Gat-Goren procedure

Posted , 9 users are following.

A year or so ago there was a fellow on here that was contemplating having the Gat-Goren procedure done. I think his name was Neil. Does anyone recall if he went ahead with the procedure? If so have we heard from him regarding the outcome? Anyway I started researching Gat-Goren again recently. Seems like it has promise, but like FLA finding someone to perform the procedure is difficult. This was plublished in March 2018 ( I think) in a medical journal

In varicocele, there is venous flow of free testosterone (FT) directly from the testes into the prostate. Intraprostatic FT accelerates prostate cell production and prolongs cell lifespan, leading to the development of BPH. We show that in a large group of patients presenting with BPH, bilateral varicocele is found in all patients. A total of 901 patients being treated for BPH were evaluated for varicocele. Three diagnostic methods were used as follows: physical examination, colour flow Doppler ultrasound and contact liquid crystal thermography. Bilateral varicocele was found in all 901 patients by at least one of three diagnostic methods. Of those subsequently treated by sclerotherapy, prostate volume was reduced in more than 80%, with prostate symptoms improved. A straightforward pathophysiologic connection exists between bilateral varicocele and BPH. The failure of the one-way valves in the internal spermatic veins leads to a cascade of phenomena that are unique to humans, a result of upright posture. The prostate is subjected to an anomalous venous supply of undiluted, bioactive free testosterone. FT, the obligate control hormone of prostate cells, reaches the prostate directly via the venous drainage system in high concentrations, accelerating the rate of cell production and lengthening cell lifespan, resulting in BPH.

0 likes, 15 replies

Report / Delete

15 Replies

  • Posted

    Hi unclkefester, does median lobe too is affected by Gat-Goren, being reduced in size and alowing a better outcome for BPH patients, (improving symptoms)?

    Report / Delete Reply
  • Posted

    Research PAE -prostatic arterial embolization. My understanding is that is the same procedure.

    There are quite a few interventional radiologists that do PAE.

    Report / Delete Reply
  • Posted

    I looked into this a few years ago. I talked to interventional radiologists and no one had heard of it. All it is is blocking a vein coming from testicle and prostate. I eventually found someone who does PAE. In fact I'm seeing him tomorrow. I don't know which is better but PAE has more history. I recently had embolization for tumors in my liver. PAE is similar.

    Report / Delete Reply
    • Posted

      I had a pet scan that looked at prostate. Bottom line is my prostate is 20grams. He wouldn't try PAE on anything under 50 grams. He suggested medication. PSA is 0.3.

      Report / Delete Reply
  • Posted

    Here I am! I'm using y first name instead of my middle name (Neil) as it got too confusing with too many Neils, Neals etc. I should probably use a funny name like you do.

    Anyway, here is the lowdown:

    First as you know the GG procedure closes off a defective vein and not a healthy artery as PAE does - this is a HUGE difference for a lot of reasons.

    Last year GG came out with a new paper and revised data which looked very good. I personally know a lot of guys who had the procedure years ago and are still very happy with their results for alleviating their BPH symptoms.

    As you know , GG relates the presence of varicoceles as the cause of BPH so if the offending gonadal veins can be sealed off then the BPH symptoms should improve.

    But in their paper they listed at the end 6 clinical conditions that would reduce a good outcome. These are:

    1. Prostate vol > 120cc

    2. PVR > 130cc

    3. IPSS > 24

    4. Presence of a median lobe

    5. CIC in the past

    6. Chronic prostatitis

        1. and 5. apply to me so I was turned down. Anyway it saved me over $30,000 which I can put away for FLA maybe in the future.
    Report / Delete Reply
    • Posted

      That should read 1. 2. 3. and 5. apply to me. My screen froze so here is the rest of the story.

      Not to be deterred I searched for an IR who would do my bilateral varicocele embolization without the use of coils. This is very very important for a lot of reasons. In Europe VEs are commonly done w/o coils but not so in the US and Canada.

      I finally found a very nice IR doctor who would agree to do the procedure w/o coils though he admitted he had never done it that way before. Still he was confident he could pull it off just using sclerosant and pressure. He was very familiar with the GG procedure and actually was working with a uro at his hospital to investigate the correlation with BPH. By the way my scrotal u/s did confirm varicoceles on both sides.

      So last Dec. I had the procedure. It was quick and painless and I watched the whole thing.

      But a week later I started to develop severe pain in my left testicle. It actually incapacitated me for over a month and I was on antibiotics and pain killers all that time. My left testicle swelled up to 3 times its size.

      This problem would resolve but would then come back once ina while, especially after sex. I went to see some of the top doctors that specialize in scrotal pain and they all said it was epididimytis. Apparently a benign cyst that I had had most of my life at the head of the epididymis had become highly active as a result of the change in blood flow following the VE on the left side. My right side was ok.

      This problem still haunts me and in fact I am in the middle of an episode right now and had to cancel a lot of activities.

      There have been hundres if not thousands of men who have had the GG procedure in Europe and none of the published reports which I studied carefully ever reported a chronic side effect like mine. No doubt it was due to the inexperience of my IR and I should not have used him when he said he had never done it.

      So a cautionary tale - if you do it make sure the IR has had a lot of experience in the GG procedure without coils. Mine was covered by insurance which was a big factor-otherwise I would have gone to Europe.

      Now my only long term option is to have the left testicle removed or live w/o a sex life! And by the way my BPH never improved!! Take care. Howard

      Report / Delete Reply
    • Posted

      Thanks Howard. I was sorting through my PMs looking Neil but Howard was the only name that popped up with discussions about G-G. What really worried me was I kept calling you Neil when your screen name was clearly Howard. Thought I should stop worrying about BPH and get checked for dementia instead LOL

      My prostate volume is approx, 125 cc (ct scan November 2015 ) and I think I have a median lobe. I thought median lobe was pretty much present in most BPH cases. Am I wrong? Last I checked my PVR was < 50 cc. I've been on finasteride for about 3 years. I'm reasonably sure my prostate has shrunk. My flow rate on a good day ( crudely measured by me with a beaker and stop watch ) is 25ml/sec ( not a typo ) a bad day 15ml/sec. Night time peeing varied, if I don't eat spicy food I'm good but spicy food can almost send me in to retention.

      So I'm guessing I'm not a candidate either.

      Report / Delete Reply
    • Posted

      Hi Unclefester

      Sorry about the name confusion - I usually go by my middle name but changed my handle here due to too many Neils!

      A few things: 90% of BPH patients have median lobes which can be good or bad. The good part is that they can be "easily" treated using targeting procedures like FLA, Holep, Turp. But the bad part is they can create emergency situations so unless you CIC they require intervention.

      Best thing is to get a flexible cystoscopy to see if you have one. In my case I am among the 5% that do not have one but my prostate is almost 300 cc due to huge side lobes. Still I can natural void and with the help of CIC 4 times/day I manage ok.

      The next thing regarding GG is to get a scrotal ultrasound to confirm you do have bilateral varicoceles. If you do and you don't have a median lobe then you would be a good candidate for GG.

      I thought I would try the 2 most benign procedures, PAE and GG-like. PAE failed totally but at least I was not left with a new chronic condition that I have now (other than lightening up my bank account). If you can afford the real GG then I recommend it as I know men that have really been helped by it. Otherwise I exhausted looking for IRs in the US and Canada with experience in GG and coould find none. So the other option is to go to Europe where they do it all the time and maybe insurance would cover it.

      My procedure actually left me with a higher grade varicocele on the left side than when I started!! Really too bad as I thought I had done my DD on GG.

      Good luck

      Howard

      Report / Delete Reply
    • Posted

      My first uro did a cystoscopy. Unfortunately, he did not do a video of the procedure and was very vague in his notes. So I don't know if I have a median lode or not. His only answer was to do TURP. Glad I found this site before I went ahead with his recommendations.

      As mentioned ealier, I'm not in a situation where I have to get something done. I really hoping that one of the intra prostatic injectables proves to be a silver bullet. I'm not confident it'll happen though.

      FLA is certainly a viable choice if I need to have something done. I'm in NY so going to TX for treatment by Dr. K would be a hassle. Dr Sperling does it but I've heard mixed reviews.

      Locally one of the DRs. has lots of experience with HOLEP so that is an option also*if I don't mind the side effects.

      Report / Delete Reply
    • Posted

      Hi uncklefester, would you mind to explain which are main side effects from an Holep surgery? I have read so many mixed information about it so I was very confused.

      Report / Delete Reply
    • Posted

      Hi lrp1 The only side effect I find objectionable is retrograde ejaculation (RE) some say the don't mind it, others say its ruined their sex life. I was on Tamsulosin for a while which so I've experienced RE first hand. Orgasm was different, probably not as intense but not bad.

      To me HOLEP is a decent alternative. Very little blood loss, reasonably fast recovery, very low retreatment some say better erections. My treatment of choice would be FLA but its not covered by most insurances ands its expensive.

      Report / Delete Reply
    • Posted

      I too have been following the trials of 2 small biotechs with their injectible solutions for BPH. Both companies have had good success but both are now facing bankruptcy I believe in part due to competing interests.

      I had hoped that CIC would buy me time for one of these easy solutions but now I have given up hope. There was a recent posting here by Dave who had a robotic SP which removed his 300 cc prostate and he is doing great. I may just do that next summer as mine is the same size.

      Regarding GG I do suggest you get a flexible cystoscopy to confirm whether you have median lobe. Also a scrotal u/s to confirm bilateral varicoceles. I had a talk with Dr. Sperling in New York about doing the VE w/o coils to mimic the GG procedure but he got very angry with me when I suggested many men's lives have been ruined by coils. There is a whole forum devoted to the devastating effects of coils.

      You still may be a candidate for GG and if you wish i can suggest a very nice IR in Detroit who uses glues rather than chemical sclerosants and he is covered by insurance. But really the best thing is to go to the source in Israel if you can afford it.

      Report / Delete Reply
    • Posted

      I'm fortunate, but I was watching my cysto on screen and stated, " Looks like no median lobe" which he stated, "correct." His notes were also very through.. I mistakenly believed I had a bladder diverticulum as I was kind of 'out of it' on a double dose of valium. I thought he said, "Oh, Bladder Diverticulum" but prob actually said NO Bladder Diverticulum."

      I got my patient file today with the following notes;

      "The ultrasound findings of the bladder include the following: There is no evidence of any lesions, calculi, median lobe, diverticulum or ureteroceles within the bladder. The bladder wall was measured to be 6mm in thickness. The post void residual urine volume is 58cc

      Uroflowmetry was poor, but I was zonked out after the Cysto and shaking a bit = 7ML max, average of 6.1ML... Prob from Rapaflo's effect on detrusor, as that one is the strongest A Blockers in terms of relaxing stuff.

      Cystoscopy-Diagnostic The following findings are noted: The anterior urethra is normal. There is no evidence of any pathology relating to the prostate or bladder neck. The prostatic urethra showed evidence of bilobar hyperplasia of the prostate. The abnormal

      findings in the bladder are as follows: The bladder is mildly trabeculated, 2 cm LLO."

      Did your Uro leave any notes as those above?

      My Uro does the Rezum procedure and we discussed it. He also was writing down, "Turp" but crossed it out and said, no, " bad sexual side effects."

      He did not try to push me into anything, instead wanting me to try some different a blocker (alfuzosin) and come back in January for another round of PVR. I suspect my detrusor is a big part of my current weak flow.

      I'm actually lucky - but I requested this guy, and he really does care about patient well-being.

      I'll find out more in January regarding estimated size of Prostate, but from what I've gathered so far, it's mildly to mid enlarged, so I'm guessing 30 to 50 CC.

      Report / Delete Reply
  • Posted

    Abstract of latest Gat-Goren paper

    In varicocele, there is venous flow of free testosterone (FT) directly from the testes into the prostate. Intraprostatic FT accelerates prostate cell production and prolongs cell lifespan, leading to the development of BPH. We show that in a large group of patients presenting with BPH, bilateral varicocele is found in all patients. A total of 901 patients being treated for BPH were evaluated for varicocele. Three diagnostic methods were used as follows: physical examination, colour flow Doppler ultrasound and contact liquid crystal thermography. Bilateral varicocele was found in all 901 patients by at least one of three diagnostic methods. Of those subsequently treated by sclerotherapy, prostate volume was reduced in more than 80%, with prostate symptoms improved. A straightforward pathophysiologic connection exists between bilateral varicocele and BPH. The failure of the one-way valves in the internal spermatic veins leads to a cascade of phenomena that are unique to humans, a result of upright posture. The prostate is subjected to an anomalous venous supply of undiluted, bioactive free testosterone. FT, the obligate control hormone of prostate cells, reaches the prostate directly via the venous drainage system in high concentrations, accelerating the rate of cell production and lengthening cell lifespan, resulting in BPH.

    Report / Delete Reply

Join this discussion or start a new one?

New discussion Reply

Report or request deletion

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up