Gat-Goren procedure

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.

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

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.

Howard, Just read your second post. Sorry you didn't get the results you hoped for. And worse yet, you developed another painful condition.

Thanks again for your input

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

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.

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.

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.

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.

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.