Going with Focal Laser Ablation for BPH

Wow John that is awesome news. I am with unklefester, more than a little jealous. Really glad to hear the good news for you tho. I will contact Dr K this week finally and see if he thinks he can help me post failed PAE. Do you mind if ask about how much it cost out of pocket?

thanks Joe

Yes sir I spent $20,000 and would spend twice that right now. I can't write a check for that amount but I charged it to 3 credit cards at the time. Me and the wife will get it paid off soon I hope. I can now pull from my 401k with no penalty and I would love to use the money to get to enjoy my retirement which will happen in July I hope. I have suffered for a lot of years waiting for something like this. 18 months ago I knew I had to find the answer. 

Good luck to you. Dr. K will talk  to you until you do not want to talk anymore. He will not charge you a dime He is unbelievable. He and Wlser have been wonderful to work with.  You are welcome to use my name and any of my comments as it is fine with me. I just want to help other guys.

I know it sound  like a lot of money and it is but it made so much logical sense as to why it would work and how to save the sexual functions with this procedure. I discussed with him why it was so high priced and he told me that there was not as much profit in it as it appeared to be. He has to pay for the time on the 3 TMRI which he uses for the whole procedure it is in one hour billing minimums. So it is sometimes for about 3 hours total per procedure. He pays $5,000 per laser tip and that is a one procedure for each tip unless the cooling tip gets too hot then he will use two during a procedure. Visualase is doing well on these tips after they sell him a $300,000 laser machine. He pays also for the surgery center room per procedure done and he uses more expensive conscious sedation which is really great and I can tesitfy. Some use a Valium pill for this procedure and that is NOT GOOD. He has a sedation nurse and a procedure nurse and the cost involvd.

I figured a 25 to 30 percent gross margin to then run his business with and make a profit after that. I am not making excuses I am just telling you how I got my mind around the cost being so high before I said go. I have ran businesses for 40 plus years, it is just how my mind thinks. This is expensive high tech precission equipment in this procedure. They then have liability insurance, office rent and other cost and without doing large volumes of procedures, it is not a great business model. IR Doctors for the most part are not running them through the in factory style you see in some procedures. I think it will be better for them and us one day but by then insurance will cover it and the insurance industry and government  will beat it to death just like all the other things they have done it to. 

I might not feel this way if my results had not been at least as good as I have now. But I am pleased I spent this money.  It is going to get a lot better. Of course the credit card bills are just now coming in the mail!!!

You are doing the smart thing to just call him and learn the facts as we cannot get enough research and education in all the procedures for this condition especially if there is no charge for that inquiry. All the other doctors I met with hit my Medicare for a consulting charge. Sperling took $250 cash from me for his 45 minutes of time as he does not do any insurance for anything.

Thank God I found this man. You will see what I mean. Please let you know your thoughts and experience. Good luck brother. and thanks for your support of my journey. If I can help with your I am all in. 

John

Good morning John, and thats once again for the great information. I gotta tell you I expected it to be MUCH more expensive. I would spend it today, and never even think twiceabout it, if I knew thre was a decent chance that it would help. From reading this forum for over a year, Im pretty sure htere are lots of guys who feel the same way. You really cant put a price on true relief, and relief where you still get to keep your sexual function. lets face it when you are suffering, it does not matter how much money you have saved if you are not enjoying quality of life.

Thanks, and I will let you know after I talk to DR K.

 

Just adding to John's glowing report of Dr. K.  I spoke with Dr K yesterday (it was my second call with him). He is truly amazing, willing to share in full detail complete information about any and all aspects of dealing with BPH not matter how long it takes. He is a real find. And I had spoken with his associate Dr Walser a few years ago, also a very accessible doc. Wish these guys were closer to where I live!

There have been good resluts with FLA by Dr. K and alot of men who want relief and to save there sexaul function all of them.  You will not hear from me to much because I got talked to my the mediator on my opinion.  All I ask of you men that are looking at the procedure get all the information you can before you go under the knife.  Some doctor only will tell you the ones they do.  But there are many new procedure out there to try.  I will try to help in other ways  I send out 10 letters every 2 week to the Urology Department of Hospitals and will keep sending.  Life is to short to give up anything and to make a choice with fear of your insurance company.  Get all the information you can and you dicide the best way for you   Take care and good health to all  Ken

Yes Joe I was recently, (just last month) in the same mind set as you. Scared, unsure, doubting. Trying to figure it out what to do. I traveled a lot. Spent a lot of time. Drug my wife around. Used all my vacation time at work. 

I was and have been very depressed. I felt trapped in a condition that was stealing my retirement after working for 45 years straight, I felt I was now going to walk around always looking for the bathroom and usually with a big wet pee stain on my pants. Not going on the golf trips with the boys anymore I felt like I was being in home confinement from jail. Instead of an ankle braclet I had BPH in a bad way. I could not ignor this any more.

If I had not met this one doctor I would probably still be riding the fence and looking at the options. I would still be waiting and check the internet for a new latest trick that the "Uroologist thieves" come out with to push on us older people. I tell you, I spoke with a man recently and the way he has been  treated with his condition kept me up last night as it is so wrong and needless. i almost go postal it makes me so mad. It was hard for me to believe when I met karaman ian. I must have called him at least a dozen times with questions and theories and concerns. He always not only answered, he fully educated me on the truth and the science.

No one promised me this works. But, the logic and the science of the prostate along with the different parts to the prostate all made very logical sense for the first time. and really these medical treatments they all come up with are nothing more than that, a theroy . FLA made more sense to me than PAE. It made more sense than UROLIFT. More than REZUM. For me PAE was a random shrinkage of the gland.  UROLIT was a device and clips that would need adjusting and my human tissue could grow around the device as it is clipped inside me over time. REZUM is not as focused visually real time on the areas I want removed as the precision in the FLA ability and more important it would be more adpt to destory the areas I DID NOT want destroyed. I searched hard for almost two years. I drug my wife all over the country. In our trip to UNC on PAE, she fell and destroyed her right knee cap. I drove over night straight back to Texas to get her emergency surgery and that was 5 months ago. She still limps and is still in therapy. She continued to travel with me and some doctors even met her with a full leg brace on. (I was trying to play the sympathy card to get a better price. It does not work.)

As you can see, I was all in on doing something. I could not sit back and let this beat me. I woke up one morning in December and told my wife that is it!! i am going and I am going NOW. I felt my best shot was this very unique doctors who seemed to be a throw back to the way medicine use to be practiced when doctors actually cared. You will see what I am talking about. 

I am not positive but so far this has been the right decision. It has only been 3 weeks. Last night I did not go to bed until after that wonderful National Championship game was over. I peed then and went to sleep. I got up only once and then got up at 6:30 and peed again. All three times I peed so hard a stream my wife heard it and commented. I also had a volume of 350cc each time. I can't tell you my enjoyment in that. I am going to play golf and have sex this weekend. (My two most favorite things to do in that order> that is our secret, don't tell my wife.)

I cant say that this procedure will be this great for everyone but I have found the guy I know is the best to bet the money on and the procedure that made the most logical sense at this time for me. I did it and I am very glad I did. The money is NOTHING. I can work a little more and replace it. At least I wont be peeing on myself and that would ruin my retirement. 

I wish you and every guy one this thread success as noone deserves to deal with this and not have any answers. 

Please stay in touch with me. I am going to pm you my email and contact info so if I can help I would do it in a heart beat.

John

Hi John,

     Thanks for your continued posts, and for your fierce determination in taking care of yourself. Very inspiring, and I'm sure a help to many others in the forum.

Rich

John  Im very happy for you.  You got all the information and you picked what was right for you.  Enjoy life and all it has to give you   Ken

Plane flights  to Houston are not expensive and if you need me I will come keep you company. I am going to retire soon and  since I won't be peeing every hour now I will have time on my hands and not pee!!!!! Besides, it is warm down here!! I am about 6 hours away.

Good luck buddy. As Kenneth says, go to a go guy who really cares about you cause it makes all the difference in the world.  Let me know if I can help you anyway.

John

John,

     Thank you for your kind offer!

      At this point for a variety of reasons I'm pretty certain that I will have the PAE procedure done by Dr Bagla in VA. As you know from your own extensive research, there are pros and cons of both proocedures. I had narrowed it down to PAE or FLA (with Dr K), and finally have to make a decision. I asked Dr K if the PAE was not successful (either short term or long term), would that preclude a subsequent FLA. He said it would for the study, but only an insignificant increase in risk otherwise. So FLA is my backup. Just hoping, of course, that the PAE takes care of it all.

    

Rich go do what you feel right doing.  It may work for you  Good Luck and let us know  Ken

Thanks Ken. I will certainly be posting as things proceed.

You really should keep posting Ken. You along with j12080 and others ( sorry I don't want to start listing names ) on this forum bring invaluable insights.

That is a great plan and a great choice. I really liked Sonny Bagla. He has the most experience and is a progressive Inteventionalist with the beads he uses. He picks his patients carefully so he is a match for success with them.

Rich there is no bad decision and I believe that more than 50% of success in this is having confidence in your decision so you are doing the right thing and you have a great back up plan. You go get it and please stay in touch. i want to hear how you are doing. 

I had a great day and left work early to play golf as the weather is 76 degrees and no wind today. I peed right before I left work and did not pee again until I turned at the 10th hole. Then had a beer upon finishing, then left and drove home before I peed again. My playing partners were amazed. They have not seen this out of me before. I shot 90 so I am a little unhappy that the FLA did nothing for my score. I may ask the good Doctor for a little money back and see if that works!!

Good luck buddy You will be wonderful and all will do good. It has shown to be 70% successful and Bagla's numbers are even better. Mark my word and I know Bagla will see to it. 

John

Thanks Kenneth I hope it sticks as I really want to follow your sage advice on that. Good luck to you and please stay involved with us. 

I will keep pposting but have to watch what I say.  Some dome like it.  But I just don't want anyone to be forced into anything  Information is the key to anything you do  Ken Thank You 

John thanks for your very kind support. It's so helpful. I'm not sure how confident I am, I am somewhat nervous but realize that doing nothing is a choice than also has pros and cons. So by definition, regardless of what I do, I have made a choice. I spoke with Dr B last night with my few remaining questions. He is so very available, I had emailed in the morning that I wanted to speak with him, and he called 3 times! The first two times I was out.

Now what remains is to see when our house and pet sitter will be available and to make travel arrangements. Oh, also, have a consult with my "local" (hour drive) urologist tomorrow. I don't think that he will be very supportive with my choice, but I intend to aksk him directly if I will be able to continue counting on him as my local uro doc.

You should be nervous. IT is very normal. I would worry about you if you were not nervous. But you will be great. Bagla is a great Doctor dedicated to PAE in his clinic in Virginia.

My wife says he is so cute he could be a movie star. He definitely wins the most handsome American Intervential Radiologist Award. Which I told her that I am sure you nor I could care less about.

And he is a very smart guy. He works with a supplier as a consultant on the bead manufacturing they use to inject into the patients. He works on all aspects of this procedure. He has a lot of pride in his work and will do you a good job. I am happy for you and ready for you to pull the trigger and get it DONE.

I am doing absolutely fantastic as it just keeps getting better day after day and will put out a thread in a little while about last night. I went ahead and did it and had sex!  I will tell you later how it went but I am thinking of changing my AKA now "to be "Roman Candle". I have to call Dr. Karman ian and tell him first out of courtesy because he has been pushing me to go on and do it and I was too scared. But once again, he was so right. This guy has batted 1000 with me on every thing.

Good luck again and let me hear.

John

Kenneth, you are so correct in statements about learning all you can before you let someone do a procedure on you. This is not just the information your doctor gives you, this is deep dive research. I wrote below the research I did and why and the fact that it always led to even more research before I made this important decision.

This was not like they were working on my car! I don’t need to learn about all the actual parts in that procedure. But this!! This was a choice about a procedure that would affect my life and style for the rest of time! You are so right that we all have choices but I see people blindly believing in doctors who don’t usually tell them all the facts. You hit it on the head RESEARCH what the options are first, as well as facts about how each option can truly achieve the results you wish for with regard to your glands components. Then research how these doctors can actually do what they say. IT is usually common sense logical things. Yes, it is very hard to find and depressing work in the case of BPH but you have to find out the facts instead of just becoming the fact of what you became after the choice you made. Kenneth you are so right in your comments. We don’t have to be forced into anything. People have options, what they don’t get without a lot of work is they truth. I have spent many hours on the John Hopkins Brady Institute web site defining and learning the components and how they may be important to me. That is why when I visited these seven doctors around the country I could drill them on specific question to the procedure and my prostate. Most case, I think they did not care for me but that was not my goal.

I researched for almost 18 months. I still did not know when l chose a direction and a procedure that it was the best but I had confirmed and reconfirmed logic to back it up. My choice did not have the history that other procedures had for BPH. But I went to the trouble to learn all the components of my prostate gland anatomy and I charted how each of the procedures dealt specifically with each component. I am sure you also knew all the anatomy of your prostate before you started pursuing the direction you wanted to choose but when I stated, I knew nothing and Urologist were throwing the “kitchen sink” at me with their solutions.  I said WOW. We have to step back and understand what is going on here or things may not go as I want.

First I learned that The prostate is the largest accessory gland in the male reproductive system. It secretes proteolytic enzymes into the semen, which acts to break down clotting factors in the ejaculate. This allows the semen to remain in a fluid state, moving throughout the female reproductive tract for potential fertilization. I am too old to need any of that!! I also learned that the prostate is commonly described as being the size of a walnut and mine was almost 5 times that size. Roughly two-thirds of the prostate is glandular in structure and the remaining third is fibromuscular. The gland itself is surrounded by the fibrous capsule of the prostate with the base components located in specific zones and not just randomly in the gland. So there is an actual design to this gland. The Urethra being in the center of all the zones, then the inter most zone is the Transitional Zone. Next to that and encircling the TZ zone is the Central Zone and then the bulk of the gland is the Peripheral Zone which is the largest and encircles all three of the others.  Benign prostatic Hyperplasia is the increase in size of the prostate, without the presence of malignancy. It is much more common with age. The enlarging prostate compresses on both the bladder and the urethra resulting in men having symptoms of urinary urgency, and difficulty in initiating micturition. BPH is usually, by a large percentage,  cause by the enlargement from the Transitional Zone of the gland. Ok, what is that Zone all about? I have to find out how it applies to the parts of the gland makeup.

But first I wanted to relate this understanding of my anatomy to my condition. After refusing a TRUS blind biopsy 3 times, I learn about and got a 3TMRI. Conclusion from MRI was, a dark spot that is suspicious and we should do active surveillance and Sir, you have advanced BPH with bladder retention from the protrusion of the tissue at the base pushing up into the bladder. Great! Now I have more research to do. But at this point I know the prostate is like a map of roads and areas and a doctor should be able to maneuvered through the prostate to NOT destroy the parts that are important. OK, I now have to learn what parts are important to me and why. Then apply that to looking for a procedure that accomplishes my wish list and how does the procedure actually do that?  I now started research the road map within the prostate and the parts that made up the Zones of the prostate. The Base of the prostate is the top next to the bladder. The Apex is the bottom of the gland. I will start at the Base moving toward the Apex. The Bladder neck; upper sphincter; the seminal vesicles; neurovascular bundle; ejaculatory ducts; Seminal colliculus; Cowper gland; urethra; lower sphincter; pelvic floor. This is enough for now but not all and this gland has more parts than a “Peterbilt Transmission”. Now how can any of these procedures work and not destroy any of these parts. That is my goal That was my quest. My arduous search I was making to find the answer I would have enough confidence in to go for it. My decision was not going to be made on what would be paid for by insurance, I wanted results with no damage to my sexual functions, NONE. I would borrow the money if I had to.

Ok, by now it is October of 2015. I am going to start herbs as I am not taking the drugs that the Urologist is pushing but would not take himself if he need them. I will take these as I am searching for which procedure is best for me. BUT FIRST, before made the decision, I still have a lot of questions about this and a lot more research. If there is any interest in what came next, let me know and I will send it out. Main point here is you are very right in your comments Kenneth.

Again a little too soon to announce but I think my decision was spot on and as you said earlier it was right for me and we all get to make a decision on our procedure. Research should be the key. Understand how and why your specific procedure will work is the depth of the research. And, if you don’t want to do that then you have to take someone’s word for it. Doctors have for the most part changed in our lives. Most of the time it is about the money. That is sad.

Good luck and once again we need you on this thread. You are one of us, we are all in this together.

John

Roman Candle 

Yes Sir, 

I want to remain humble in my report but I must say that it could not have gone any better. I expected pain upon ejaculation or at least an uncomfrotable feeling and blood in the discharge. There was NONE of that. I had absolutely no issue accept that the ejaculation appeared to me MORE in volume than I had before the procedure.

I ask Doctor K about it and he ask well how long has it been since your last ejaculation and I said about a week before the procedure or about a month which is not normal for me.

Whatever it was it was a very good experience. Afterward, all my fears that I have had from 20 months before I made the decision to use FLA, up until last night have lifted off of me for the very first time. I got what I wanted most. My number one concern of getting "no sexual side effects", in a BPH procedure have been my biggest concern. I was very confident that the urine stricture would be alleviated with the clearing of the tissue at the urethra, I was hopeful that the bladder retention would be relieved at the reduction of the base tissue pushing into the bladder. But I was very scared to death that I would have some type of sexual side effect from the ablation. I realized that it all worked very very well and last night, for some reason that was awkward. I am so amazed as to how well this has worked and that it was over.

My life has been so affected by the BPH that it is now also awkward to be going through my normal day no longer needing  to be controled by my urination. I could not do anything without being controled by urination. My sex life was never affected by the BPH, I just did not want to loose any of my sexual functionality which were the only good thing I had left, due to the the BPH procedure I selected. I was really scared about it and my Dr. Karama ian took the time to study the strategy and drew the path of the ablation out on the MRI showing me the tissue that would be removed and the route that would be taken ahead of time to show me how it is precisely done with out hitting or damaging the components of the prostate that effect sex. He showed me that all the work would be done in the Transitional Zone and the Median Lobe and no where near the part of the gland that would cause damage. It made logical sense to me and his confidence in the procedure from many cancer Ablations sold me. Though it had not be done under the name of a "BPH Solution", the same thing has been done many times (1,000's) for prostate Cancer with the same results they have achieved for BPH relief.

I now could not be happier. The next best thing that can happen is the longevity of the results. This makes logical sense also because it is a laser procedure, it is not possible that the BPH tissue will ever regrow in the areas removed. Those area are void of tissue that could regrow. Dr. karamanian says that now we wait and let the prostate "re-form" in it's cavity and take on it new size and shape. This will only make the urination better. I know this was a lot of money but I now feel it was inexpensive for what I think I have gotten, that is, my life back. 

John

yes it was great no issues at all no blood, no pain, just perfect. I sent a answer 11 mins ago and it got moderated. I have ask the moderator Alan, to look into it for us as I am not sure why. Thanks buddy. 

Thank you John.  That is right alot of men will not do the research and they take there doctor by his word.  How can they get the answers you need in 10 minutes that they give you.  It is true that the doctors tell use we don't need the ejaculation but why should we give it up.  I feel it goes with my orgasms.  No doctor is going to tell me other wise.  Life is to short to give up without a fight. Why should I give it up just because the doctor tells me I don't need it.   I think it 50 50 some men can deal with it and others can't. Get the information Take care Ken   

John  He was the was that e-mail me the other day  Ken

John, thanks so much for all your posts. Truly a sane and extremely intelligent approach to taking responsibility for your own health needs. Very inspiring.

Rich

John   Very happy for you.  Your dr wanted you to it before because he felt you were going to be ok.  Has for the volume you did not do it for a while so you had some stored up.  But you should have agood out come evern if you only do it once a week.  Very Very happy for you  Ken 

Thanks Ken I am still in shock. I expected help with my BPH from this procedure but I did not expect this good of results. I am very blessed with the job these guys did.  I am somewhat humbled and very thankful for the blessings. All of us are so scared of giving up control and putting it in the hands of someone else for a moment. I got some great guys to help me.

I can also tell you this Dr. K told me to stop sitting down so much. So at work they have agreed to buy me one of these stand up desk deal where you can stand a while and then sit a while. I told them thanks, I will take it but I am still retiring in July so don't think I can be bought off. Dr. K wants me to do this while the prostate is "reforming" its shape as it will be better for me in the long run.  

Thanks for your support.

John

Yes he is right.  The prostate must fill in again and it will be smaller.  Yes at home try to lay down more so you don't sit on it.  Try to make a day of it.  Don't know if you have a tv in your bedroom but pic a movie and lay down with your wife and cuddle and watch the movie.  You can kill 2 bird with one stone.  He was right  about your ejaculation he know it. That is why he was trying to get you to do it sooner.  But that was up to you.   because he did what he told you he was going to do.  Doctor that care are a rare bunch.  We must all look at all the options for us.   Take care  Ken

Hi J120,

Your story demonstrates the superiority of image guided focal therapy over let's call it the "roto rooter approach" with TURP and its variants.

Unfortunately, it sounds like the time, dedication and skill sets required for FLA may keep it out of the mainstream for some time.  The problem compounded by the fact that it is not done by urologists where most people land with their BPH problems. Can’t see urologists recommending FLA over the newer, quicker procedures being developed like Urolift and Rezum that they can themselves perform and therefore profit from.

Although maybe too early to state anything with certainty, it does sound that FLA in the right hands may have created a new gold standard in that, like TURP, it physically removes tissue, but unlike TURP it only removes what needs to be removed, therefore doing away with many of the risks and unwanted side effects of TURP like procedures. The closest thing to FLA, in concept, might be what has been termed the ejaculation preserving TURP, which unfortunately is not readily available, and even if it was does not seem as technically precise due to lack of being MRI guided.

In another thread you stated that you recently slept through the night and had a natural void of 600ml. Assuming you are having no or little retention (I assume your doc has/will check for PVR via ultrasound soon?) this shows what appears to be a very normally functioning bladder. Impressive!

Apologies if this has been asked before, but could you tell us a little about your BPH prior to FLA. Was this your first procedure? What was your IPSS Score? What was your PVR? Urgency issues? Etc. Also, did Dr. K. do a urodynamic study prior to FLA to insure that your bladder would function properly after the obstructions were removed? As you know, proper voiding is a very complex procedure, but to over simplify bladder tone can be as important as obstruction, so I am therefore assuming that your bladder tone was in decent shape prior.

Jim

 

Jim yes you are correct the urologist are very much trying to first keep FLA quite and not tell their patients about it especially if the patient has BPH. They tell them that this is really just for prostate cancer. Second the urological industry is trying desperately to find a competing procedure they can push but you understand it better than most. The key is the fact that with the MRI you have real time “eyes on” by the Doctor. Dr. K. has a lot of “eyes on” experience not only as an Interventional Radiologist but he has always specialized in the prostate from his fellowship to his directors position in Houston. 

Yes I am now completely sleeping through the night I am getting up once a night but it is my own fault. I do not wake up needing to urinate. I some nights wake up and wonder about it and can’t go back to sleep so I get up to go watch the stream. Dr. K. laughs at me and says I will stop that when I get tired of my new toy. Wow does it flow right now! I am not having retention now but I will get retention checked after I find a new Urologist. My last one will not be my doctor if I had FLA. I know I do not have retention now as I can first tell from the feeling and the huge flow during urination. But I will check it when I check my PSA in a few months.

Ok, prior to FLA treatment. My PSA was 5.7.  My size was 125. My density was .030 which was good. I had one suspisious location that was under active surveillance for the last 18 months. It was remove also during the Ablation. I had nocturia and was up 6 to 10 times a night. I would have to walk around to urinate. I had incontinency sometimes 2 to 3 times a day as I could not make it to the mens room. BPH controlled my life. I had to carry a bottle in my truck to pee in. I have had to pull over and pee on the side of a road. I could not go anywhere without peeing first before I leave and then learning where the bathroom was the minute I get there so I am ready. I had no sexual issues but that was what I did not want more than anything. FLA gave me my life back with NO sexual side effects. I am only 27 days out of the procedure and ALL my symptoms are much better or completely removed from my life. I now go in the daytime 4 to 5 hours between urination and I do not have incontinency any more. Jim, I would pay five times what I paid if I knew this would be my results. Yes, this was my first and only procedure and it was FLA. I researched every procedure for 20 straight months. I will send you a history of that next as you seem like you would be interested and I can tell you would understand my procedure of research and the logic I used. Research is the key. Why would a person just take the word of a urologist???

One other thing to note, Dr. K is about to begin a clinical trial the is will partially fund for 7 to 10 men on BPH. He will pay for a percentage of the cost to lower it price for them. I could not do it for several reasons and I past and wanted to go before that. IF anyone has interest they should call him and discuss it with him directly. Several men on this site have called him for advice and information and have all commented on the level of attention, interest and support he gives them. I believe at least two people have contacted him and signed up from this web site. He wants and will publish the results. This is to change the situation you were speaking to earlier of acceptance, this will really help. Bottom line is this will also be very long lasting solution as the tissue is removed and will not grow back where it was ablated. 

John 

John,

Sometimes, as we get older, we just get up at night. Nothing to do with the need to urinate. However, once we're up, we may "feel" it and decide to urinate. This as opposed to needing to urinate with a full bladder.

Not to rehash what we both agree, but medicine is among other things a big business. And just like you're not going to be sold a Ford at a Chevy dealer, you're not going to be sold FLA at a urologists office. Be interesting to see how things go and I'm sure insurance reimbursement will have a lot to do with it. If it all comes together, it could change the way IR's practice, and hopefully there are enough of them out there.

You definitely were quite symptomatic prior to FLA. Do you know what your retention was beforehand? Was it measured by bladderscan in your urologist's office or did you have a bladder/kidney scan which is often combined with a void test. If so, did they comment on your bladder size or characteristics, for example was it trabeculated and if so, to what degree?

Given the volumes you mention and your own observations, I'm guessing you don't have any retention now but I think it's important you get it checked out at least for awhile. I'm in the same boat as you are with urologists and for similar reasons. My urologist wanted to do one diagnostic procedure and I decided to do a different one with another urologist. The second one is very good but too busy to see as a regular urologist. It will be hard to go back to the first one since we were at such logger heads over the direction of my treatment. The main reason I need a urologist now is to periodically check for retention as I would like an alternate method to CIC of doing so. I am tempted to buy a portable bladder scanner but the cost is around $6,000. If anyone(s) are interested, maybe we could buy one and share it. Great tool to play around with and see what's really going on inside! Interested parties can PM me with their location. 

Jim

 

Glad to hear how good this went for you. I am still considering both procedures but the ablation sounds like it may offer more precise results without the possibility of damaging the bladder or rectum as is possible with PAE.

I live in DC but have family in Austin so I could spend some time with them.

We have a cruise to Europe planned late this year so I wonder how long you would allow for recovery before undertaking a long flight and cruise.

Thanks

Ever been to Beeville---used to live there.

Yes sir, Beeville is the county seat of beautiful Bee County and I use to live in Blue Berry Hill which is out side of and really just a part of Beeville. That is an amazing coincidence. Beeville is only a population of about 15,000. That is great country. I is ashame you got sentenced to D.C. you deserve more like Beeville.

Austin is less than 2 1/2 hours from Houston. I would recomend you go to Houston and stay 3 to 5 days and then go up to Austin. Regarding the Cruise, you will be ready to go anywhere within a month to two months. Two might be best as you are going to be on a boat. But I doubt you have much bleeding with the procedure if you do FLA I had very little. 3 or 4 drops was all at any single occurance and Dr. K said that is normal. Not really bleeding in my book. The pill they give you stops the urgency, any stinging and any bladder spams that might happen. It is called Uribel and it is wonderful. No side effects for me and you cannot even tell you took it as no feelings of a drug or medicine at all.

So I am pretty much well! Dr. K says it will get better but I don't know how it can do that? I put a new vent on the roof yestertday! Played golf on Friday. Working on my truck this morning. I am 35 days post procedure right now. I can assure you that 60 days out you will be totally good for anything except bull riding. But feel I could now travel overseas after 30 days for sure and I am ready now. I hit my glory day in three weeks after the procedure. It was amazing. I felt completely different on a Friday night. First the nocturia and then the daytime urges stopped. My lower back still gets a little sore but my wife says I do to much. Dr. K. says just go live your life but no hard work outs (weights) for the first 45 days. 

With the catheter in you do not get up and you sleep through the night. The sixth day I took out the catheter. Then I was getting up for the next 16 days either 3 to 4 times a night and I messured and logged my urine and the time accept at the office. I was back to work in two weeks as planed.

I could acutally tell something had changed on that Friday night. Dr. K told me it would happen but he said it would be about 1 month out.

That Friday night I slept completely through that night and only got up one time about 4:30 a.m. My volume and flow had increased gradually after the catheter was out according to my logs but that night they really increased in both volume and flow. That was the first time that I had done that in several years! In fact, I did not remember what it was like to sleep all night. The sound of hard flow and volume of the urine hitting the toilet was a beautiful sound that I had not made for many years. I remember being envious of hearing that sound in a public toilet from an adjacent stall. Shame on me.

I was use to getting up 8 times a night, then down to 3 or 4 after the cath came out, then POW it just happend and I slept through the night. Since that night I have only gotten up one or two times if I get up at all. Last night I got up twice but I had two beers yesterday afternoon and two glasses of wine at dinner time. I also drank a lot of water ater being on that roof.

Good luck Richard, pray and ask for patience, guidance and wisdom in making the decision that each of us BPH men ultimately have to make. You will use your common sense and logic will lead you to your answer. FLA was right for me. PAE was the answer for others. Even HoLEP and TRUP have worked for some men. I will help you anyway I can just let me know. 

My advice would be that if you have not spoken with Dr. K, you should call him and be prepared for a wonderful experiece as he will not try to sell FLA but will help you with questions on any procedure in an effort to educate you. But I will warn you, he will talk until you are out of breath. He cares that much. I went to meet them all and most of them are good guys. He is the best but then my wife I am pretty darn happy right now.

I will PM you my phone number if you want to talk anytime I am avalible. Even during football....Go GREENBAY..

John

Hi Richard,

One of the important predictors of success in all the procedures is the condition of your prostate and bladder prior to the procdure. Maybe I missed it, but could you go over what is your current situation including age, progression of symptons, prostate size, median lobe or not, frequeny, urgency and the amount of retention, etc. Also, do you know your IPSS score, or if not, you can complete the questionaire in a few minutes if you 'google' it.

Jim

Should have added -- what tests did your doc do, including ultrasound, cystoscopy and urodynamics. I think urodynamic testing is a must before undergoing any type of these procedures although from what I read here it's not often done. One of the PAE docs mentioned appears to use Tamusolin (flomax) response as a predictor (if you have a good Tamusolin response you tend to have a good PAE response). I can see the logic behind that but personally I would have urodynamics as well to make sure that my nerve and blader function are good enough to produce desired results. Remember, in the case of  LUTS (lower urinary tract symptons), the prostate may only be part of the problem. Bladder and possibly nerve condition can also play an important role.

Jim

Jim

Hi John, How soon after the FLA do you feel you could go back to work? If I recall you don't have a strenuous job. Do you think recovery time would be less on a smaller prostate? 

Good morning Unckle. First, please don't let that nasty rumor get out that I don't have a strenuous job. I have them believing it will hurt when I am gone!!

Yes, I believe your recovery will be faster and better than mine and I planned my procedure to be back to work in 2 weeks on January 3. I made that date.

I found that the only issue was sitting down for extended times hurt my lower back and felt like my prostate went to sleep. I work with some great young guys. They bought me a Varidesk that you raise and stand up to. It is great. I could have gone back sooner with this desk. At least partial days because it was holidays and a lighter load.

Yes, I think the smaller protate volume will help a great deal. I should have done it sooner rather than later. But we have all been there. I thought I could beat it with diet and herbs and at the same time, we must do our reasearch. Plus you are what I classify as still "a young pup" so you will do good. Dr. K will demand it and make it happen.

Go Packers

John

Sorry Unckel that moderator got me once again. I hope he lets it through later but bottom line: I guess I should not have mentioned my new desk which helped my back yes, your smaller volume will greatly help your recovery. Dr K can tell you they removed a lot of tissue from me. I was back in 2 weeks by design. I could have gone back earlier with that desk. You can stand up. The guys at work got it for me. I love it.

Do you think a week off iss too optomistic? I work in a machine shop standing most of the day is normal

I don't really know. You are much younger than me. I could not do it in a week espeicially if you are running equipment. If you are not doing the actual machinist work, I would say no sooner than 10 days or two weeks but remember, you are not having near the amount of tissue removed that I did. I thing Dr. Karaman ian can will give you a good honest ansewer. i can tell you this, each time he told me something, he hit it on the head on my recovery. He also knows the comparison of what I had removed and what he will remove from your prostate. You should ask him his opinion on that topic and ask him why? You know he will be happy to discuss it with you. Ask any and all questions he is ok with that to the point that I really thinks he likes it. He likes you well educate. 

Unckle, in thinking about it some more, I bet you could go back that soon as your current or past BPh symptoms are no where near as bad as mine were. Remeber, I waited too long to do this and I was peeing on myself with urgency, I had bad nocturia and got up 8 times a night. Those symptoms were what I had to recover from NOT the procedure. You are recoved from the procedure well enough to do fine work after the catheter comes out. I just need my symptoms from BPH to clear up. And that happened on the 22nd day post procedure. I was back to work on the 16th day as they had improved enough but on the 7th day of that month POW. it all came together. 

So bottom line, I think you can make it back to work in 7 to 10 days. Heck I went to NASA for a whole day the day after the surgery and I was riding all over that place on the "Wally World" Tram they had to take you between buildings. 

Thanks John. Sending him my CT scans this week. I'm sure he'll contact me after he has a chance to look at them. My job isn't very strenuous. I could have someone put a vice on the mill if need be. Heaviest thing I lift all day is probably my lunch 

Good evening John and Tim and others  I just read this .  Renal & Urology News About procedures.  Turp declined from 72% to 48%  And the other procedures are up from 6% to 44%.  Men are starting to take a stand with there well being.  They just don't take the first thing that there doctor tells them.  I am very happy about this.  That is the way it should be.  We are in control of are body's and we need to step to the front of the line.  Take care all.  Research is the key  Ken   

Good to see you back here Kenneth.

Thanks.  Just trying to help  Ken

Hi Ken,

Unfortunately, in the stats cited by the article, the shift was from TURP to laser prostate surgery such as Green Light and not to the newer, less invasive procedures. 

I did however read a more recent article that talked about some shift toward office based procedures such as Urolift and I believe REZUM, but the motivation was not so much to benefit the patient as the physician.

Apparently, insurance companies have significantly lowered their reimbursement for TURP making in-office procedures more profitable for the doctor. Because of this, and the medical marketing of procedures like Uroloift and REZUM, raising concerns in my eyes of a lot of premature and unecessary procedures without properly informing patients of the risks of the new procedures. We have instances here, for example, of retro after REZUM, a risk that apparently was not conveyed to the patient.

And, of course, don't expect PAE and the newer FLA for BPH, to be promoted at all by the urology community, nor can many of us afford those procedures.

Replacing TURP with less invasive options is a good step, but it's still a minefield out there for patients with whatever procedure or operation an individual urologist performs being sold to them, whether it's right for them or not. 

That said, it seems that "around the corner" never looked better and I'd advise anyone who didn't need a procedure now (low to moderate bph) to hold off and wait for better stuff. 

Jim

 

Yes I know and it is a step in the right directions  Alot of the laser procedure are better for the patient because of less bleeding and they have better control of the laser.  I did that to see if anyone was looking things up and reading  In any procedure you have you need all the information you can to pick what is right for you  Thanks Jim   Ken 

Its what you've been preaching Ken ( I mean that in a good way) I was almost a victim of TURP. Although I haven't ruled out HOLEP, which is similar, I'm going to be the one making the decision not a DR. telling me pys what needs to be done.

I looked at HeLOP breifly in my attempt to find my direction and it scared the Bejeebers out of me.

Correct if I am wrong on this procedrue but it is basically a procedure where they go in and through the urethra. Then go into the prostate through the urethra wall and remove as in "scoop out" the tissue. They then push it up into the bladder where they then cut it up into very small pieces and then over time it is passed out of bladder with the urin? I was told to be advised that normal ejaculation would certainly cease with this procedure. 

The discription of this procedure gave me the mental image of a miniature meat packing plant in my bladder and prostate. I wroked at one of these when I sixteen moving the sides of beef and expecting to be drafted soon for Vietnam. I thougth of that job at that time of my life as prep training because I was sixteen and had not seen the inside of a meat plant before and in my mind that was like war. I got hurt and in the hospital for several months just before the draft so my great Unkcle Sam did not want me. Hurt to bad and became the side of meat myself for a while. 

My understanding was that this process is even more bloody than the TRUP.  I may have this partial mixed up but that is what I thought in it was explained to me?

That is right.  What ever procedure you have You are the one that has to feel it is right.  You have to see if it will fix the problem not cause more.  What you have told me you are doing ok for now.  Make a least of all the procedure you are looking into  The pros and cons.  Also look as how good your doctor answers your questions.  You need the answers not go have a surgery that they only answer half way. And when something come up they said it happen but will fix it.  Remember this is your body and you have the control of it.  I know you will do what best for you.  You are already looking into a few procedures and your not rushing.  Take care and I'm here for you if you need to talk or look something up  Ken 

I had the same reaction to TURP after I watch a video.  There was so much blood and that doctor just started cuting away at the prostate not looking what he was doing.  Just going up and down from the bladder neck.  When he was done I think you could put a whole arm in there.  With leser I think there is less blood because the laser cauterizes the blood vessal.  I still don't like them but I can only make that discision for myself no one else .  Take care guys ken  

I'm no expert on HOLEP but here is what I know.

1) Very little bleeding. Everything is cauterized as the laser cuts. No where near the amount of bleeding as TURP.

2) Yes tissue is cut then pushed into bladder. From there a morcellator is brought in to cut it up into small pieces then flushed out of bladder. This way tissue can be biopsied. Tissue is not left in bladder to decay.

3) 1 night stay in hosptital sometimes released same day.

4) Catheterized for over night Rarely go home with catheter in. Due to low chance of swelling.

5) Proven longevity of procedure. I'm pretty sure HOLEP has been around since the late 90's. 

6) Many consider it to be the new gold standard

7) Its not widely used due to steep learning curve and expensive equipment

8) Around 90% chance of retrograde ejaculation.

10) General anesthesia

11) Many HOLEP patients have better erectile function after surgery.

12) Treatment of any size prostate.

One thing I have noticed. Rarely do you see anyone on here or on the internet complain about HOLEP procedure. I think one fellow on here talked about a rather long hike he did the day after the procedure. 

 

Here is a thread on this site discussing HOLEP

https://patient.info/forums/discuss/my-holep-prostatectomy-273055

Thanks for the great information, I have a lot of investigating to do and will have to speak with various doctors. I was stationed at Naval Air Station Beeville in 1977, eventually grew to really enjoy the area.

Wow,  I did not know all that! My Uro I visited at UTSW sold me off of it. It sounds pretty good, except of the RE part. I can not live with Retrograde Ejaculation.  Not my deal. but other than that it sounds pretty good at least results wise. My Uro told me that the discharge of the tissue removed and bleeding of the urethra was more than turp. I guess he was not doing that procedure yet so he tried to push Urolift and REZUM on me. 

Like I said google the procedure you'll see most of I what I said mentioned on multiple websites.In the end, I'm leaning towards FLA but if HOLEP didn't have the RE I would do it in a heartbeat. If Dr K was closer I would definitely have FLA done. I should finally find out the size of my prostate this week. 

10-4

I got you. let me know what you find out. And decide. I am here if you need me. 

Good evening.  Don't know if you read some of the post that some of the men that had a holep procedure.  They had it and 2 or 3 months later it did not work they end up having a turp done to clean up what the holep messed up.  One why or another they end up doing a turp on you  Take it easy  Ken

You know by know not all doctor tell you everything  Take it easy  Ken

Hey Buddy  Just checking to see how you are doing.  The last time I heard you were doing great.  I know you only have a few months to go.  Are you looking forward to retireing.  I don't answer to many post anymore.  Have nothing good to say about some of them and I feel sorry for the men that have them done.  FLA to me is a great procedure and I hope the FDA appoved it soon.  Enjoy your life  Ken 

If the FDA approves it for BPH how long before insurance companies will cover it?

I think the FDA has approved it, it is the insurance community that needs to buy in.  This is an Expensive initial procedure, but between PAE and FLA will probably prove out through testing to be the more permanent of the minimally invasive procedures.  This would make it very cost effective.  I think in Dr K testing that he will show that this will be the most cost effective of the procedures, with an almost nill failure rate with close to 100% BPH relief to different degrees.  They will start finding out how much prostate material remove and in what locations provides the Best Relief for the BPH condition.  Also, because the have high definition percision 3T MRI visual during most of the procedure, it will start becoming like dentistry to repair a decaded tooth.  If they could only get the cost of some of the expendible laser equipment down in price and as there becomes more of these MRI scanners from more manufacturers around the world, that price will come down quite a bit.  So, again it becomes a battle with the Uro's and the IR's.  Most men do not have a Normal access route with an IR to even find out about this future BPH option.  That will be a huge issue and that is why the URo's are deferring so much attention away from procedures like PAE and FLA.  I think to stop the battling, a URO should be included in the FLA procedure team.  That way he could still get a piece of the action.  I have seen on some of the PAE Clinical Trials that they have had a URO on their Team.  The Uro can handle the follow-up on the patient for the rest of his life.  Although, I don't think the URO's should be diagnoising Cancer with their current procedures.  I think that Medicare will allow you to have an annual MRI once you have had a supicion of Cancer or Prostate of Bladder Issue where the MRI was used intially.  You have that MRI from your FLA procedure.  Dr K told me that insurance pays the same rate whether it is a 3T or a 1.5T MRI, so you would go for the best one out there at the time.  So medicare should not refuse in the future.  Cancer diagnosis should done with the 3T MRI or even improved procedures in the future.

Mike    

Surgical specialties such as urology have the highest incomes while the lowest are the non surgical specialites such as a family care physican. I can't see most private urologists simply turning over their surgeries to another doctor in return for aftercare. There may be more hope with hospital based uros -- probably the ones working on the PAE studies -- because they are salaried. Still, their salaries are often tied to producivity, but hopefully something can be worked out so that the better procedures triumph regardless of who does them.

This reminds me a bit of the sometimes uneasy relationship between gastro's and ENTs, where the diagnosis and treatment of certain conditions -- GERD for instance -- may be different depending on whether you initally see a gastro or ENT.  Laryngopharyngeal reflux (LPR) is a common ENT diagnosis, yet many Gastro's dispute the existance of the condition. That's because they are only allowed to work below the neck!

Jim

I agree Jim, but you don't see the IR's really pushing this procedure either.  The technique that Dr K is using is almost the same thing he does to handle Prostate Cancer patients.  Also, IR's are not really hurting for work either.  they are doing ablation and embolization all over the inside of the body.  This BPH using FLA could be a Golden Spoon for them, but I think the cost factor will weigh out with the insurance companies.  Look at PAE, another IR procedure..  It has been out there for 8 or 9 years and is done more outside this country than inside.  This very website I found following PAE.  First developed in Portugal, then they went to Sao Paulo Brazil, then out to Austrailia, England, Asia and finally to the US where they have to fight the Bureaucracy.  It is still not Insurance approved, but it is FDA approved because it is not technically surgery and there has been many performed inside and outside Clinical Trails (maybe as many as 400 - 500 golbally and still not approved in the US by Insurance companies), which they are still doing in several locations in the US.  Not only that, their Trails have showed, depending on who's info you use 83% to 92% success rate.  Even though the accuracy and success rate will be very high, I still see that it will take money and time to sell it to insurance providers.  Especailly now they are greedily fighting to get much richer in the distruction of Obama Care to the NEW System, that they don't know what that will be, maybe private sector.  That means more money.  

Mike   

Kenneth, thank you for checking on me. I am really good. I played golf here this afternoon as it was 73 degrees today and we are now waiting on the next cold front. I am feeling great and golf did not hurt anything! Most amazing thing is I had to pee only one time and that was after lunch and 9 holes of golf. Then I went in had a beer about 6 pm peed again and drove home. As normal life all returns it is hard to recall how bad symptom wise it was before the procedure. But I made my wife promise me she would continue to call it to my attention how bad I had it just two months ago and for 8 years back. I do not want to stop being thankful or remembering what a blessing and gift this has been. I am very anxious to get a new PSA score just to see what the number reduction will be. I will do that in 3 more months. 

Yes I am looking forward to retiring and it is soon. It seems too good to be true but It will be 47 years I have been in the work force. I never did not have a job in all those years. I am sure it will be like a kid at first and then I will get bored so I am going to fish, play golf, work out, do yoga classes, and do what ever else I can find. Maybe a few domestic trips around. And still try to help other men suffering from BPH.

I miss you on the post and I wish you would stay with it as your sage wisdom is good for the people. I am going to be avaliable to tell men who want to know about FLA, large median lobes, retrograde ejaculation, prostate anatomy, real informtion of the real procedures, and naturally I will tell them about Dr. Karaman ian as he is not like the other doctors that you and I have such disdain for. It is hard to not get too involved as I too, just like you, feel so sorry for the men who just go with the doctors word on what they can do for them. Or buy what insurance companies will pay for. These procedure will define themselves in comparison and will work themselves out over time as to which ones are real and which ones make men dearly sacrifice something to try to find relief. It is just ashame that so many men will first go through it and then have to live with it the rest of their lifes becasue they were acutally taken advantage of by these doctors and by the system.

Dr. K is really one of a kind. I cannot tell people and expect them to believe me. But I will try to get them to at least interview him and talk to him about their situation. Then they will start to understand as I did.

I remember when I was a kid and first saw a TV. I remember a commercial by RCA of the dog. You may remember the spotted RCA puppy that would sit and look at a TV in the commercial and cock his head to the side and stare at it in bewilderment. That is how I felt, like the RCA dog, when I met Dr. K. and called him on the phone so many times with more and more questions.

You may be old enough to remember those commercials. I have never forgotten them as they were so profound to me. Please stay in touch. Your a good soldier in the battle to get men better treatment. We all need to continue to help and add to the research facts as treatments grows. I am not going away just because I thing I have gotten my great cure. 

Kenneth if you need anything please ask. 

Good luck, John

Funny you mention Nipper the RCA dog. There is a building in Albany NY with a very big likeness of Nipper sitting on top of it. When I was a kid my father would always go that route on the way to my aunts house so I could look at the him on the roof. 

That is a good question.  I hope it will be soon  Ken

Thanks John..  No I am not going away  I will try to give my opinion when I think I can help.   I was reading a trial on Turp against Laser.  The biggist problem they say is talking your patient into them. They do say Laser is better then turp because not as much blood and hospital stay so it cheaper. And there is no difference in improvement. This trail was 100 men from 45 to 65 they gave you all the  percentage of all the side effects. The men that had the turp 5% had to have blood because they lost so much having the surgery  Also 8 of the 100 have to have another procedure withing 2 months.  They also said that with both there is a 25% chance of retro ejaculation.  At least that is more they some of the doctors tell you.  With all the other procedure that are out why do men still put there self through these procedure.  There were 5 doctors that were in this study.  They said that the problem is that alot of the doctors will only do 2 or 3 of the procedure so you have to take what they offer With the new Turp that they started doing button turp.  They can stay away for the ejaculation duct and the bladder neck and also the seminal vesicles.  They have more control of the button.  It does take longer but if the doctor care he will do what the patient wants.  Not say you don't did it and there will be no change.  Ya right.  I sent a question to my doctor .  Being they have this new turp.  I ask him can they do the same with Holep can they just get rid of the tissue that is causeing the problem and leave the rest alone.  I see you are doing all the good things in life.  Enjoy all of it.  Also don't put nothing off because you never know what is around the conner.  That is why I'm going to Vegas in a few week.  Going to have some fun and  Gamble  Take care and same to you If you need something I'm here for you or anyone that need some help.  Good evening  Ken .   PS  Yes I remember the RCA Dog Bozo the clown and I am from Michigan.  I remember the twin pine clown also  I think they were much better they some we have today....  

Hey buddy.  We use to go by The Big Boys restaurants.  They were still around in the 80's when my kids were little.  Ken

Ken

I am a huge Big Boy lover.  They are headquartered here in SE Michigan.  We aslo have A&W rootbeer.

I am waiting for a response from Tim.  It maybe to late, being that he lives around NY.  

I am glad that I am going with the FLA.  Hopefully near the end of February or the last half of March.  Waiting to get my MRI order from Dr K to get my scan done at the University of Michigan.  My insurance will cover that.  I am getting tired of this damn BPH.  You can't go anywhere or do anything without fully planning out your bathroom strategy.  I have not been back to work for over 3 years now, because unless I have a clostomy bag, I never know when I will have to go.  I am an engineer and I have to be on the go all the time.  I have 3 and 4 hour meetings that I am leading, and I'll be damn if I am up front and all of a sudden I have to go and can't make it.  

Have you decided what you are going to do?

Mike  

For now I think I am good.  Use to get infection all the time.  Had 7 in 2014 also had sepsis that year.  Had a Urolift in 2015.  I go in March to see my urologist been having some leaking and pain sometime at the end of going to the bathroom.  I think my stricture has gotten worse. It's just before the prostate.   He will be doing a scope in the office.  I use to live in Michigan came to florida in 1992 to take care of my Father-in-law.  I use to love the hot fudge cake that Big Boys had.  A & W was great to.  Hot dogs and chile and a cold A & W root beer.  I think you will be fine with the FLA.  John had a good out come.  Dr K seam like a good and caring doctor.  Take later If you need something let me know  Ken 

Hmm I don't remember Big Boys. Were/are you from the NY area?

No I lived in Michigan for 35 years  They were great  Ken

oops now I see you were talking to Mike

Hey John...Good afternoon hope all is good with you.   Just saw a add for the Varidesk.  I think you said the people at your office got you something like that.  First time I saw the add. They look very nice and as long as you can still do your work it's great.  We don't want anything to happen to your new prostate Take care  ken   

yes, it is really good I stood up all day today and it really helps my back. I think it will hlep me at work as you can do a lot more standing up. iI think it will actually help the prostate. 

So far I have only had cystoscopy done, that is one thing I have been trying to figure out which tests I should ask my urologist to order. Even he says I am too young for TURP (66), but hasn't suggested any other procedure yet.

Hi Richard,

You want to better evaluate both ends of the LUTS equation, the prostate side and the bladder side. Testing of course is dependent on what your urologist thinks you need but they can include cystoscopy, bladder/kidney ultrasound, TRUS, MRI and urodynamics. According to John, Dr. K. I believe prefers the 3T MRI and specifically recommends one manufacturer. You might want to contact John on this. As far as urodynamics go, video urodynamics are the gold standard but not all urologists offer this. 

Jim

66 is too young for TURP? I am 63 and my uro suggested TURP the first time we met. Hank

Jim and Richard. I have found that most of the IR doctors prefer the 3 

T MRI and the brand they like the most is the Siemens. I think this is due to a more open architecture with regard to the software but I am not positive on that. GE is also good. NOTE, the IR doctors will also tell you that a pelvic coil is just fine to use. It is definitely much more comfrotable than using a rectal coil which, as implied is inserted in the rectal for about 40 minutes. It is not painful but it is not the chosen prefered way (in most cases) to have an MRI when you can use a pelvic blanket that just lays across the body. 

The 1.5 T MRI is not a good enough image for PCa. It may be fine for just looking at the prostate and imaging BPH patients but it cost no more money for the 3 TMRI and it is the strongest in imaging. If you have an issue finding one in your area, I am positive Dr. Karamanian will be able to tell you where one is in your area. 

My recomendation is to find a good Interventional Radiologist that specializes in prostate treatments and imaging and have them order it as a urologist does not usually want to order one for you they do not know what the are looking at. An IR needs to read it. Dr. K never charged me to order one and to read it for me even when I had not yet decided to do FLA. The only IR that did charge for both was Sperling. He even charged me 250 for what he called "consult with me" in a interview I had with him. I am 65. Every thing after FLA is now wonderful. I dont think it can get any better but we will see. Doctor now claims more improvement for next 60 days. Can't imagine what that could be?

 

John,

Is your head in the tube for 40 minutes or just your lower body? My prior MRI experiences have been with garden variety MRIs and while I did last 40 minutes once (I forgot what they were scanning for) it was not fun. Since I'm currently not looking at treatments, I don't have an immediate need but at some point I might want a bettter picture of whatever obstruction is going on down there.

Jim

 

I was 57 when my problems started. My uro was gun ho to do TURP. Glad I didn't listen to him

Jim,

i just had it done last week. It was an hour, and my whole body was in the tube. I could see out the end a little bit. It is not that bad, but I have had at least 6 MRIs in the past. They give you music to listen to as well as eye coverings if that sort of thing bothers you. I was able to nap believe it or not.

My urologist said that a TURP should be the last resort.  There are to many other procedue you can try.  Ken

Head's up about napping in an MRI. I nodded off during my first 3T MRI. As might be expected, the body can do small movements while you are sleeping. Mine did enough that I had to come back a second time to redo part of the scan that was not clear because of the movements.

How the heck do you lay still that long?

I find it very relaxing. At first I thought the loud noises would be jarring, but I got used to them and then nodded off. And it's not like I live in a city where I might be used to sleeping with noise. It extremely quiet at my house. 

Some of it may be due to having done some yoga throughout my many years on the planet. There's a deep relaxation pose, called "the corpse" in English, that I just love. Some of my most relaxing moments.

The last MRI  I had they they ask me what kind of music I liked.  They put on country and I listen do that.  still heard the pounding but it was fine  Have a great day  Ken 

Glad you enjoyed the experience, just glad I don't need it

in the near future

Jim

Enjoyed is a little too rich, I would say tolerated the experience...

I have had worse experiences with MRI in the past. It hels when you can see out the end of the tube.

Wow, John. I just came across this writeup---outstanding. I know you did your homework but this went above and beyond, great job.

Rick

Thank you for a generously detailed account of your journey and experiences. I am 32 years old and have suffered greatly with BPH symptoms since age 19. I've been researching/waiting for a procedure to come along that would be at least less threatening to my sexual function. I'm in NC and have been saving up to pursue a PAE. Now I will continue to look at the FLA thanks to your posts.

You are welcome and good luck to you I am shocked that you are so young and have experienced this condition. I asume you have consulted a doctor and have a diagnosis of BPH? That should be your starting point. At your age, this is unusual. Most all the other men on this thread are in their 50s to 80s. If you do have BPH and not one of the several other things it could be, I feel FLA is an excellent choice today for relief from the symptoms while saving all your sexual functions which is key to a young man like your self. You can contact a very good specialized doctor in FLA after you detirmine what is causing your condition. But the key to FLA success in my opion is the doctor chosen to do the procedure. This is as much art as it is science. A doctor who know really what to do and not do is the key to the success of this procedure. 

See Dr. Karamanian great doc and highly recommend. It been 7 weeks since I've had mine. Doing much better and expect to see even more improvement.

Jim

I agree with John (j1280). Statistically, you are very young to have bph. So you first want to make sure that your problem really is BPH, and not something like prostatitis with similar symptons. And while no one can diagnose you on the internet, given you have had these symptons since age 19 is more suggestive of prostatitis than bph. Have you seen a urologist? If so, what tests have they done? 

Jim

John,

I know you began this thread over a year ago.  

My situation is worsening.  My PSA is 5.3 and prostate is 120 cc.  I've had 3 MRIs and a biopsy.  No PCa.  But symptoms are worse.  I can barely sit as it feels like I'm sitting on a baseball. 

Quality of life is suffering. 

My Uro is a world renowned surgeon. He has told me not to rush into a partial prostatectomy.  My prostate is too big for TURP.  

I wish my doctor could just remove it and be done with it. 

I have thought about PAE but cutting off blood flow doesn't sound right.  What if I need antibiotics for acute prostatitis one day and there's limited blood flow to deliver the antibiotics to the infection?

Dr K sounds great. 

How are you doing one year out?

I know your early reports were great but this became a long thread to follow on my cell phone.  

Can you private message me so I can send you my number?   Would you be able to talk with me please?

I'm going to borrow from my retirement so I can pay for the procedure.   If God gives me 10-20 more years I don't want to be suffering. 

Thank you.  God bless you. 

Michael 

Michael.  John will help you Just give yourself a little time.  Don't give up hope  Please.  Ken

Michael, I have PMed you all my contact number and you can usually reach me as that is my cell phone and my cell phone has been surgically attached to me for a long time.

I want to say that you have a large prostate so a 5.3 number is not necessarily vey high for that large of prostate. Since you have the MRI your prostate density can be measured also but you do not have cancer now so that will probably remain the case. My prostate was 125.

Call me and lets talk as soon as you wish. 

John

Hi Michael,

Have you looked into HOLEP? It's an established laser procedure for larger prostates and should be covered by your medical insurance. Your sexual function will be intact but like TURP, retrograde ejaculation is common. Significantly less invasive than prostadectomy.

Jim

Thanks Ken. I'm going to reach out to John.  

Yes John, I saw that last night. I had forgotten you wrote to me a year ago. I will call you tonight. I was anxious to speak with you today but did not want to bother you during work hours. Thank you!

I haven't looked into Holep. I have read on this forum the experience of some men.  Frankly, I'm not concerned over RE.  I'm in pretty decent shape for 59 but have zero libido.  Plus, my marriage is very cold-distant and has been for many years and I would never consider being with another woman, so consequently, I think little of sexual function.  I just want to be able to sleep and sit through a staff meeting or a 40 minute sermon at church without so much agony. 

My PSA density is around 0.5 and has varied between 0.4 and 0.8.  My % free PSA has varied between 27% and 39%. 

The few men I know who had cancer and had prostatectomies are doing great.  

If I had a positive biopsy I would have had a prostatectomy and I would probably be feeling 40-45 instead of 75 on certain days.  

Hi Michael,

If you're not concerned about RE, then I really think HOLEP is the best procedure for you with the caveat I'm not a doctor and haven't examined you HOLEP is well established and is more like TURP in that it's more aggressive than say Rezum, Urolift, PAE or FLA. That means the results should be "TURP like" or better.

One reason many haven't heard about HOLEP is because it's mostly performed at the larger, teaching hospitals and thefore not on the  local uro's "suggestion list". The important thing with HOLEP is that you want a surgeon who has performed hundreds of these procedures to give you the best result. And as I mentioned before, it's an established procedure for larger prostates so you should not have any insurance issues.

Good luck moving forward.

Jim

Dr Lingerman in Indiana, and a guy at Mayo Clinic in Scottsdale are the best known surgeons for the Holep procedure that I found in my research. I forget the guys name at Mayo, but he is on their website.

Thanks Jim.  I will research HOLEP.   A good friend had TURP 3 months ago. He's doing amazingly well.  Sleeps like a baby nowadays.  

I've been celibate for years.  Not normal for a married man but life's what it is.  At this point I would trade ED and never have sex again to be able to feel like I did 10 years ago. 

I'm going to call my insurance tomorrow too.  Thanks again!

Thanks. Good info for Michae and others.  I read that the right surgeon is the key with HOLEP.

Jim

I sent you a couple of private messages with links to more HOLEP information. Also, in case you missed it, Motoman just recommended Dr. Lingerman in Indiana and a doctor at Mayo  (Scottsdale) as the best known HOLEP surgeons. I'm not insurance expert, but things usually get approved easier if the doctor's office calls because they know the correct diagnosis codes, etc. So, if you want to get HOLEP approved, I'd give your HOLEP doc the name of the insurance company and let them wait on hold

Jim

Michael I am home call me anytime. Just sitting here looking after window shall give me a call

Boy John  You live a interesting life.........Don't over work yourself...Ken

Hi, Michael,

I believe the Mayo Clinic urologist Motoman is referring to is Dr. Mitchell Humphreys. He is located at their Scottsdale clinic. I consulted with him early in my BPH journey. He does a lot of HoLEP surgeries. You can find him on their Scottsdale web site.

Stebrunner

Thank you ken, I am glad you realize how hard it is holding down this chair with a glass of wine in one hand and a TV remote in the other while watch the sun go down. Life Good.