FOCUSED LASER ABLATION

I found this, it really does sound promising

Dr Sperling decided to adapt the focused laser ablation technique for prostate cancer to help men with BPH after he learned that patients who had undergone FLA for cancer reported that their BPH symptoms had resolved. He reported that “Because treatment [FLA for BPH] is outside the urethra, I’m not affecting that delicate lining. I’m simply debulking the tissue that’s causing pressure on the urethra.” The result appears to be an effective way to eliminate BPH symptoms with no significant side effects. - See more at: http://www.prostate.net/2016/bph/focused-laser-ablation-to-treat-bph/#sthash.SzRth5vP.dpuf

 

I am very happy they did do something with it.   I did read his artical on this for prostate cancer.  I had a friend that the first thing the doctor wanted to do is take it out and he said no.  Why cure one problem for another.  Thanks Ken

Does anyone know if it's covered by MEDICARE for BPH? Does anyone know someone who actually had this done for BPH?

Hi, I did my research on FLA. Dr Sperling office called me. This is what was said. First an MRI of the prostate must be done ,to determine if you quailfy for this procedure.

Next ,it is FDA approved ,but is not covered by Medicare,or insurance plans.

This is done in Florida,and New York. Cost around $22,000 dollars.

Hi Jim,

There are definitely other doctors who perform the procedure. When I arrive back from College coaching duties

I'll look them up. Take Care

Hopefully so, but scant info on the net. Other than the Sperling group, the only other docs I found using the technology, are using it for prostate cancer, not for bph. I think what we want is some level of comfort that this procedure is working for bph backed up by more than one doctors web site testimonials. That said, on the surface it sounds like the procedure that all of us have been waiting for, so I really hope it's the real deal. If so, sign me up!

Jim

Dr Sterling is the doctor that is doing it.  It was used first for prostate cancer.  But he found out that after the treatment the prostate got smaller.  Let hope some more doctors start doing it..Good Luck  Ken

Hi Ronnie, I sure would like to know names other Doctors doing the FLa procedure? Is Dr. Sperling the only one?

looking forward to your reply.

at Inspire under focal-laser-ablation-patients, there are some who claim, after FLA for cancer their BPH issues were resolved or much improved, 

this is new, as most published reseach is devoted to FLA for cancer, this seems to be just a side effect, but positive for BPH 

Yes the moderator blocks any information that they feel might be a promotion. So if I find something I can not send you a phone number or a website. I dont really understand the motive but ok it is their site.

And I have found a great Doctor who is very educated in Focal treatments in the prostate in fact not only studied it he did a fellowship in the practice. He is the director of the Prostate laser center. He is very willing to help suffers get educated in his and all the treatments avaliable. My wife and I went to visit him and 3 hours later we needed a break. He never stop the whole time. He looked at my MRI and on it he showed me though it was 125 cc, there was no cancer at this time. He showed me the sphincter, the pelvie floor, the seminal vesicals. the nerve bundle and the ejaculation ducts, and the restriction of my urethra by the BPH tissue on my prostate. Also the bladder floor and its condition. He did not do the MRI but he could sure read it as he is very expurt in that discipline. He then showed me how and where he would reduce my BPH tissue and why and how there would not be risk of sexual side effects.

Unlike the other doctors I traveled a long distance to consult with, Dr. K told me there would be no cost and he never used any presure or suggestion to me or my wife at that meeting.

Later I have called him back with questions 3 times. He always calls back and we end up speaking for at least an hour. He said it is important for men to ask question and begin to understand the condition we have. He sure educated me on my Prostate condition and all my options.

I will personal message you his information and if you like, you can call him. He will call you back. I will give you a phone number, email address and a you tube he did that is technical to a group of other doctors. It is also attached to the web site and he has a protal you can insert you cd of the MRI and hit the button to upload to his computer.

Thanks. Are you planning on going ahead with FLA with this doctor?

Jim

Yes that is my current plan. I will do in January

I would appreciate information on this procedure. I am considering either this or embolization.

Richard 11472 

i have been been traveling all day. I will send you the research  I have from the last year  on FLA and the three Interventional Radiologist that perform this procedure tomorrow after I get to my office. I will personal message you then.

 

J12080  Hello.  I'm so happy there are still doctors out there that care about the patient and not just go in and cut away.  Doctor K seams like a good guy.  You said that you will have it done next year.  Will he be doing it. Good luck  Ken

Richard,

I went to the prostate laser center website in Houston. Dr k has some very detailed info on his site. I also went to the Speeling website and Lillian called me up the next day. She was real nice and informative as well. I did not get into too many details about cost other than they do not take any insurances and the price is about $22k. I think your Insurance may pay for some of the test.

Rich, Dr K says on his site, I think, does not take insurance or medicare. You said that there would be no costs to you. How is this being paid for? Is he conducting Clinical Studies? I am in Michigan and my urologist is sorta pushing REZUM, which he does quite success fully. The only problem I see in that many of the patients are having catheter issues and some pain 5 or 6 months later. Still, it shrinks the prostate in the end, but takes time to work itself out and some people have some temporary issues. There is a huge amount of interest in this procedure on the patient Web. That leaves PAE, which there are 2 primary Interventional Radiologist in the country doing it succedsfully, Dr Sandeep at the Virginia Prostate Center and Dr. at the University of North Carolina.exercise

Good Morning Mike.  How big is your prostate or do you just need it pulled apart.  Have you looked in the Urolift procedure.  I had that done about 20 month's ago and I'm doing great.  Some men on here have had good the REZUM procedure done but I think it all depends on the doctor.  One guy had it done in the office and he said it hurt.  I feel when we have anything done in that area we should be put out. What ever you decide get all the information on anything you do and ask question  Take care  Ken

Mike let me correct what may be a small misunderstanding. Doctor K. does not charge for his consultation and they are extensive. I sent my MRI to him, he spent a lot of time on reviewing it. I then went to his office and he spent 3 hours showing me and my wife the anatomy of my prostate and how he would ablate the tissue and how he would not get near my semical vessicals, my nerve bundles, my ejaculation ducks nor would he touch the urethra. He showed us the equipment for the procedure and introduced us to his nurse. He had to procedures that day for FLA on PCa. We got there at 2:30 left at 5:30 and he would not take money for the education. Since, I have spoken on the phone with him 3 times for about an hour each time with follow up questions. He always calls back and he always says, "please call back if you have any more questions". This is unbelievable. I have a friend who has no colon. They place an internal bag in him. Now he needs a biopsy and they cannot do it with out puncturing the bag. Not good. I told him to call Dr. K. The results, Dr. K explained all the options out there. Dr. K cannot help him directly but he research other Doctors that could, called my friend back and gave him a procedure in Oregon Hospital and a Dr. at Cleveland Clinic that my friend should explore. Again, he charged my friend nothing. 

As far as procedure cost, yes, it is $20K. He does not take insurance. But he provides the codes and information for the MRI and some of the other parts to be covered by insurance and the patient can file with the insurance company and he support the effort of the patient. 

I have said all along that men who wish to investigate this should call him. Discuss the procedure and all the other options he will gladly anwer question about. If you have an MRI you can upload it to him on a protal set up on his web site. 

Remember, all the Interventional Radiologist are doing this procedure for cancer. I dont have cancer. My interest in this is due to the fact that it is non invasive, fast procedure, that starts working fast as it debunks the tissue out side the urthera that is pinching the urthera and not letting you pee. The procedure is FDA approved and little to no blood. No damage to the urethra. 

Main highlight to me NO SEXUAL SIDE EFFECT. That is what I want. 

Yes, I visited him and spent the time. I also visited Bagala, in Virginia; and Isaacson in Chapel Hill, then to Sperling in Florida, Then to see Walser in Galveston, then to Busch in Tennesse and finally to Dr K (Karamania) in Houston.  NOTE all of the spent about 45 minutes with me and all of the charged for the time. Sperling wanted cash only. Draw you own conclusions but I have never met a Doctor like Dr. K. In know way was he self serving. He said he wants to inform men as the choices currently in this condition BPH are scary. And the IR community has realized that tissue ablation for PCa has resulted in major reduction of BPH symptoms. NOTE. Sperling told me he has done this more than 80 times. I ask for a list of 3 or 4 references that he did this FLA on for BPH. That was in September, I have followed up with 5 phone calls to get the references. I am still waiting and in all fairness, the say they will get them. I still will wait and I still will call and ask. I dont give up. 

I will personal message you Dr. K's contact information along with a youtube he did on FLA for a group of Doctors later this morning. 

Good luck. We who have this condition need to share and help each other cause only us no how truely bad it is to live with. If $20k can get me out of this, I will find a way to do it. There is always a way. 

Hi Mike, Northwestern Hospital in Chicago is doing a clinical study  on PAE.

Medicare should pay for this. Do you have urine retention?Have you had a cystoscopy?? They will do all these tests again. If you qualify ,their should be no cost to you.

good luck.

Richard, I am letting you know that I sent you a personal message with the information on Dr. K as this moderator will not let us share the contact information on providers. I guess they feel we may be advertising. I dont really see the point in that but this is their site and I am but a user so I must do it that way for you to have the contact information.

If anyone else needs any information, just let me know and I will do the same.

AGAIN, we all must try to help each other learn as much about ALL these possible solutions and educate. We are in a real predicament with BPH. My prostate is 125cc with PSA of 5.7 and all the bad symptoms. But I give thanks for no PCa at this time.

I like PAE and FLA.

The diffence to me between the two is that PAE is more of a random procedure with a "shotgun" style approach to the shrinkage location and FLA is the precise removal of the prostate tissue as so many of the procedures are now. With FLA, they do not go into or destroy the inside of the urethra. Also the debulking is a coagulation of the tissue which the body will absorb and pass as waste. Additionally, with FLA the MRI provdies real time visiablity and thereby the accurate precision of what they are ablating. Rezum and Green light are  performed differently than FLA..

Urology is offened by Interventional Radiologist getting into their market. But the truth is  that Lasers and Ablations of many organs including the heart and the brain have been preformed by the IR Doctors for decades. Again, the UROS are the ones trying to come up with an alternative to laser ablation. As the Uros have not been dealing in lasers that long and their medical education until recently has not exposed them to this procedure they have  learned it in their practice and with on the job training.  Now if I wanted a TURP I would go to a Uro. Yes, this FLA seems expensive. But actually it is the lobbying against the IR procedure in this case that has kept the procedure from being covered by insurance or by medicare. Same is the truth with the PAE procedure. I still like them both and ironically they are both preformed by IR doctors. Maybe I am tanted as I have never yet had a decent situation with any Urologist. Wouldn't it be great if the UROS had to have the procedure preformed on them before they could do it to other men? Might just change some things. It is not fun having a condition with no cures only band aids.

John I understand that theoretically FLA targets and PAE is "shotgun". I would wonder about FLA in terms of regrowth of he ablated tissue  - spending over 20k if it's not going to last more than say 5 years will be expensive. PAE not exactly cheap, but it's got more of a track record than FLA doesn't it ? And I believe the surgeons are getting better at it all the time.

Mike, that is a great point to be considering. I am not an expert or a doctor but what I do understand is that all of the procedures have an issue with regrowth of the tissue over time. It is said that the TURP is proven to give a man on average about 10 years. TRUP is barbaric but they have over 10 year of data on it.

On the remainder of the procedures, I dont think we know as of yet. Logic scenarios that I have discussed with both the PAE and FLA doctors is that first, they do not know but it is a fact that the gland still continues to grow and the different procedures will all have different time frames of how long the results last. PAE has a result of continued growth as well, but possibly slowed as the blood supply is reduced. Except it should be noted that the arteries will continue to regrow and replace the blood supply with a new flows of blood. When I ask how long for the vessels to replace and regrow to increase supply, I was told to expect  about 3 possibly up to 5 years but they really do not know.

When asking about FLA I had an even more vague answer but the premise was that the voided area next to the urethra from the laser was done at an angle of pitch, roll and Z-axis that would match and align with the same angle and direction of the urethra. Kind of like the calculations used in flying an air plane. The machine is set up using correct math calculations. The laser would then be drug backwards inside the prostate lining up and ablating the tissue (in my case) to create a channel or cylinder that is approximately 3.8 cm x .75cm or in conversion to inches, 1.5" x .3". Think of the laser path creating a cylinder inside my prostate that is about the size of a normal HB number 2 pencil like we used in school (the old yellow pencil) but would be  only 1.5" long and next to the urethra. This is the size of the voided cylinder of tissue that is removed and Dr. K would do 4 of these tissue removals around the outside of my urethra. Kind of like a North South East West cylinder position around the urethra. He drew me a picture and correlated it to my MRI. Each cylinder would egual the removal of about 6.5 cc of tissue. Together the four would equal the removal of about 26cc of total tissue. Each of these  4 cylinders where the tissue was removed would be close to the urethra and be about 2mm distance from the urertha. These cylinders of removed tissue would scar over when they heal and the new growth of the prostate tissue will not, in theroy, grow inside the cylinders where tissue was removed. This does not mean that the prostate would stop growing. This is my case and would be different with different size prostates. 

Just to show you how far I have thought though about all of this for the last year, I think it makes sense to maybe have a PAE after a FLA. The PAE would shrink the size of the prostate additionally if it worked. So the FLA removes the best possible tissue, that being the tissue impinging and pinching the Urethra. In my case, that would be 26cc of a 125cc prostate. Then a PAE could be done which would reduce the prostate again between 30 to 35 more percent. I am not saying I would do this but it seems like a good strategy with what is on the table now with treatments. When I spoke to Dr. K about this he said do one and then observe the results before I get to bullish on another proceduer. In considering between PAE and FLA , I decided that IF I chose to do one of these the FLA again makes most sense as the one to do first because when the ablated tissues start to heel, it needs all the blood for heeling that the prostate can get. Then after the prostate heels, the blood flow can be reduced further with the PAE procedure. This Just makes sense to me. 

I did not answer your question but I think FLA would last longer but not sure of any of this. I hope this explanation is coherent and makes sense. This is just some of the take away I learned from Dr. K. But it is really comforting to have a Doctor who will get into the nuts and bolts of the procedures that could be done and how and why it would work. He is VERY honest and tells it all in his discussions. Best part is he did not charge me. I felt guilty.

Good Luck 

 

Hi John,

That's a great answer and hard to digest first thing in the morning! I understand the main rationale, FLA first so prostate can heal - I think the flaw in that logic is that if they get the 25cc out you'll feel great and in no need for PAE. If it grew back failry quickly you won't notice much difference at first so by the time you decide on PAE it will be as if you are back at square one.

So still the question is, how much time is it buying you? 3-5 years of relief for over 20k is a chunk of cash but it's all relative - I mean the pain and depression from having BPH is huge so really any money is worth it. I still don't like the idea that FLA is so new, it's targeted ablation but have mistakes ever been made, would they tell you? Same logic for PAE but many more have been done and Dr S told me he has never had a problem, I'm sure there might be a couple of bad cases due to surgeon error because they were still inexperienced at it.

By the way Dr S in Australia told me that there is documented evidence that at least one case of someone who had PAE experienced further improvement AFTER 6 months.I'm at the beginning of my third month and it's hard to be sure but I think it's still getting better. Not where I want it to be yet on the other hand definitely better than before the operation.

Cheers

Michael

Hi JIm,Your knowledge  is well appreciated. I have a theory and would like your opinion on this? When a man's sex life has stoped for many years,he builds up fluid in the prostate that use to get released, Now this don't happen 

the prostate gets swellen,and enlarged BPH takes place.If the fluid was released i don't think he would get an enlarged prostate> I asked a Uro this question and he said no?

What do you think?

Thanks Jim,

Hi Frank,

I've heard that regular ejaculations are good for overall prostate health, and might for example help prevent or at least mitigate the symptons of prostatitis, which by definition is an inflammation/swelling of the prostate.

But as to whether or not it would actually affect the size of an unswollen prostate, really don't know. One would think there might be some survey research in this area. That said, if I had to guess, I might agree with your doctor in that there do seem many men with enlarged prostates who have had very active sex lives.

Jim

Hi j120,

As to PAE vs FLA, I think one prime consideration would be track record, as what looks good on paper does not necessarily turn out that way in the real world. My understanding is that PAE has more of a track record at this point and therefore might be a more prudent choice. Are their any interventional radiologists (IRs) who do both procedures? What about the IR journals? You would think they might be comparing the two procedures as they are both done by IRs.

Jim

John,

I want to thank you for all of your detailed and Well Traveled Information on FLA for BPH.  I think that YOU are the most informed and have been to every KEY Doctor for most of the Logical Procedures.  I just hope that my Reply will not be taken down due to over informing on specific details.  As you have said, the Men today need to be Fully Informed as to their best choices based on their individual conditions.  In the past our choices generally reaked havoc with the male sex organs and left them either sexually dysfunctional, a colostymy bag or with lots of pain and agravation the rest of their lives.  

I am 70, good physical condition, I have a PSA that has been running around 10.0, my prostate is around 108cc, I have had the 12 Truss Biopsy with negative results, I have had an ultrasound to see that I was retaining, after peeing, around 180cc of urine, and I have had a Cytoscopy to verify that my Urethra is being pinched by my prostate and everything else is normal.       

John, correct me if I am wrong on any of this information.  I am just trying to put everything together.  For BPH only and My Perspective, it looks like (1) FLA, (2) PAE and possibly (3) REZUM are the Best (REPEATABLE) "Least Invasive," "Retain Full Sexual Function", for what would be classified as "Longer Term Fixes for BPH", the data is yet to come in on how Long Term they will be for, currently around 5+ years.  There are Forums on the Patient Web for ALL of these discussions, FLA being the newest and the least available information with little to no current Patient feedback.  As far as the costs go on these 3 procedures, depending on your insurance coverage and or if you want to be part of a "Clinical Trail" (Longer Term Minimally Invasive Fixes for BPH, with "No Sexual Side Affects" like ED or Retrograde Ejaculation): 

1. (FLA - Focused Laser Ablation - Interventional Radiologists) looks like about $20k to $25k give or take the individual and the amount your insurance will cover on Out of Network for Test procedures.  I don't know of any Clinical Trails for it and it is FDA Approved.  The procedure goes through your rectum and then to the prostate, with a 3T HD guided Laser Probe that ablates the excess prostate tissue away from the urethra to allow urine flow.  This is a relatively New Procedure for BPH, but the doctors that are performing this procedure claim to have a high success rate with minimal risks and the same procedure was initially used to eradicate cancer and the beneficial side affect was to reduce BPH symptons.  This probably has a low chance of BPH reoccurring due to the scar tissue that is left on the prostate surface.  Doctors Sper---g and Dr K are the only 2 that have been mentioned and (Neither accept Insurance or Medicare). 

2. (PAE, Prostate Arterial Embolization - Interventional Radiologists) This procedure was developed overseas and is just in the last few years being preformed in the US.  They go through the Femoral Artery, or in some cases an artery in the wrist with a fine guided catheter probe.  They use pellets to block the blood flow to the prostate that in time makes it shrink to re leave pressure on the urethra to improve urine flow.  High Success Rate of 93% to 97% and they have data covering patients out over 5 years  Costs vary depending on the doctor and your insurance company or if you are part of a Clinical Trail.  It is classified as a non-surgical procedure and insurance and I think now Medicare will cover part of the costs.  In the United States, Dr San---p, in Virginia has the most experience and published the most journals on this procedure.  He is no longer at Inova and has his own new location.  Dr Isa----n, of UNC has quite a few procedures experience, Doctors Sa--m, of Northwestern University and Dr K--ly, of U of Miami are the latest involved in PAE.  All of these doctors have been at one time involved in Clinical Trails.  These Trails have now covered ALL sizes of prostates and has worked equally as well no matter the size.      

3.  (REZUM - Urologists - NXThera Company Developed this Procedure) This procedure goes through the Urethra and uses hot bursts of water steam to ablate the prostate tissue that is blocking urine flow.  This procedure may have a chance for regrowth because it seems to form more of a softer scar than if a laser was used.  The Downside is, because they go through the Urethra, a Catheter is usually required after this procedure for an undetermined amount of time, usually only a few days, but there maybe a need to re catheter again before everything heals up to 6 months.  Also, some people on the forum claimed that the urine flow was good at first and months later sometimes they would have total urine blockage again and have to go through emergency because they could not pee, unless they were self-catheterizing.  The excess tissue that is not absorbed, has to pass out through the urethra and can block up your system.  It looks like this procedure is now paid by insurances and Medicare and is FDA approved.  I believe they are even covering prostates of 80cc and larger now.  

The "Short Term Fixes for BPH (mostly performed by Urologists)  I consider, with Minimally Invasive Procedures, with "No Sexual Side Affects" like ED or Retrograde Ejaculation:  

(1) Urolift, (2) iTind, (both procedures only move the actual blocking tissue out of the way) (Urolift) with a series of spline type stints and (iTind) with a temporary stint that is removed after about 5 days, which is suppose help the impeding tissue to sort of reshape itself so not to block the flow of Urine and Semen, thus the cause of (BPH).  There are no Long Term studies to prove that these 2 procedures are nothing more than a Temporary Fix until the next best thing comes along.  The good thing is that both of these (Repeatable) procedures are now covered by most insurances and Medicare.  

Traveling to these doctors is not an issue for me because my wife works for Delta Airlines.   So after reviewing these 3 Long Term Logical procedures, I have read ALL of the Forums on most of the Prostate Procedures to relieve and or eliminate the Pain and Embarrassment of having BPH.  Of the 3, it appears only REZUM would be covered completely by any form of Insurance, unless you can be part of a Clinical Trail, where most of the costs would be covered.  I was close to having this procedure done by the top Urologist in Michigan that is doing the REZUM procedures, Dr Haf---  in Troy, MI, until I found out more about FLA, the Newest of the Long Term Procedures.  PAE has a lot of case studies, but there are only a few IR's that are performing the procedure that is being fought by the Urologist, that was first done in the US about 6 years ago and first performed globally was in 2009.  Even then it was not a new procedure, just applying it to the prostate was new.  IR's have been embolizing tissue, tumors and organs for years.  I would think that if it is so good and not invasive that it should be fully approved by now.  They are doing the Cost Study Analysis on it now to see if it is a cost effective procedure, before it gets fully approved. 

Again, thanks a lot to ALL of the Contributors to this and the other Prostate Forums.  It finally seems like the Medical System is paying attention to a Major Problem that can Affect over 80% of the Men who live past 60 years of age and also would like to maintain a sexual lifestyle for as long as they can.  I am amazed that we were stuck with these old archaic procedures for so many years that for something that was suppose to help a common urinary problem, that ended up ruining so many men's lives permanently, many with colostomy bags and no longer having a sex life and so many with painful side affects.  This battle between the Urologists, the primary holders of the old procedures, and the Interventional Radiologists with new and highly beneficial procedures, have got to stop and maybe they will work together and to expedite these procedures so the insurance companies will cover the expenses. 

Good Luck to All!!!

Also thanks to frank74205, jimjames, Kenneth1955, richard542 and mike588

They blocked my response, I just dont get it. I will remove a name and try again then if not, I will pm this to  you. Sorry

It seems to me that the real issue is that the equipment capital cost of the 3TI (2-3 million) is so high that PCa has received all the attention with regard to imaging solutions.

Procedure cost are so high that no one wants to underwrite the clinical trial efforts to prove efficacy of FLA for BPH. Clinical are paid for through collaboration between either hospitals or universities and equipment manufacturers or drug companies. The skin we put is the game is our bodies to study.

Only a few well trained experienced IR doctors are now showing the interest. Some doctors are specializing in FLA and they have interest in BPH as it could be as big as Lasik Eye surgery because that is how many of us have this problem. It is quoted that 75% of men over 70 have enlarged prostates. And yet look at what we have offered to us by the Urologist to deal with this. Yes we have treatments but the side effects of those treatments are thing even the urologist would not want to live with. I really feel that the guided imaging solutions like FLA and PAE are the beginning of the treatments that will not destroy the urethra and nor have the sexual side effects.  

In Interventional Radiology through the course of treating PCa with FLA, IR doctors have witnessed surprising improvement in BHP in some of the PCa patients they have treated. Logically, it would depend on the location of the PCa lesion as to weather or not lesion removal in a prostate would give BPH relief. If the cancer is in the transitional lobe of the prostate there was a lot of cases that had many BPH symptoms clear up as the urethra was free up from the tissue removed. For those who can wait, I feel FLA for BPH is on the way. Now as doctors like Dr K started using the same procedure to actually remove targeted tissue around and for urethra relief, we should start seeing a better and more precise solution for pinched urethra pressure. The use of this Visualase laser is very precise and that is because of the real time imagines thanks to the 3TMRI. They can get very close to the urethra without guessing and not damage the urethra.    

The irony is that this procedure is exactly the same procedure used to remove the PCa lesion. This is NOT new technology.  In fact, I watched a video of a PCa lesion removal where the cancer was wrapped all the way around and right up against the urethral wall. It did not go inside the urethral but it was 360 degrees around it. The Doctor used the Visualase Laser and removed the cancer all the way around without any damage to the urethral. The Visualase Laser tip with the cool cannula cost the provider $5,000. each and they can only be used once then discarded. Then there is the cost expense to use the 3T MRI. If you also do it in a hospital or outpatient clinic there is about $7,000 cost tacked on for them. One would think that at $20,000 they would be making a killing but the truth is they are not. Hopefully with insurance and Medicare someday coming in with procedure codes and approvals to pay, we will not only get coverage but the price will go down as the market is far bigger than the prostate cancer market is. It is the Urological lobbing against these procedures that are hard to overcome for the interventional radiology industry.

My problem is I just cannot wait much longer. A lot of what I said is also true with regard to PAE from the market and insurance perspective.I also love the PAE and I am a fan. It is just a different approach. PAE is more random in results as the shrinkage cannot be targeted or controlled. FLA is very targeted, precise and can be control. When done by a talented Doctor, he will map out the problem and a course to ablate the tissue causing the problem without touching or damaging the Seminal Vesicles, the Ejaculation Ducks, the Urethra and Urethra Sphincter, or most importantly the Cavemous Nerve Bundles.  Bottom line is you need a very talented IR in each of these procedures. Urologist cannot provide these treatments. That is why they are all scrambling to find another procedure to sell. Yet all the techniques and

That is why they are all scrambling to find another procedure to sell. Yet all the techniques and procedure have some damage issue. Watch the You Tube videos of Green Light or HiFO  or HoLEP or REZUM or TUVP or if you really want a horror movie watch TURP. Each have side effect which we have chosen to just except as we get tired of these symptoms.

Thanks again John,

Have you succeeded in getting any names of people to talk to about FLA ? It sounds great in theory I just worry that if they are being evasive in referring anyone with BPH, as it seems they are, something does not feel right.

I wouldn't be too hard on Uroologists, they have plenty of things they can work on without treating BPH and they didn't study and research these new procedures.

Mike, I fully agree with you and you are correct, but consider if you will the TRUS blind biopsy done by Urologist. I am sure we have all been told by a urologist that your PSA is a little high or you DRE indicates swelling or a lump and we need to do a biopsy.

It is done as an in office procedure it take on average 10 minutes to complete.The national average price is $1,100 for this procedure. Yes, it is covered by insurance.  In the US alone it is done approximately  1,200,000 annually. That is well over a BILLION dollar anual market.

It is quoted that somewhere between 2 and 3 percent of the biopsies result in infection and  approximately 15,500 men were hospitalized last year due to this. The number of false negitve and positive in this procedure are not acceptable to me.

The Urologist do not want to support or tell you about a 3TMRI test which will in fact get 100% coverage of the prostate versus the only 60% coveage of a TRUS biopsy. And, they don't tell you that IF you do have a biopsy then you must wait 6 to 8 weeks to have an MRI because of the blood and healing tissue from the biopsy  will not let the MRI image through.

I fully understand they do not want the MRI technology getting into their billion dollar annual play pen even if it is less painfull and more accurate and safer. They will still tell you that you need this TRUS procedure. When needles can be used after the MRI if it  shows a reason to use them either as a focal single needle biopsy or a 12 or more multi needle biopsy.

I do not wish to be hard on the urological industry but this is all the truth and no one wants to loose a billion dollar fast easy revenue stream to better advanced technology. This is just one of the beefs I have with them but it is real. I wish they would treat all of us a little better.

Hi John,

Well I didn't know about any of that, I was never asked to do a biopsy.

The insurance/medical and pharma industries really need to be looked at, rackets and sometimes downright evil people - as they say "money is the root of all evil"

Michael

BOY! you are right on for everything you have said!   SOOOO  Impressed here.

I am like you. I just don't know. Yes I have been all over the country. On PAE, dr Bag---- told me that his success rate was over 92%. Then I went to chapel hill to see dr isa------son and he said it was 75%. Naturally, I ask why the difference. He said that success was in the eye of the beholder and clinical success is much different than symptomatic success. This made me turn my head like that old dog in the RCA commercials on TV. Remember those? So I called back the other doctor bag----. and he said he was higher in success rate becasue the was more selective in who he would do the procedure on. There are 2 maybe three more FLA docs in the us I can tell you about in a PM. but by far  dr  k is the most amazing I have found and may be my choice. if i go I will do a blog if this moderator does not block me. it will be pre, during, and post procedure updates of the good the bad and the ugly of FLA.

Thank you again for all this useful information. I'm going to be waiting anxiously to hear the results of your procedure in January if you go through with it. You have done a lot of homework.

I was leaning towards a HOLEP to just be done with this, but I can probably hold out another year or so.

I too am curious why Dr K doesn't share the names of some references with you. Maybe they can't? Or maybe it is a red flag about something. 

Hi Mike,Thanks so much for all this info,it is priceless. I hope you make a good choice.At 87, with retention,  i 'm still trying to make a decision on what procedure to follow.How old are you Mike? You have a talent for this forum,keep up the good reports.

Hi Mike, Have you been thru a clinical trial?What are the risks and side effects?I don't know much about this procedure?

Thanks 

frank,

Mike, if you are pressed with needing a biopy, just let me know and I can get you hooked up with a 3TMRI in your area and the contact information a trained IR in Prostate Cancer to read it for you. You will still have all your options open to you at any time. 

Hi John,

Thank you and thank God I am not in that situation, just regular BPH.

I had special CT scan and an MRI in Australia where they injected some liquid so they would have seen and in fact would not have done the PAE if they saw cancer. Not sure if that is as good as 3TMRI.

Just realized I did not answer you question about getting the references from   d r sper...ling. The answer is NO I called again on last Wednesday and was told that during the coming holiday time up they would work on finding people with only BPH that were treated. I have not heard as of yet. 

One might think that their task would be easier since they claim they have done over 80 of these for only bhp and not cancer. 

As you implied, this does concern me. 

john

Dr. Isaacson says that it takes 4 months to reach maximum benefit.

Neal

I agree with you. The Trus biopsy can cause prostititus. Think about jabbing a needle 12 to 64 times through the wall of the intestinal track, which is teeming with bacteria, directly into the prostate. I can't think of a better way to give someone prostititus if that were your purpose. An antibiotic pill or two isn't going to stop that.

Also, a TRUS biopsy, without being guided by a 3T MRI, can miss a cancer altogether; or find a slow growing cancer, causing the doctor to recommend "watchful waiting " while you are dying from an aggressive cancer which it missed, but which is right next to the slow growing cancer.

A doctor who doesn't recommend the 3 T MRI, doesn't have their patients' interests at heart, and should be promptly fired.

Neal

No, no let me please correct the record. It IS NOT Dr k that has withheld the references.

It is dr spe...Ling in florida. that has yet to produce these. dr S claims he has done over 800 fla procedures for cancer and over 80 procedures for bph. I just want 4 references from that 80. I ask for this in september!

Dr k has not done this a procedure exclusively for bph. And is up front with that information. Yet. Yes I know that appears to be less experience but he makes up for this in educaton and ability in IR. And he has done many for PCA. I have tried to get dr S to give me the information to no avial. I wI'll still.

Go to Dr k in Houston Web site. If you would like contact info I will PM it to you. You can speak to him and he will not charge you. He is so easy to talk to and no doctor ego from him.

No NO Motoman!!! 

Let me correct the record. It is not dr. k that is not providing this. I went to dr sper.....ling in september and he told me i could get the references. His staff has not produced them as of yet. I still hope they will. his claim is he has done over 80 for bph. And over 800 for cancer. I do not doubt but it should be easy to get 4 or 5 guys to be a reference from that many patients. 

dr. k is very very straight honest and highly educated IR doc. he tells you the truth he has done many of the procedures but not one labeled as "for bph". 

he is completely capable to do it and has done very complicated IR procedures for prostate cancer, heart and brain. he is a skilled IR. All three of the doctors I visited are very capable. 

Hi John,

I was more curious about Dr K giving you references, I didn't think Dr S would ever do it.

Regards

Michael

Indeed I am encouraged, now about 9 weeks after PAE and while it's not "great" it seems to have improved in the last week or so in that I can stop Flomax without suffering.

Mike,

I have spoken with reference on dr k but they were not people who did FLA for specifically BPH. It was for cancer even though it is the same procedure.

Ironically, I actually found out about dr k when I went to meet walser at  university of texas medical branch. dr k had done a fellowship for over a year there under dr w and the staff and dr w had mentioned dr k in our discussions. These people were very sad in speaking of his leaving the hospital. they looked like their dog had died and they could not speak highly enough about him. they said they tried financially to keep him but he wanted to go do this consentration on prostate laser procedures.

Natrurally I had to ask how do you spell his name? Then I dropped the subject but I am a old enough man to recgonize that I needed to prusue more information on him. So i chased him down and I am very glad I did. Weather I use him or not, I have learned so much as most dr's will not spend the time.

Back to the refeneces, dr s acted like no big deal. And in front of me told his administrator to give them to me. But as you felt, they are stalling and it bothers me as it should not be that hard if you have done 80 + of these procedures. I will not give up and in fact will call again today as she told me last week she would do it over the holiday. So we will see.

John

 

John,

I believe Dr K must be an amazing and good guy. One of my thoughts about FLA was that is done mainly for Cancer patients. Issues like retro-ejcaulation are probably not foremost on their minds and probably those patients are in an older age group. Out of the 80 plus how many were BPH or are they all BPH ? What did the references for Dr K tell you?

Hey Jim  This is Ken  I just wanted to let you know that I had my Heart Ablation on Monday  It took 9 hours.  My doctor told me I should not have any more problems.  I think the worst part of the whole thing is when the nurse took the catheter out.  It hurt alot They he told me that If I don't pee in 6 hours that they would have to catheter. me.  I told them no your not.  It took me about 8 hour to pee abourt 100 cc very dark but I peed.  Feel ok but my chest hearts when I lay down.  Have to see the doctor in a few weeks.  Iam just taking it easy and not doing a things.  Take care all  heal well  Ken

Hi Ken,

Very happy things went well! Hopefully, one more problem you don't have to worry about anymore. What instructions/limitations do you have and for how long? Do you need to be in thinners? Please keep us informed of your progress.

Curious about the catheter thing. I understand that in the end you didn't need it, but when you thought you might, why didn't you just catherize yourself? A lot chance of UTI with CIC than with a catheter nurse not to mention probably less trauma.

Jim

Correction: Last sentence should read in part: "A lot less chance of UTI..."

I found this in the Journal of Vascular and Interventional Radiology just now searching FLA for BPH

MR Imaging–guided Cryoablation for the Treatment of Benign Prostatic HyperplasiaCited in Scopus: 1

Pejman Ghanouni, Harcharan Gill, Elena Kaye, Kim Butts Pauly, Bruce Daniel

DOI: http://dx.doi.org/10.1016/j.jvir.2011.08.010

Journal of Vascular and Interventional Radiology, Vol. 22, Issue 10, p1427–1430

Published in issue: October 2011

Hide PreviewFull-Text HTMLPDF

xA patient with benign prostatic hyperplasia presented with chronic lower urinary tract symptoms despite prior surgery and continued medical therapy. Using a magnetic resonance imaging–guided transperineal approach, two cryoprobes were placed into the transition zone of the prostate gland, and two cryoablation freeze-thaw cycles were performed. At 10 weeks after treatment, the frequency of nocturia had decreased from once every 1.5 hours to once per night, urinary peak flow rates had increased from 5.1 mL/s to 10.3 mL/s, and postvoid residual urinary bladder volume had decreased from 187 mL to 58 mL.

 

the 80 were a claim by dr sper.....ling not dr k

if ejaculatory duck or semial vessicals are not touched in procedure then side effects are not an issue. I have reviewed my MRI with dr k and he says in my procedure he will not get anywhere near them. so unlikely to have any effect. Please understand that in any reduction of prostate size, a patient will have a lesser amount of ejaculatory fluids produce as the prostate is smaller this includes PAE of FLA. But do not confuse this with retrograde ejaculation. It is not the same.

some of your comments are being moderated - thanks for the info I see - yes I understood 80 were Dr S. and not confused about retro. I guess I'm paranoid, I would worry that the heat from FLA would still reach ducts and damage them, that's why I would want to know what statistics the doctors have, they should know from follow ups if any had retro. Yes of course I understand FLA would reduce amount.

Being that it was going to be 3 to 5 hours he felt I needed it.  I told them what kind that had to use.  I have a stricture just before the prostate.  So my urologist told me to tell them no bigger then a 14fr coude catheter.  Which I made sure that it was before they put me out.  The only other thing they did not they did not tell me was then put a A line in my wrist to check on my blood pressure.  Never heard of that.  I had a lot of gause and tape and they told me not to touch it.  Had my back and chest shaved and my groin on both sides.  I can take a shower today going to pull off the plugs have to watch for bleeding.  No driving for 3 days and no heaving lifting for a week.  Still tired Had a general anesthesia they must have gave me alot to keep me out for so long.  They started at 9AM and did not get into my room till almosy 6PM.  but we do what we feel is right to take care of ourselfs.  I hope this will be the last for a while I see my urologist on friday.  Al is fine I hope.  Take care all  Ken

Why was you pee dark? Dehydration?

Hi Ken, Sorry to hear about your recent  problem. Did you have another Uro Lift? I thought all was going great for you? So sorry to  hear what hppened>

Looking forward to your response.

Frank,

I think it was because I was not drink alot and the dye they used in the heart.  The first time I pee on my own was dark but the next time is was more yellow.  All the nurses in that hospital were catheter happy keep coming in every hour asking be if I went.  One even had a catheter with her.  I told them no once would have told them again. Every man pee diffrent.  I go maybe 3 times a day.  I have a good bladder it that sometime it takes me a while  Have a nice day  Ken   

No frank  My urolift is fine.  Had a heart ablation done on monday  I have a-fib so I think he fix it.  It did fix my heart rate up from 52 to 76  So I think It will be good for now.  May not be as tired I see him in 3 weeks  Take care  Ken

I'm curious, you said your hert rat went from 56 to 76 and that its a good thing. Isn't slower better. Mine hovers aroung 50. Doc says its efficient and don't worry about it. Should I rethink this?

You just have to watch it.  Mines over the last 6 months went down to 44 that is to low.  I think it will be better for me.  I will not be as tired.  With it getting down to low.  I would fall asleep watching TV which was not like me.   They were looking at a pace maker.  I will see if it will last  I see him in 3 weeks. Ken

Hi Ken,Their is medication you can take a-fib-my wife had that. I hope your feeling better.

tkae it easy.

Iteresting. Hope it solves your problems

Yes Frank.  Was on it.  But still had 5 a-fib attacks in 11 month's was tired of going to the hospital The Iv's and stuff was getting to much for me so my doctor said that it would be best to fix it..I was in a-fib when I got to the hospital on monday they had to give me a bata blocker to fix it before he starter.  Still on 2 blood thinner but he took me off the heart pill.  so we will see.  I stll have a linq monitor ing my chest if I don't need it they can take it out. Hope your doing better  Ken

I hope so.  Tired of hospital  Take care  Ken

Hey Ken ,Get well,your to nice a guy to be in the hospital.

Thanks Frank  not a fan of the hospital  How you feel  Hope you get  better with your proplem  Ken

That is true when you make the prostate smaller The prostate cells do not make alot of fluid so you still have the ejaculation but less.  I would rather have some then nothing at all.  Take care  Ken

I'm going to try and get this topic back to Focused Laser Ablation, and less personal messaging.

j12080, let us know when you get some references. 

Are you still planning on having the procedure done in January?

Thanks

No problem  Focused Laser Ablation is a very good idea and worth the time.  As long as you have a good doctor you should have no side effects  Take care  Ken

Thanks for the article. My main issue with FLA is that there seems to be so little data on it so far and so few doctors performing it. I did read that paper from 2011 but it was only one person. Anything published since? Personally, I would like to see a real study or at least hear from a decent number of patients who have had the procedure who can provide feedback. 

Jim

Motoman, 10-4 I will let you know when I get the references, first I taped my meeting with sperling in his office an I am going to listen to it again tonight just to be sure of what the commitment was.

Then tomorrow, I will get the wife to call his assistant and see if she has better results than I have had. I am like jimjames on this, I really want to speak to someone who has had this done fla for BPH.

If they have done 80+ of these procedures I am sure they book at least 2 each month so it should be rather easy to get 4 or 5 men to discuss this procedure with prospective patients. I actually do not know anyone with our BHP condition that is not sympathetic to others who have BPH and wanting to help other men.

Kenneth is correct in my opinion, the key to "no side effects" rest fully on the skill of the IR with the laser. No side effects should logically be easier to produce than is cancer which can be located anywhere in the prostate as compared to what  they are removing the tisse next to the urethra.  This is only in the Transitional Zone of the gland.

As far as January, yes, that is the plan, but, I must admit I am still vacillating between doing PAE or FLA.

So, I am going to call dr k back and discuss some technical questions I have on  the  ablation location in the prostate and structural integrity of the gland and the urethra that is left in place after the ablation. He will discuss with anyone for as long as they wish to discuss it if  he is not in a procedure. And he always calls back. If he prefers, I may go down there and talk in person with him so we can both look at the MRI during the discussion.

I will let everyone on this thread know. We have to support each other and stick together.

John

John  I think you have a good plan. The doctor try to down play the side effects mostly retro.  They tell you all will be the same.  And if a man has been on flomax or something like that you know most of the time it's not.  Before I have anything cut away I want a guarantee that it will not happen.  Life is to short to give up anything .  We have enough taking away as we get older.  I believe in fighting for it   Take care  Ken

Ken before I knew about PAE at least my Urologist was honest about retro with regards to surgery - the statistics might say some percentage do not experience retro, he said basically to count on having retro after surgery.

Until we know more about FLA from men who had BPH and are otherwise healthy I would say the only procedure that guarantees no retro is PAE. Or maybe Urolift but that procedure sounds scary to me.

We have to see more trials.  I had a uro-lift done over a year ago  No retro and my orgasm are more intensce then they were before.  I like it that way  Take care  ken

Mike, FYI

In my research trip to NCU and Virginia both docs told me that in a lot of cases of successful PAE, the patient offen experienced a loss of semial fluid production when the prostate is shrunk, the production of the fulid deminishes somtimes greatly. The patient believes  that it is retrograde ejaculation but in fact it is not. Bagl.... told me it is the same experiecne and effect to the patient as RE is for the patient so what they call it does not really matter to the patient as the experience is the same.

I am sure that this would happen slow over time as the gland atrophies.

John

oh I didn't know that, not looking forward to that happening :-(

yeh I spoke to someone who had Urolift and he said the same thing, but apparently his bladder was so shot that he had to self catheter. After hearing what John says I'm sorry I didn't try Urolift first.

You will still have a ejaculation but it may not be what your use to.  I would take any instead of retro  Retro is when the ejaculation goes into the bladder.  They will not be touching the bladder neck  I had it and it sucked  Take care  Ken

Sorry about that.  I had 4 implants.  Do you have a problem with your bladder.  I didn't it was just my prostate got closed My urologist just opened it up.  Ken

I think anyone who waits too long will have a bit of a bladder problem - my Urologist told me, if you have surgery and passage opened up it can take months for the bladder to adjust - I think I have some of that going on, I feel an urge, if I hold it the urge goes away after a few minutes.

When you say you had it, you mean while on medication?

to calrify, I had PAE for a second time 9 weeks ago, no retro so far

Mike,

It may not happen to you. I heard alot of guys speak of their results and not an issue. My prostate is so large I don't see how that would happen to me. Volume now 125cc

It may not bother you either. Keep positive. Good luck.

John,

Thanks for that I was feeling a bit down when I heard that, mine also was very large I believe 115 or maybe 125 even.

Regards,

Michael

Researchers analyzed the medical data of 93 BPH patients (with a mean age of 63.4) with moderate to severe LUTS that had undergone PAE from 2010 to 2014. Medical data included evaluations performed at baseline and six months after the surgery, such as levels of prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), the quality of life (QoL) index assessment, and pelvic magnetic resonance imaging (MRI).

Researchers then compared the whole prostate and central gland volumes, as well as the prostate zonal volumetry index (ZVi) (calculated according to both volumes), with the clinical outcomes of the patients, defined by the IPSS and quality of life at six months after PAE. Clinical failure was defined as an IPSS score above seven or a quality of life score above two.

Results showed that six months after surgery, mean PSA was significantly lower than at baseline, and that clinical failure was reported in only four cases. The researchers also reported a marked reduction in prostate volume after PAE (30.6 percent for the whole prostate and 31.2 percent for the central gland).

The clinical parameters were also improved after PAE, with significant mean decreases in IPSS from 21 to 3.3, a reduction of about 84 percent, and quality of life from 4.7 to 1.2, a decrease of about 74 percent.

Researchers found that a higher whole prostate volume before surgery was significantly correlated to the level of improvement in the quality of life, and a higher central gland volume and ZVi were correlated to the level of improvement in IPSS and quality of life. The higher the reduction after surgery, the better the patients’ outcome. According to the authors, a ZVi above 0.45 predicts better clinical outcomes with 85 percent sensitivity and 75 percent specificity.

“Baseline [central gland] and [whole prostate] volumes as well as ZVi presented strong correlation to clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible,” the authors wrote.

“Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi [is above] 0.45. Finally, studies including larger cohorts and longer follow-up periods are still warranted to corroborate such findings,” they added.

Yes I was on Flomax and a couple of the other pils got off them quick KEN

DO YOU STILL HAVE THE SAME AMOUNT OF EJACULATION  KEN

Yeh the first time I took Flomax it was just horrible and I stopped right away and Doc gave me Cialis which worked nicely - I don't know how but some years later I took Tamsulosin and it did after a few days cause the retro but it didn't feel as horrible so I persisted for a while before the PAE and after so as not to cause stress on the bladder.

I would say a bit less - not a drastic difference

Thats a good thing  Take care  Ken

Hi Ken, I started cic Oct 24, it's better than the foley catheter. Getting up throughout bedtime ,at 2 times to do this ,i'm getting used to it.I don't know why i get this pelvis pain in my left leg,starts at the testicle and proceeds down the leg..I'm seeing a new URO Dec 13,hope he has some answers for me.

stay well

 

Wow, 2 PAE procedures

Frank  It's good your started CIC JIM had some good stuff for you.  He know what he's doing.  You know it something new to your body and as we get older we have them eche and pain that we did not have when we were younger.  It could be something small like the way your sitting or something.  Take it easy  Ken

thank you you too Ken!

I was very lucky to be offered a second shot at no charge - the docs who did this in Australia are on salary and have no financial incentive that I know of at least for now, I think they really care and want to help guys like us

John,

When you talk to Dr K, ask him if he knows of any time line when this procedure is approved by Medicare and or the Insurance industry. I am sure that there are several IR's besides Dr K and Dr S doing this FLA procedure for BPH. He must be part of a group of doctors that is pushing this highly effective procedure. It is approved by the FDA, so it should not be to long before they get the other approvals.

Ask him if there is a site where we can read patients who have had the procedure to get their feedback. Also, are there any Clinical Trials for BPH going on where we could be part of it.

Unless you have an extra $22k sitting around, this is quite expensive, especially without any backup data. Otherwise you are almost better off getting Urolift or itind done now because insurance and Medicare covers both, and then you c

an wait the year or 2 until it is approved.

MikeSkier

Good question and good idea I will let you know his answer. I do know that Sper....ling told me he was prepare a report and white paper on FLA for BPH with his information on the past patient he has done. Not sure if it is for a journal or for insurance. I will ask about that also. 

In the mean time you point is well founded one could do the PAE also and wait 2 -3 years for progress in the FLA area. I know it is not insurance approved either but it is a lot less of an investment while waiting and it gives volume reduction with out side effects. Mine is too large for Urolift. Need to study more on itind. But I like you idea.

John

John,

It sure seems like there is plenty of interest, at least on this website, about FLA. It is almost a no-brainer if either medicare and or insurances start covering it. It sure would be great if there was enough imperical data to substantiate the cost to them to approve this procedure. With visual accuracy and percission that we are hearing about without having to tear up or to scar tissue on the inside of the urethra, the spincher to the prostate or bladder. I am sure that they will have to a couple years of Clinical Trails to a directed format before we see any approvals So, therefore we need a minimally invasive procedure that the costs are currently covered to get us through waiting for full approval of FLA. I think some insurances do cover PAE because it is minimally invasive, not any more expensive than Urolift or itind, and it is not classified as surgery.

John, when you see and or talk to doctors K and Sp, let them know about this website and send a couple links to some of the hot topics, like FLA, PAE, REZUM, UROLIFT, ITIND. The patient website is the most complete source of patient feedback on the Web. You will have to give them instructions on how to be a member as a patient to have access, because it is a British website and they do give all the site privileges to non British. Even though it is British, there are participants from.all over the world, but most are Americans.

My prostate is 108cc and my BPH has to be improved quickly. I am 70 and would still like to be able to do things and even work part-time. I currently can not do that because it is so unpredictable. Sometimes at night I am up as many as 7 times and definitely do not get enough sleep. Daytime it can vary, but I have to be carefully because sometimes there is no notice as to when I have to go. I have not been able to work for the last 3 years because of this. So if we could do something to get us through this wait period. MikeSkier

Could you please give me info on this doctor sounds great what procedure did he do on you? I very sexually active and I'm scared about side effects with these other procedures thanks

Ray, I will send you the contact information on a Personal Mail message as this site will not allow us to share contact information. 

Did you get my private message I sent you. You can call me and I will be happy to give you more infromation. FLA is the way I am going for many reasons. Top of the list are I don't want any sexual side effects.

I'm late to this discussion... I'm a recent 'inductee' into the BPH problem, well, recent in that it has become problematic enough to looking for sulutions... Is there a reason that one cannot do the FLA and PAE on the same occasion, and kill 2 birds with one stone..? Cheers- Jed [Australia]

Welcome to the club 

Jed111 Good that your seeking some help but  PAE and FLA are 2 different procedures done by 2 different doctors.  They are both less invasive they some of the others with less side effects.  Look into them there is alot of information on the internet  Take care and good luck  Ken

Since they are both done by Radiologists, it would make sense to perform both at the same time... the FLA for reduction, and the PAE to maintain it that way... but obviously, this might be too much to hope for..? Cheers

Jed  Yes that would be nice both done by the radiologist but they are both done in different way Maybe one day  Ken 

HI Jim,My scanner test showed just what you said. It was completly empty after CIC. I remember the first URO i went to said he wanted to do Turp and nip the bladder. I didn't know what he meant be just nip the bladder.

Whst does this mean Jim?

Thanks my friend,

frank,

 

Hi Frank,

Unless you had a diverticulum (pouch) like I do, I was pretty sure that the scan would show empty after CIC. What comes out a few hours later is urine produced by the kidneys after you CIC. This is normal. Curious, did you notice what type of bladder scanner they used? Did you see an ultrasound image of the bladder or was it just a digitial readout of bladder volume? I don't know for sure what you're old uro meant by "nip the bladder". Maybe he was referring to the bladder neck, ie a bladder neck incision (cut) in addition to the TURP. 

Jim

Hello, I read with interest your comments about Dr K. I am interested to know whether you went ahead with the FLA procedure for BPH and if so, has it worked for you?

John will get back to you soon.  He's a busy man.  He had it done about 5 month's ago and he is great.  Everything works the way it should and no side effects.  When he get a chance he will let you know  Have a great day  Ken

OK, thanks Ken! Have a great day.

Hi Kenneth... how is your heart now after your heart ablation? I have this same problem and have been avoiding the heart ablation for 10 years due to 1 chance in 200-300 of having a stroke during procedure. Have you had any episodes of A-Fib since your ablation 7 months ago? thanks

Hello Jay.  Doing great have not had one attack in the 7 months.  Has far has the doctor is concerned I do not have a-fib anymore.  THey burned everything on the left side of my heart. I was taking off my blood pressure pill.  my suger is great.  Also off one of the blood thinners.  And I will be going in August to my heart doctor he may take me off the other blood thinner and we are talking about taking out the monitor that was put in my chest last year.  Also after 2 months been going to the gym lost 50 pounds and been great.  Talk with your doctor don't wait.  You can have a stroke at anytime.  Have it done you will be glad you did   Ken  If you need to talk PM  me 

Thanks Ken for your help. I have already had a stroke, about 12 years ago. Luckily I recovered all my faculties after a few days, but it was months until I felt okay again. This is how I discovered I had A-fib. Very difficult awakening to the A-fib problem. Thanks again.

Jay please go get it done.  I had 2 mini strokes.  I was not going to wait and have another one that I would not come back from. Call your doctor  Ken

PS- Hey Ken... congratulations on the great outcome on both of your procedures...  You're living my dream. Best

JAY how old are you.  Over the last 2 years it was hell in and out of the hospital.  Im going to be 62 HAVEI it done  Ken

I'm 63 so far... haha. Thanks

That is great.  Now go see your doctor so you can have this done.  It is time to enjoy your life and have some fun  Please  Ken

JIm, Yes ,he meant a bladder neck incision,in addtion to Turp?

What would would be the reason to do the bladder neck incision? along with Turp?More money??

Thanks  Jim

frank

Hi Frank,

Are you talking about your normal urologist now and not the Urolift doctor?

This is a little beyond my pay grade, but did he mean to do a bladder neck incision in addition to TURP or instead of TURP? Sometimes they do it instead of TURP for smaller prostates and I assume it's less invasive. If I remember correctly, he gave you 50-50 odds of getting off the catheter with a TURP?

Jim

A bladder neck incision is likely performed as part of the TURP procedure; Part of the prostate is on the bladder neck, and is generally resected (or incised) during the procedure.

The TURP is a global procedure, and there certainly would not be an additional cost (to you or to your insurer) for this, as it is generally a part of the procedure.

A TUIBN (Transurethral Incision of the Bladder neck) is often offered to patients as a "minimally invasive" procedure (vs the TURP) for men who wish to preserve ejaculatory function (but often have minimal symptoms).

We have been offering the Urolift in conjunction either with resection of a median lobe or a TUIBN for the right cases; there have not been enough performed to document whether this is an improvement.

Frank is in his 90's, in full retention, no natural voids and can only void via CIC. As best I remember, his current urologist gave him a 50-50 chance of being able to void without a catheter with TURP and very little chance with Urolift. Unclear exactly what his urodynamics concluded, other than he mentioned the word "failed". He seems to tolerate CIC very well. Difficult choice as I see it. 

Jim

CIC, for those with the dexterity, is a wonderful option.

A Urolift can be attempted as it can be done with no general anesthesia, but I see a very small success rate with that in retention, particularly in larger prostates with substantial median lobes.

And what about something invasive like TURP for someone in their 90's like Frank with maybe a 50-50 chance of success?

Jim

If he is of minimal anesthesia risk, I think it is a wonderful procedure, assuming his gland is of an appropriate size. With newer technology (such as the "button", which eliminates the need to use glycine), TURPs can be performed safely and effectively.