Going with Focal Laser Ablation for BPH

i dont really know. I know they remove tissue in the Rezum and I do know it is somewhat radom in the removal process. Meaning it is targeted to an area but not pin-pointed to in design like laser removal is precise and targeted.

You would need to talk to an FLA specialist. The only one I could recommend is Dr Karamanian and I know he would tell you the possibilities and then the specifics of your case after he look at your MRI. IF you get an MRI it would show you what is left after the Rezum. Then you could make a decision with the facts at hand.

Hi KBM ,

all depends on your  exact  problem  definition . If you have enlarged  median lobe   protruding to bladder and  causing  " pressure  valve "  on  bladder neck,  I  consider  FLA as  Best solution for you . But you need 3 T MRI scan first and consult all  the problem  with experiences doctor -for instance  Dr. K from Houston .  Pls see my beast  - protruded median lobe totally blocking  bladder neck .   I'm  after FLA  at April  3rd.  and FLA is my life changer.  Cost is about 21K.   Stan  

priro FLA  median  lobe

Stan,   Before you had FLA did you have more difficulty urinating when your bladder was very full.  It looks like the pressure of a full bladder would press the median lobe against the urethra,  like a ball valve.  There have been several people on this site who say it is more difficult to get flow started when their bladder is very full.  There are also some who said they could urinate through a catheter with a full bladder.

Thomas

KBM,   

There has been some anecdotal evidence that FLA does not work well for small prostates.  Search through this discussion and some other's having to do with FLA.  This is not backed by any clinical evidence, partly because not much clinical evidence exists. If you contact Dr K or another who performs FLA, ask him about it.

Thomas

Thomas

Good evening.  I was not going to get into the discussion .  But just going to give my 2 cents.  Dr K is a very nice guy if you go with him he will try to do the best for you.  But have you look into anything else You said that your prostate is 30 CC and it is protruding into the bladder.  What about Urolift.  They could bring the prostate out of the bladder and clip it to both side removing it from the front of the bladder making the tunnel with our cutting.  Just thinking out loud.  Good luck with what ever you do.  Ask questions before you do anything  Good Luck  Ken

Hi kbm,

I see you're new here. Have you looked into any of the established procedures like Rezum? FLA is relatively new and had no trial data to support it. I'm not saying it's not a reasonable choice for some men but you really should look into ALL the alternatives before making a decision. Also, as has been stated, men with prostates your size have reported poor results. But as also stated, anecdotal reports aslone is unreliable but that cuts both ways.

Jim

Exactly Thomas,  like ball valve -as much  pressure in bladder  as more difficult urinating.  I used CIC for more  then  1 year to buy time for study  and  proper method selection .  There were just 2 option  after all  - REZUM and  FLA .  I selected FLA  due to my problem  in urethra. In urethra  there are  some  small strictures and  generally lighter  diameter of it  - so REZUM could be risk  for urethra damage.  

I forgot to write - before FLA I  took  PAE  - totally failed.  Just then learned that in case of such  big  median  lobe with bladder neck blockage   is  PAE not effective.  

Hi Stan, attached is a picture of my beast. I have an elevated bladder neck that is a result of the prostate growing into the bladder, Similar to yours.

My prostate is a pretty normal size at  30cc. I have read like others that the small prostates seem to have difficulty with FLA. I have been in touch with Dr. K and am close to making a decision. As always any info you care to part with would be appreciated.

Please tell what size was your prostate? And how successful was FLA for you?

And thanks for all your posts, yours and everyone’s posts have probably helped many of us lurkers in one way or another

 

Hi  Airman  ,

are you from Europe ,too ?,Or are you  night bird ? 

Here in Central Europe is  just 9 , 15  AMi. .

Of course I'm not  doctor , but so long time  interesting to  BPH problems  that have some knowledge  already.    Can you send me  lateral  MRI scan ?  ( from side  similar to my scan ) There will be more clean visible anatomy of median  lobe.   My prostate was just 45 cc  , e..g not big, but as you see from my scan  , the median  lobe is really huge  and causing obstruction of bladder neck  .  The correct name of this diagnose is  OML  - obstructed  median lobe.  Probably  your diagnose is similar.  My FLA from April  3rd. 18 is success. 

I think  ( just think ) that  in case of OML  diagnose  , FLA is the Best solution  ,even if  your prostate volume is 30 cc, due to problem is OML  and not the rest of prostate.  FLA can solve  this  OML very effectivelly  dur to full control  on MRI  visualisation  during the procedure , so the doctor can  ablate with laser  exact  parts of OML and not to  harm   fatal structures  --- nerve bundles ,  ejaculating  ducts,  bladder neck  , urethra chanel , external sphincter,...   I think no other method for OML is so effective as FLA.    Maybe REZUM  , but doctor has no such good visual  control  as in case of FLA.   Anyway  all written is just my  point of view, surely pls consult  with Dr. K  for FLA and with another very exper.  uro about REZUM.    I dont reccomend you any other method for OML.   Happy decision ,  Stan    

North of the border of the US, just up late. Below is a lateral view.

I plan on talking dr. K again tomorrow and discuss the areas he sees as the blockage. The MRI and cystoscope photos show the elevated bladder l guess u called it OML. Either way with a small prostate this seems to be the most serious issue as I surmize there is not enough density in the small prostate to cause the kinds of symptoms associated with BPH. It seems that it is more like bladder neck obstruction.

so you are 5 months in? 

 

Airman,   

Your images are very clear.  Are they 3T MRI ?    I have also heard of a MP 3T MRI, where MP is multi parametric.   Are they MP, and do you know what multi parametric means ?

Thanks for posting your images,

Thomas

Yes  you have blocked urine flow through the bladder neck and narrow internal urethral opening at the base of the urinary bladder.  Slightly different  diagnosis as OML .  Dr. K  will inform you  in details. 

Im 5 months  after FLA  .  No CIC anymore,  nightmare  ,....   But as you see I have damaged  bladder with plenty  of  diverticulum   ( see upper bladder wall ) .  In addtion  I have trabeculation of the bladder ,  occured  from repeated obstructions in the urethra - 12 years of BPH .  When an obstruction occurs, the muscles walls of the bladder have to work too hard to move urine past the blockage. This leads to a thickening of the muscle walls and a loss of elasticity.  Thats why my  bladder  current  capacity is just about  250 -350 ml .  It will be very difficult  to obtain some elasticity back.   Stan   

Stan: Thats why my  bladder  current  capacity is just about  250 -350 ml .  It will be very difficult  to obtain some elasticity back. 

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

Actually, loss of bladder elasticity will more often INCREASE bladder capacity, not decrease. Sounds like you may have OAB and need bladder retraining. I don't know your history but I wonder if that might have been your functional problem all along as I suspect it has been with others who have had possibly unnecessary surgeries. Or perhaps you had a full urodynamic testing prior to FLA in which case I stand corrected?

As to CIC -- which you refer to as a "nightmare" -- a nightmare to me is a surgery, often unecessary, that potentially can make a situation worse, not better. Many here therefore have found CIC not a nightmare but a godsend and btw CIC can often restore bladder elasticity as well if not better than any surgery because it empties and decompresses the bladder completely.

Jim

Yes those are 3t MRI with contrast dye. I just looked at the cd and info and there is no mention of multi parametric anywhere. 

Interesting to note that GE and Siemens are preferred manufactuers of 3t MRI machines according to Donnie at Dr. Ks office. 

Thanks for that Stan!

i can’t decipher much other than the protrusion which is pretty clear. There are probably over hundred images that make little sense to the untrained eye. I cannot get properly oriented and some are just plain awful.

Anyway you u seem to have an eye for this, I do have mild trebeculation and the beginnings  of some diverticulae. Ultrasound and the cystoscopy revealed  that last year. The urodynamic testing looked good for bladder fucntion post a successful procedure.

Here we are big on turp for small prostates and aside from all the horror stories and the enevitable RE considered a “successful” long lasting procedure for te elevated bladder neck condition

how many times a day we’re you CIC?

I’ve just started with the flex coude a few months ago and have a enterococcus infection, 6 weeks of antibiotics. I really want this all to end so my brain can engage in something else!!

 

In my case  has  trabeculated  bladder  DECREASED capacity , what Im very sorry. 

CIC,   nightmare - there is misunderstanding    .   CIC is very  usefull  practise   and helped me to buy time for  my procedure decision . Nightmare was night nocturia,  3-4 times awaking a night....   

Now all these is  the past  ,e.g.  CIC, nightmare - nocturia + 3-4 awaking .  Sorry for my english . 

Thks for clarification re CIC. But did you have urodynamic testing done prior to FLA. your trabeculated bladder may be associated with decreased capacity but not the cause. OAB is sometimes confused with BPH/LUTS and can result in unecessary surgeries. A 3T MRI cannot replace urodynamics because only the latter measures bladder function.

Jim

Jim

I will post a video that we made a few weeks ago showing real-time urodynamics by MRI, done at the same time as the mpMRI. Basically, patients have to fill their bladder before MRI (drink water) and wear a condom catheter. We do the video sequence in MRI (no contrast needed) and can calculate maximum flow rate, urinary retention volume, etc. The mpMRI is done after the video. This really maximizes the information and tells us who can benefit from FLA for BPH opposed to those who cant. If I can figure out how to upload it, I will by Monday for all to see. I think this is a new and different way to see anatomy and function in a single setting with no invasive procedures.

Cheers! eric

Hi Eric,

First a belated welcome to the forum! We have been waiting for some time for a medical professional familiar with FLA for BPH to show up! So thank you and please try and stay around.

You have mentioned your association with Dr. Sperling, who many of us are familiar with. That said, for some reason none of Dr. Sperling's patients have shown up here, nor has anyone here been able to get any data from Dr. Sperling after contacting his office. The dozen or so patients here who have had FLA for BPH all had their procedures done by a Dr. Ara Karamanian in Houston with the exception of one done by his associate, a Dr. Walser (sp?).

Can I ask if your are an MD who has personally performed FLA for BPH or do you work with Dr. Sperling in some other capacity?

What some of us here are looking for here is some study data for FLA for BPH. Do you know if Dr. Sperling plans on publishing anything soon? We are familiar with data on FLA for PCa but it's really the FLA for BPH data we want.

We want to know what kind of results you are getting, what type of patients it has been most effective on, and how durable is the procedure. We have also had a small number of retro ejaculation reported, one case of a numbed penis head, and would like to better quantify those types of sexual side effects as well.

As to your the video of what appears to be a novel and non invasive form of urodynamics, of course we are interested. That said, traditional urodynamics have proven themselves over time in terms of reliability and predictability in helping to determine suitable candidates for prostate reduction procedures and in predicting outcomes.

Why not therefore use traditional urodynamics as well prior to FLA? I do understand that your novel approach is non invasive, but when compared to the surgery itself (FLA for BPH) traditional urodynamics is relatively non invasive -- arguably less so than a cystoscopy --  so I don't see any harm in measuring twice before cutting once.

Jim

 

Hi Eric, it might be easier if you post your video on YouTube and give us the name and the poster name. Thanks. Hank

Stan

When did you have FLA? With Dr K?

You mention $21,000 .

I received an itemized cost for FLA from Donnie several months ago. For $28,500

That's more than a 33% cost increase

I don't understand.

Michael

Michael

The itemized bills that you can request from a hospital will differ than the cash pay price. These itemized bills are for insurance purposes only.

We have calculated the total bill for FLA, which came out to $42,000 just for hospital and professional charges.

For cash pay, many hospitals will typically charge 1/2 (about $20,000) since insurance companies also only reimburse about 1/2 of our billed charges depending on our contract with them.

The bottom line is that billed charges never equate with collections whether insurance reimbursement or cash pay.

Eric & Michael

I do know that John the first guy that had it done by Dr. K. did get reimburse some of his money but he just had to stay after the insurance company

Take care.........Ken

Hello Michael,

The list of CPT and ICD10 codes that I send out does not show the prepaid discount of $7,500. This brings the cost down to $21,000 for FLA for BPH with Dr. K. Hope that clarifies for you. I usually have been on the phone with someone before sending that out and have quoted them the $21K.

Take Care,

Donnie

Eric,

Thanks, very helpful. With what Donnie wrote (below), it makes sense to me now.

Michael

Donnie,

Thank you very much! Yes, that helps a lot. Really appreciate this.

Michael

Remember that physicians who do FLA in an imaging center (i.e Sperling , Karamanian, Hamilton) have no contracts with CMS or insurance companies so they charge based on what a hospital might bill and collect (donnie and Karamanian got that data from UTMB) or simply what the market will bear.

Hey Michael

This is to Michael and any men that are looking into any of the BPH treatments.

Has you know that I look into anything. I am not scared to e-mail a doctor for information.

I got a e-mail this morning from Dr. Bagla who has been doing the PAE procedure for years. I had a question for him. Will stopping the blood flow to the prostate are you not killing the prostate. Some one asked me this once before

This is what he told me: The background of the prostate will stay alive. The beads travel to the area of the increased blood flow which is what BPH has. Then the tissue will regress and shrink since it has lost blood supple. I have never seen and would not anticipate that the entire prostate could be infected by the PAE.

I find this very interesting. Maybe one of you were thinking the same thing...

Have a great day.........Ken

Good afternoon guy's.

I was doing some research on FLA and I got a e-mail about a Phase 2 trail for cancer that is going on in CA. I was asking about the price and if any insurance was going to take it up.

All it told me was about the doctors that will be doing it and some of the other stuff you need to know. Where it is going to me. 10 sheets that have to be filled out with your information and stuff you have to know before you go for the treatment

Well it is being done in CA. They said that the Imaging and Biopsy cost is $300 for the MRI is another $500 and for the Treatment it is $25.000. They also said that they take Debit and credit cards and please call your bank to ensure that the whole amount will go through.

One thing I did not know or heard from any of the men that have had FLA is they do not want you to ejaculate 72 hours before the treatment so they can see the structures that hold the seminal fluids. Which is a good thing.

Most of the other stuff is about normal things that need to be done like any other procedure. If I get any other reply from any of my e-mail I will let you all know.

Take care and Happy Healing..........Ken

Good morning

Good morning all. We have been talking about many procedure. It is good that we have different ones because they are not one size fits all.

I got another e-mail from Dr. Bagla. I asked him about retro. This is what he said. We ask doctor should have our patients concern at heart. We are trying to help them with there urinary problem but we should not here them and there concerns.

In large glands I have seen a temporary reduction in the ejaculating volume in less then 3 % of the patients. So in other words it will come back to normal.

Take care all......Ken

That should read we should here them.........Ken

eric1962=Dr.Eric Walser, UTMB's Chairman of Radiology