FLA 7 month update after treatment in June 2019 by Dr. K

Hi Patrick,

I had this procedure done almost 3 years ago. by Dr Karamanian.

FLA stands for "focal laser ablation" and is not performed by a urologist but by an interventional radiologist.

Hope that helps

A PAE (prostate artery embolization) is done by an interventional radiologist. Focal Laser Ablation was originally done (and still is) to treat select areas of prostate cancer (it is focal and not general) and done by a laser that ablates tissue. Later it was used to reduce prostate size and helps or almost cures BPH issues. It is very precise and uses very expensive imaging equipment and is NOT covered by any insurance, to it's all out of pocket, unfortunately. Dr. K receives rave reviews here but the cure rate is not 100% - nothing is.

Hi all,

Sorry for slow response when everything is working it is not top of mind. I will try to remember to give regular updates.

My FLA (focal laser ablation) was mid-June last year so almost 12 months now. The Dr was in Houston Dr. Karamanian at the Prostate laser clinic.

Current summary:

Still sleeping through the night

Still can go with high volume and finish quickly, not quite stripping paint but rate/volume is similar to a much younger man. No dribbling or stop start at all.

No urgency and can play a round of golf with no distress and not thinking about bathrooms

All the gear works and no side effects of any kind - no retro, no problems at all.

Happy Happy Happy.

I have not noticed any reduction in flow rates as time has passed - still seems to be consistently very strong. Time will tell how long it lasts but so far so good.

As of June last year was aware that for prostate cancer FLA is frequently approved by insurance. As for BPH unsure I did not have insurance but now with 12 months passed would certainly ask the doctor for the current state of play.

I have stayed in touch with Dr K and his team and continue to hear about good results (and continue to send in my response forms to contribute to his clinical database.)

Very thankful to Dr K and feel very fortunate this was done last year when travel was still possible.

Best to all.

Joe

Hi Arlington yes I had a very enlarged median lobe. PAE was not a durable solution for me but so far FLA is.

Also noticed my previous response seems to have a formatting issue and some parts cut off.

The point making there was that as of last June am aware that FLA with Dr. K is frequently approved by insurance for prostate cancer. I traveled from overseas so could not use insurance. At the time was hearing that BPH patients were struggling to get insurance approval. However with another 12 months passed and clinical data building all the time- would certainly ask for my self and push hard to try to get approved.

Dr K does a lot of follow-up and stays in touch - have sent in patient response forms several times to add to his clinical database. Hopefully as the data grows insurance approval will become more standard for BPH. I believe that in their clinical data they are showing success in a majority of BPH patients.

As for recovery time had a few ups and downs - certainly feeling it and some bleeding for the first few weeks. Flow rate steadily improved over the first two months. Passed two clots within the first 6 weeks that were at least to me... breathtaking... but would say after 6 weeks had most of the flow benefits and most of the healing. Mind you he typically does six passes of the laser... but my prostate was so large he did 12 passes and took quite a lot of tissue to make the effects of the procedure durable... and had warned me that there could be healing up to 6 - 8 weeks.

Thanks a lot, Joe. Continued success.

I was noticing improvement for 9+ months, most in the first 6 then continual slower changes. I believe some of it was due to the bladder problems I had (and still have) due to urinary retention over 15+ years. While most of us are told we have 'BPH', and that may be ONE of the issues, I (and others) have additional complications that all impact our urinary health.

Tim,

I also have bladder issues and currently self-cath 6x/day as I am unable to void without a catheter. Curious if you were able to void naturally before your FLA procedure and did you travel to Houston to have it done by Dr. K? I am researching options while using CIC to hopefully rehab my bladder and am interested in your history prior to your FLA procedure.

Thanks and good luck going forward!

Hi Patrick,

Interestingly, I'm in an almost identical situation to yours. Have been CIC'ing since Summer '14 and am at about 6 times a day. Waiting to see more clinical results for FLA for BPH. I did already try PAE in Fall of 15; however, largely due to enlarged median lobe, it didn't help.

Best of luck!

I was not doing CIC prior to the FLA, though I may not have been far from needing to. The urologist I was seeing at the time wasn't very helpful. He wanted to do one of the standard procedures, of which I was not interested.

While we can have common symptoms, the causes can be so different for each of us. I've read some who have excellent results to many different procedures and some do not. So many variables - makes the decision that much more challenging.

I did go to Houston (I live in Atlanta) - had the FLA for PCa and urinary flow issues, flew back after 3 days with a Foley. Procedure was painless (they gave me Versed, so I don't remember most of it). Only suggestion I make to people is do not be in a hurry to get rid of the Foley. If you take it out and cannot urinate, consider having one re-inserted until you can. Amount of time it can take to heal varies for all of us, the amount of tissue ablated, it's location, size of our prostate - lots of things.

Thank you Tim

I was self cath 3-4 times a day as I could void a little in between , as Tim said do not rush in retrieve the Foley , as longer is in as better it is , I removed it a seventh day and had to put it back two weeks later .

One of the benefits of CIC is using the technique post-procedure to avoid the Foley which I wore 7 weeks prior to starting CIC. I was SO happy to lose that Foley and have become habituated to the CIC routine which buys me time for bladder rehab while exploring options. Some here have rehabbed their bladder with CIC, avoided any surgical intrusive procedure, and were able to lose the catheter, much to the surprise of their urologists, who of course recommend whatever procedure they specialize in.

Bottom line, good advice to take your time and explore all options before rushing into a procedure with minimal chance of success and living with irreversible side effects.

Hello Arlington and thanks for your response. WOW, CIC since 2014...you are a warrior! I'm assuming you found a uro who supports your CIC regimen without pushing you into a surgical procedure...well done! I'm learning how important it is to be your own #1 health advocate and make your decisions based on thorough research rather than depending on decisions made by self-interested physicians. Good luck to you going forward and let us know if you find a good option to stop CIC.

Patrick

I initially went in to acute urinary retention due to an antihistamine cocktail prescribed to me for hives and I have never been able to come out of retention.

Yeah, my uro still pushes his TURO, but in a nice way. He said CIC'ing is a viable alternative for those who prefer it to a procedure. Unfortunately, at my last appt. about a year ago, he suggested that I stop Rapaflo since I was cc'ing anyway. When I did so, things closed up to the point where I was no longer able to insert the catheter and it took me about a month to resolve. The worst result of that was that I am no longer able to pass through the best and most discreet catheters (by far) that I had found; the Coloplast Speedicath male compact. If I can get back to a point where I could use those, it would be significantly better.

So what are you using now if not the SpeediCath? I agree about the compact and would use it 100% of the time if it was covered by Medicare but have been advised that a history of UTIs is required for Medicare to cover them. As such, I use the SpeediCath standard FR14 as my "go-to" cath which Medicare covers.

Apparently BPH caused my urinary retention which was not discovered until I had a bicycle fall and ended up in the ER where a CT scan showed a "massively distended bladder" and 5300 mls of bloody urine was drained with a Foley. Up until then, I was urinating regularly and had no idea of my urinary retention. ER staff could not believe I was not in excruciating pain with my bladder condition. I was not. I left the ER with the Foley and was referred to a uro where I failed a urodynamics test and began CIC after wearing the Foley for 7 weeks. My uro agrees that a procedure will not help until I regain bladder function and says "no use in expanding the pipe until,the pump is working...". Apparently I have nerve damage from my bladder being stretched for so many years. I had no symptoms other than a decreased flow which I attributed to my age of 70.

Have never heard of Rapoflow, but declined my uro's suggestion of taking Flomax after my PCP prescribed it and it put me in AFib which I had been diagnosed with and had a cardioversion to return me to NSR until I began taking Flomax. Is Rapoflow an alpha blocker like Flomax?

Ahh, these golden years!

Yes Rapaflow is a selective alpha-blocker in the same family as Flomax and the generics. First time I took one, I almost fainted while jogging. I read a study on the NIH website claiming that approx 50% of men are helped by taking alpha-blockers. I was in the other 50%. I tried all 4 that were available at the time, but had no benefit and a few side effects. Other than lower my BP, I could not breathe well when lying down, which affected my sleep.

Ah yes, those side effects! Flomax was a good lesson for me to become my own number one health advocate! The same physician that diagnosed my AFib prescribed Flomax that put me back into AFib after a successful cardioversion! After researching, I found a warning had been sent to all healthcare professionals from the manufacturer about the possible side effect of arrhythmia. Apparently my doctor did not get the memo!