Going with Focal Laser Ablation for BPH

Congratulations on your procedure! Could you give us some more detail regarding your bph history including PVR, IPSS score, and any pre FLA testing? I tried go get the info from your past posts but it looks like your profile page and post history is locked for some reason.

Jim

Hey Steve,

I second your opinion on Dr and Samantha. I'm guessing you're a couple of days out of your catheter. Recovery is slow and not necessarily steady. As Dr K said to me, 2 steps forward then 1 step back. I can attest to this so don't be disheartened if you are better one day and worse the next. 

I am at 4 weeks and the difference now is amazing!

I wish you a speedy and full recovery. 

Ross

Good deal Steve glad you are seeing improvement at 25 days.... I'm at 4 weeks and 1 day and haven't seen to much improvement, but being positive there is more to come..

Hello Joe,

I had my FLA with Dr. K 10 days ago, all is going very well for this point in the healing process. Everything works as it should, the flow is slowly but surely getting better and my cyst is gone and my abdominal pain (from cyst) is gone. I looked very carefully for months (years actually) at all options and no doubt for me FLA was the standalone choice for so many reasons.

The new nurse Donnie is supposed to be the best FLA specialist nurse in the USA, Dr. K was fortunate to partner with him. I was the last with Samantha I think (who was great). 

My personal approach to choosing where to stay boiled down to convenience and comfort, this procedure was going to be a turning point in my life and by God I was going to make the most of the experience including a comfortable room while I was there!  With that said I chose the Marriott (medical center) which is literally one block from Dr K's office. So I was was able to walk over on the follow-up appointment the day after the procedure, and it's only 10 minutes from the MRI center. Not the fanciest hotel, or the cheapest but they did have fairly priced room service with healthy (promote healing) choices on the menu, and I had several special requests which they took care of. Just ask for a room NOT facing the main road (noisy and sirens).

If you need transport Moh is AWESOME, very dependable and professional (sport coat/slacks!) and very fairly priced for car service, light years better experience than an Uber or taxi and same or lower price!

You are in excellent hands, best of luck and keep us updated!

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I will start from the bottom of your message and go backwards. YES I would and I am certain that the rest of the people that had FLA would highly recommend the procedure. 

Yes, I am not sure if Samantha is gone but the man you are speaking of is Donnie Sartin and he is a very experienced RN in all FLA procedures. I would actually call him the absolute best in the business. He knows Dr. Karamanian very well as they worked together at the Hospital UTMB when they were both there. Donnie is wonderful. He is as good in his field as Dr. K is in his. This could be called in my opinion the "Dream Team" for prostate FLA procedures. I hope you will report back on this and tell me if you feel the same way. Since I was the first guy back in December of 2016, I got to have Donnie as my RN and I cannot begin to tell you how good he is. Let's see what you think, I think I already know how you will feel. 

That injection you are speaking of is exciting and you are correct, Dr. K wants to help his patient so much he goes above and beyond with every one. I will look around on google for you and see what is down there in the medical district. His office is downtown and next M.D. Anderson. So, I will look and so can you for something more affordable and still in a reasonable area. I have time tomorrow to look. 

Thanks also for the hotel recommendation, that sounds like where I need to stay.

How many days were you there? And did you fly with the cath still in?

Thanks again so much Joe

Hello Joe,

It is natural to be nervous! They will help you with that on day of procedure, believe me, after the IV goes in, you will not be nervous  Seriously, trust and confidence will go a long way to fixing nerves.

I was at marriott from Wednesday night to Sunday at which point I flew home with catheter in place. So 4 nights. I used wheelchair service at both airports which was AWESOME! Zip through TSA. No charge to do this, just ask for wheel chair when you arrive at the curb at airport.

I was worried about flying with catheter, no going to lie. I intentionally booked a direct flight so no plane changes to deal with. I also booked a "first class" seat for more comfort and room. It was NO problem at all. I emptied my leg bag one time in the plane bathroom on a 3.5 hour flight. Easy peazy. BTW- I had one carry-on bag, maybe 25 lbs, and it was no effect on the catheter to lift it.

Now, I drive a 2500 GMC diesel pickup and that WILL pound your poor cathetered urethra! Get a donut or foam type prostate seat. Makes ALL the difference!

Onward upward!

I called his office one morning, and left a message, and the Doc himself called me back that afternoon, and talked for about 45 minutes. I told him all about my prostatitis issues, as well as the failed pae. So he had me send him a copy of my MRIs, he looked at it, and says hes pretty sure he can help me. And now he is studying injecting an antibiotic directly into the prostate during the procedure to hopefully actually cure the prostatitis once and for all. Not to mention he also says the laser itself will kill a lot of infection by itself.

So far he seems like an innovative personal Doc, that really wants you to get well.

Joe

Ross will tell you he almost waited too long to do the FLA. He was on a trip with is wife and went into full retention and could not pee at all. He went to the emergency room and they installed a foley catheter. In fact when he went to Houston for the FLA with Dr. K he had been with that foley for a while and was kind of in an emergency state. Ross is more than happy to be contacted and discuss with you if you have interest now or later. 

Good luck I hope this helps. 

John

Thanks Hank. What I would like to do is to get a support group contact list now of the several guys that have had this done and let Dr. Karamanian distribute a list of names so that people with like issues can speak directly with men who have had this done. Joe has things similar to what Ross had and they are in the same age range. There is a benefit there for communication. Dr. K could give this information to people who call in with questions. I know I wanted to hear from the horses mouth.

I was the first FLA/BPH person to my best knowledge and I could not find anyone to talk to and I was scared to death. I went to see Dr. Sperling first in Florida and he claimed he had done over 100 FLA treatments for men with BPH.  My meeting with him was 45 minutes and he charged me $275 to talk and he wanted cash. Yet he could not give me a single person to talk to. He and his nurse Lillian told me several times they would get me someone to speak with on the BPH side and they had the names of cancer patients only. I did not want a PCa reference. I wanted a BPH and if you have really done 100, you should be able to provide 5 people. They could not even provide ONE and I called every week and sometimes twice a week for four months to no avail. At first it was to get a name of someone, anyone, and then it was because I was mad. They told me that then they tried to stop taking my calls. Understand at that time, this even scared me more about the procedure. 

I then went to see Walser and Karamanian and they both had done a lot of FLA for prostate cancer as Sperling had but they both told me I was going to be the first guy they did that did not have cancer. I met with Karamaian for 3 hours and he would not charge me anything. No money. He really went through my MRI with me and my wife. They had done several cancer cases and they had greatly improved the BPH in those cases for the patients. The procedure was no different  accept that there was no targeted cancer lesion to be removed. In a BPH case, they only were removing the tissue that was pinching the urethra and pushing into the bladder and they could show this on the MRI before they did it! He used my MRI and showed me and my wife just that.

I was at this time still wanting and considering PAE but several things bothered me about PAE. Mostly it was the randomness of the treatment. They had no way of controlling the exact location of the atrophy of the prostate tissue after the PAE was done. My BPH had caused a specific problem that caused my urination problem. That could be seen on the MRI and that is what I needed fixed.

I find it ironic now that I am almost a year out from my procedure and that there are now about 10 men who would gladly tell there FLA treatment story to other men in need. They will compare notes and condition and symptoms and try to help other men make a decision on what to do. They were also once scared of this so they understand the unknown fears. I think the one thing I have heard from so many of them is "don't wait too long." I have to admit I heard this from Dr. Isaacson at UNC when I visited him about PAE. He told me as I was leaving, you bladder is starting to tribeculate and what ever you do, make a decision and do something sooner rather than later. I think that was my kick in the pants as it really hit home with me. 

I hope that I can rally all the men to participate in an effort to be a voice for men with BPH. I know Victor will and Mike will and Ross, will and Pete will also. That is the 5 that I was looking for a year ago. I know this group can help.

Can you tell me of any other BPH treatment out there that has a support group of men to help people with facts about the procedure from a patients prospective? It is one thing to hear a Doctor tell you what to expect  in a treatment but it is another to hear the facts from men who went through it. This web site stops a lot of that interaction that is wanted and needed in this effort so I think it should be give out by the doctor. It is what I wanted when begged for those references a year ago. i just wanted to hear from the person who went through the procedure and not from the doctor I was about to pay. I would verify with the doctor after I heard from the patient.

thanks for everything.

Hi Joe, everything John said is true. Feel free to PM me and we can have a conversation about your situation if you want.

Ross,

How are you doing?  It has been awhile since we talked.  From what I have read you are doing great, peeing like a race horse and sex is unbelievable.  I see that John is back on line.  He went through quite a bit with his dad.  Now his dad is almost as young as him. 

So you missed all of the hurricanes that should make you feel good there on upper Manhattan.  You know that one of these days, NY is going to build that wall around the island?  Sound familiar?  How is the biking?  I have had some soreness when I go on a long ride.  I pushed it as well by starting  back again about 2 months after the procedure.  I did look up those seats you told me about, but have not purchased one yet.  I have found them anywhere from $60+ to almost $200.  I will probably get one over the winter. 

So, what is new with you?  I have heard that that once you got rid of those stones, it has been totally great for you. 

Let me know and if you want to PM me you can.  We got to get Unclefester into Dr K.  He is a fellow NY'er and had a ton to issues with his business, having to relocate at the last minute, when he was getting ready to have FLA.  I think he is still trying to get it done, but he is in the get-by mode right now and he can push it out for awhile. 

Later Mike  

I just wrote and mailed the $21,000 check, thsts a hard one to write LOL. But hopefully well spent.

I also done the DNA test for prostate infection yesterday and sent that off. Hopefully Dr K will know from that panel what antibiotics to inject during the procedure. We are hopeful this might take care of the prostatitis as well as the BPH.

I will PM you and ask some more questions OK?

Thanks again 

ps thanks to John for all the great info as well.

Jim

Hi John,

>>I have to admit I heard this from Dr. Isaacson at UNC when I visited him about PAE. He told me as I was leaving, you bladder is starting to tribeculate and what ever you do, make a decision and do something sooner rather than later.<<

A couple of questions:

How did Doc Isaacson determine that your bladder was starting to tribeculate? What exactly does that mean?

Thanks!

Rich

Hi Rich,

A trabeculated bladder has a thickened and irregular wall that can be easily diagnosed by ultrasound. It is often caused by an enlarged prostate which forces the bladder to overwork.

Untreated, the voiding function deteriorates and puts the kidneys at risk.

As Isaccson suggests, a trabeculated bladder suggests something needs to be done, but that doesn't necessarily mean a procedure like PAE, or another surgery is indicated. The normal progression is a period of watchful waiting where meds such as Flomax and/or Proscar are tested to see if things can be handled medically. If the drugs don't work or aren't tolerated, self cathing (CIC) is also another great option although unfortunately it isn't generally offered because it doesn't fit into the profit model of a urologist's practice, in my opinion. And then there are the procedures and surgeries.

Jim

Rich, 

Sorry for the late response, I went back to my old job today to answer some questions and help them with some issues and they kept me all day. I just got home. 

Trabeculation of urinary bladder is a common complication of benign prostatic hyperplasia, a predominant cause of bladder outlet obstruction in elderly males. This is a thickening and toughening of the bladder wall. The issue is with the thickening of the tissue,  there is a flexibility loss and you lose the ability to push out the urine especially when a blockage is involved in the urethra. You can look up Trabeculation and BHP on the old computer and it will they you about it. 

Dr. Isaacson of UNC witnessed my bladder Trabeculation in the MRI I sent him before I went to see him for the discussion on PAE. He showed it to me and it is very visible in the films I also verified it with Dr. K and he confirmed it was mild to moderate at the time of the MRI. Dr. K. measured it on the screen when I met him. I was told during that meeting that it can improve some with full voiding and the key is to not let it go too long.

Isaacson was very gracious and felt it necessary to tell me that most importantly, I need to do something sooner rather than later. Just do something and stop waiting. I am not one to take those horrible drugs that are offered for BPH and I did not ever take them in the nine year history of my symptoms.  

I am glad I did not. The problem with the listed side effects of the medication is that those effects are not "side", and that word should be dropped when discussing the medications. Those are simply the "EFFECTS" of the drugs. No "side" involved. The word "side" is misleading and is a marketing technique used by the profession to diminish  there importance. I  am aware that some men have had temporary relief from the medications but the effects of the drugs where not and are not in my game plan. The drug effects are glossed over quickly by the Urologist when discussing what to do for BPH. They act like the effects are better than the BHP symptoms. 

I am now one year out and I was ask the other day if I was urinating like a 40 year old and I said I really can't honestly evaluate how a 40 year old urinates. I hope they have as good a flow as i do. I can say that I urinate like a health 66 year old man should urinate. I am still very infatuated with the flow I have now and I enjoy just relaxing and watching it happen and the feeling of completely voiding. In speaking with Ross one day he told me he makes lots of suds now when he urinates. We laughed as I know what he means. Bottom line is I don't think I have a bladder issue at this point. I am very pleased.

In gong  to my old office today I urinated three times in 12 hours. I did remember how I uses to have incontinent issues at my place of work and it was very embarrassing for me especially when coupled with the fact that I could not void completely yet could not hold it long enough to get to the mens room. I would have to go back and forth 3 times to empty just once.

For now, I am very happy with this results and glad I went the FLA route. Again, I think the success is mainly in the hands of the person who does the job as I have said before it is as much art as it is science. 

John

John

Kenneth, 

What I was told is that this Trabeculation is caused by incomplete voiding. Straining with the inability to move the urine out of the bladder. I was doing just that because of my urethra blockage that I was shown in the Urethra being pressed in on from the tissue of the enlarged prostate gland. Once I saw that on the screen, i understood why i could not pee. 

This whole thing reminds me of the oil industry. I have been in and out of oil deals my whole adult life. It is a Texas thing. This compares in my mind to what we call "back pipe oil' pressure or lack there of.

I had a revolution of comparison In my mind to somewhat like the oil industry. The bladder being the oil reservoir. The Urethra being the pipe casting. The oil being the urine. The line pressure in oil movement determines if a pump is needed topside or down line to move the oil out of the reservoir in the oil business. IF the casing is damaged in the route of the oil flow you lose or stop the pressure with an imbalance in the pressure on one side of the flow.  This is why the urethra blockage needed to be cleared then the pressure balance would change and urine would flow.

This may or may not be a good analogy but it is how I logically associated the situation as I looked at my original MRI. And then again when I saw the openness of the urethra pathway in the last MRI after the FLA procedure. 

I think there was somekind of blockage.  My doctor said that when he did the scope on me the prostate was wide open with the clip still in the place were he put them.  I remember when they catheter me the first time after 32 hours Tuesday afternoon.  After 3 try when they finely got it into the bladder I flat a pop before the urine started coming out very slow.  I told the nurses that and they said you must have had something blocking the opening.  So something at to be closed for some reason.  I still would like to know what the heck went wrong.  Maybe there was part of the bladder neck stuck together.  I don't think anyone will figure this out.  I am glad it' working now.  Thanks again  Ken  

Thanks Jim.

I'm guessing that an MRI which I had of my prostate that was done to check for PCa would not include the bladder. I'm also assuming from your post that if the bladder is trabeculated, the possible treatments are the same as dealing with LUTS. If I'm correct, then the additional knowledge about the state of the bladder would only seem to indicate a level of urgency to deal with things rather than an alternative treatment. Do I have that right?

Rich

   Thanks for your complete explanation. Very helpful.

Rich

Hi Rich,

Can't speak to the MRI but you could request a written report and see what was covered and what wasn't. 

@Rich:  I'm also assuming from your post that if the bladder is trabeculated, the possible treatments are the same as dealing with LUTS. 

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

Trabeculation can be a result of an obstruction, and therefore is associated with LUTS, but it's really only part of the diagnostic picture, and in fact you could have a trabeculated bladder and not have significant LUTS.  Other important factors are your IPSS score, residual, and pressure flow, as measured by urodynamics. 

I think one of the reasons that Baglia and other IRs, focus on trabeculation is since they are not urologists, that is what they see on their 3TMRI, as they don't perform other necessary testing such as bladder/kidney scans and urodynamics. 

So to answer your specific question, your treatment choice should not be based on trabeculation alone but on the entire picture of which a good urologist can help you with. 

@Rich: If I'm correct, then the additional knowledge about the state of the bladder would only seem to indicate a level of urgency to deal with things rather than an alternative treatment. Do I have that right?

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

I don't think trabeculation alone indicates a "level of urgency". Again, it would be a combination of bladder architecture and bladder function, the latter of which would be measured by urodynamics as well as noted by your IPSS score. Kidney function is another factor and that can be ascertained by both blood work an a bladder/kidney ultrasound. 

But assuming you have reached a "level of urgency" when all factors are combined -- this still doesn't mean surgery is the only choice. You can still first try meds or self cathing if you want. The meds may or may not work, self cathing certainly will work in terms of emptying your bladder completely and protecting your kidneys. 

Jim

Hi Rich,

I posted a detailed answer but looks like it went into moderation. Hopefully, it will be out in a day or so. 

So, meanwhile, a short answer. 

Trabeculation is only one part of the picture. Other important parts are your IPSS score, bladder/kidney ultrasound results and urodynamic test results. 

It's the complete picture that helps determine your "level of urgency", not the trabeculation per say. But even if the level or urgency is reached, that does not mean that surgery, be it TURP, PAE or FLA is your only choice. You can still try meds or self cathing first if you want. The meds may or may not work, but self cathing certainly will empty and protect your bladder completely as well as protect your kidneys.

Jim

Hey Jim.  I think that was my problem when I was in the hospital.  I have read up on Trabeculation of the bladder. When they did the first set of catheterization they got it through my strictures but could not get it into the bladder.  If the wall of the bladder is thick  can the bladder neck get stuck together.  When they did get it in I felt a pop then the urine came out very slow. But when my doctor did the scope he said all was fine and the prostate was wide open.  I just don't know.  I hope it don't happen again  Ken

Hi Ken,

Don't know what caused your problems but from what you have related, it doesn't sound like your issues had anything to do with a trabeculated bladder wall. Glad things finally got resolved. 

Jim

That's good to know.  Wish I could find out so it would never happen again.  Who knows Thanks Ken

Thanks for the clarification. I don't see any message that has been flagged for moderation ... did the web site change how they handle those, just not showing them until they're approved?

I'm trying to decide whether it would be advisable for me to get a full diagnostic work-up, or at least a bladder/kidney ultrasound and video urodynamic test. I've had LUTS for many years. When they started to get worse, I went on tamsulosin, which helped a great deal but with very bad side effects (sorry John, I should just say non-therapeutic effects . I opted for a PAE with Dr B, which I had about 8 months ago. My LUTS are now marginally better. I'm sort of almost OK w/o any meds (I did try daily Cialis for a while which did help). I can live with the symptoms as they are now, but certainly don't want to stress the bladder or kidneys. Do you think a full diagnostic work-up would be useful at this point?

Thanks.

Rich

Hi Rich,

Can't speak to the MRI but you can request a copy of the report and find out what was included. 

You don't treat trabeculation per say unless you are symptomatic. Thats where your IPSS score, residual, bladder/kidney ultrasound, and urodynamics come in. I think the reason the doctor in question focused so much on trabeculation is that he, like most IR's, rely on primarily their 3T MRI's as they don't do the other tests which are performed by urologists. For this reason, I recommend that anyone working with an IR, have these important tests done prior with a urologist. 

So again, I would say that the sense of urgency is determined by the entire picture, especially the functional components, as opposed to a single factor like trabeculation. And to clarify, there is no separate treatment for trabeculation I'm aware of, not would you want to treat it if it doesn't present problems.

-- Jim

Hi Ken,

I've always had cysts in my kidneys as long as I can remember having ultrasounds. I've also been told they are normal and nothing to worry about.

Jim

Hi Jim,

    Guess I'm still not clear based on my history and current symptoms on whether you think the diagnostic testing would be advisable at this point, or if I should just wait and watch for a while.

Rich

I never know that.  Learn something new everyday.  But this was the first time I was told about them.  I hope they don't affect my defected kidney.  The left one is smaller then the right and it is sitting on the bladder and pelvic wall.  We will see as I get older  Ken    

I do not know why your MRI would not show your bladder and any trabeculation on the bottom of the bladder as it did in mine. I also had my MRI done originally for prostate cancer. I'm not sure why it would not work the same in yours.

Interesting. Thanks. I'll need to look into that.