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

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Howard31850
Howard31850

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

 

1 like, 117 replies

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  • Howard31850
    Howard31850

    Posted

    OK - so here is what has been happening this week ..

    We were supposed to drive down to Detroit last Sunday and stay with friends till my procedure on Tuesday. But during Sunday I could tell I was getting a UTI so stayed home. By early evening it was intense so off to ER where I got some Macrobid. I am fine now and interestingly the culture came back negative so it must have been irritation ( or maybe Providence?).  Anyway I cancelled the procedure for now and Dr. Vartanian was ok with that.

    On Sunday while the UTI was brewing I was researching the beads use in PAE. Quite by accident (or maybe Providence?) I came across an unsecured web site that dealt with the subject of "against varicocele embolization". It dealt with the problems that the coils used in these procedures have caused people. I STRONGLY recommend it as essential reading for everyone. It is long but worth every second.

    As soon as I read about the coils I realized what has been bothering me about the "GG-like" procedure I've been touting here. During my consultation with Dr. V 5 weeks ago he mentioned the use of coils for sealing large ISVs. I didn't say anything but had a bad feeling about something.

    So over the past few days I reviewed my notes from a year and a half ago while reading the 1500 plus posts o the Gat-Goren thread on another forum. There were several posts from guys who had GG done by Dr. Gat who discussed coils.

    Dr. Gat was dead set against the use of coils for a lot of reasons. Among them he said that coils prevented sealing small collateral veins that open up during the sealing of the main ISVs. Also, coils often move during the first few weeks which can cause leakage and regeneration of the ISVs and the varicoceles. Also coils can become attached over time to muscle tissue and organ tissue which can cause very serious health issues. There were many other concerns.

    So Dr. Gat just uses a sclerotising fluid injected from the top of the ISVs using a catheter. He has an assistant apply pressure on the patients lower abdomen to keep the foam from flowing into the testes region. Many guys describe how Dr. Gat puts a computer screen in front of them so they can watch the foam move through the veins and seal up everything.

    On this forum in addition to the 17 guys who had Dr. Gat do their procedure there were 2 who had it done in the US by VIRs who do varicocele embolization. One of them initially had good results but after 6 months developed severe health issues and regressed along the lines of what has been described by many people in the site I mentioned above as coil-related problems. The other fellow seems to be doing ok a year out.

    I also got a copy last year of Dr. Gat's patent application from 2010 in which he describes the details of his procedure. It is very different than the standard varicocele embolization I was scheduled for last Tuesday even though conceptually they are the same.

    So now I understand where the apprehension was coming from. I should have remembered this critical aspect og the real GG procedure and pressed Dr. Vartanian on it when I met him. But at least it is not too late. I wrote him yesterday and sent all this stuff to him and asked him if he can do the procedure w/o any coils and if in fact he has done it in the past. There is as much art as science involved  and I don't want to get my scrotum sclerotized by mistake!

    So that is where things stand now. I think I lucked-out with my UTI and apologize to everyone if I mislead you. I got carried away with my own wish for this procedure to be the same as the real Gat-Goren one to finally cure my disease and started to believe my own rhetoric! At leats I called it "GG-like" and not GG.

    I will keep you all up to date on this. Maybe it will still pan out.

    Neil

     

  • Howard31850
    Howard31850

    Posted

    For anyone interested I came across the following 2 papers that deal with the different kinds of embolizing agents available for varicocele embolization. These papers are freely available (just type in the title). They show the difficulty using liquid agents similar to Gat so they require a doctor experienced with liquid agents. Now at least I know what to request and to ask the doc about his experience with liquid agents. The education continues ...

    1. "An Overview of Embolic Agents"

    2. "Comparison of three different embolic materials for varicocele

    embolization: retrospective study of tolerance, radiation and

    recurrence rate"

  • Howard31850
    Howard31850

    Edited

    Hello all - just want to give a quick update:

    I received more info from Dr. Gat on the details of his procedures. Guess I should not have assumed that it was just a simple varicocele embolization - which it is but not simple.

    Dr. Gat does not use coils at all - he said they will leak and move and even if they don't it is almost impossible to seal collaterals and othe small relevant veins if coils are in place.

    So he developed a special type of catheter with balloons that can be inflated and deflated to isolate regions of a vein that he wants to destroy. These balloons will keep the liquid sclerosant from going where it shouldn't go and flowing into the small collaterals he wants to seal.

    So while it IS a varicoclele embolization procedure and will eliminate them it is also a detailed vein destroyer to ensure there is no pressure left on the testes.

    So I've tried a few times to ask Dr. Vartanian if he has any experience with a non-coil embolization but he no longer responds to my calls - so I guess that is my answer which is too bad because I liked him. But as with most doctors if you start talking outside their zone of comfort then you are just a nuisance and a know-it-all.

    So I am continuing my search for an open-minded VIR who has experience with non-coil embolizations. Ross has give me a contact at Columbia in New York and I have a call into him. At least now I am better armed with the details of the GG procedure and how it differs from the standard coil varicocele embolization. I should have been armed with this knowledge at the start but at least I avoided a big mistake (thanks to my UTI) and now will assume nothing.

    To be continued ....

    Neil

    • jimjames
      jimjames Howard31850

      Edited

      Neil,

      Sounds like if you want a G-G like procedure you should book a flight on El Al smile Even if you find an expert IR who is willing to try the procedure, which I'm not sure you will, it would be their first one. Glad the UTI came in handy.

      Jim

    • Motoman
      Motoman Howard31850

      Edited

      I'm wondering why you don't have the expert in Israel do it. Do you know the cost of having him do it? Does insurance cover the procedure you were going to do here, but not there?

      Good luck in your search!

    • Howard31850
      Howard31850 Motoman

      Posted

      Hi guys,

      Yes - if I do find someone in the US who can replicate this process then it will have to be someone who has been doing it for a long time with lots of experience. This is not the type of procedure you want to be the guinea pig .

      The cost of having Dr. Gat do it is prohibitive and is not covered by insurance. Last I heard he was charging $30,000.00 plus travel.

      I am trying to find a procedure here locally that we can all access and that is covered by insurance for varicocele treatment but has the added benefit of treating our BPH. Now at least I understand better what to ask for and to avoid coils.

       

    • ross73654
      ross73654 Howard31850

      Posted

      Neil,

      My consult with Dr David Sperling at Columbia was interesting to the extent that he had read the GG papers and was fully aware of their claims for bilateral varicocele repair as a way to stop the advance or reverse the symptoms of BPH. He made no comments as to whether or not he agreed with their claims.

      As Columbia is yet another major NY hospital to have extricated themselves from my dreadful Obamacare excuse for health insurance, I can no longer persue this option with Sperling unless I pay out of pocket and right now, I am preparing to have my FLA done in Houston next Thursday.

      I will be following your discoveries with a great deal of interest.

      Ross

      Ross

    • ross73654
      ross73654 uncklefester

      Posted

      Hi Uncklefester, 

      Back in 2013, I was able to get myself on the clinical trials being done by Dr Bagla for PAE at the Inova Hospital in VA. It gave me some relief for maybe 2 1/2 years but in the last year and particulalrly the last few weeks, I have been deteriorating rapidly. I have recently gone into AUR and will be arriving in houston unfortunately with a Foley. My MRI reveals that I have a very large median lobe pressing up against the entrance to my urethra and the MRI also shows that the PAE had zero effect on my median lobe as the blood supply there is completely in tact.

      I have great hopes for FLA and it couldn't come at a better time.

      Ross

  • Howard31850
    Howard31850

    Edited

    Just wanted to give another update here:

    I've had a few more good communications with Dr. Sperling at Columbia Hospital in New York ( he is NOT related to Dr. Sperling of FLA fame).

    The discussions focused on the use of a special catheter by Dr. Gat which uses inflatable balloons to target sclerosant to specific collaterals and secondary veins that open during the embolization procedure.

    Dr. Sperling studied the patent by Dr. Gat I sent him regarding this special catheter and he said that no one to is knowledge in the US uses this catheter.

    BUT he did tell me that he accomplishes the same goal of sealing off collaterals and secondary veins through the use of coils in the ISVs to direct the liquid embolic agent to the desired locations.

    So I found this remark quite hopeful in that Dr. Sperling does understand the need to close these veins while treating varicoceles.

    I will speak with him again next week about the use of coils which sometimesave a reputation of sticking to tissue on  muscles and nerves or migrating awy from the site causing many problems. I want to know if and how the latest coils avoid these potential devastating problems.

    So I found all this encouraging. Also Dr. Sperling is a Fellow of the Society of Interventional Radiologists (SIR) so he should be up on the latest technologies.

    I wish Dr. Vartanian had engaged my questions the same way and not deleted my emails! Oh well .. his loss!

    Neil

    • Howard31850
      Howard31850 jimjames

      Posted

      Yes - but he was referring to stuffing the entire ISVs with coils and not treating collaterals. I could never get an answer from Dr. V about this but Dr. S addressed this directly. Dr. Gat claims his balloon-catheter invention allows more precise control of where the embolic fluid goes but Dr. S says he achieves the same control dynamically.

      The other concerns that Dr. Gat raised were above coil migration over time. Also I have seen reports of coils attaching to tissue and nerves which can cause devastating pain. So I next need to discuss these coil problems with Dr. S. Maybe the new coil techniques avoid these concerns. But at least I feel better about sclerosant control in sealing the secondary veins which is important for BPH according to Gat.

      Neil

    • jimjames
      jimjames Howard31850

      Posted

      If Dr. S. is ammenable, maybe you can get the two of them to talk?
    • richp21
      richp21 Howard31850

      Posted

      What is this Dr Sperling's first name? That could help dispell any confusion.

    • Howard31850
      Howard31850 richp21

      Posted

      His name is David C. Sperling not to be confused with Dan Sperling of FLA fame. Also David is a certified VIR whereas Dan is not even an IR though he presents himself as such!

       

    • Howard31850
      Howard31850 jimjames

      Posted

      I won't try to communicate with Dr. Vartanian any longer which is too bad. But when someone deletes multiple emails and refuses to answer phone calls regarding issues of importance to the patient then that says boatloads about the doctor's character. This is where Dr. Karamanian shines. But I guess we have to keep in mind that Dr. V was accepting me as a Medicare patient whereas Dr. K's patients are self-pay which may make a difference in the level of personal attention we can expect. Though I don't think it would make a difference in Dr.K's case.

      I hope my dialog with Dr. Sperling continues ok. I am reading a recent book on the latest embolic agents available so I hope to have a good discussion with him about coils. But he may jettison me as well since I ask too many questions!!

      Neil

       

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