Anyone had the PAE procedure?

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I've had the Urolift but with disappointing results. Have been reading about PAE and it sounds promising. If you've had it I would like to know your opinion. Also, can it be done after the Urolift (do the implants have to be removed)? Thanks,

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  • Posted

    William,

    Many here have had the PAE procedure (myself included). I am not aware of anyone who has had it AFTER a Urolift. The PAE shrinks the prostate by about 30%, and this might change the way the Urolift implants are anchored to the prostate, so you should check with both your urologist who did the Urolift and the IR who is going to do the PAE. Maybe someone here can shed more light on this situation.

    Tom

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  • Posted

    Just as a matter of response, I haven't had the PAE but I have had the REZUM procedure. I was diagnosed with PC back in 2015 but have only been watchful waiting. I thought the REZUM might help to get rid of any bad cells along with that portion of the prostate that died off. I am told that is unlikely. Also, at five weeks post procedure, I am a bit disappointed in REZUM as you are with Urolift. I have heard people with good results from both so I guess I am just one of the unlucky ones. That, or I had too high of expectations. I like the idea of the PAE because it cuts of blood to the prostate. I was wondering if it also would cut off blood to any tumor in the prostate and if so, might it keep any tumor from growing. Anybody have any input about the PAE in that regard?

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  • Posted

    The problem is the blockage of the bladder by the medium lobe. You probably need surgery. The PAE is for stopping future growth, and if there is blockage now, I don't think the PAE will work, as I have experienced.

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    • Posted

      Not true at all. I had blockage, median lobe, dribbling, used self-cath. PAE has solved all the problems, even dribbling and leaking after voiding. The bladder is still tense due to the increased wall thickness, which makes me wake up twice per night on average. During the day can go without peeing up to 4 hrs. PAE shrinks teh whole prostate by 30%, median lobe up to 36% in some cases, if performed right and arteries are still in a good shape and allow for easy access for the IR. Having atherosclerosis and being overweight complicates PAE procedure and makes it sometime ineffective. It doesn't prevent future growth in the long run due to revascularization, but helps in the 12-24 months span most of patients with large prostate.

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  • Posted

    I have had both, first PAE and then Urolift. Can't say either was really a success for me. The PAE clearly wasn't and it can be harder to be successful per the doc that did mine if you are overweight. Apparently that factor and I was pretty complex case with respect to multiple arteries to my prostate and he couldn't get in a good position to block them. I was in for the max time they could allow for the radiation exposure so had to quit.

    I could live with a lot of my symptoms other than getting up 5 times a night. It is slowly, or quickly, killing me. Urolift seemed to help flow some but not the number of times getting up. Doc thought maybe my bladder had hardened over time and put me on OAB meds to see if that will help. I fly a lot for work and the max I could've have gone between pitstops before was 2-2.5 hours. Just had a flight that was 4.5 hours in the air and was able to hold off until we landed for a bio break. Unfortunately that increased endurance isn't translating into better sleeping times.

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  • Posted

    No procedure is perfect for everyone. You take your chances. That is why you have to sign a waiver of liability before undergoing any procedure.

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  • Posted

    I had a PAE in March 2017. I've had modest improvement and have been able to stop taking any meds (tamsulosin). I think it's real important to have the procedure done by an IR who has a lot of experience doing the procedure. I opted for Dr Bagla in Virginia.

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  • Posted

    I've had PAE first by inexperienced docs, then by a so called expert with a lot of success. Don't know if Median lobe is to blame, but it did not work at all. The expert doc in Denver told me before the procedure "sometimes it does not work and we just don't know why" After the procedure he was quite confident that it was going to be effective.

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    • Posted

      My Uro said same thing about my REZUM. Said procedure was successful. I guess he meant the procedure went well but the result so far has been unsuccessful. Only six weeks out so far but no more blood seen or detected in urine via urinalysis . There is still some in ejaculate though. So after six weeks, the jury is still out. A shame though that the Youtube video suggest positive results after two weeks. I haven't seen any yet.

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    • Posted

      Vernon from what I read around 6 weeks out is the time you should see improvement not only Rezum but other procedures relying on tissue dying then being passed out by the body. All surgeons tend to say it went well but this time I could tell by look on his face he looked really happy and confident he found the problem.

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    • Posted

      Thanks for the reply Mike.

      Its been almost 2.5 years for me. Psa went from 1.5 to 2.2 in eight months.

      I'm beginning to experience a slow return of symptoms. I guess prostate is growing as to be expected. I worry about Pca

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    • Posted

      I wouldn't worry about 2.2 I think anything below 4 is quite normal and as you probably know PSA can go up and down depending on activity before you do the blood test - I think this is the problem with PAE and many other procedures really, it will grow back. My latest PSA is 2.4 or 2.6 I forget.

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    • Posted

      Vernon I had PAE in Australia a few years ago - TWICE because they encouraged me to try again. Then about 6 months ago my Urologist told me he had referred several people to someone here Dr Nutting who has had a lot of success, and it was worth trying again. Sadly I must have blood supply they can't see and get to because it didn't work.

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    • Posted

      Thanks Mike,

      I found Dr. Nutting to be an expert on Liver embolizations. New to (Pae). Dr. Nutting goes in through the groin (femoral), the more experienced guys use the wrist. Dr. Nutting inserts a catheter to use a landmark to locate the correct arteries.

      This method is for less experienced or learning Doctors.

      A prominent researcher looked at my Mri following Pae and mentioned one side needed more treatment. There were a few other details.

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    • Posted

      I understood he is not that "new to PAE" he's been doing this for a few years and has done maybe a hundred procedures and my Urologist testified that he has had some success . He uses sophisticated equipment what do you mean by catheter as a landmark ? Going through the femoral is a choice he is more comfortable with, why would the wrist be better? Who is the "prominent researcher" ? You can send me a private message if you don't want to show it publicly. Thanks

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    • Posted

      Hi Mike,

      I'm sure Dr. Nutting has had some success. Dr. Nutting instructs the nurse install a urinary catheter. The catheter is easily identified during the procedure, making it easier for the Doctor to identify the prostate arteries. Experienced Doctors do not practice this technique. The wrist vs the femoral artery. Patients experience a shorter recovery time because the artery in the wrist is smaller and a more suitable location. Dr. Nutting also prescribes Cipro which we all know will damage your tendons.

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    • Posted

      I wonder, Carlos, from where all this misinformation comes from? can cite us the source? I myself underwent 20 months ago with a great success, regardless if a pronounced central lobe. There is no difference in recovery time in cases of wrist va femoral insertion of the stainless steel catheter for prostate embolization. The urethral (so called Foley flexible catheter) is inserted only for the purpose to help the urine void during and right after the procedure in patients with severe BPH. It has nothing to do with the identification of proper arteries to embolize. I didn't have one. Wrist vs femoral often depends on the degree of calcification if the corresponding arteries and easiness to get through. Length of the path is approximately the same. Femoral path a bit more dangerous fir bleeding and often requires deeper sedation to immobilize the patient. Tells nothing about the the exprieng of Dr. Notting, who seemingly had plenty of experience of liver embolization as IR doctor. Total misinformation. In my opinion, Patients who suffer limited PC and BPH are good candidates fir FLA performed by only one doctor in US.

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    • Posted

      Gene,

      I was told that for a man over 5'10" the femoral artery is used, because the length of the path is a factor - was told this by the head of the IR department. Using the femoral artery post op was an issue for me because I had to be in a bed on my back for about 6 hours so the wound could heal and was told that if I got up it could cause bleeding that would require surgery. My bladder kept filling up and I requested a Foley catheter and that drained off over 600ml of urine. I was very happy to get the Foley out and stand up, and go to the bathroom on my own. I also got a back spasm during this process, so I am no fan of being in a hospital back on my bed for hour after boring hour at a time.

      Tom

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    • Posted

      Tom,

      Everything that you describe is probably correct. I'm 5'8", so it was not a problem for me. Also, steel catheters used in IR for the delivery of plastic beads are usually of different length and diameters, which are manufactured by different medical companies. They are all disposables and quite expensive.

      6 hours on a back is definitely an exaggeration . It's another 1.5 hr on a back to give the time for blood to create the clot and polymer that closes the small cut in your femoral to harden. The only possible complication is bleeding after the PAE. Wrist artery is smaller but safer to use. Any IR can use both, has nothing to do with their skills, generally.

      Usually PAE takes 3.5-4 hrs end to end on your back and being sedated in order to stay still during the procedure when the images from previous and embolized arteries are subtracted.

      Length of the steel catheter is not used to diagnose where the tip is located due to the different anatomies of vessels in different men. (0% of men are able to hold their urine during PAE due to sedation. Foley is used only by few IR an only in cases when it was used before PAE. 90 % of PAE IR operators don't use Foleys catheter installed. Some use a disposable to relief the patient after the procedure.

      You were not a lucky one. One of patients wrote yesterday that was not "cauterized" 😃. He definitely meant that a Foley catheter was not installed into his penis. PAE without a stainless steel 2 m catheter would be impossible. Immobilization is usually easier than an arm. Wrist is often use in IR procedures when there are many atherosclerotic plaque build up in femoral path to prostate.

      I was responding to the medical nonsense of IR skills and somebody being "cauterized".

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    • Posted

      Gene,

      I am 6'1". Operation began about 7am-8am. I was lightly sedated - actually aware of everything and very comfortable. No pain. Was back in the recovery room at about 10am. By about 12:30pm I asked for a Foley - since the last time I peed was at 7am. My bladder felt like it was going to explode. Once the nurse put the Foley in, a bit of pain, but instant relief. The Foley came out and I was able to stand up and get out of that bed at about 4pm.

      Tom

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    • Posted

      Gene,

      I'm sure Dr. Nutting has had good success. At the time of my procedure Dr. Nutting was using the foley catheter to assist in locating the prostate arteries. Experienced Doctors at that time were not using this method. I do not post misinformation, I call it research. Dr. Bagla, Dr. Carnivale, Dr. Mcwilliams, Dr. Bhatia. Entry through the wrist is less invasive than the femoral artery if you qualify.

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    • Posted

      I was skeptical until I did a google search and found the following on Johns Hopkins site; "A Foley catheter (a thin, hollow tube held in place with a balloon at the end) may be inserted into your urethra and positioned in your bladder to provide a reference point for the surrounding anatomy."

      So weird you would think the imaging equipment they use is enough not to have to use something like that to help them.

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    • Posted

      Carlos,

      Foley can't be used to locate prostate arteries. It doesn't have any cameras and it's only purpose is to alleviate the void. Of course, it can be used a reference point of the prostate/bladder neck, where the inflatable part of it is located but modern conic scope fluoroscopy used by most IR performing PAE is sensitive enough. They all put some contrast into the system and use digital subtraction technology to embolize and verify the results of embolization. ne of your emails is on review and possibly contains information about the use of Foley in PAE for some other purposes, rather than for for void during and right after the procedure, but I can't understand how the rubber tube inside your urethra can help to localize quite entangled bundle of arteries outside the prostate. It's true that currently in PerFecTed (proximal embolization) PAE they try to reach to a smaller vessels inside the prostate and plug them too. That allow to solve the large median lobe problem, but again has nothing to do with the skill of the surgeon. Regarding the recovery time. I was 70 at the time of my PAE. I was allowed to take the shower the next day, never saw my IR doctor again, and recovery was related mostly to the excruciating pains in the area of the prostate during the process of tissue infarction and death. Never even noticed my wound around femoral artery. According to my research wrist technique is used mostly when the femoral path is obstructed. It's also used during the standard angiography and angioplasty of heart's coronary vessels.

      I'm myself a research scientist and usually thoroughly research the subject, particularly when it touches my health or surgical procedure. There is no point for me to call Dr. Bagla. I have studied the procedure and talked to my doctor about the detail before the PAE. Most patients of PAE never see the Foley, unless they request it.

      That's why I called it misinformation.

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    • Posted

      Gene,

      You tube... search. prostate artery embolization UBC Urology Rounds. Posted one year ago. Dr. Bhatia University of Miami 2:40 Identification guide specifically discusses foley is no longer used after about twenty cases.

      Dr. Bhatia is one of the top guys on the US.

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    • Posted

      Gene,

      My point is and was Dr. Nutting preferred the Foley on Patients at that time. No choice in the matter. This is first hand knowledge.

      I hope you reviewed Dr. Bhatia's presentation.

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    • Posted

      Carlos,

      I'm well aware that some IR docs use Foley during and after PAE to alleviate the void but not to help them to locate prostate arteries. I insist that this statement is misinformation or innocent confusion of yours. I've read everything available on YouTube and beyond, all the research papers published. Nevervencountered such claim that Foley help locate arteries. Keeping prostate in one place during PAE, maybe, but unlikely, it's too flexible.

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    • Posted

      Gene,

      Please take a look at Dr.Bhatias presentation listed on previous post. He mentions and it is in writing on the screen. If not interested please guide me to your presentation on youtube.

      Best regards,

      Carlos

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    • Posted

      Carlos,

      I've seen Dr. Bhatia's presentation. He does right on a slide titled "Identification of prostate arteries" -"Foley is useful for beginners" without any explanation how it's useful. I heard only that Foley is used to make it easier for some patients to make it through the procedure.

      How it can help to identify the right arteries to embolize is still a mystery for me. For reasons of irritation and too many tubes around many IR operators prefer not to install it.

      Your conclusion that Dr. Notting is a beginner is still baseless, albeit Dr. Bhatia mentions that Foley is for beginners.

      Wrist or femoral is dictated by the state of the arteries as my IR operator told me.

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    • Posted

      Gene,

      Thanks for checking out Dr. Bhatia. I mentioned Dr. Nutting preferred to install the catheter. The catheter as mentioned by Dr. Bhatia et.al. is generally used by Doctors new to the procedure. FYI, I never called Dr. Nutting a beginner.

      Best,

      Carlos

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    • Posted

      carlos

      My note was only in regard of why Foley is used. It doesn't help to locate arteries. The beginners note fro Bhatia a bit arrogant. It was used on patients with acute urine retention and old X-ray equipment. Read my notes above. Below is an excerpt fro a research paper writen in 2016 :

      The use of a Foley balloon in PAE procedures for patients without AUR may not be justified anymore because it would induce patient distress and it carries a risk of urinary tract infection and urethral injury, given that the need for using a Foley balloon for anatomical localization of the prostate is diminished with the use of cone-beam CT or rotational angiography.

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