Going with Focal Laser Ablation for BPH

Hi Dale,

While you're making a decision, consider getting off the Foley and start self catherization (CIC). It will do everything the Foley does but it will give you your  life and freedom back. Many of us here, including myself, have found CIC a life changer. Whats more, unlike a Foley, CIC can help rehab your bladder. We have several threads going on CIC here, and I'm also glad to walk you through the simple process of picking the correct catheter as well as technique.

As to FLA for BPH -- or any other procedure for that matter -- it's important that you first find out what's going on not just with your prostate but your bladder. I assume you've had a cystoscopy and a bladder/kidney study, but have you had a urodynamic study? Urodynamics is a functional study that will diagnose and help predict prostate reduction surgical outcomes. Unfortunately, if the bladder isn't up to task, no surgery will help.

Unfortunately, we haven't heard much from Sperling's patients here, but around 8-10 of Dr. K's patients have reported back. My take is that those who had viable bladder function going into FLA, had very good results but those that didn't have good bladder function, did not fare as well. Again, you really must  find out what your bladder issue is before trying to fix the prostate.

Jim

Jim

Thanks so much for the info. I have only had cystoscopy. Doctor only said that Bladder looks OK other than some irritation from the catheter. Urethra looks OK. Prostate enlarged and pushed up into bladder creating a mound. No bladder/kidney study and my urologist did not even suggest it. No urodynamic study suggested either. It is extraordinarily difficult to get in to see a urologist here in Southern California. Following my first catheter, every urologist I called would not see me for months. A nurse where I had my shoulder surgery used to work for a urologist and called in favor to get me in to see him. One who is considered the best around my area won't see me until Feb. I just couldn't see myself sitting with a cath for that long and he also only does a TURP. But, my failed attempts to get out of a cath have me considering surgical options quickly. I don't even know how to get a urodynamic study or how long it would take to get an appointment.

My first foley was very painful to get in. The blockage was difficult to pass. The second one was worse; it wasn't just the enlarged prostate...the nurse said she felt some sort of blood clot blockage. She had to invert me on the table to eventually get through. The third and fourth each went in easier and with mush less discomfort. So, maybe self cath is an option now that things have settled down a bit. But, I an concerned about the irritation form the foley and wonder if I can tolerate doing a self-cath.

I have read about using the speed-caths, Coude tip, 12 guage as a first choice. I mentioned self-cath to my doctor and he does not support it. I think in California I need a prescription to buy catheters. So, I'm back to waiting months to get to see a different doctor for a prescription. I feel stuck.

Dale  If I were you I would get more information on Dr. K.  We have had many men on here that he has done are very happy. they are doing great  Ken

Jim.  I hate to change the subject but I think this is important.  It is about the 4 D Urolift.  I got a e-mail while I was in the hospital.  From Barbara H.  from the company.  She told me that they are not formally studied this variation of the urolift. They are letting the doctor do what they want.  In Australia there is a doctor doing the urolift with a bladder neck incision.  With them doing that the bladder neck will not close right which will cause retro.  If they keep letting them do this then Urolift is just like the others.  It's not right  Ken  

Thanks. I have requested a consultation from his website.

Hi Dale,

To be blunt, you've been receiving sub standard care and testing. Without more tests, "your bladder looks OK" is an insult. You need both a bladder/kidney ultrasound and urodynamic testing, preferably video urodynamics. As to Dr. K., he is not a urologist and he would be at the end of the list of people to see, not at the beginning. First see another urologist, get the bladder/kidney scan and urodynamics. Dr. K. doesn't do these tests. Then, after you get tested and evaluated, that would be the time to see Dr. K., assuming that your bladder is viable enough for a successful FLA. As to Speedicaths, I recommend starting with the Coude tip model in size FR14. Size FR12 may be too flexible and therefore harder to insert until you practice some. 

Jim

Ken, 

Once these new procedures go off trial, the doctors will tend to customize things with varying results. I think that's one reason we're seeing such a range of results for example with Rezum and now maybe with Urolift. With Rezum, the docs take like a four hour course, practices on one or two patients with a rep in the room,  and then start zapping patients on their own in what appears to be different ways. I wouldn't go with a guy who hasn't done at least 100 procedures with either of those procedures. 

Jim

But I know that is true but with the Urolift why do 2 procedure.  There is a doctor Martin Elmes that is doing a laser incision of the bladder neck and the urolift.  That is not right.  Urolift is the only procedure that does not cause retro but if you make the laser incision of the bladder neck to keep it open you will cause retro.  It's wrong.  There making it just like all the others  Ken 

It does seem to defeat the whole purpose. It's really caveat emptor in medicine these days and that includes urology. If you don't go into the doctor well read and knowledgeable, it's like good luck!

Jim 

Hey Jim. There keeping me over night have a bladder and kidney infection. Started on antibiotics they will see tomorrow. If they will send me home.infection. in urine and ct scan showed it in bladder and kidneys. Take care ken

Dale hope all works out for you.  Just a update. Will be in the hospital for another night to get another round of antibiotics. Hope this catheter comes out tomorrow.  Ken

Hi Ken,

Sorry about what you're going through. Hopefully the antibiotics will fix things. 

Jim

Doing much better. Get another round od antibiotics tonight. I hope i get it out tomorrow.  Ken

Hi, Dale,

Your first experience with a Foley sounds similar to mine! The insertion was so incredibly painful that I thought there was no way I could self-cath (CIC). The first urology nurse, who showed me how to do it, did such a poor job that I ended up in the ER a few days later with urinary retention. I felt pressured by the doctors to make a decision and felt like time was running out. I ended up spending 3 months on Foley catheters—which they changed out every 4 weeks.

Then I found this forum and read Jimjames thread on CIC, and decided I needed to learn how to do it. There is a learning curve—easier for some, more difficult for others—but it allowed me time to decide which treatment I felt was best for me. BTW, I was one who had a difficult time with CIC, but the end result has been worth it!

I also changed urologists. None of the urologists I’ve seen have been supportive of CIC. Can’t say I like my current uro, but his staff is amazing! Along with this forum, his staff helped me learn how to CIC—and they are able to insert and remove Foleys painlessly. You might want to call several urology clinics and ask if there is a nurse who can teach you—or call a spinal cord injury clinic, as they have patients who CIC. You shouldn’t need to see a doctor for this.

Your clinic should be able to give you some free samples of catheters. I asked for ones pre-coated with lubricant. My urologist set me up with a supply company. Also, on occasion I've had my primary care doctor write a prescription for me. It's good to try several different brands. I now use Speedicath FR 12s and LoFric Origo FR 14s with the coude tip.

Stebrunner