Going with Focal Laser Ablation for BPH
Posted , 73 users are following.
Ok, I have decided, I am going in the next 21 days for FLA. I have picked dr. k if the schedule of my wife's treatments can allow it along with his schedule. He is busy with some complicated PCa cases as well as talking about a partially self funded clinical trail scenario for BPH patients.
If I cannot line up with him, his associate is Walser and I will get him as they still work together at the same hospital. Maybe I can get both involved and get a double bang for my buck. I will let you know soon.
3 likes, 1293 replies
TKM j12080
Posted
I second what Hank is saying. Log onto You Tube, upload your video, and post the link. Although the moderators may block the link. You may have to PM the link, or find another way to send it.
Thomas
eric1962 TKM
Posted
Still trying to post the video....
Stay tuned
E
vic04161 j12080
Posted
j12080 vic04161
Posted
Vic, I don't think you will have final results for months. My results changed and varied several times but was always much better than before FLA. Other guys seemed to not have these continuing changes. They were not bad just differing and happened a few times during the recovery time.After 11 months I leveled off and felt normal with no more changes and I have been consistant since. I thought many times I had fully recovered but I think on any of these procedures it takes a lot longer time to get to your new normal. The prostate has to reform with any of the prostate procedures available. I am now 2 years into it and very happy. Life seems really good right now and I seem normal for my age. Some nights I get up once or even twice and some nights not at all. It all has to do with what and what time I drink for the day. Let week was member guest tournament for me and I sure drank a lot of the wrong things.. Not doing that again for many reasons. All of them under the category of too old to live like that. But I did have fun.
I think and hope you will do good with more time after you feel things are you new normal. Please stay in touch and just ask if I can relate any of my time to you. We are all different. I know if I would have waited until now i would have had the advantage of all the experience that Dr. K has gotten in two years. He is a wonderful doctor as I am sure you already know.
Tucsonjj j12080
Posted
Good info... I am leaning to doing self catheterization for a long while, then probably a HoLep procedure... I happen to have a very competent HoLep Doc here in Tucson... two, in fact. I think that is the best, IF insurance covers it and you don't mind total retrograde ejac.
eric1962 j12080
Posted
I was finally able to create a You tube link for MRI urodynamics in a normal volunteer.
It is at
https://youtu.be/DgnJoK8xle0
We are working on this as a way to investigate bladder dysfunction and BPH at the same time as MRI for prostate cancer. As you all know, some men with small prostates have bad urinary retention symptoms and some men with huge prostates have no symptoms.
We think the urodynamic data will add to the information from the MRI at no additional cost. The bright urine is the natural MRI appearance of fluid so no additional contrast or catheterization is needed. When we are ready, the patient urinates into a condom catheter connected to a bag and a video MRI sequence captures the details. We believe that we can calculate post void residual, maximum urinary velocity and maybe even evaluate the muscular contraction of the bladder in normal and diseased states. Work in progress.
As some newer laser products are made specifically for BPH and cost less than those made to eradicate cancer, the ability to monitor urinary function at each follow up MRI study is helpful. It may allow radiologists also to compare the effects of competing therapies, including Rezum, urolift, transurethral proceures, steam vaporization, etc.
martin_victor eric1962
Posted
Here's a video from Dr. Feller regarding latest clinical data on FLA. Cancer is discussed primarily but much can be learned from his conversation on the positive results and lack of complications from this procedure...be it cancer or BPH.
https://www.urotoday.com/video-lectures/prostate-cancer/video/mediaitem/1088-embedded-media2018-11-15-21-05-49.html
kenneth1955 martin_victor
Posted
Thank you Victor
This was very interesting but I did not here anything on retro which is a concern to some of us. I would like to know more.
I think I am going to send him a e-mail to see if i can get anymore information
Thank you again..........Ken
vic04161 kenneth1955
Posted
I'm about 4 months from FLA, at this time I would say my condition is pretty stable. most of the time i get up once at night or early morning. The flow is not as good as on the 2.5-3 months after FLA but i would say it is still good. No major problems with nether sex life nor anything else. Overall at this time I am satisfied with FLA outcome and received what I expected just hope it will last for some time and if it does not the other options are still on the table. The technology is changing and improving fast so there may be even better options in the future. My best wishes to all of you guys.
kenneth1955 vic04161
Posted
Hey Vic
Thank you for getting back to me. I'm happy that all is doing good for you. Better then before the procedure. Do you know how much was taking out and you say you have no problem with sex. Does that also men no retro ejaculation.
Most of the men that have had it done did not get it. I read about a man that had it done at 75 he told the doctors no that wanted to do a turp. He went and had it done and he said that his sex life improved and he got his ejaculation back. Off all pills
Hope all goes well for you. Everything takes time...Ken
vic04161 kenneth1955
Posted
My size was 125 i had 11 ablations. I have no retro although the sperm itself seems has changed it is not as viscous as it used to be though the volume didn't change.
kenneth1955 vic04161
Posted
Vic
I know Dr. K is very good on what he does. If he can he will not get rid of anything if he does not have to. That is why I think he takes his time. Have not talk to him in a while.
I think has we get older the force is not all ways there. I know with my Urolift My orgasm and ejaculation are very intense. But on the second try the orgasm is still good but very little comes out.I guess we don't make it as fast as we use to.
But we move on....Just glad I still have it.......Glad all is good......Ken
j3333 j12080
Posted
Don't dare criticize the 'm' o---der a tor or your post will be deleted... sigh...
joe34587 j12080
Posted
Hi to all fellow sufferers of BPH. Just to say you are not alone plenty of us are struggling with mixed, variable and incomplete medical advice on what to do are our ability to void slowly disappears.
I have now had a PAE with Dr. Schlaphoff in Sydney Australia Oct 2017 and last week (ie June, 2019) a Focus Laser Ablation (FLA) with Dr Karamanian in Houston. so thought with these behind me could offer a somewhat unique perspective.
Two years ago things were getting really bad several near fully acute retention episodes and a UTI forced my hand to make a decision. Also terrible frequency, 5 - 7 times up at night, urgency, etc. About 130 size and a large median lobe pressing into the bladder and causing restrictions. Taking two a day Tamsulosin. Two different Urologists suggested a TURP as the gold standard of care though actually only told me very little about it. However when pressed they both said their was a reasonable chance of incontinence, retro and ED and there were no guarantees. As a 52 year old that sounded pretty bad.
Spent a lot of time reading these forums and doing my own research. I considered the Rezum procedure and did consult with the inventor. It sounded like the results might be better than a TURP however the process and recovery as described did not compare well to the PAE in my opinion. (I have not had Rezum just did some research so can not know for sure.)
I eventually chose the PAE and Dr Glen Schlaphoff in Sydney Australia. He is a real pro - has a great caring team, the latest equipment and is a leader in the field. The operation was painless, no catheter, home the same day and the care was excellent. However due to the architecture of my blood vessels he was only able to do the embolization on one side as he felt it unsafe to do the other side. Even so I had remarkable improvements in flow, frequency, urgency, started sleeping through the night and went off the Tamsulosin. It was like getting my life back. Easy gentle process with great results the only downside the median lobe was still big and still there. As I had no other choice at the time he saved me from a TURP and I am very grateful.
However my prostate kept growing and based on another 3T MRI in April of 2019, with an even bigger median lobe and symptoms slowly returning it was time to look at options again. Consulted with two Urologists both said TURP the way to go. Consulted with Dr Schlaphoff - he was again terrific, took time for me and was open and honest - we could try PAE again and it might buy some time but with my unique architecture he was not sure it would be best. I asked him about FLA and he was aware of it and thought it might be worth considering though he was not yet offering it in his practice. What a joy to get an honest opinion like that.He is really a terrific doctor and I would highly recommend him to anyone with these kinds of problems. I believe that his other patients where he could do embolization to both sides continue to do well over time so far.
So that brought me to Dr Karamanian to learn about FLA. He took the time to read both of my 3T MRI's and called me in Sydney. He was generous with the time up front at no cost and was clearly focused on care and achieving good outcomes. He is a unique person in his knowledge or engineering, medicine, lasers and IR and is a real pro - and a great human. He told me that he started out doing FLA for prostate cancer and then later discovered from his cancer patients that they were no longer suffering from BPH symptoms. This led him to start doing FLA for BPH. He now works on the prostate exclusively which I think is a big deal in terms of learning and gaining experience. He has apparently now treated 250+patients for prostate cancer and or BPH. He mentioned the BPH results are very good for flow improvements, with very limited side effects regarding ED or incontinence and limited retro.
I had the FLA last week Tuesday. Started at 6am very nice so not waiting around all day fasting... canular in, twilight drugs in (no general anesthesia), local pain killer in up front then the foley in. Not nice but did not hurt. Then onto the MRI machine lying down on the stomach fairly comfortable. Partial memory of the operation - could hear a few things but no pain then it was done. The FLA is done through the back door although you are not really aware of it at the time. They are also pumping cold saline through the foley to protect the urethra from the lasers heat so plenty going on. Took 4 hours then went back to the hotel for recovery. Catheter in for a week. Did not enjoy that but not that bad really. Hardest part is keeping everything sterile and clean to avoid getting a UTI and it limits mobility a bit.
The day after the operation went back to Dr Karamanian's office for a follow up. He showed me some images from the procedure and the before and after images. It was eye opening - You could clearly see that he was getting within 1 or 2 mm of some critical areas without hitting them. He believes that he ablated about half the prostate and there was clearly no blood flow to those areas. More specifically he ablated the areas in the "transition zone" specifically to improve flow. The median lobe appeared to be gone. Looked really good we will see.
But still no pain, able to sleep, eating normally. Got the catheter out yesterday again no pain not a big deal. I will say though that the nurse (Donnie) came to the hotel to take it out rather than making me go to the practice - a very nice and thoughtful thing to do. He mentioned there might be some retention issues in the first 24 hours however so far so good.
Also hardly any bleeding at all whether during or after the procedure. What a difference from a TURP.
Also Dr Karamanian and Donnie had both said it takes three weeks to "break even" on your flow and then you will see improvements. However for me I seem to be back where I was before the operation already in the first 24 hours.
I am waking up "feeling like a man" so no concerns about ED and no incontinence at all. We will have to find out about the retro later as have not tried yet.
So while I did not enjoy the procedure or the recovery so far it has not been bad and is significantly better than a TURP. I still seem to have my abilities and time will tell if the flow improvements arrive.
I will post again as time goes by with some updates.
Final thoughts.
Both the PAE and the FLA procedures were not painful and not that bad.
I found the PAE a bit easier, it was shorter, had no catheter and gave me excellent results pretty quickly. However for me the PAE was not durable whether because of doing one side or because the prostate was able to re-vascularize I don't know. Also there is some radiation but that did not overly trouble me.
Knowing what I know now if I was a candidate for PAE and thought they could do both sides and could get Dr Schlaphoff - I would have confidence in doing this. Time will eventually tell us how durable it is and if re-vascularization is a limiter.
The FLA was more involved and included the catheter for a week however again not that bad and much easier than a TURP. It was clear in the images that he smashed the median lobe and opened up the flow areas. No ED and no incontinence. Flow so far so good. Time will tell if the flow gets much better. I am hopeful that this proves to be an effective and durable solution.
Knowing what I know now, and if my flow continues to improve over time - if I was a candidate for FLA and could get a time with Dr. Karamanian I would have confidence in doing this. So for now waiting and will provide some updates as time goes by. Fingers crossed that flow keeps getting better and stays that way!
andrewcalgary joe34587
Posted
this is great update, please keep us informed on your progress,
THANKS !!!
Tim-B joe34587
Posted
Joe,
Glad to hear you are doing well. I had FLA with Dr K in Dec 2017 for both PCa and LUTS (didn't have much BPH but my urethra was being pinched by something within the gland). My prostate size was ❤️0cc.
Dr K ablated approx half of the gland and I showed flow improvement over the next 9+ months, so don't be worried after just a few weeks if it's not where you hoped. I am now 18 months post and have zero problems. I cannot tell you the last time I woke up and needed to urinate. I can now drive 4+hours or fly to the west coast and not worry about it. The freedom it provides is wonderful. Subsequent MRI shows no evidence of the PCa and my PSA has gone from 2.2 to 0.3.
Good luck with your recovery.
-Tim
Tim-B
Posted
that is less than 30cc. Apparently the forum software interprets a less than sign as something else....
arlington joe34587
Posted
Joe,
Thanks very much for your post. It is really helpful for those of us considering these procedures. I've been in retention and having to CIC since Jult '14. I had an unsuccesful PAE in 2015 (I, too, have an enlarged median lobe). The FLA is the procedure I'm watching most closely (although I've been in no hurry to have another one). I've recently had some real problems passing the catheter through - so maybe my calculus will change.
Thanks again and please keep us posted regarding your continued recovery/progress.
Best of luck!
arlington joe34587
Posted
Hi Joe,
How long did you stay in Houston after the procedure?
Were you able to care for yourself or was someone with you.
Thanks a lot.
joe34587 Tim-B
Posted
Thanks Tim so happy to hear of your success - what a relief for you!
joe34587 arlington
Posted
Hi Arlington I am from Sydney and was not in a hurry to jump on a 15 hour flight when unsure about post procedure flow. Also have had difficulty in the past with self cath so again wanted to be close to the Doctors. So stayed for 9 days total. This gave me time to be sure there was no UTI and that the flow was ok after the cath was out.I think it would have been ok to leave sooner with the cath in just didn't want to and am able to do my work from anywhere so didn't really matter.
My wife and kids are in Sydney so was here alone. Dr K arranged for a post op nurse who collected me from the surgery center, drove me to the hotel and stayed with me for 12 hours. Really needed her there would not try it alone. She knew how the cath worked, shopped, cooked and generally looked after me very well. Money well spent.
Also should say stayed at the new Marriott Residence Inn about a mile South of Dr K's office. Cost of about $150 per night. Room has full kitchen with full size fridge, living room and large separate bedroom and bath - very comfortable and they also have a restaurant that serves free breakfast and optional dinner that you can choose to pay for. Kroger, CVS and Walgreens are about 100 yards away this place was terrific. Although, at least for me, the 20 seconds you get to walk across the 8 lanes of traffic before the light changes seems surprisingly short when walking at the pace of a man with a catheter in... 😃It is the one at Main and Kirby Street.
arlington joe34587
Posted
Thanks a lot, Joe.
I'm forewarned about those 8 lanes of traffic!
TKM joe34587
Posted
Joe,
Can I ask, since they enter the prostate through the rectum, sparing the urethra, does it cause problems with bowel movements ? I assume they give antibiotics from the start. Do you have to eat a special diet, or take stool softeners ? If there are problems in this regard, how long does it last ?
Thomas
joe34587 TKM
Posted
Hi Thomas,
It was not a problem. Much less prep than a colonoscopy. Regular diet is ok. They give you two "fleet enemas" you take one late the evening before the procedure and one before you leave the hotel for the procedure. They worked in a few minutes and then were done no big deal.
They do give you some antibiotic cocktails and an anti spasm medicine that apparently can cause some constipation. They also ask you to drink 4 glasses of metamucil (they give you the packets) - two for the day of procedure and two for the next day. My procedure was Tuesday and the metamucil worked on Thursday am with no discomfort and regular after that.
I did eat pretty light after the procedure (having read of other prior patients constipation struggles) and I did try for an anti-inflammatory tilt in the diet. So plenty of blueberries and other fruit, oatmeal, ginger and green tea. Stayed away from any packaged foods.
They had said the "break even" flow takes three weeks however I was at "breakeven" as soon as the catheter was out and still "going well"...
Joe
fred53808 joe34587
Posted
I am considering FLA, and I hope you can you provide some more detail about your experience this past June. You said the procedure lasted 4 hours, how much of that time were you actually in the MRI machine? I am a very anxious person and concerned about being fearful during the procedure. While in the MRI, were you aware of what was going on or asleep or half asleep? Is the sedation like that for a colonoscopy, where I go to sleep? Thanks for any insight you can provide.
Fred Block
andrewcalgary fred53808
Posted
If you go with Dr.K you will be under conscious sedation, I didn't feel anything, I had 15 ablations, 5 for PCA and 10 BPH, took about 4 hrs,
you will have the Foley when you wake up and will keep it for 7 to 10 days, and remove on your own, very easy, my urine flow now is excellent, and based on 10 measurements, my average urine flow rate is 16.6ml/sec, 3 months after FLA
Tim-B fred53808
Posted
Joe,
Try not to be overly concerned with the procedure. Dr K uses Versed. Most of the 4 hours I do not recall. Donnie started giving me sedation after I lay on the MRI table and I vaguely recall some snippets of conversation, but the next real memory is getting up and leaving the MRI room almost 4 hours later. Dr K asked my pain level - it was a flat zero. Neither during the procedure nor after did I have anything other than very mild discomfort, most of that just getting used to the Foley. Yeah, it's uncomfortable - but you learn to adapt.
Ankle sprains and tooth extractions had more discomfort than FLA.
eric1962 fred53808
Posted
We do the procedure in a hospital and provide IV sedation which basically keeps you comfortable and unaware of the confines of the MRI machine. If necessary, I bring in my colleagues from anesthesia and put patients full asleep. This may require a night stay in the hospital. Sometimes anesthesia is required in complex focused ultrasound or cryoablation procedures. Some BPH transperineal therapy is done with such small needles that only local anesthesia is needed and patients go home right away. Hope that helps. Happy holidays!