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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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