Going with Focal Laser Ablation for BPH

Doctor Sperling is the doctor that does FLA.  I have read in his reports that he can remove prostate tissue without causing damage to any of the sexual function.  If your median lobe was in your bladder he could have remove only that.  With the FLA procedure.   Ken       

Karamanian Houston 

Sperling Florida

J12080  I'm very happy for you.  It looks like you did your research.  Which I wish more men with do.  Alot of men just take there doctors word and then end up having more then one surgery.  This procedure looks like it will help you and many with alot of the problems and no side effects.  I think alot of men would see a doctor more if the side effects were not in the program.  Good luck and lets us know when your done  Ken.

John-

What is the size/volume of your prostate? 

Again, best of luck - looking forward to hearing your report.

-Tim

Tim, 125cc and large median lobe protruding into the bladder. The plan as diagrammed out is to ablate three sections along the urethra in area about 1.5 inches each to relieve the urethra pinching then also remove the tissue pushing up into the bladder. And I have a suspicious area in the median lobe that could be low grade cancer and they will pull a biopsy and then ablate the area out of me. All in all I think this will remove just under 30% of the prostate.

Good j12080, I had the same size 125 and had FLA in July of this year. Everything went well all as dr k promised. I would comment you will have to ware cath for 6-7 days and it is probably the most uncomfortable time. I removed mine in the shower on the day seven it was pretty easy. Today I give bleedings and uro flow I very healthy. I’m glad I went with FLA it was quite a bit of struggling, it is expensive but in my opinion worthy every penny. My FlA took abour 4-5 hours. No pain during the FLA and dr k had 11 ablation on me. Dr k didn’t tell me but I would take it easy with food for a first day or two. I had no bowl movement for a first two days. No heavy lifting no exesize as it may provoke bleeding. I live in Houston so I didn’t have to have any long traveling hove. I took easy for first week then went to my office. First few days  I would say the worst. On the second day after FLA I ask dr k to change my cath for the smaller one and it was much better. I think you will be happy with results dr k is a great and caring doctor and the procedure is great it preserve all men function with no retro or ed damage. Good luck

For some reason, this board does not allow links of any kind.

Good luck next week.

 

I did not use or put any links or references to any web sites. I just kept trying to delet sections that I thought migth be upsetting them and send it again. I do not understand if they want this site used for patients to help each other, they should at least send us a private message explaining what we need to do different. Do not get it?/?

I agree - I find the UsToo site a better resource.

Not sure I'm following you. Are you reffering to another site? If so can you PM me a link. 

Yes, go to the UsToo dot org site. It is by far, the best online support/resource site I have found.

Same here, please forward to me if you get it.

Thanks

Is that just for PCa, or BPH also?

Majority are PCa, but there are several BPH related threads as well. Now that FLA is being used for BPH, that will only increase. Another plus is several doctors that specialize in FLA / Urology also post in some of the threads.

Plus - I think it benefits every man to know more about PCa. With all the changes of opinions over the past few years on Gleason 3+3 (is it cancer or not), Active Surveillance and newer treatments.

 

Thanks Tim. I'll check it out.

Hi Tim,

    I didn't see any links for forums at Us Too. Am I missing something?

 

Tim, I thought you would like to know this. I found it interesting and respectful. I recieved a personal message from the Moderator explaining that the reason my post was pushed into hold for moderation was because the name of Doctor K has a lettering sequence that flags their software to check as that particular sequence is the same as a spammer that was trying to infiltrate the sight.

I assured him it is NOT (Kar a man ian) at the Prostate Laser Center in houston and thanked him for the honest exposure of the issue. He said they are working to improve their detection software. I think that is classy that the Moderator would provide disclosure on this and take the time to explain. If we all learn why these things happen, it makes us more easily accept the site. 

That was very nice of him to explain it to you.  We all need to work together .  Thank you  Ken 

We cannot include urls (links) in a post.

The word dot is the period. ustoo dot org

 

If anyone has any questions about why posts go for moderation or any other questions you can message me at any time and it is untrue to say we do not allow links of any kind. There is an FAQ about links below which is in the Help section linked at the bottom of every page in the forums. 

https://patient.uservoice.com/knowledgebase/articles/398316-adding-links-to-posts

Regards,

Alan

Hi Tim,

   I was able to find the site without any trouble, but I didn't see any links at the site for forums. Am I missing something? Thanks.

Rich

Inaccurate or incomplete perhaps, but not untrue. Including a link causes a post to be flagged for moderation. While I appreciate the concern and need to prevent the spam bots, there are other ways. I do not know if this is a limitation of the forum software itself or implementation of the rules, but to the end user - it can and does seem excessively restrictive and impacts the useability. 

Posts I have made with links to other support sites were flagged for moderation and posts that were nothing but pure text have been flagged hence my impression that functionally at least, links are best excluded in forum posts and sent via PM whenever practical.

 

Near the bottom of the home page are several images/links - one of which says 'Find a Support Group'. This site has info/groups for all types of cancer/health issues. Info on PCa, prostatitis and BPH has posts in many forums, so I suggest you search for those key words.

 

Also, the forum specific site is Inspire, that is likely where you want to start. I will PM you a link.

Emis, I got stopped again and all I can imagine is that this site is still stopping the name Karmanian? Please let me know as I was under the impression that this issue was repaired? Thank you for your attention to this. 

Regards, John

I have a doctor that would like to be a member of the forums that is already mentioned in several.  How best should he register?  He is a doctor of (Interventional Radiologist - IR) for Prostates and Prostate Cancer that is in Houston Texas, USA.  Many of us that are on these forums are from the US and there are some priviliages that we don't have on this website.  Please instruct as to what he should do.

Thanks

Mike

Thanks

MikeSkier

I would imagine he can just register. Dr Sperling posted the other day.

How are you doing post surgery Mike?

Mike, What "priviliges" are you talking about? I didn't realize colonialism was still alive here  

Jim

 

Hi Mike

I am new to this website but was very inspired by you experience. Like you I have a 175 gram prostate with a median love. I was originally thinking of PAE but having read your testimony and that of John and Ross I feel more comfortable with FLA.

Please help me with Dr. K's contact details ie address, telephone, email rtf.

With the kindest regards

Leonard

I was checking in with you and wondering you current condition? Did you decide on PAE or FLA? How are you now?

Hi all. I am 12 weeks post FLA and continue to do well. I hope everyone else continues to improve.

The board seems very quiet about FLA, most discussion over Rezum and Urolift.

Does anyone know if Dr. K has submitted his trial results yet?

Rick

Richard  glad your doing good.  When I talked to him last month he told me that they would not be out till the end of the year  Take care  Ken

Hi Rick, Glad to hear you are doing well. Can you give us some more details?

Thanks,

Fred

Hi Richard ,  congrats  .  Pls let me know more details about your progress,  PVR, urine flow,  side effects, and many more.  Im  filling my excell table with all available FLA patient  ( more then 20 already ).

Im  6 weeks after  FLA and looks fine, too .   Who has interest for results in  my evaluation  jusrt PM  ,or send me e mail.  Happy day to all  , stan

Hi Stan,

I'm definitely interested.

Will pm you with my email.

Thanks,

Fred

Hi Stan I would be interested in seeing your data as well. I am 7 months out from my FLA and I am as bad or worse than prior to the procedure. Very disappointed here! My brother is having the same problems, and he is 4 month is out from his. He is part of the study group, so his results are not going to be good for the study at all.

Both of us have almost complete Retro, and difficulty urinating.

I would like to hear from some other guys AFTER the initial results. I started out really good, and then slowly went back to the way I was prior to the procedure.

Richard glad you are doing well, and I hope you continue to progress forward.

Thanks Joe

HI Joe,  very sad message from you.  I have your record in table as  positive ( in February ).  Can you explain in details what happened ? And share more info : prior and after FLA ?   if its more convenient for you pls  PM  me.  Stan   

If possible pls  let me know  answers  on following issues Prior and after FLA:

BML

big median lobe

UTI

urinary tract infection

PV

prostate volume 

IPSS

score quality of life 

CIC

self cathing

PSA

prostate cancer markers

RE

retro ejaculation

PVR

post-void residual

ED

erectile disfunction

FC

Foley catheter after FLA

SE

side effects

PF

urine stream -peak  flow

I am very interested too Stan I will PM you. I have been traveling a lot this spring. 

I have been in contact with Pete, Ross, Victor, Michael, and we are all still very good. I need to call back to Fred today. 

I am very sorry to hear from Joe and his brother. These are really two very good guys and I wish them nothing but the best. 

Sorry to hear that it's not doing good for you.  Ken

Hi Joe, this is record in my tabl focused on your results..  pls add there some add. details.  many thanks, Stan.  All table I can send you just PM me.  Stan

October2017, PV 47 ml, 0 -PVR,  but poor PF, prostatitits ,hard tissue, failed PAE, RE  

Joe,

Did you have a “smaller” prostate?  I know some on here have NOT had the results they had hoped for but were on the smaller side.  Mine was 45 grams pre op.   My results are ok.  Definitely better than before the procedure but not what I had hoped.  Part of my problem is an overactive bladder.

Hey Johin  hope all is well.  I wonder what is going on.  Dr. K had a good run there but what is going on in the trail that it is not doing as good.  Is Dr. K doing the trail or does he have other doctor doing them.  Take it easy  Ken

Yes sir I did, mine was only 42, and brothers was 45. That very well may be what is going om.

Hi Joe, thanks for sharing. Sorry about the poor results from you as well as your brother. Just curious, what were the problems before FLA ? Did you have bad retention ? Some posted here, that procedures may not fix if you have bad retention. Hank

Ken, I dont know what's going on. I have been traveling with my wife and living the retired good life everything is great with me except the company has mess up some things and asked me to come back and help them Straighten It Up I decided to fly back into town and help them but it's going to cost them. I will try to research and see if I can find out anything. I talked to Ross, Victor and a couple of other guys and everyone that I spoke with was doing good. I'll let you know if I can find out anything I am very perplexed

Thank you Take it easy to.  If you can  Ken

Hey John,

We should catch up! 

It's exactly a year ago today that I had my FLA in Houston and I have to say that the last 2 - 3 months I have noticed that things have yet again improved for me.

Joe, I am so sorry that things have not worked so well for you. I am starting to see a pattern here though that men with smaller prostates - say 60g or smaller - are not doing nearly as well as those of us that have been treated with much larger prostates - 100g and up. There has to be something physiologically different about smaller prostates with obstructed urine flow vs much larger prostates suffering from plain old BPH. Has this been seen with other ablating procedures like rezum? 

It is troubling but I have to believe that Dr K and others are also starting to see this pattern. I wonder what his opinion is? 

Hank I went into acute urinary retention twice in the week prior to me flying to Houston to have FLA. I arrived in Houston wearing a foley.

FLA has been the best thing I have done for my chronic BPH and enlarged median lobe. Retention is a thing of the past.

@Ken: I wonder what is going on.  Dr. K had a good run there but what is going on in the trail that it is not doing as good. 

---------------

What is going on is predictable. A handful of initial successes doesn't mean that a procedure will be 100% successful and that is in fact what trials are for, the bigger the better. Not a criticism but a reality. I think what you will see in the end is around a 70% success rate leaving the other 20% as outright failures or marginal. Not surprisingly, this is similar to most of the other non invasive procedures such as Rezum for example, and not that far off the mark that Dr. K. himself predicted I believe over a year go in another forum.

I think you will also end up seeing similar retro figures like Rezum at 5-10%. I truly wish and hope this will not be the case because I was looking for that magical procedure that always works with no lasting side effects. I'm also looking for a cheesecake that won't make me fat

When the trial data is released we will know more but what is really needed is a double blinded trial peer reviewed trials like with Rezum and Urolift. I can't see this happening with only one or two doctors performing the procedure, but maybe if more IR's start doing it then the industry will fund a peer reviewed trial.

Jim

Jim

Hank, I had retention prior to my f l a procedure I was not completely blocked but I could not fully void and therefore I had urges every 15 minutes on a normal scale. This went on for several months and dr. Isaacson at the University of North Carolina told me I better make a decision quick and do something . I could have never lived with the self Cath routine . But, All that was over after the focal laser ablation procedure and I do completely void now.

Hey good to see your post. Yes, let's catch up., I also am very upset to hear about Joe. Victor had a small prostate and he has had very good results but you may be onto something about the size of the prostate being an issue. I also wonder about prostatitis issues and this seems to be a real cloudy area with regard to treatment of the prostate. It just seems like no one really understands or knows what to do about chronic prostatitis and it seems like it is

Yes Jim That is true.  The same happen in all procedure.  I don't think they will ever do a trail between REZUM and UROLIFT which they should By the way if you fine a cheesecake that is not fating let me know.  My Mother use to make one with a sour cream topping.  Take care  Ken

Ken,

I think a rezum vs urolift trial could happen because they are both well funded. Fla is not so I don't see any head to heads but the problem is we don't even have a peer reviewed trial Phase III trial on FLA alone. When Dr. K. publishes it will be a first step but still a long way to a Phase III.

My point was that I believe expectations here were unrealistically raised on FLA based on some a handful of men who had a successful procedure. But if you check any of the procedures, you will find the same type of success stories with all of them, including TURP. Someone just posted the other day how GreenLight changed his life, and I'm sure it has. But we know that's not the case for everyone with GL. Individual success(s) is only part of the story and that is what trials are all about, so men can look at the data and then make an intelligent decision.This doesn't mean you have to wait for trial data, but if you don't, it's important that you understand the inherent risk.

Jim

 

Same here Joe. Both of my fla's started out great at first then went down hill. My second one started out really good. Good stream and no hesitation. Went down hill from there. After my second Fla went down hill I took cipro for 3 weeks, everything got really good again then after about a week or two after cipro went back down hill. I am back on cipro and things have improved but not near what it was. At this point I do fairly good during the day but goes down hill in the evening. I am better than I was before second fla, but not much. I to had a small prostate. Going to see a new uro in a week or so to see what my next step may be. 2 fla gave me retro. Hoping at some point I can get myself in a better situation.

Jim

Yes I know that.  And yes it would be a good thing.  But I also think it is the how good the doctor is And if they take there time and the way he handles his patients.  There are to many doctor trying to make a name for there self and just move to the next patients.   Good and bad in all procedures we will just have to sit back and wait.  Ken   

Hi Stan,

How many cases of FLA have you logged so far?

Jim

Ross, welcome back. As far as I understand, there are 2 types of retention. Acute and chronic. Acute is a sudden inability to pee, usually due to an obstruction, drinking too much, or holding it too long, or bad constipation, etc, requires a trip to the doctor office or emergency. Many of these cases can be resolved after a short period of catherization, and solving the causing problems, because the bladder has not been damaged yet. Chronic retention on the other hand is very much due to long term permanent damage to the bladder. The person can still void but can not empty the bladder. When chronic retention worsens and becomes chronic total retention, the person can no longer void. 

   You had 2 episodes of AUR, but I think you did not have a badly damaged bladder like some of us here, with long term problem. 

   Many urologists when stating that procedures most likely will not work for retention, I think they mean chronic retention, not the acute yet temporary type. Hank 

I am very interested in FLA, but I have both problems, chronic retention and small prostate. Hank

Hello Hank, I had a small  post void residual, but not a lot. Other problems were 3-4 times going during the night, getting stream started. And the terrible dribbling afterward. Maybe we should nick name that PVD post void drip lol. And I also had chronic prostatitis as well.

Dang Jim hate to hear the second one did not work either. I know you are very disappointed. I wish I could tell you maybe the Cipro will help, but if it does at all it will be for a short period of time.

I am really disappointed in the results also, and not just because of the large amount of money invested. But mostly because it really seems like the most logical approach. And the early results sure gives you some hope for a while. I guess we just keep trying different options. Just curious what URO are you going to try?

Joe

BPH and chronic retention often go together. So you can have a successful prostate reduction surgery or procedure with chronic retention as long as the bladder is not too bent out of shape. Urodynamics will help tell whether a bladder is viable enough for a successful surgery. I understand where you're coming from regarding the small prostate, but I don't think there is enough data yet to draw a conclusion with FLA and small prostates. And even if there were more data, there could be multiple reasons why it doesn't work as well with small prostates including the fact that those men may have been misdiagnosed with BPH/LUTS and therefore a prostate reduction procedure would of course not help.

Jim

Hi Joe, small PVR. Are you taking any meds ? Because if you are, you are masking the actual PVR. Hank

Hi Stan the above data is still pretty accurate. Now I do seem to have some PVR and really have to concentrate and force the bladder to empty but I have not had it measured, since right after the procedure.

I am up usually 3 times per night to urinate, sometimes I feel like I have some prostatitis issues still. But I had the DNA test done again in March, and one test came back negative, and a follow up test came back very low bacteria count.

My PSA is great at .5 it has never been that low. So wondering how the FLA might be affecting that.

Have a lot of difficulty getting stream started, and very bad dribbling after its stopped.

Mostly the same problems as before the procedure. Only the Retro ejaculation is a new one for me, and very uncomfortable. I keep hoping that will improve but it does not seem to be. It almost feels like there is a blockage right as it tries to come out.

Dr Picel of UCSD said his PAE will not help much for prostate smaller than 40g. I start to think people with smaller prostates have worse bladder problem coming in. Uros just assume that it  is prostate problem. Hank

Hey Hank, I am not taking any meds now other than B/P meds. I have been tempted to try them again, but I really wanted to know where things were naturally. I can usually empty my bladder to what feels empty with a lot of concentration,and patience. But sometimes when I am in a hurry I just leave it, and try again later. My stream is very weak, so it takes some time to finish and I get frustrated.

With PAE I believe it's different. Smaller bladders will not lose as much mass in shrinkage. It's always a combination of bladder and prostate no matter what. I don't think you can say that smaller prostates have worse bladder problems. On what basis? What's interesting is that studies do not show a direct correlation between prostate size and bph/luts. You can have more luts with a small bladder and less with a large bladder but also vice versa. Going back to FLA, again much too small a sample size to say that smaller bladders are harder to treat with FLA. But let's just assume for discussions sake that they are. It's still speculative why they would be harder to treat unless you had a lot more information than we have, and quite possibly more information than Dr. K. has, because my understanding is that not all of his patients were scoped and had urodynamic testing. A high def MRI is just high res imaging and is not a functional test like urodynamics.

Jim

Just a local guy. Thought I'd shop around just to get another opinion. Hoping this uro will be optimistic. I do have a pretty good stream when things are working good. Don't think I have any obstruction maybe bladder problem. Just looking for some relief.

Jim

I think we went through this before. 😀 I don't quite believe the statement "prostate size does not matter". Rather, I believe in some medical literature I've read a while back. It in its utmost simplicity 

, it stated that if the prostate is less than a number, something like 25g, it's more likely bladder problem. I am sure there are exceptions. Hank

25 g is the size of a normal prostate.

From the Mayo Clinic:

"The size of your prostate doesn't necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms".

"This analysis demonstrated that over time, both prostate volume and serum PSA are highly predictive of the natural history of both the symptoms and the urinary flow rate changes in untreated (or placebo-treated) patients."

This is a direct quote from Reviews in Urology, Spring 2000.

Hi joe, you cannot really tell your retention level without a scan or a cath. Also, during the day, when you are active, the PVR tends to be lower than at night. Hank

HI Jim  , I have records for 20 patients. When my FLA  was done in April 3rd.  Dr.K  said Im No. 26 . So some patients didnt take a part n this forum . Stan     

I don't think the two statements are mutually exclusive. Note the word "over time" in your citation, yet prior you were talking in absolute terms. Again, per Mayo (2018), 'The size of your prostate doesn't necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms". Also your example of a 25mg prostate blurs the issue because that is not bph by definition, it's a normal size prostate.

Jim

When all is said and done what I'm trying to point out is that you don't make treatment calls (or bladder calls) on prostate size. We have tests for that with urodynamics being the most important. The other point is that there just isn't enough data available here from FLA patients to make any kind of call regarding prostate size and results. Enough to speculate? Sure. We do that very well here.

Jim

I have 3 out of 20 then with retro and one with erectile issues. Jim 81578, oe74831, Joe's Brother and  jay111. Am I missing any? That's 15% retro and one out of five men with a sexual side effect. I realize the sample size is small but that's all we have to work with and certainly not the expectation we were led to believe. Rezum by contrast is 5-10% retro and I haven't heard of any erectile issues. Hopefully, the ten unaccounted for will have no sexual problems which would bring it down to 10% retro but we don't know that now.

Jim

Hi Jim,

According to my point of view FLA is the "last resort " of low invasive methods  for difficult  BPH patients. 

What could be the difficulties ?  Prostatitis, big median lobe,  very small prostate,  urethra strictures and stenosis, e.t.c..   The last one is my problem  .  My urethra is extraordinary narrow, with very sensitive external sphincter  and bladder neck. It was damaged just with  Foley catheter CH 16 ( 5.3 mm  diameter ) with serious bleeding last February.  I provided before  FLA  about  1 year CIC  with satisfactory  results, using narow catheter Speedicath  Tiemann CH 10 (3.3 mm diameter ) with cloude tip.

Catheter  Speedicath  Nalaton CH 10 with straight tip stabbed - bloody  damaged my median lobe in last January.  In emergency  they inserted  mentioned  Foley  CH 16 with damage of external  sphincter  !!!!  Double damage in few days - bad experience.  Wearing  Foley  one month I decided for  continuiong of CIC with mentioned Speedicath  Tiemann  CH 10 with cloude tip . No such problems anymore. Why  cloude is functional  oposite to straight tip was clear just after  MRI scan where big median lobe protruding to bladder is seen.  Who has interest for detail scans an analyses just PM me. I can send a lot of  material,data, pics,  even  analysis of BPH reasons,e.t.c.. 

 

   In April  2017  I was in Lisbon Portugal  for PAE  , but in this time I didnt know  that PAE is not effective in case of big median  lobe.  So  bad luck of  spent time, money,  hopes... 

After this bad experience I started to study  all  available methods.  

On one side - Open prostatectomy  as radical  method with many side effects, or robotic da Vinci procedure as no TU metohds , or  on second side  not TU low invasive ones just REZUM and FLA..   

note :

TURP and other TU ( trans urethral )  methods were risky for me.   

And  one day  I  have had to decide, when the situation became  worse. PVR  300-350 ml,  3 times a day of CIC  , incontinence, IPSS 32 ,e.t.c., bad bladder condition,  hydroneprosis of  kidney ,.... 

One day you has to decide too, Jim . 

Focused on low invasive methods there were just 2 options  REZUM and  FLA.  Even I was preliminary agreed with urologic clinic  in Berlin Germany   ( the nearest to me - just 1 hour flight ) . But due to  REZUM is TU method ( trans urethral ) method  and Rezum instrument is CH 20 ( 6.6 mm diameter ) and of rigid metal  nature,  I decided for more complicated  and very expensive  method FLA in Houston . 

It has logic -  if  flexible  CH 16 catheter damaged my urethra and sphincter  what can I expect from  rigid REZUM   CH 20  instrument ? Probably  serious damage of my urethra.  So FLA  became only method  for my special  diagnosis  . REZUM  in BERLIN is much cheaper , even partialy  covered by my Europe Union  health insurance program , and FLA is very expensive , plus  flight 18 hours,  hotels, e.t.c.. 

But now Im happy with result  after 6 weeks  due to I knew all  positives and some risk of my selection.  

...............................

And nearly all  who decided  for FLA  made  the similar evaluation as me  what is the best method AD HOC.  According to my Excell table data of 20 patients and their analyses , patient  selected FLA  after serious evaluation  and all of them have some special problems described above.   

Thats why  optically seems FLA to be more risky then  REZUM.  We  FLA  patiernts are special  cases , which  found FLA as last resort  before  some more drastic methods - TURP,  Green laser, etc...

My point of view is that  FLA is the best  method  for  patients who have knowledge of their  exact  diagnosis,  MRi scan bladder and prostate evaluation,  urodynamic tests,  e.t.c.  Who has interest for many details ,scans, pics,  even  analyses of  some BPH reasons,  just PM me. 

I think the  patients with very small prostate and patients with  serious prostatitis  have to  find another  methods as FLA or REZUM.  

 

Have a Great Weekend  all  my Brothers in arms.

Stan

( Sorry for my English - its just No.5  in my language knowledge  level )    

Hey Jim I understand, I have already done the same thing, I went to a URO at St Thomas in Nashville. After I told him what procedure I had done he was pretty much done with me. He did a DRE, asked me if I was able to pee, and that was it.

I have been reading about a URO in Florida, that is FLA literate,and uses it for cancer. I may eventually go see him.

Let us know how it goes with the new URO.

Joe

Stan,

You don't have to justify your choice to me, not tell me what I may or may not need to do in the future. We're all big boys here and make our own decisions. I'm very happy that FLA worked out for you and pray your results hold. My post was not to challenge your decision but to simply point out that the initial results reported here were not representative of the twenty patients documented here so far, and in fact the results and sexual side effects are either similar to, or worse than Rezum. This is important information for any men trying to make a treatment decision and hopefully will be looked at that way, just information and not anything for Rezum or against FLA. Personally, I would choose neither at this point, but again that is just me and I respect anyone choosing either as long as they have as much information in front of them as possible. This forum is not the end all, but very helpful in that regard.

As to your "special cases" argument, I have been following FLA since the first patient reported, and I see absolutely no evidence that FLA patients are any more "special" or difficult than with any of the other procedures. If you read the threads on Rezum, Urolift, TURP, GL, etc, I think you will find an array of pre-surgical symptons, just as you do with FLA.

Again, congratulations, and I'm impressed this is "just (language) No.5". You do better than a lot of us with language No. 1.

Jim

Stan,

One last point, and maybe this is a translation issue. You said"...According to my point of view FLA is the "last resort " of low invasive methods  for difficult  BPH patients. " 

As I mentioned in my last post, I disagree with your assessment that the FLA patients are any more difficult than with any of the other procedures. Many failures in ALL procedures are "difficult" cases.

But let's assume you're right for discussions sake. You're saying FLA is a "last resort"? Are you then saying there are better surgical choices if you don't fall into one of your "difficult" categories such as small prostate or narrow urethra? If so, this is the first time anyone has presented FLA like that. It has always been presented as universally the best choice for bph/luts for those who can afford it. Whether FLA might be the best choice (or not) in selected cases as you suggest, is another story, and I'll argue that every procedure (including TURP) has merits in selected cases.

Jim

Will do Joe, I'm looking for a miracle and will settle for just a little help and a understanding uro.

Jim8

Thanks for sharing Stan. You've made the right choice. Hank

So did Joe and Jim. They both made the right choice. Hank

I think I made the right choice even though it didn't guite work out the way I wanted it. Jurys still out. I was looking for the least invasive side effects. I did end up with retro but had to get a little more aggressive on the 2nd time around. Didn't want retro but didn't care that much cause I'm not a youngster and don't have to be macho cause ive been married for 4o years and wife didn't care. She likes it no mess .lol..I may get better with cipro and I just started back on aleve that may just get me back to peeing good. One step at a time.

Jim8

Joe,  Can you say who the FLA literate URO in Florida is and where he is located ?

Thomas

Hey Thomas I sent it to you in a private message. I dont think links, and or dr names are allowed here on the forum.

Joe

Hey Joe,

Thinking when I see this new uro I'm not even going to tell him about my 2 ablations. What you think does he really need to know. Just start from scratch.

Jim8

Hi Jim,

If you don't mind I'll throw in my two cents. In most cases, the more information you give the new uro the better in terms of helping him give you the best advice moving forward. Personally, I would be totally upfront with him regarding your past procedures and also share with him any tests results, including 3T MRI's, etc.

Jim

Hi jimjames,

I appreciate your opinion and I think it's good advice. Just don't

want the new uro getting an attitude as all the 2 uros I've had did get an attitude.

Jim8

I hear you. I've had lots of attitude by docs. Paitent centered medicine looks great in the articles but often missing during your office visits!  If the attitude was because you had an unorthodox procedure outside of what urologists offer, there is nothing you can do about that other than explain to them that it's a type of ablation procedure using MRI guidance. Urologists know what ablation is and I'm sure that after they shake their head or whatever, they will then focus on your current symptoms and whatever procedures they have that might help. I still think it's important they know what's gone on as part of their clinical workup. BTW what procedures does the new uro do? Also, if you haven't had urodynamics, consider it now. Ideally video urodynamics. Not every uro may offer it but should be available at the larger medical centers.

Jim

 

Thanks for your advice jimjames. I probably will take my 2 MRI reports. I don't think Fla is unorthodox not sure if you think that or your just saying from a uro point of view. The last 2 uros thought that. 2nd uro told me it was snake oil. Hope this 3rd uro will be optimistic..I choose fla because it was the least invasive and a good first step and leaves me with other options.

Jim

I was referring to the uro's point of view as they are generally not very well educated in procedures they don't do and particularly not well educated in procedures outside of the urological community such as FLA or PAE. Hopefully, your visit will not get bogged down in the past and the uro will move forward with you. Bringing the MRIs with you is a good idea but don't be shocked if he doesn't take them seriously enough. The important thing is to get yourself evaluated and see what he has to offer. Not sure if I'm repeating myself, but since will be the third time, I'd focus on evaluation more than treatment at the moment. I would bring up urodynamic testing if he doesn't, and unless he has a good reason for not doing urodynamics, I'd consider seeing someone else as well. There are two parts of the equation. First getting evaluated and then perhaps getting a procedure. Ideally the same doc is involved with both but it doesn't have to be that way.

Jim

Hey Jim for what its worth, I agree completly with jimjames. You should definitely tell the new Uro everything.If he has attitude about it just find somebody that does not. Not telling him what. You have already had done leaves out a huge piece of a puzzle thst he needs if he is gonna help you.

The last uro I saw in Nashville, was cool about it, he didnt have anything to offer me help wise. But when I told hom what I had done he just said yea thats "our" newest procedure.

My appointment on the 29. I will let you guys know how it goes.

I will go in with a positive aditude.

Thank you guys for your advice.

Jim8

Hey Guys,

    Wanted to give you a little follow up on my uro visit. 

Told the new uro about my two ablations. He was open minded but had a bewildered look on his face. He pretty much at least he said he new nothing about it. Told him the details about ablations and he asked how much i spent and had a bit of a shock on his face. Also told him that i had retro his look went from shocked to go figure. Any ways he wants me to come back in in a month or so to do a uro flow which is as far as i can tell is what jimjames says urodynamics. Test the flow, pressure and if my bladder is emptying fully. He also wants to do a sonogram and a cystoscope. He did do a dre and said that my prostate was concaved on one side and had some dimples on the other side. He thought that to be pretty unusual . I did too.  I did like him and he let me talk as much as i wanted with no rush. That's where i'm at now.  Funny thing though is I went to my regular gp and I asked him to give me a prescription of Alfuzosin 10mg to try. I heard that it might work better than Flomax which i was taking  4mg. Started on Alfuzosin and it seemed to work maybe a little better, but the side effects were worse a lot of lightheadedness and totally gave me a stuffy nose with sinus head aches. Took it for about 6 days and had to stop cause of the side effects. When I quit i decided to not continue on with flomax just to see what happens. Been off of everything for about 7 days and im peeing just as good as with the pills. Not super great, but i am peeing. Hoping that urinating may slowly get better I'm a little shocked that things are working  without the pills. My stream is fair, only get up once a night, things work pretty good during the day, gets a little worse in the evening and i do have hesitation, plus a little bladder pain here and there. Really not  sure  what to think. Hoping new uro can shed some light.

Thanks for letting me tell you my situation.

Jim 

Hey Jim glad your doing better with out the pills.  What I like to know is did you get retro from the first one or the second one.  And were you on Flomax all the while.  How long have you been off it.  Maybe just maybe when the Flomax get out of your system. You may get your ejaculation back,  It does take a while   Good luck to you and here hoping   Ken

Thanks for the update Jim. Sounds like you have at least found a Uro that will listen to you. That always a major accomplishment lol. And it sounds like he is going to do all of the appropriate testing.

That is definitely odd that your prostate is concave on one side. That could explain your symptoms, if it has caved in against your urethra, the cystoscope should show if that is the case.

I sent yet another sample to microgen yesterday, just to see if I do in fact have an infection.

Please keep us up to date.

Joe

Ken, got retro second time around. Been on flomax from the start while time. Been off every thing for I'd say 9 days and still have retro.

Jim

Jim don't give up yet.  Give yourself some time.  Last November I was in the hospital and the doctor in the hospital put me on Flomax again.  I was on it for 9 days.  Stopped the day I came home.  Doctor told me to take it till the bottle was empty.  There is still 30 pills in the bottle.  Being I was on the pill for only 9 days.  I just had to check when I got home.  Well that was a no go nothing.  It took a little over 3 weeks to get back to normal.  I will keep my finger crossed for you..  Ken 

Hi Jim,  interesting  progress   after  canceling of Flomax.  The side effects  of alfablockers ( Alfuzosin, Tamsulosin,e,t,c,, )  are for many of us  much more  unpleasant then any benefit.  Even as in your case is no   significant  change of urine flow prior and after taking alfablockers. 

To qualify  more closely  your health condition  I reccomend you to make   2  tests in home ( as I'm providing  oftenly during my healing process  after FLA) .

1.  Home aproximate  uroflowmetry test .  Qmax   is maximum  flow rate  in units ml/sec.

Prepare measuring can  ( with mililiter scale -bigger laboratory glass test tube,e.t.c. ) . The beggining  of void about  3-5 second  let pee free  to toilet , then  void to test tube for 10 seconds.  Measure volume of urine divide by 10  and you have aprox.  Qmax.  If it will be about 15-20 ml/sec  its fully OK  for healthly man  in age more then  50.  If  about 10 ml/sec  its still good result for our age and after miniinvasive procedure.     Problematic is poor flow Qmax just about 5ml/sec. 

2. PVR  - post void residual.  After natural  void ,you can take  shower ( not warm water ) and   there will be still some  add. natural void . And after it provide CIC  ( salf cathing ) and measure the rest in ml.

Volume  0-50 ml  is  good result,  50-100  ml   is problematic but still not dangerous. 

These 2 parameters are very important  ( among many others of course ). And is highly  suitable to  make other tests with your Uro  as  cystoscopy,  detailed  dynamic uroflowmetry , PSA,  TRUS,  MRI.

But if  you will be in  range  Qmax about 10ml/sec  and PVR  0-50 ml  you are not in danger  and dont stress to  provide  urgent  surgery . Its   suitable to  find relax life mode  with regular  watching and healthly life style.

Stan      

I have to add  to my words ," you are not in danger  and dont stress to  provide  urgent  surgery . Its   suitable to  find relax life mode  with regular  watching and healthly life style."   But other tests  must confirm  NO   threats  as prostate cancer,  bladder &  kindey damage ,e.t.c...