BPH problems NEW treatment

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GENTLEMEN; my name is Phil and I live just outside of Denver CO. in Centennial. I am 68 years old and have been having BPH problems for about 3 years. I started to take Super Beta and tried several natural pills but found they had no results, just a bunch of advertising crap.  I went to my PCP doctor and he put me on Finasteride, then Avodart, and then Flomax. I took them over a 9 month period and found they caused all sorts of problems from dizziness, to E.D. and dry ejaculations. All of them are bad stuff, please stay away from them. My issues were getting worse. Having to get up at night 4 or 5 times, stopping and starting, weak stream, have to push or strain to start, etc.

I decided to go to a prostrate doctor and did much research on the internet and found one locally who was advertising the newest treatment being the “Green Light Laser” I was excited. I made an appointment with him. I had to do several tests with him including a Cystoscope (small camera down the urethra) which was not fu at all. I would ask your doctor for a local. He found no cancer and that my bladder was working fine. He found a very small amount of scar tissue which he removed with the scope. He said many people get these form when they have other operations and get a catheter during the operation and the doctors sometimes are not very easy and cause it. I have had several operations including a hernia just 1 year back. He indicated he wanted to wait for about 3 months to see if everything would heal up and them we could go for the Laser treatment.

After waiting 3 months and then going back in to see him he indicated that there was this new procedure out called “UROLIFT” and he felt it was much better and less invasive.   He also indicated to me that he had found that the Laser treatment was very underpowered and he many times had to finish up with using the button TURP method to get it done. He gave me all the information on it. I did some more research on it including this webpage. After seeing that there was some people reporting poor results in this “UROLIFT” procedure I decided to go see another proctologist to get a second opinion. Was I ever glad I did.

The new Doctor told me he had been part of the original studies done on the “UROLIFT” and found it very disappointing. That many of the patients saw very little or no improvement after having it.  The brochures show that you get 2 of the stainless steel implants but in all of his patients had at least 4 or more put in. He also said the tool they use to do the implants is had to use and if the Doctor is not very good there can be other problems with them not being placed in straight. He said that the other big problem is that the prostate continues to grow and at some point the implants may begin to cut into the gland and cause more problems. At this point if you want to have the “Green Light Laser” treatment done they have to go in and remove all the stainless steel implants which is not easy and takes up more healing time.  He also indicated he has done over 1,000 of the Laser treatment and had no power problem and it is the best way to go if you have to go that far. The main problem is about 30% of his patients have Dry Ejaculation after this procedure.

Then he tells me that there has been a breakthrough and it is the best thing out there so far. It is called “REZUM”. It is a water vapor therpy. It is a minimally invasive BPH treatment that delivers with just a few drops of water a targeted, controlled dose of stored thermal energy in a water vapor directly to the region of the prostate gland with the obstructive tissue. The procedure can be performed in a physician’s office and may minimize the procedural discomfort, post procedure complications and side effects associated with other BPH treatments.

It eliminates the Hyperplastic tissue from inside the prostate which then allows the urethra to open up normally again. It provides patients with significant improvement in BPH symtoms, including frequency, intermittence, urgency, weak stream, straining to urinate and nocturia while preserving erectile function and urinary continence.

I will be getting back with my new proctologist in the next few weeks to set up tests so I can proceed with this treatment and I will get back on this after going through with it. I guess there is about 6 or 7 places in the US that are now offering this treatment which is still going through more testing but he says he has done 50  or so and it is really looking like this will be the new  way to treat BPH. Here is a web page with more information. Have a great day. Phil

https://bphnews.com/2015/12/02/nxthera-publishes-1-year-results-of-rezum-ii-clinical-study-evaluating-the-efficacy-of-the-rezum-system-in-treating-bph-symptoms/

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  • Posted

    Hi Phil,

    We have had people here with good results from Urolift (see relevant threads) but also with not so good results. A lot depends on a person's individual situation and the doctor performing the operation. An operation or procedure that is good for one person may not be the best for another.

    There is also a relaitve new bph treatment called PAE. You may not have heard about it from your urologist because they don't perform it. It's performed by an interventional radiologist. 

    The REZUM treatment you mention is quite new but sounds very promising. Another promising treatment, at least on paper, is something called MRI Guided Focal Laser Ablation. As far as I know, it's only performed by one doctor currently, a Dr. Sperling. 

    Personally, I don't want to be the first kid on the block for any of these new and promising treatments. I have chosen a different path called Clean Self Catherization (CIC). It allows me to empty my bladder completely any time I want and has virtually eliminated all my bph symptons. Meanwhile I will follow the newer procedures such as PAE, REZUM and Focused Laser Ablation. Sometimes these things pan out, sometimes not. 

    Wish you the best moving forward. 

    Jim

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    • Posted

      Hi jim.. I would suggest to you to research the HOLEP procedure. I got mine done in December of 2015,approximately 19 weeks ago.It was not a "walk in the park" for the first 10-12 weeks of recovery but my results have been very positive. The key to this procedure is finding the right Doctor as there are not many who have the training to perform this ...I was also getting up 4 or 5 times a night and suffered from Prosticitis on a weekly basis... While none of these procedures are perfect,the HOLEP procedure has worked very well for me and many others..Check out the HOLEP blog on this site...Sam
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    • Posted

      I had Ruzum done 6 weeks ago. I am apparently an outlier, but I still can't pee as well as the day before I had it done. My doc says that other than me, his results have been universally good. Most people can pee without a cath within 7 days and he says he has one guy he did on the same day as me who hadn't peed without help in over 4 years who is now funtioning normally.

      For me, this has been one big sh*tshow - but for most others its ideal. Sexually - I'm fine, no RE. The PAE seems to do the same thing as Rezum, but its even less invasive, but takes longer to work. I might try that first as there is no catheter involved and apparently virtually no side effects or down time, even short term. Good Luck!

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    • Posted

      Hi Sam,

      I decided to pass on the more invasive procedures  such as HOLEP because of the incidence of sexual side effects such as retro ejacuation. I'm actually quite happy at the current time with managing my ocndition with self catherization. I'm glad yours has worked out. You wee smart to pick a doc with lots of experience. That seems to be key.

      Jim

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    • Posted

      Hi Oldbuzzard,

      Where did you have the Rezum done? Was it part of a trial? Did you ask your doctor how many he has done? While I have no reason to doubt the veracity of your doctor, I always give pause when a doc tells me "you're the only one I've had a problem with". Good luck with PAE if you go ahead with it. 

      Jim

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    • Posted

      I had it done at the Cleveland Clinic and it wasn't part of a trial. He's done over 60 of them and I researched it thoroughly, including talking to the parent company that makes the unit. In the clinical trial, of 82 people, the longest anyone went needing a cath was 10 days (only 3 needed more than a week) and I broke that record by 10 days. It's unlikely that I would have the PAE done because it does the same thing Rezum does (kills tissue) via constricting blood flow instead of steam.
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    • Posted

      I talked with my Doctor on the PAE treatment and he said that is also really not a good way to go. Lots of issues with it. I guess it is a way of zapping the capilaries around in the prostate which kills the blood supply so it stops growing. too many things can go wrong there. JMO.
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    • Posted

      Was your doc a urologist? Urologists don't do PAE's and tend to bad mouth it, often without much knowledge of the procedure.

      Jim

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    • Posted

      If the doctor you talked to is a urologist, remember to take what he said with a grain of salt. Urologists don't perform the PAE, and therefore DON'T MAKE ANY MONEY ON IT. The PAE is done by a different kind of doctor called an interventional radiologist.

      Neal

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  • Posted

    Phil,

    After considerable research on my bph treatment options and my increasingly diminished ability to pee, combined with every side-effect ever reported with FloMax, I finally selected UroLift (UL), and I am so happy I did. I did give strong consideration to PAE but went with UL because it does not destroy prostate tissue at all. I will delve into that concern in another post if pressed to do so. Why did I select UL? Very simple: it works and it works fast. I know it may only be a stop gap solution but so are TURP, PAE, and many other procedures. Moreover my enlarged prostate was nevertheless functional and I did not want to have it ablated and lose sexual function and or face urinary incontinence issues. Before UL I could pee only dribbles and that was with the maximum dose of FloMax. I could have sex but was so obstructed, I could not ejaculate. Two weeks post UL I could pee as I did when I was a teenager and I was now able to ejaculate easily. If I find that my renewed abilities fade with time I can again have another UL implant installed and if that should also fail I can do PAE or any other procedure now available. Moreover, UL is covered by Medicare. If you are eligible for UL I strongly advise you do it. As for alleged UL failures, find a physician you have faith in to perform the procedure. I was the first UL patient my urologist had done but because I was his first patient I had the benefit of having a UL rep, also a urologist, advising and guiding my urologist and the entire procedure lasted only 20 minutes. I also should add I had the dreaded 3rd lobe and that was dispensed with by merely pinning it back so it could not obstruct my urethra as it passed through the prostate. And I should add my 3rd lobe was relatively small. To conclude, UL is fantastic, the odds are it will probably work for you if your prostate is not overly enlarged and you do not have a large 3rd lobe, and your bladder has not been overly stretched by years of urinary obstruction. And if UL eventually fails you can stil have other and perhaps newer treatment options when those become available.

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  • Posted

    I went in yesterday for my 2 week check-up after having the Rezum procedure.  Doc says everything is going normally(based on all his other patients).  He said mine was the first one he did with just a local.  Next time he needs to maybe wait a little longer for the deadening to take or give a little bit more juice or maybe both.  I'll be able to forget the pain if all ends well.  Right now after 16 days, I'm able to easily go, but not a lot yet.  Interestingly though, I get thru the night with 2 trips and sometimes and only one to the bathroom.  Right now, there is a little blood at the beginning and this is probably part of the healing process.  Hope to report good results in the near future.  I'm going to try it again.  Digital monitors and wireless communication have been around a long time.  I'm reminded of that every time I pray for a healthy prostate exam(finger=digital monitor, prayer=wireless communication),
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    • Posted

      I'm glad you're doing better than I was at 2 weeks - I think your experience is much more typical. I'm not sure that they can numb you well enough to make doing this with a local a good idea. Knowing what I know now, I would have asked to be twilighted like they do for something like a colonoscopy. My life was not at all enriched by being awake for the procedure.
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    • Posted

      How are you doing? I have read several have had to wear a cath for up to 6 days how did you do? Are you peeing with blood or has that cleared? 
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  • Posted

    Phil,

    I am checking in to having the Prostate Artery Embolization (PAE) done with Dr. Charles Nutting with RIA Endovasular, located in the Denver Tech Center. This procedure is done by interventional radiologists, not urologists. If you ask a urologist about PAE expect them to throw some shade on this procedure. Most urologists promote the procedure they've trained in. There is a thread on this forum about PAE. It's worth a read before you make a decision.

    Stebrunner

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    • Posted

      Thats good to hear. I'll do some more research on PAE. like you said they all want to do it their way. Thanks for info.
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    • Posted

      I live in Boulder and I would like to know if you followed up on this, and, if so, what your exerience has been.
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    • Posted

      Jack,

      You can see some of my postings on a thread on this site at http://patient.info/forums/discuss/has-anyone-out-there-had-a-prostate-artery-embolization--301859?page=5#2186702

      Here's the post I made right after the procedure:

      Had my PAE done last Thursday (about 4 days ago) with Dr. Charles Nutting of RIA Endovascular in Denver. The procedure took 3 hrs with another 2 hrs in the recovery room. They used Twilight sedation, and I felt no pain. At times when the imaging camera was out of the way, I could see my arteries up on the screen--pretty cool!

      Dr. Nutting went in through my groin and embolized both sides. I had been self cathing (CIC) for the 2 1/2 months prior, and they put in a Foley catheter for the duration of the PAE. They wanted to use the same size I used for CIC so they used a FR14 with a coude tip. No pain or problems with its insertion or removal.

      For about 8 hrs after the procedure, I had sudden, frequent urges to urinate. Each time I peed a weak stream. Dr. Nutting told me that this would last for a few hours, then the prostate swells for a few days. I'm in that phase now. The self cathing was painful and tricky at first, but has been settling down. Looking forward to my prostate shrinking.

      Now on day 4, I'm feeling better. I've been taking Advil to reduce inflamation, and I'm taking a 7-day course of antibiotics.

      Last December I experienced acute urinary retention--they drained 7 liters out of me! 5 urologists have told me I will never regain bladder function and that I will have to self cath for the rest of my life. I went ahead with PAE, because my prostate was already at 90 cc and getting larger and something needed to be done. I also wanted to make self cathing more comfortable and easier.

      In the past few months of self cathing, I've noticed that my bladder is signaling me when it's time to urinate, and before I self cath, I try to pee naturally. On occasion, I've peed a weak stream for a couple of seconds. Most of the time it's been some dribbling. The signaling and the dribbling tell me that my bladder is trying to work. I'm hoping PAE will remove the obstruction and that I can eventually restore bladder function.

      My Blue Cross insurance declined to cover the procedure, saying that it isn't covered by Medicare (U.S.). I opted to pay out of pocket. Time will tell if I've made the best decision for my prostate issue. At this point I'm optimistic.

      -----------------------------

      Here's where I'm at a little over 2 months past the procedure. Self cathing has become much easier. I'm now able to frequently pee a weak stream and can often naturally void about 100 ml. Then I cath the rest.

      Before PAE my prostate had grown to 90 cc with a large, mis-shapened median lobe that was pressing into my bladder. I totally flunked the urodynamics test my urologist gave me. A cystoscopy showed that my urethra was clear and that I have bladder stones.

      Once my prostate stops shrinking--which should be in another 2 months--I will have the bladder stones removed. Usually the stones are removed before PAE, but in my case, we decided to have them removed following. The idea is to get the median lobe to shrink and pull away from the bladder, making bladder stone removal easier.

      I am very empressed with Dr. Nutting and his staff.

      Stebrunner

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    • Posted

      Hi Stebrunner

      Hope your doing well. Thanks for the reply. Based on web research I also came to conclusion that PAE might be best alternative but did not come up with right Google search to find specailist performing procedure in our region. I kept on coming across the same two centers in the US (in NC and VA). Your post made me aware that there was a specialist in Denver. I  am glad to hear you had a positive experience with Dr Nutting. I will be calling the office to try to get an appointment. Thanks for your help

      Jack

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    • Posted

      Hi, Jack,

      Be sure to check out Dr. Nuttings bio on the RIA Endovascular web site. He trained for PAE with Dr. Pisco, who pioneered the procedure, in Portugal and with several other radiologists who were early adapters, including Dr. Bagla in Virginia.

      My cost for the PAE was $13,000, because my insurance company won't cover it. I am in the process of appealing their decision. Of that amount, $3,000 covered Dr. Nutting's fee, and $10,000 went to Sky Ridge Medical Center, the hospital where my PAE was done. Sky Ridge is on the south edge of the Denver metro area.

      The nurse who checked me at the hospital told me I was very lucky to have Dr. Nutting doing my PAE as he has patients coming in from all over the world to have procedures done. BTW, this nurse isn't on his payroll. Dr. Nutting pioneered a procedure to treat liver cancer.

      I know that my case specifics were challenging, and I'm very pleased with the progress I've made so far.

      Stebrunner

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    • Posted

      Hi Stebrunner

      I did check it--very impressive! I made an appt this morining. Thanks for your advice and help.

      Jack

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