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Question from a reader in today's Daily Mail Health section.
For a long time I’ve suffered from an enlarged prostate, but I cope quite well so I’ve managed to avoid surgery. Nevertheless, when I heard about UroLift I thought I’d finally found the answer. Now I’ve read about yet another procedure, PAE (prostate artery embolisation). If you were in my shoes, which procedure would you choose?
Answer: After four decades in medical practice I have learned to be cautious of any new drug or treatment, medical or surgical, especially before making recommendations, because experience tells me that new quite often isn’t better and can sometimes end up being worse. An enlarged prostate, known medically as benign prostatic hyperplasia, is increasingly common in men with age. Over the years, male hormones cause the gland — which sits around the urethra and underneath the bladder — to become slowly enlarged. This can obstruct the urethra, leading to a poor stream, hesitancy (an intermittent stream), urgency (needing to go in a hurry) and nocturia (going more than once at night). Medications can be very effective — alpha-blockers work by relaxing the muscle of the prostate tissue, while alpha-reductase inhibitors block the effects of male hormones — but a significant number of men do still require surgery.
Since the Eighties, the most popular option has been transurethral resection of the prostate (TURP), a keyhole procedure where a wire, guided by a camera, is inserted into the urethra then heated to burn away some of the enlarged gland. TURP remains the gold standard because it’s the only procedure that long-term studies have shown is safe and effective. However, some men fear TURP as it involves a general anaesthetic and two or three days in hospital. Some are also anxious about the potential risks, as TURP can damage a sphincter (or valve) at the entrance of the bladder, causing retrograde ejaculation — where semen is sent backwards into the bladder. Erectile function is not harmed, but patients are no longer fertile. The UroLift System is a new option that can be done under local anaesthetic. Two to four pairs of what are effectively treasury tags are used to pull back the enlarged tissue, improving flow. The procedure seems to be effective, but no more so than TURP, and there are questions about how long the effects might last as we don’t yet have enough long-term studies to know.
Also the treasury tags are, in part, metallic, which may distort the signal in MRI imaging should that be needed in the future, for example to diagnose prostate cancer.
PAE is another new procedure (first used in the UK in 2012) that must be regarded as experimental until we see the results of large studies — and the National Institute for Health and Care Excellence approves it. Here, the prostate is shrunk by using microscopic particles to block the blood vessels supplying it. It’s done by feeding a catheter up through the main artery in the groin under local anaesthetic.
I think you will guess the option I’d prefer if I were in your shoes.
0 likes, 58 replies
stewart_75893 derek76
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derek76 stewart_75893
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uncklefester derek76
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So he'd rather have a cheese sandwich than sex? I feel sorry for him if he gets no pleasure from sex.
derek76 uncklefester
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nealpros derek76
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Hi Derek,
The TURP can lead to incontinence, and or impotence. The TURP is called the gold standard because the advertising from the company that sells the special equipment needed to do it, uses that phrase in their advertising. It's been used a long time, and therefore, on many men. That does not mean that it's the best procedure, only that over time it was the most used. If you look throughout this site, as you should before you make any decision, you will read many horror stories about it.
The PAE is done by an interventional radiologist, not a urologist, so it will never be recommended by a urologist. A general practitioner probably has no business recommending any of these procedures unless he has had them done on himself.
The Urolift, like the PAE, has only been done in the last several years. There are, therefore, many doctors out there who are just learning to do them. You don't want a doctor to be learning on you.
In summary, both the Urolift and the PAE can be very effective if done by a a doctor with a great deal of experience successfully doing the specific procedure.
The PAE is by far the most benign of all of the procedures for BPH. I had 3 of them, and the third one, done by a second doctor, has been very effective. I would have 10 of them before I considered a Urolift, and I wouldn't consider a TURP under any circumstances.
Neal Pros
derek76 nealpros
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No need to preach to the converted, I am only the messenger relaying an article about what is still the worlds most used procedure. I you read my posts on here going back years you would know that I turned down TURP in 1995 and that as soon as I read Johnny's first post I PM'd him of its dangers and listed the alternatives with a link to the NICE web site. I don't know if he ever found it to read and others I sent him as they were not replied to.
However TURP does work for some prostates and Johnny has been advised by his consultant who is evidently the deparment head.that it can be done without RE.
I don't know about profit for makers of TURP equipment which is cheap compared to Laser equipment. Also laser procedures for State hospitals in the UK and Canada is a cost saver overall as it is normally day surgery.
Three PAE's? Wow! That really is a successful procedure:-) Why did the first two not work?
After my GL in 2004 life was back o normal by day three. After my Thulium/Holmium laser in 2013 it took a couple of weeks as I got an infection as the catheter was let in to long.
In Johnny's case we don't even know if PAE is an available option for him in Canada.
nealpros derek76
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3 PAEs. As it was explained to me, it's like your wife struggling to open a jar of pickles, handing it to you, and you opening it easily. Perhaps she had it mostly open before she handed it to you.
PAE is the least involved of any prostate procedure. No general anesthesia needed, no pain beyond the insertion of an IV, NO CATHETER(!), short recovery, no burning urination, and one 1/4 inch cut in your groin.
Neal Pros
derek76 nealpros
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nealpros derek76
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I paid for second one. MEDICARE paid for the third. As to beads, I don't know. My best answer is my answer above about pickles.
Neal Pros
derek76 nealpros
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Jezzaman nealpros
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Hi Neal
I am extremely interested to know more about your experiences with the PAE.
I have had one which altough it has shrunk my prostate I am still "occluded" according to the UROlogist at my local hospital who wants to do GL TURP on me!
My PAE was done under trial at the Oxford University Hospital under a Dr Tapping. in Feb 2016.
I would consider another if I thought it would have more of an effect.
My current symptopms are very mild. Just a slower flow and frequency when I go out drinking pints of beer, coupled with occassional Acute retention. (its only happended a handful of times in 3 years and I can now catheterize myself Ok when this happens)
I sleep through the night despite drinking wine often of an evening! First passing in the am about 7am,
sometimes not until later!
nealpros derek76
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nealpros Jezzaman
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My last PAE was done by a different doctor, Dr. Bagla at Virginia Vascular Institute. He said that the first doctor may have missed two of the major blood vessels to my prostate.
Urination in men is definitely affected by how much we drink. I was drinking 4.5 liters per day. The doctor told me that normal liquid consumption is 1.5 liters per day! I measured it by drinking 8 ounces of water and counting the gulps. In my case, it took 8 gulps, which made it easy to count for one day without carrying a measuring cup around all day. Cutting down my liquid intake was easy, it surprisingly turned out, and very helpful.
It turns out that we never own alcohol. We only rent it, as it goes right through us. That said, Dr. Bagla told me that alcohol and caffeine irritate the prostate. When I reacted in horror, he said that it's a lifestyle choice, meaning that it's in my hands to decide. So, we probably can expect trouble if we do too much of it. I sometimes do, but I'm prepared for the consequences, as you could be with self cathing if necessary. But the additional PAEs may make that unnecessary.
The PAE is so much more benign than a TURP, that if I were you, I would definitely consider a second, and perhaps a third one with a different, very experienced and successful doctor(s), before a TURP. But first, see a different urologist and get tested to find out exactly what is going on, which you can then discuss with the IR doing the PAE, to confirm that the PAE will help. Remember that the urologist has absolutely no interest in you getting a PAE, but a TURP means continued employment for him or her.
Neal Pros
Jezzaman nealpros
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Hi Neal,
all very useful information for which I'm grateful.
Also very interesting that only the third PAE worked for you. Did they do MRI scans on the first two PAE's you had to see whether the prostate had shrunk?
As I said in mycase it had reduced but that doesnt automatically translate unfortunately to a lessening of the constriction around the Urethra! Im in UK where as far as i know there are no "big names" in the PAE procedure. There are however the pioneers of it in Portugal which is a possibility for me. I need to do more research.
JT
nealpros Jezzaman
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There were MRIs used in all of the PAEs. The first doc just seemed to have trouble identifying the proper blood vessels .
Under the circumstances, it may be a good idea to consider Portugal. You definitely want someone who is very experienced doing this.
But, please continue to do your research !
Neal Pros
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