Going with Focal Laser Ablation for BPH

Hi Captain,

If you're concerned about retrograde, then you're pretty much just left with FLA or Urolift, as the two procedures that should be safe. Keep in mind that all of these procedures are only as good as the accompanying bladder function, so prior to making a decision you should have Urodynamic functional testing done (preferably video urodynamics) in addition to the usual cystoscopy, bladder/kidney ultraound, and in the case of FLA, the 3T MRI. Unlike these other tests, urodynamics will better pinpoint the relative role of both prostate and bladder have with your urinary symptons (LUTS). Also, keep in mind that FLA for BPH is quite new, has no published trial data, and no long follow up, in answer to your question of the possibility of additional growth affecting results. My observation is that we have had 10-12 men here who have had FLA for BPH, with the majority having very good results but 3 of which had marginal results and one less than marginal. This is consistent with the results of other prostate reduction procedures, which generally run around 70-80% successful at best. My personal take is that all these percentages could be better with more rigorous screening such as urodynamics prior to the surgery or procedure.

Jim

Hi Ken,

I've read your thoughts on this before but unfortunately my experience shows that most doctors are not that creative with their surgeries and procedures and tend to do them all alike. That doesn't mean there aren't doctors that won't use their head more before they cut, but you have to look. 

Jim

Hi Jim, you recommend urodynamics test often. Doesn't it involve filling your bladder to the max and then trying to pee ? Many of us here will fail that test. I failed that test at home every time, whenever I drink to much and try to hold it in too long. I guess I saved many trips and copays from going to uro office. Hank

My thoughts exactly. I wouldn’t let that test determine whether I have a procedure or not.

"Urodynamics" is a catch all for a series of tests. It could be as simple as voiding into a cone that measures flow rate (uroflowmetry), or as sophisticated as measuring voiding pressure and nerve responses which involve small catheters in both your bladder and rectum where fluid is introduced into the bladder and then expelled. When I talk about urodynamics, I'm referring to the more sophisticated studies. Video urodynamics has the advantage of visualizing the entire voiding process via ultrasound in real time and can sometimes pick up issues that might otherwise be missed. 

Jim

Hank,

As to "failing" the test by over hydrating, again it depends on who gives the test, who analyzes the results and how sophisticated they are. That's why I recommend video urodynamics, not just because the test is more complete, but because they are generally given by voiding specialists who have a better understanding of the voiding process, and are not just ordering the test to dot all the i's, or for additional revenue. Also, the "fill" part of the test, is only one element, and even if there is no sensation at 1000ml, doesn't mean one "fails", depending on the pressure flow measurements, again depending on who analyzes the results. Unlike a surgery or procedure, there is really very little downside of urodynamic testing, and it's certainly no more invasive than a cystoscopy -- arguably less so because the cahteters are smaller.

Jim

Jim

Hank,

It's one important piece of the puzzle, not the entire answer. The more sophisticated the test and interpretation, the more helpful it is. Again, very little downside compared to a surgery or procedure that may or may not work out. 

Jim

Captain Call, 

I sent you a quick private Personal Message if that helps. 

FLA is as one time as anything else that does not remove the entire gland. All of the procedures offered do not and are not designed to stop the cellular multiplication of the prostate gland. Therefore it continues to grow. The theory on the FLA is that the growth (we hope) will not continue in the same location that was blocking as it was tissue removed and scar tissue left at the removal area. In my case it is was along side the Urethra and in the median lobe that was pushing up into my bladder. I also preferred FLA as it did not go up and damage my Urethra. 

CAPTAIN@@ What is your current condition as far as urinary functions, sexual , and side effects?  Is this still your recommendation over HOLEP? 

ANSWER@@ Sex is great no issues at all. Erections started unprovoked on the day after the procedure. No sexual side effects. I woke up that morning and it was there, catheter and all!! Kind of freaked me out at first as I was not expecting that surprise. Well, yes my recommendation to myself  was FLA  and I am happy with the decision.

My recommendation to you is do your research, talk to actual patients and let them tell you there experiences, make a list of what are your priorities are for success. Don't just believe what is written out there. And last get a doctor who really truly cares about your success and your well being. One who hears you and knows what is important to you and tell you the truth. One who will take the time to show you before you do the procedure what they will do and explain how it will work and then shows you after the procedure the results of the work they did. Then, one who will be right there with you through the recovery period and answers your phone calls and concerns all the way. No matter how many question you may have. 

Many of us are very willing to help you with our experiences. There are a number of us now and it grows each week. I would say that your expectations can be made and met if you know them up front and communicate the to the right doctor and procedure. 

John

I chose FLA after almost 2 years of researching because my one demand along with results was NO SEXUAL SIDE EFFECTS. FLA is the best change of that in any of the treatments available. FLA is not standard, random or routine. IT is custom to the situation, precise and focused on the tissue causing the problem. Its realtime eyes on during the event and that is what I want when a doctor is doing tissue removal in my body. The other procedures are not done this way. 

It was a long scary process listening to all the different offerings by the doctors who are such great sales people during my research and then deciding what to do. I really feel I chose the best option for me and it was the most logical that made sense to me as the how and why it would work. I don't think I could be happier at this point. But we all are different and have different needs and desires. As I have said before, this is not completion between treatments. It is knowing what you want and finding the symptomatic relief that is best for you. I wish I could have had the opportunity at 53 to have the FLA. That is about the time it started to hit me and I was first in denial and second the only options was a TURP. No Way on a TURP.