Another PAE Experience
Posted , 3 users are following.
Summary:
I had PAE (Prostate Arterial Embolization) done yesterday at Advantage-IR in Scottsdale, AZ, by Dr David Wood. It was easy and painless. It will take at last a week to see improvements. It's very early still, but so far I have no side effects.
Here's a description of my experience, which I will update in the next few days and weeks. I am assuming that the reader knows what PAE is (a procedure to reduce blood flow to the prostate to cause it to shrink).
Background:
I've had increasing typical BPH urinary problems for over 5 years, recently to the state where I needed to do something.
This is the first prostate procedure I have had done. I tried Tamsulosin briefly, but didn't like the side effects, and it didn't help much.
- Prostate: 40 cc, trilobal
- IPSS: 21
- Age: 70
The procedure was finished at 3:00 pm yesterday, and it's only 9:00am now. So far, so good. No side effects at all this morning. I will update over the next few days and weeks.
Experience:
The staff and doctors at Advantage-IR were wonderful. Very friendly, caring, helpful and professional. I would not hesitate to go there again.
The procedure was scheduled to start at 12:30 and I had to fast (no food or water) from 4:30 am. I got out of bed in the early morn and had a breakfast burrito and drank lots of water to prepare for the fast.
Preparation involved inserting an IV in my wrist, and shaving my groin at the area where the arterial catheter would be inserted. (This shaving with a scratchy electric razor was the most uncomfortable part of the whole procedure! ) I was also wired with a BP cuff, OX monitor and EKG.
I walked into the procedure room and lay on the bed, underneath a fluoroscope. There were 4 professionals in the room preparing to work on me. A sedative was administered into the IV and I went into a very relaxed state. This was done before the arterial catheter was inserted in my groin, and I don't even remember that happening (I suspect they put me under a little deeper for that). I periodically became a little more alert and could ask questions of the IR doctor, or the anesthesiologist, and everyone answered patiently. When I was thirsty they put a wet sponge between my lips for me to suck on. It was not at all an unpleasant experience; I almost enjoyed it!
They kept me for over an hour after the procedure was complete to ensure that the groin artery puncture was not going to leak, and then my wife drove me home.
I was prescribed a list of drugs for the next few days, including Cipro (antibiotic), Medrol (a steroid pack of pills), Pyridium (for urination pain) and Diazapam (Valium) to both relax the bladder and help me sleep. Since I usually have trouble sleeping after taking steriods, I welcomed the Valium last night. They added a heavy dose of ibuprofen to the list of drugs, I guess partly for pain and partly as an anti-inflammatory.
So far, so good. I have not had any side effects from the procedure yet, but I understand those could set in later today. In discussion with the doctor he told me that the downside of having a smaller prostate (40 cc is the minimum size they will treat) is that there is a slightly lower rate of successfully reducing BPH symptoms (maybe 85% vs 90%), but on the other hand post-procedure side effects are usually less and last a shorter time, and in some cases are non-existent.
Weighing the low risk and minimal discomfort of the procedure against an 85% chance of improvement was an easy decision, especially with Medicare covering the cost. If this doesn't help I can always try something else. Urolift would probably be next.
Speaking of risk, the doctor did mention one possibility which he emphasized that he had not seen in his practice. In less than 1% of all reported cases the patient has had an ulcer develop on the glans of his penis, apparently from some of the beads going into an artery that feeds the penis. He said they eventually will heal on their own, but it may take several weeks. Post procedure, the doctor told me that he was confident that all the beads had gone in the correct arteries, so I'm not worried about this possibility... , well, not too worried...
I will update this as things change, or don't change.
0 likes, 14 replies
daryl54162
Posted
Day 3 (2 days after procedure): Still absolutely no side effects. No pain, no more frequency or urgency than before. If not by now, then there won't be.
Dr Wood told me that men with smaller prostates (mine was 40 cc) generally have at most 1 or 2 days of discomfort, and some have none at all. He assured me that lack of side effects does not correlate with lack of effectiveness, so I'm still hopeful. I should start seeing some improvement around day 7 if it's going to happen.
daryl54162
Posted
Day 4: Unexpectedly I have had more symptoms today. I was up about 5 times in the night to urinate, compared to 1 or 2 usually, and am experiencing increased frequency today. Still no pain at all.
Everything I had heard about the process indicated that the first day or two are the worst, and then it gradually gets better. But I was fine on days 1-3.
On the other hand, having symptoms means that something is going on down there, so it could be a good sign...
daryl54162
Posted
Day 5: About the same as Day 4, though not up quite so often in the night.
Flow rate seems a little diminished today.
ProstatePete daryl54162
Posted
I had PAE about 7 weeks ago here in Miami. My recovery was the opposite of yours. The intense and never ending urgency was brutal starting while I was still in the recovery room and continuing for a couple of days. However by day 5 or 6 I was already urinating much better than before PAE and all symptoms including the intense urgency were gone. Now at 7 weeks, my urine stream is great! Makes me smile when my stream hits the toilet water. My Prostate was much larger than yours (105cc) with an enlarged median lobe so maybe that's why things were so different for me. Hoping you enjoy the same great results I had. And like you, if I ever have to do it again I wouldn't hesitate.
daryl54162
Posted
Day 8: I am only getting up one time at night now. Before it was usually 2-3. Urgency might be a little less.
Otherwise I don't notice much difference. My stream is about the same strength. Emptying my bladder still requires a few pushes at the end.
It's just a week, and they said it takes a week to start improving, so I will be patient. Hoping to see more improvement soon.
daryl54162
Posted
Day 13 Update:
Progress is slow.
Flow is definitely getting stronger -- with a full bladder and a little push I can just about hit the back of the toilet.
Every night now is just one trip to the toilet.
Urgency is reduced and easier to put off.
But: I still need multiple squeezes to empty my bladder.
And one disturbing symptom that may or may not be related. I play a lot of basketball, and just since the PAE procedure, after running for a while my right calf starts to hurt like a cramp, but unlike a cramp it persists for a couple of days and stretching doesn't help. I suspect that some loose ("untargeted") beads made their way into the arteries feeding this muscle and are reducing the blood flow.
If I keep going, my left calf also has the same symptoms, though not as extreme.
It's possible that it's just low magnesium or potassium, or something else unrelated, but very suspicious that I have never had this happen before and it started the next time I played after the PAE.
Hopefully this is something that my body will learn to compensate for.
daryl54162
Posted
Dr Wood responded very actively to this leg pain problem when I told him about it.
He first assured me that there is no way any beads had accidentally "leaked" into the calf. The arteries are too far apart.
He believes that a likely cause is that the point of insertion in the right femoral artery may have healed with some constriction, reducing the blood flow to the whole leg. He arranged for me to immediately go to their office for a thorough ultra-sound of the arteries in both legs. The tech couldn't analyze the results for me, of course, but sent her findings to Dr, Wood. I'm waiting to hear back from him.
daryl54162
Posted
Regarding the leg pain: Dr Wood said arteries and blood flow in both legs was normal. So still no explanation.
However, I played ball again this morning and the pain was much reduced, so hopefully whatever happened is fading.
daryl54162
Posted
Day 16 Update:
-- I can almost completely empty my bladder in one continuous stream, with no pushing at the end. The last of the flow is slow, but continuous up to the last few drops. No more multiple pushes and squirts at the end. This is new.
-- I can just about hit the back of the toilet with a full bladder. This is also new.
-- I have been up only once each night for more than a week now.
-- The desire to go still comes on suddenly sometimes, but it's easier to put off without distress. It's not "urgent" any more, just something that needs to happen fairly soon.
So progress continues in the third week.
tim06748 daryl54162
Posted
This is very detailed and informative. Thank you.
I am the same age here in the UK.
What was particularly interesting was that your prostate size was average, like mine, and yet it still gave you BPH and symptoms for a long time.
I am trying to research the concept that a prostate can cause symptoms even at small to average volumes. The impression is given that the prostate has to be large/oversized to create LUTS but I suspect that the actual volume/size is not relevant (?)
daryl54162 tim06748
Posted
I've puzzled over the same questions. Why does my 40 cc prostate cause problems similar to someone else's 80+cc prostate? And why does PAE often provide less improvement in a smaller prostate than a larger one?
I don't know if anyone has the answers to these questions.
daryl54162
Posted
Two Week Update:
Rate of improvement has slowed down the past few days.
Before the treatment there were good days and not so good days; BPH symptoms varied from day to day.
I'm seeing the same variation now, but at a better average level. Yesterday I actually had to be wipe urine off the back rim of the (elongated) toilet, really strong flow. Then this morning was much diminished, maybe half-way across the water. My best days before the treatment were close to that.
A new symptom started about a week ago: Hematospermia (blood in semen). At first it was just a little trace pink color. But lately it appears almost more blood than semen. Bright red. A little disconcerting, but I had been told to expect it. I guess it can last several weeks.
Dr Wood advised me that I should see most of the improvement within about a month, and I am half-way there. Improvement should continue out to 3 months.
daryl54162
Posted
I just had my one month follow-up after the treatment. My IPSS score went from 21 to 10, which sounds like a little more improvement than I feel.
The main complaint I still have is urgency. Generally a couple of times a day or so I will get a strong need to find a toilet in the next few minutes. This seems about the same as before.
Night time frequency dropped from on average twice to once. I don't think I have gotten up more than once at all in the past couple of weeks, but always at least once, usually between 2 and 4 am.
Flow rate has definitely improved, which means less time spent standing in front of the toilet. I still have to push out the last little bit, but the bladder feels empty after that. It varies from day to day, but I generally can hit the back of the elongated toilet (above the water) and some days could hit the back rim if I tried.
I don't see any traces of hematospermia any more. Sexual function is back to baseline.
The calf pain that I came on when I exercised, starting right after the treatment, has subsided. It's unknown if this was related or coincidental.
I was warned before the procedure that my 42 cc prostate was borderline, and might not show much improvement. There has definitely been improvement, and considering the minor discomfort and hassle involved, definitely worthwhile. Those with larger prostates should expect even better results and might want to consider this.
The doctor said I should still see more improvement in the next couple of months, and we have a three month follow-up scheduled on November 1.
daryl54162
Posted
This is probably my final report.
3 months out, I am about the same as I was before the procedure. I can state that it did not work for me.
There was some improvement for a few weeks. IPSS went from 21 to about 10. Now it is back to 19.
The doctor warned me before I did it that my 40 cc prostate is borderline. Prostates this small are about 50-50 I think.
Anyway, any other treatment I want to try next is still on the table; that's the good part about PAE.
One other thing -- It may be my imagination, but sex does still seem a little better than before. Able to perform a little more frequently, and arousal seems better. Could be my imagination, but I'll take it.