2nd PAE just done

Posted , 16 users are following.

I had my second PAE yesterday - my first was in 2015, and technology has improved, so I felt it was worth a try. My first procedure was done through a groin puncture, and was unsuccessful. The Interventional Radiologist only treated one side, and that side missed the prostate artery. He could not find the artery on the other side.

The treatment yesterday went in through the left wrist. The right side was treated successfully, but the left side was problematic. The artery was located, but was too small to embolize. The IR claims he can solve this problem, and I will need to return for another attempt.

Overall, at least in my case, this was four hours of torture. If I get good results, it will have been worth it, but I won't know that for at least two months. The procedure is done awake, with very little sedative, so the doctors can communicate. My biggest mistake was not demanding a foley catheter before the procedure started - I went into retention in the middle of the procedure and had to be catheterized. The promotions claim that a "pinhole" is used in the wrist to access the artery. The "pinhole" is about the diameter of a 20 penney nail.

You are in a steady x-ray for the entire procedure, so radiation exposure might be an issue.

I should mention that last October, I had a Urolift, 5 pins, which left me in worse shape than before I had it, which is why I elected to undergo another PAE. The Urologist was pushing for me to get a TURP, of course, which is their favorite obsession.

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  • Posted

    Hi Ramblin. sorry to hear of your PAE problems. I was set on that until the urologist said the process takes 6 weeks and only 70% successful and then persuaded me of urolift as it was 'instant'. I presume you have seen my post Geoffrey 61005. I was glad i did it as i hated thought of catheters which is common with other procedures.

    I had hoped for an optimum outcome but am ok with being half better and maybe with time it may improve further.

    Good luck for a decent outcome.

    Geoff

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  • Posted

    Ramblin,

    Good luck, I think Urologists like TURP because they are sure it will work at least for the obstruction. If they are aware you don't want side effects they might recommend other things if they are not greedy to make money.

    My Urologist for example surprised me, I've had 2 PAE's done with no success back in 2016, I went to see him re Rezum possibility and he does that but prefers some type of Turp - he didn't think Rezum would do much for me but said he would try if I want. Anyway he recommended I try a THIRD PAE saying he knows a local guy (Denver) who has had good results. I asked him about radiation, he says at our age it's not worth worrying about since it can take 20-30 years to cause problems. In my previous PAE's (in Australia) the first was via groin, the second via wrist, little discomfort. I had serious sedative they didn't need to ask me anything. Pity you did not do self catheter before the operation probably would have avoided retention situation, sounds very unpleasant.

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  • Posted

    I'm really sorry to hear about your travails.

    I also had a PAE in 2015. 5 1/2 hours. He talked me into going in through the wrist after 2 months of back and forth and then, in the middle of the procedure, said they can't access the artery and will need my consent (and agreement to add about $1000 to the cost!) to go in through the groin. (Not sure that consent while under twilight anesthesia would have held up in court!) Bottom line - it didn't help. Probably mostly because the PAE results for those w/ enlarged median lobes are much worse.

    I'm still in full rentention and CIC'ing about 6 x daily. This usually isn't so bad but for the past month I've had a lot of trouble passing the catheter through the urethra. Very disconcerting (and scary!). Trying to get to the bottom of it.

    Best of luck to you!

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    • Posted

      arlington, sorry to hear - where do you get the enlarged median lobe has worse results? Are you basing that on medical studies or just anecdotal evidence based on people who respond to patient.info discussions?

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    • Posted

      Thanks Mike. Actual evidence of patients on this forum (another one just popped up in Tom's message just below this one) - including myself - as well as counsel from interventional radiologists. There are a couple who say that they can have excellent results w/ PAE in all instances (enlarged median lobe included); however, it seems that they over promise/under deliver.

      Even more importantly, many on this forum have cited studies noting that the success rate for those w/ enlarged median lobes are much lower. If you're interested, next time you see one of those you may want to ask them for the citation.

      Best of luck!

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    • Posted

      Have you tried softer catheters. I am using two. One is Cure catheters and the other is Mckesson, which is much cheaper.

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    • Posted

      Hi Arlington,

      Do you get any bleeding now with your CIC? Also do you use Coude tips?

      Sometimes I have the same problem and I take some nsaids like ibuprofen which seems to help if for some reason my prostate got irritated and swelled a bit due to temporary inflammation. I have more suggestions.

      In my case I had a PAE 3 years ago which went through the wrist. I was considered a perfect candidate due to my large prostate and large arteries. And indeed, the procedure was a great success and took only an hour but sadly I got no benefit from the PAE. I do not have a median lobe but just large side lobes as confirmed with a cystoscopy. Good luck. Howard

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    • Posted

      Thanks Hank.

      Yes - I'm experimenting w/ 2 now (all speedicath) in 2 different sizes (Fr14 and Fr12):

      Coude intermittent (not as flexible)

      and the new Flex Coude Pro Standard - which are very flexible & have an ingenious, compact design

      I still prefer the speedicath male compact - but it's stiff and not coude - so harder to insert if that is a problem like it has been for me lately.

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    • Posted

      Thanks Howard.

      I had bleeding for a couple of weeks when I was having an incredible amount of trouble passing the catheter. Then I went back on Rapaflo alpha-blocker and things settled down a bit. I'm still unable to pass the Speedicath male compact, non-coude through though.

      I'll try the nsaid thing. Did you say you had other suggestions?

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    • Posted

      I think the bleeding can cause some inflammation from the irritation which makes it harder to pass the catheter. That is why nsaids may help. I added more lubricant too which helped. I also got into trouble when I tried to reduce my alpha blocker (uroxatral) but when i got back on it the problem was reduced after a week. I use Speedicath 14fr coudes. The coudes are essential for me. I also modified my technique a bit so after the catheter is in half way I point it straight down at the toilet and very gently push up on it until it slides in. I used to have more of a horizontal position before. Have you heard anything about jimjames?

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    • Posted

      Thanks. I know that pointing it straight up for the first half (because of the shape of our anatomy). It makes sense that it should be lowered for the last part.

      I heard somewhere on this forum that he has had some other health concerns.

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    • Posted

      Arlington,

      When you had bleeding, did you have a UTI afterwards ? I had a little bleeding using Speedicath coude and a UTI afterwards. I switched over to the red rubber GentleCath by Bard size 14 and 12 since then, and it goes in much easier, no bleeding at all. I must have a bend near the bladder that the stiff Speedicath has trouble navigating whereas the GentleCath can bend right around it, no problem. I want to avoid UTI and the antibiotics as much as possible.

      Thomas

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    • Posted

      I had 4 elements that were out of range in my urinalysis. My uro said they were only about 1/4 toward a full infection - but I did a course of antibiotics anyway and it might have helped calm things down a bit - I'm not sure.

      Yeah - the new speedicath flex pro are very fleixible and gentle too.

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    • Posted

      I tried Gentlecath and I agreed that it's much softer than the green Speedicath. I used to bleed very often with Speedicath but now I don't anymore since I switched over to Cure.

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    • Posted

      You are right about Speedicath having problem navigating around the bend. It was exactly what happened to me, for 3 years, lots of bleeding. I was having problems getting a 12fr through. Now I have no problems getting a Cure 16fr. Haven't tried 18fr yet.

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    • Posted

      Howard, I think it was Lester that posted that jimjames retention returned so he went for PAE, which unfortunately failed. Before that, Kenneth posted that Jim had other health issues.

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    • Posted

      I use them all. M14, M14C, HM14, HM14C. My favorite is HM14, hydrophilic straight, but I use M14 more often because it's cheaper. I think they are PVC. Whatever, they are what they claimed, the most comfortable catheters.

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