Focal Laser Ablation / Prostate Cyst - New Member Dr K Club

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Add me to the Dr K Club. Yesterday Dr Karamanian with his professional nurse assistant Samantha (Prostate Laser Center Houston TX) used FLA (Focal Laser Ablation) to help me with my problem. I'm resting comfortably in my Houston hotel room as I type this. I discovered FLA and Dr. K on this forum while researching early in the year and wanted to give back by posting my experience.

Quick symptom background- weak stream ever since I can remember, worsened some over the past few years along with nocturia (2-4 times per night). I was scoped 20 years ago, found nothing and went on to Alfuzosin. Scoped again 10 years ago, "bladder neck obstruction", still small prostate (30 grams), mild BPH.

Fast forward to beginning 2017 when I once again undertook my every 5-10 years review of what's new in treating prostates. Wow, lots of new stuff. PAE immediately caught my eye, Tried to get into the Stanford PAE trial of Dr. Gill but did not meet criteria (too small prostate). As it turns out this was a blessing in disguise! During my TRUS there they made no comment about my prostate other than small.

I followed up on another procedure that caught my eye, FLA, and contacted Dr Karamanian. He arranged for a 3T MRI where I live (1500 miles from Houston). The MRI results were stunning to me as #1 there was a cyst right at my bladder neck and the top of the prostate. Well hell that would explain my symptoms eh? And the only way I could have ever known it was there was by having the MRI! (or a skilled ultrasound operator seeing it) #2 Secondarily, there was an area of my prostate that looked very suspicious (possible tumor).

Dr K reviewed the local MRI scans that I uploaded to his website (easy, convenient, quick) and suggested I have a TRUS biopsy to identify if the suspicious area was malignant before we went any further. This I did locally, and thankfully all 14 biopsy cores were normal. Just looked bad on MRI and this happens not infrequently.

With this out of the way I scheduled my appointment with Dr K to have the cyst and some prostate tissue ablated. First attempt to get down there was thwarted by the monster hurricane a few week ago that flooded Houston. I rescheduled everything and got the FLA done yesterday.

Everything you've read about working with Dr K is true, he is a skilled, innovative, caring, accessible interventional radiologist, and his nurse Samantha is a jewel by any measure. My procedure yesterday went off with no complications and thanks to the very nice people doing it, I had nearly no anxiety.

I won't know initial results until next week when I remove the Foley catheter, and of course the full results for another 6-8 weeks after all the swelling and ablated tissue is absorbed. But I have a lot of confidence in a great result, and even if for some bizarre reason I don't, I've not caused irreversible damage/side effects, as FLA (skillfully done!) apparently has none (RE, incontinence, impotence, etc).

The lessons to pass on here to other readers are:

1. Get a 3T MRI before you do ANY procedures on your prostate, otherwise you don't really know what the hell is going on! Ignorance is not bliss. If not 3T at LEAST have a TRUS (trans rectal ultrasound) done by an operator who knows prostates!

2. FLA for BPH and other amenable problems like cysts/tumors is a compelling value proposition. When FLA is done by a skilled and competent practitioner it has an extremely favorable risk profile. I would suggest FLA is a very technical procedure requiring both art and skill, far more so for example than jamming a tool into your urethra to staple the prostate walls back. I could see where FLA outcome would be very dependent upon who is doing it!

3. Everything you read about Dr Karamanian is true, he's an awesome human being and he has a gift for what he does. That is a rare combination and "we" are very lucky to have him out there working his magic. He took all the time needed at every point of the process.

Not sure yet if insurance will pay for it, I filed for a pre-authorization and they approved it, so looks good for reimbursement. Dr K does not file or take insurance and you will have to pay him upfront which is what I gladly did. If insurance does not pay it's still the best money I'll ever spend.

We all have our individually unique physical challenges, after 40 years I think I finally found the fix for mine, and I wish only the best for anyone suffering who reads this.

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  • Posted

    Hi Pete,

    Thanks for the very informative post.  Please keep us posted on your details/progress as you recover.

    I was wondering:  do you know if you had an enlarged median lobe?

    Best of luck to you!

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    • Posted

      Thank you for the kind comments. I did not have an enlarged median lobe. Prostate was small comparatively speaking. Dr K should be able to (easily) deal with a median lobe, in goes the laser fiber, away goes the lobe cheesygrin
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  • Posted

    Pete

    ?Mike here.  From Michigan.  I am a Dr K patient from April 16th.  John was my mentor to go with Dr K.  I was originally going with PAE and Dr Bagla in Virginia.  Glad I went FLA.  I have been watching all of these procedures for over 4 years around the world.  Unlike John, who with his wife went and personally visited each doctor for each procedure.  John is doing great.  He had his done on Dec 19th.  He was the 1st procedure patient, but not in the clinical study and I was suppose to be 1st in the study, but due to sponsor issues he did not have all his approvals yet for my procedure.  I had a 179cc (tennis ball size) prostate and an enlarged medium lobe.  I think the largest one so far is around 240cc.  

    ?So, I would assume that you were not in the Clinical Study due to possible other issues?  How did Houston look after the hurricane?  Dr K took his family and went way north of Houston.  Your the 2nd Pete as far as I know.  The 1st was from Hong Kong and he had his about 1 1/2 months age, but he is doing great as well.  When you read all of the internet info, it does not matter where you go, TURP is still the Gold Standard.  Well, those idiots are looking through Rose Colored Glasses and all they are seeing is Fools Gold.  This procedure within a year and a half will be the Real Gold Standard.  Welcome to the Dr K's Club.  We call him Dr K because back when we were talking procedures on these forums, you could not mention a persons name.  But gradually the moderators are allowing us to use some names as long as there is no promotionals involved.  We now have doctors on the forums and with all of these patients, this is the most informative website in the world, especially for prostate procedures.  

    ?You have lots of fun ahead of you as you start peeing like a race horse and become fascinated over something that us men have always taken for granted.  

    Good Luck and Enjoy your new Prostate,

    Mike  

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    • Posted

      Hello Mike,

      Thanks so much for the background and comments!

      Houston seemed to me to be running "normally", at least what I saw coming from IAH to downtown. Correct, I was not in study. I feel great, but looking forward to removing my Foley tomorrow! smile

      Best,

      Pete

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  • Posted

    Update.

    I removed the catheter two days ago on Wednesday, six days following the procedure. Had frequent urge to urinate which over the succeeding 48 hours or so has lessened and improved steadily. Flow is weak which is also to be expected at this point and as swelling goes down over the next 6-8 weeks, will only improve.

    Got up four times Wednesday night, and three times last night.

    With that said, all else is otherwise fine. No side effects (also as expected), "everything" works just fine biggrin

    So, it's all downhill from here.

    Side note, Dr. Karamanian called to follow-up with me yesterday and noted he has changed his staffing and hired a new (male) nurse/assistant, and Samantha is no longer there. The doctor noted the new nurse has perhaps more experience in FLA than any other nurse in the USA, so future patients will be in very, very good hands!

    At this point I continue to believe I made the absolute right choice by going with Dr. Karamanian, so thankful I took charge of my own care and got that 3T MRI, and I thank again those that went before me and posted their experiences to this forum. 

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    • Posted

      PS- as with other members of the Dr. K Club, readers can feel free to message me in regards to my experience or for travel logistics to Houston. I'm glad to pay it forward and help if I can.

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    • Posted

      Oh no. I was hoping to see nurse Samantha one of these days. Now that hope is shot. smile Pete, thanks for the update. Hank
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    • Posted

      Pete,

      Good to know you're out of the catheter. You are lucky -  6 days is a walk in the park I had to keep mine for 14 days!

      Now is the time you need to keep the faith and have patience which ain't the easiest thing sometimes.  Your prostate is now bruised and battered and bloodied like its done 15 rounds with a prizefighter. But the good news is it has no choice but to get better. Baby steps for a few weeks and you'll start to notice things getting progressively better.and better. I look forward to hearing about your recovery so please post.

      I'm sorry to hear about Samatha leaving Dr. K; they were truly a star duo! Do you have any idea why? I thought the set up between them was working so well.

      WIshing you the very best.

      Pete Kline

      HONG KONG

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    • Posted

      Pete.

      Mike here, Dr K Club April 6th. Good to here you are doing good. Have you recruited any other friends from Hong Kong? You could set them up with your friends in Arizonia, charge them a fee and split the money.

      I agree, will miss Samantha, she was good and comforting for us old guys. I think a male nurse might be a little discomforting for some In a personal situation. In my case, my blood oxygen levels were a little low, so for 3 1/2 hours and totally conscious for the whole procedure. It was nice having her to keep me still and to talk to. I am 6 ft 3 and it was very uncomfortable staying still while conscious. When I had the procedure, Dr K did not have all the special cushions then. I am an automotive engineer and work with ergonomics as part of my job. Dr K was an engineer first before he became a radiologist. We sat together the next day and decided he needed more cushions to keep people comfortable and still for the long time in the machine. We went to several ergo sites and picked out what he needed. Will miss Sam, she was very personable.

      Good to here you are doing great.

      Mike H

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    • Posted

      Hi Pete , how is your progress now ?  Im flying to FLA next sunday with procedure on April 3rd/ Stan 
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  • Posted

    4-Week Follow-up Post

    All good!

    Everyone tells me the magic really kicks in at 6-8 weeks post-op for FLA for BPH but I'm experiencing improvements by all measures at 4 weeks. No negative side effects. No discomfort. Focal Laser Ablation is "surgery" but compared to some of the stories I read here, recovery has been a breeze!

    After removing catheter, there has been no pain or discomfort of any kind in regards to prostate. Some initial urinary urgency which has improved every day and a bit of blood upon initiation of urine stream and blood in ejaculate which is perfectly normal and has now 95% abated.

    The feeling of a "marble in my bladder" is completely gone (the cyst causing this was ablated). The BPH symptoms, nocturia, ability to hold urine and stream strength are now all better than pre-op, and as I mentioned the best is yet to come!

    Insurance reimbursement is still in process but still represented by the insurance company as reimbursable. We'll see and I keep that info updated.

    Dr. Karamanian continues to follow-up with me weekly, which is a very nice and and unheard of personal touch. He is a special guy!

    Bottom line: if all progress were to stop today and insurance not pay, I'd still consider the experience well worth it in terms of expense/effort/results. I'll post again in 2-3 weeks and let's see if things get better as everyone says they will.

    I'll take this opportunity to once again URGE men to take charge of their own care! Don't let your prostate and/or urethra be destroyed and risk retrograde ejaculation and incontinence unless you have exhausted every other possible choice! I researched heavily, for years, and FLA was the clear choice of treatment for my BPH and prostate cyst, and all of my function has been perfectly preserved with essentially no risk of side-effects. The only question remaining to be proven for FLA is durability, and in my opinion, ablated tissue sure as hell can never progress to hyperplasia or hypertrophy again! 

    Happy Member of Dr K Club

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  • Posted

    5-weeks since procedure update. Wow. Great. And the "best" I'm told is still to come in next 1-2 weeks. All blood in ejaculate and urine stopped 5 days ago. Got up one time last night and that was because bladder was full! Firehose of a stream, complete void with no dribble. Stream in general is better than maybe...ever. Can hold urine, regularly, longer than in any recent memory, maybe...ever.

    Could not be more happy with my FLA procedure for BPH with Dr. Karamanian. If it continues to get better from here, well, that would be crazy...

    Bad news! Despicable scumbag insurance company has determined to not pay anything. This after "pre-approval" letter saying it will pay. I'm going to fight in every possible way. USA health care system so broken, pays for destructive, side-effect ridden, poorly diagnosed procedures, declines safe very effective procedure. How f'd up is that. Regardless, it's the best money I ever spent (invested!).

     

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  • Posted

    PS- IPSS symptom score from 21 pre-op to 6 as of today. No side effects, no recovery discomfort. Total symptom resolution.
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