Enlarged median lobe management by PAE

Posted , 10 users are following.

Where do I can find articles, or could someone share personal experiences about PAE procedure and enlarged median lobe 

management by IRs?

Somebody here, previously to PAE, had a conversation with an IR about

how to manage median lobe enlargement, during the procedure, 

specially how to obstruct blood flow, without bad consequences to bladder and urethra? 

0 likes, 15 replies

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15 Replies

  • Posted

    My surgeons told me the median lobe was not an issue and there was no special procedure, it would just shrink - that never happened. The Urethra not affected, nor the bladder. The idea is to starve the prostate and kill the parts that are obstructing, apparently it works around 80% of the time but I'm starting to doubt those numbers.

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    • Posted

      Hi mike588, that´s the problem. Most doctors said (including me) that an enlarged median lobe poses no problem when doing a PAE, but most here that have done the procedure claims that what affects him after a PAE is exactly the median lobe not treated.

      That´s why I´m looking for accurate information about it.

      What´s is the real trutyh behind it? Are there any types of image scans that can reveal it, particularly image scans that don´t use iodine contrast?

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    • Posted

      I don't know but I can tell you that my PAE embolized a small part of the prostate, but on the other side away from the Urethra - it's not like it worked and did not handle the median lobe, it did absolutely nothing to the part of the prostate that constricts the Urethra. I can't recommend it why spend thousands of $$ with something so chancy? I don't trust there is accurate information, especially for those who had it done 5 yrs down the track, how long does it last? I don't know what you mean by image scans, I think the reason they do it with contrast is to see the blood flow into the prostate so they can plan the surgery.

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  • Posted

    I have an enlarged median lobe.  The 2 docs who have done the most PAEs in the US both told me that the procedure is much less successful w/ enlareged median lobes.  I had the procedure anyway and was hopeful; however, for me, it didn't work.

    Best of luck!

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    • Posted

      Hi arlington, may I ask you please, if your doctors said to you that THEY CAN´T EMBOLIZE CLOSE THE BLADDER AND URETHRA, adn of course shrink better the prostate, because they can risk to cause a necrosis on these organs, and that´s why people with enlarged median lobes had no success after doing a PAE?

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    • Posted

      They said that there was a slight risk of embolization of the bladder and rectum.  They did not say that this had anything to do w/ the enlarged median lobe (I think the relative lack of success w/ enlarged median lobes was for other reasons).  They said that it had to do w/ the risk of the embospheres possible getting in to the wrong blood vessels and causing necrosis to those organs.  This is why, even though the smallest embospheres could potentially be the most effective (because they would block more blood flow) they were a bit rskier to use because it was easier for them to get in to the wrong areas. 
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  • Posted

    I have an enlarged median lobe and the PAE worked for me.  Is it complete relief?...no but a major reduction in my IPSS score (aprox. 10 points) and I have reduced my fear that I'm suddendly not going to be able to go. 

    ?    As for getting success stories from this website, it's a bit misleading.   When a "new" procedure comes out people are happy to post their success stories.  Once the procedure is normalized the only people that tent to stay on the sight are people that have had an unsuccessful treatment and are looking for other options. 

    ?    Bottom line....PAE can work for median lobes but the success rate is probably not as high as general enlarged prostates.  There are some people on this site who have tried to infer a success rate based on recent posts but that's simply a guess and a potentially misleading one at that.  A big factor is probably your insurance.  If you can get it covered like I did, the incentive to try is there.  My Urologist recommended a Rezum procedure but I didn't like how long some people were on a catheter.  My work requires me to be 100% healthy and I can't work from home.  Thus, it was worth a try.  One week after the procedure, I was off of all meds and back to working out daily. 

    ?   Do I believe I will need another procedure in the future?...probably  Until the docs can figure out why the prostate grows as we age, it's almost inevitable that people will have multiple procedures over a lifetime.  If this buys me five years I would be extremely excited.  I think FLA has a lot of promise as well as Aquablation.  The problem is that both these procedures are in the early phases.  Thus, each patient is hand screened and the best possible patients are selected.  This will invariably lead to higher success rates.  The same with PAE.  The only thing I can say is if you look at any procedure I think you will find nothing is a guarantee.  What attracted me to the PAE was the limited downside if it didn't work.  You can ask the other members  who have replied (and it didn't work) if they are much worse off than before the procedure.  I think you will find the vast majority of failures are pretty much where they would have been without a procedure. 

    ?   Good luck.   I know that it is extremely hard to make these decisions and unfortunately the docs are of little help.   Both the urologists and IRs want your business and appear to inflate the success rates and minimize the side effects/failures. 

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    • Posted

      That's great news that it worked for you, Marc!

      To help others in making their decisions - more info that may be helpful:

      The 2 docs who have done the most PAE's in the US each told me that their success rate w/ enlarged median lobes was about 20% points below that of those without enlarged median lobes.  But, to Marc's point, one of them said the results were 90/70 success and the other one said 70/50 (just reflects the personalities of various doctors). 

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    • Posted

      I received this info a while ago from someone who had a partially sucessful PAE - something you could ask about maybe? This is not mine, another guy had PAE and wrote about it. I don't know how he is doing now I will try to reach out to him and ask him how it is now.

      May 22, 2015  Results from my “after surgery” Cystoscopy and Ultrasound prostate scan show a 43% reduction in prostate size and I’m retaining 33% less urine in my bladder. But I’m still not emptying  my bladder completely, due to a “bulge” from my median lobe, which is still blocking part of prostatic urethra and still pushing up into my bladder. Although my prostatic urethra, below that bulge, is about twice as wide as before the surgery so for guys without this genetic anomaly, the surgery should open everything up nicely. My urologist suggested we wait and see how things look in 90 days, since there could still be changes taking place, so I am hopeful that more shrinking back of this bulge will happen.

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    • Posted

      Hi arlington, I just wanted to know if an enlarged median lobe (the part that constricts the urethra) usually can´t be completely embolized bi IRs due to the possibility of necrosis of that organ or even a bladder ischemia, and if these problems can´t be managed by IRs due to, maybe equipment limitations or due to the patient prostate arteries. Why doctors say that enlarged median lobe can lead to a failure of a PAE (that´s my goal).

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    • Posted

      You probably should ask a PAE doc.

      I think they told me that the procadure shrinks the overall prostate about the same % but, because of the location of the enlarged median lobe, the same % shrinkage there just doesn't help enough.  

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    • Posted

      Unfortunately PAE docs are very elusive when I talk about an enlarged median lobe. To me it seems that they don´t want to tell something, maybe because they still don´t know how to manage it? I would like to make a CT scan (without contrast) that could show if my enlarged median lobe is pushing my bladder and causing some BPH symptoms specially difficult begin urinating. Does a transrectal ultrasound can help?

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    • Posted

      M.ine was obvious from the MRI as well as the CT scan.  Once I saw them I had no doubt.

      I found Dr. Isaacson at UNC Healthcare to be an extremely straight shooter.

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  • Posted

    There is a new long as term study of Urolift that you can find by searching for it in the Canadian Journal of Urology.

    Neal

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