Alternatives to TURP for BPH?

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I have had BPH for about 30 years. I had surgery about 20 years ago and have been taking medications but my BPH has worsened  especially in the last few weeks. I have discussed having the TURP procedure done but my doctor tells me that there is a bout a 5 % chance of being incontinent  and/or impotent afterwards. This scares me a lot. I have begun to learn about some other procedures like Rezume and I wondering if they have lower instances of these after effects. I would also like to know if there are other new treatments - and how they compare. 

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  • Posted

    Rezum appears to be the leading non invasive procedure now. Retro ejaculation should be under 10% and I believe incontinence and impotence would be rare. You could also self cath (CIC) like me. Retro ejaculation, incontinence and impotence are 0%. If you don't have an enlarged median lobe, Urolofit may be a good fit. No retro, incontinence and impotence I've heard of but there have been reported complications like with any procedure. You may also hear about something called FLA. Personally, I'd stay away from it as only 25 patients have reported back which IMO is too little to make a decision on. Also the anecdotal reports show results no better and possible not as good a Rezum.

    Jim

    Jim

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    • Posted

      Hello jimjames

      Thanks for the reply. You say that you believe incontinence and impotency are rare for rezum. How did you come to that opinion?

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    • Posted

      I haven't heard it reported here or mentioned in my readings. That said, I'd go to the Rezum site and/or other resources and go over the study data. The exact percentages should all be there. I recommend anyone do this, regardless of procedure, before being operated on. That's the problem with FLA. There is absolutely nothing to look up because there are no published studies.

      Jim

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  • Posted

    Hi Joseph, I had focal laser ablation (fla)for a median lobe with 100% success and zero side effects and zero pain but first may I ask what surgery you had before? FLA is the least invasive but costly but well worth it, in my case I came to the conclusion my health was worth more than my bank account and when it comes to quality of life and avoiding nasty surgical side effects along with pain and permanent damage I would go with FLA but not with just anyone, I flew from New Zealand to Houston Texas to get Dr K who you can read about by doing fla research on this forum, each bph condition is different from anothers and therefore requires very careful consideration once establishing your own specific condition for example traditional turp surgery can be either useful or a nightmare depending on what needs to be done and on who does it, do lots of research don't trust the so called experts and don't believe anything until you prove it, yes its difficult at first but well worthwhile to avoid permanent damage and pain, kind regards Brian. 

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    • Posted

      @Brian: FLA is the least invasive

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      What makes you say that? Less invasive than TURP, yes, I don't think it's less invasive than Rezum, Urolift or PAE, for example.

      Jim

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    • Posted

      Hi Jimjames, I have done a great deal of research and like I said to Joseph it comes down to what each persons specific issue is and who does it, you mentioned only 25 fla patients have reported back, I know the number of successful fla patients is very high in comparison to other options and certainly 25 successful patients is not correct, many fla patients don't bother reporting on this forum because they feel they will be undermined by people who for whatever reason want to belittle it. As I said to Joseph and anyone else who reads this -do your homework well!

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    • Posted

      @Brian: I know the number of successful fla patients is very high in comparison to other options and certainly 25 successful patients is not correct

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      On what basis are you claiming that "the number of successful fla patients is very high in comparison to other options". Yes, there are more than 25 patients but those patients are from a doctor who has not reported any of his data. Dr. K., the one who just about everyone here has gotten FLA from, only did 25 FLA's for BPH the last time someone reported back. The majority of them have posted here in the forum and their results are no better than Rezum, in fact I'd say they are not as good. There have also been a couple of cases of retro reported and one person no longer can get erections without Viagra, an issue he didnt have before the procedure.

      I find your comment that people here "belittle" FLA insulting. Why is that you are so sensitive to other points of view. EVERY procedure, be it TURP, Rezum or Urolift, has been critiqued here but that is not "belittling" it's information sharing and how men benefit from forums like this.

      If you want to have FLA, go ahead, but if you're going to post that the results are better than other procedures, then either back it up or don't complain when others disagree.

      I truly hope FLA will work out because it has a lot of things going I like. That said, based on the scant data available, I haven't been able to convince myself that it's better than some of the other alternatives with actual study data.

      We do agree that "do you your homework well".

      Jim

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    • Posted

      Hi Jimjames, Dr K is collecting precise data at his own financial loss and is wants all other FLA Dr's to do the same and to share their findings, it is an outstanding technology which has excellent results and as you say is far less invasive than turp which for decades has been considered the gold standard but as we all know has many documented sad results and common sense begs us in this age of technology to find a better way which is why like you and all of us we are all keen to find it, I am sure it will be easy to find sad results for all the available options and thank goodness good results too, if you feel my opinions are biased then I welcome you to supply data to back up your statement that resume has better results than FLA as since you indicate you yourself are unbiased  will you at the same time supply the sad results with an honest conscience for the good of your fellow man?

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    • Posted

      Hi Joseph, if you go to the patient home page,type in prostate problems then you will see prostate problems click on prostate problems, scroll down to going with focal laser ablation for bph posted by j12080, there are 1058 replies dated 2 years ago, actually j12080 helped me to have confidence in FLA and he is in a better position to supply information to you, he is a very helpful person. I recommend you contact him as will be happy to assist you, kind regards, Brian.
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    • Posted

      I talked to Dr. K twice and he was very compassionate and gave of his time generously.  I think the problem is not finding enough clinical studies covering FLA for BPH.  
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    • Posted

      Brian,

      I'm sure Dr. K is a wonderful doctor and human being. You probably are too. But this is not what the discussion is about.

      YOU made a claim that FLA has better results than the other less invasive procedures like Rezum. I asked you to back it up and you turned around and asked me to prove it isn't so. LOL.

      Brian, THERE IS NO PUBLISHED DATA on FLA for BPH so you can't make any such claims and to ask me to prove you're wrong does not comply with the laws of logic and critical discussion.

      The only thing we have to go by with FLA are the anecdotal reports in the various threads here. And if you read them you will find a mixed bag of results no better than Rezum. We've had several outright failures, some retro and one fellow who can no longer hold erections without Viagra. It's all in the threads.

      BTW Dr. K. never projected more than I believe a 70% success rate which was a post of his in another forum over a year ago. It's others who have made it seem like a miracle cure, not Dr. K.

      I suggest you look up "confirmation basis" because I think you are biased because you have so much invested in FLA. I have no investment whatsoever. I've never had a procedure or surgery and am open to all of them and frankly nothing would please me more than to find out that FLA is better than Rezum but you cannot make that claim right now.

      This will be my last response to you as I think the forum has more than heard enough both of our views on this topic.

      I wish you well.

      Jim

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    • Posted

      Hi Jimjames, like you I do not have investment in FLA as you put it, and like all of us here we all want the best for our fellow man, although discussions can at times be a little heated its based on all the good we see in something and disturbs us when someone else seems to find fault, I certainly do not want a battle I just want people to hear a well balanced point of view, so then take good care, kind regards Brian.
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  • Posted

    Joseph, If you want a procedure that is not trans-urethral, you are down to FLA or PAE.  There is much, much more research on PAE and it is FDA approved for BPH.  I have been researching in-office injections for BPH, but these are small companies having trouble financing the clinical trials.  
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    • Posted

      I see you've been looking at injectables. What ones in particular are you looking at? I've been watching Fexapotide Triflutate. Seems that company went to the EU for their approval. Some are predicting they won't get approval because their trials were iffy

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    • Posted

      Hello uncklefester

      What I'm trying to do is find a bph treatment that works AND has a low incidence of after effects - mainly incontinence and impotence. If you have any knowledge of this I would be really interested.

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    • Posted

      Clinical studies are your best source of information.  Everything here is anecdotal except for reports from individuals who are reporting on their own procedure results (and technically even that is anecdotal.)  There is lots of good information on this forum but there is lots of mis-information as well.  In my opinion, you should disregard anything that isn't backed up with data (i.e., clinical study results.)  FWIW, when I asked my urologist about the likelihood of incontinence from a TURP, he told me in 30 years the only times he's seen that is with patients who were already having problems in that area.  (And this piece of information is worth exactly what you paid for it!)

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    • Posted

      Fester:  The three injectables are PRX302 by Sophius Corp, Nymox-1207 and Gel-Tx by ProSurg.  I talked to the president of ProSurg. I also talked to one of the doctors who headed a clinical study for Gel-Tx.  The doctor felt there was promise for this procedure, but the company is small and clinical trials are expensive.  For Nymox-1207, improvement in 1-2 to weeks.  No sexual side-effects.  Lasts 6-1/2 years.  I feel that this will be a viable procedure for a common disorder.  Done in one office visit.  I don't know if these are available outside this country.  

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    • Posted

      I think we are looking for something with the least side-effects, well-tolerated, and good success rate.  Some TURPs come with significant sexual side-effects.  Can be high for retro-ejaculation.  The prostate is reduced by some sort of energy (e.g. heat, steam, water) using a variety of methods.  Many men on this forum want to maintain sexual function. PAE doesn't use the urethral route and these associated side-effects are eliminated.  So this is an alternative and approved by the FDA.  

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    • Posted

      Hi Lee and Joseph, what are your thoughts on the following;I was told by a urologist surgeon who was going to perform turp on me as I had a median lobe pushing my bladder valve up and restricting the flow that will become incontinent from the turp aftter I had asked him if he cuts away part of my upper shincter bladder neck valve and removes the prostate urethra and cuts away a fairly large portion of the prostate approx 50% that then that upper bladder valve wont hold urine and the only valve left to prevent incontinence is the remaining lower prostate valve, will that lower valve be able to hold all the urine in the bladder and in the prostate?He said NO! and that I will be incontinent, then he said the trouble is we dont know if the lower valve will hold the urine as it depends on each person, I also asked another urologist surgeon and he said youl be fine it usually the second turp that is when incontinence happens.So as you can see its quite conflicting information and each man will have a different blockage issue and a different surgeon with perhaps a different view, so because I wanted to avoid the above and avoid  retro ejaculation, and avoid penis urethra potential damage as many urologists will slice up the length of your penis urethra to avoid damaging it from the turp tools, I chose FLA which is done via the anus with a tiny laser, it worked very well 100% success and zero pain during and after by Dr K.
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    • Posted

      Hi Brian, just curious. Do you know the size of your median lobes, also known as Intravesical Prostatic Protrusion (IPP), before your successful FLA ? Hank
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    • Posted

      Brian, I'm glad that it worked for you.  I talked to Dr. K for about an hour.  I sent him my image studies.  He wasn't confident it would work for me.  Mine could be a contributing bladder issue.  I would rather have FLA than a TURP where one doesn't always know what damage is done by damaging tissue and valves. I like the fact of using imaging during the procedure so one has a good view of what is being done.  When a urologist goes through the urethra, there is not a good overall view, just what it is in front.  

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    • Posted

      Hi Hank, Im sorry I don't but the prostate was approx 65mm high by 40mm wide about 55gm, Dr K unblocked the median lobe restriction without any side affects at all and without pain, but he said he had also taken some tissue along the prostate urethra to help the flow, 

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