue to assess my own situation to determine if in fact FLA is the best solution for me.

Good luck to you!

Neil

Just wanted to ask you if you consumed a lot of liquids, including alcohol before your AUR occurred? Also did you hold your pee in for a long time and then could not NV? Both these things will make me go into AUR but I can self-cath so avoid a trip to the ER.

Neil

"But you've gone into AUR once or twice since then and once just recently. Things change!"

No just once. 

For me it's about getting a procedure done at the right time. I have been considering many different options for a long time now and don't know of another procedure that is more targeted and precise. I believe it might have the potential to become the new gold standard for BPH treatment. 

There will always be exceptions and I am willing to take that risk as I believe my risk factors for this procedure given my symptoms going in, are minimal. 

TBH, I haven't been in a rush at all. I've been studying all my options for a couple of years now. I respect your point of view and appreciate your concerns and I thank you for voicing them.

Ross

Neil, I see you mention FLA , have you decided against the  G-G type  procedure?

FWIW FLA would be at the top of the list if I was considering a procedure now. My only hesitation would be that not a ton of data on FLA for BPH at this point, but sounds like you're probably more on top of that particular procedure than I am. Like you say, it's more targeted and precise, which is very appealing and at this point in time at least you will get the kind of support and care from Dr. K. that is unusual in the business.

Jim

Hi Ross,

Just want to add that antihistamines in things like allergic medications and cough syrup to name a couple can put trigger an AUR.

Also, sometimes uros will misdiagnose frequent urination as an over-active bladder and prescribe medications that can also trigger an AUR.

I certainly wish you all the best in your decision and there is no doctor I respect more than Dr. K. Also I believe I proposed to his nurse Samantha before my wife reminded me that I was married!

But still - surgery is surgery with all the risks that it entails. If it were me (which it is!!) I would try to bide my time and avoid AUR triggers like sitting for a long time and holding it in. FLA is still very experimental in terms of technique and outcomes and risks. I sure wish you well!

Neil

Hi uncklefester - No - not at all. I will explain what has happened later tonight.

I only mention FLA as a possible fall- back position perhaps a year from now if the GG procedure does not work ( more later).

Or, if I cannot find a VIR here who can perform a close analog to the real Gat-Goren procedure then I just plan to keep on CICing indefinitely until a simple solution to BPH is discovered or FLA is fully validated.

Neil

"What is your condition right now at this moment? Are you taking any drugs?"

I yanked the catheter out on Wednesday evening and I appear to be doing ok if not a little sore and going more frequently, perhaps every hour to 90 minutes. My flow seems ok albeit intermittent.

As far as drugs are concerned, I am taking 5mg finasteride (yuck) and instead of my usual 10mg Alfuzosin, my uro gave me a week's supply of Rapaflo as a nuclear option. 

"Just wanted to ask you if you consumed a lot of liquids, including alcohol before your AUR occurred? Also did you hold your pee in for a long time and then could not NV?"

Alcohol was involved on the two AUR episodes. The most recent episode occuring at the end of a night's sleep having had a few drinks the night before.

I would be willing to learn to CIC but truly hope that I'll get through the next 13 days without incident. My one attempt at self-cathing this past Tuesday morning was a total disaster!

Best

Ross

 

Neil,

You are a wealth of information and a true gentleman for sharing your knowledge and experience. 

I'll make sure that Samantha knows you still care

I am avoiding alcohol completely now until I have had my procedure. In fact, I just turned down an invite to a local bar with some of my old mates. 

Neil thank you for the kind sentiment and I wish you well too. We have some more investigating to do for the GG method and I sure hope we can find someone to perform this procedure properly and safely here in the US. If GG can at the very least stop the progression of BPH, then a successful FLA  (or any other procedure that works for you) in tandem with GG could be an effective and most impolrtantly durable solution.

I wish you the best,

Ross

Thanks Ross.

I would add that my first 10 or more attempts at CIC were bloody messes and disasters but it really is an important survival skill to learn at some point. Even if FLA is successful (and I pray for that) it is only temporary as no one knows its durability. So at some point you really should learn CIC. It certainly wasn't on my bucket list but it is now!

Also, you mention your concern regarding your bladder/kidney health. If you have a good baseline now, these organs do not crash overnite so there is plenty of time to respon to any developing issues.

For example, last year my ultrasound showed bladder wall trabeculation and mild hydronephrosis in my left kidney. But now those problems are gone thanks to CIC.

So every 6 months I will get an ultrasound as well as pee/blood tests to check on these organs.

Even after FLA you will still have to do this as well.

OK - so now to the top of this thread and a discussion of GG and "GG-like".

Neil

LOL were you sedated when you proposed?

Yes!

Well, at least you've got an excuse for the proposal