Going with Focal Laser Ablation for BPH

Mike  at least your going in the right direction.  Keep talking to your friend.  Maybe he can find a good urologist that will not talk him into anything.  What was his PSA last year.  I am 61 and it is free on my insurance they paid for it once a year.  And just because it may be high it does not mean there is something wrong.  Tell him you will go with him if he what.  You can be in there after for his result.  Just to be safe.  Information is the key.  And for his ED problem  It may be something else.  High blood pressure or he may be a Diabetes.  He will never know unless he goes and gets checks.  Keep bugging him  Take care  Ken

Hi Mike,

It's really not just about prostate size and rate of growth. And in fact, that is one of the problems of the uro doc treadmill you describe so well is where LUTS (lower urinary tract syndrome) and BPH (benign prostate hyperplasia) have become almost synonymous when in fact they are different.

A number of studies show no correlation between prostate size and LUTS. There are probably multiple reasons for this but one reason is that a healthy and toned bladder can empty itself properly even with obstruction. And conversely, a stretched and untoned bladder cannot empty properly even without obstruction.

One often overlooked cause for LUTS are years and years of bad voiding habits such as "holding it in" and rushing the job. These habits cause the bladder to expand, lose tone and in many cases become dysfunctional.

Unfortunately, your average urologist doesn't address these issues, and simply equates your overgrown prostate with your LUTS. If drugs don't work, he will then recommend a TURP or nowadays maybe a more profitable procedure like REZUM or Urolift. If that doesn't work he might operate again or finally actually give it some thought and then tell you that the problem is your bladder. Shouldn't he have told you that first???

My suggestion for your 62 year old friend, or anyone in his situation, is to first find out what the actual cause of the LUTS is before deciding on a course of treatment as opposed to the usual vice versa. It could be obstruction but it could also be simply a weak bladder or possibly even nerve damage.

This discussion group has a number of folks whose doctors did the surgery before getting a full understanding of what was causing the symptons. It's not surprising that a certain number of these people ended up with failed surgeries or procedures.

Jim 

 

Thanks Ken,  

My friend Dan is always denying he has problems and never takes care of them up front.

I am going to definetly take care of my situation if this all works out with Dr K.  John was the first and is having excellent results.  I almost got caught this morning on the way to the store and had to pee and my bottle was gone because I forgot to put it back in the vehicle after the last time I used it.  I will be glad when this is all over with and I can get back to normal.  I haven't worked in almost 4 years because of this condition.  I can not be up in front of 30 to 40 engineering people giving speaches and having to excuse myself for the bathroom every 1/2 hour to an hour.  Then there is always that chance of an accident.  Nothing more embarassing.  

Mike

Yes  That would be a problem  Have you tryed the male pads.  I use the gray ones.  Here in Orlando I got them from CVS Drugs Store.  They do hold alot.  They just fit in the front of the under ware.  I had a Urolift done a few years ago.  Had a catheter for 3 days.  They put 250cc in to make use I could pee.  I was able to get 200 cc out and they said I could go.  I drove to a place I was going and I felt I had to go.  I did not make it in the building.  I put one leg out side and it just started.  There was a lot and it held it all.  I changed when I went in.  No one know.  Good luck to you..John was very happy with the doctor and the procedure.  Ken 

Hi Jim

So True.  Most guys to this day do not know the difference and BPH is advertised every where you go in a cartoonish way.  When my highly recommended urologist started going through all the progressions with me I started asking questions and reviewing options.  I wish I was more intuitive about when in a hurry he suggested that I have the Truss Biopsy (12 Shots in the Dark - Target Practice).  I did not bother to investigate because he prescribed this in a hurry after he saw my PSA was going up with an oversized prostate.  This was 4 years ago and I would have never had it done, but that was before I new anything about the 3T MRI where they can see soft tissue tumors and if needed do a visually guided biopsy with lots of percision and very little risk of infection and using the FLA laser, ablate the tumor along with other needed tissue to take care of 2 things at once.    

In my case I have had the Cystoscopy  a year ago to verify that my bladder is fine, my prostate is pinching my urethra, therefore the BPH.   My median lobe is more oversize than the rest and at 108cc when a normal prostate is in the 30's.  John's prostate was 125cc and he had a lot of problems and after lots of time consuming research he decided on the FLA procedure.  He could not delay having it done any longer.  I too, am having FLA hopefully if everything works out.  I went through the same course of research that John did talking to exactly the same people.  I was going to have a PAE procedure by Dr Bag la or Dr Issac on, until I ran into John.  I had been through the Sperl ng Speal, but never any data or patient referrals that I could talk to about it and he wanted a lot of money up front.  As far as the FLA goes, I think it will be a while before this gets fully approved so that insurance will cover it, because of the cost.  There are all the new urological procedures out there that insurance will cover.  They don't want to give you too many choices, especially when they start comparing intial costs.  I think long term that visual guided high deffinition 3 TMRI scanning they are using with the percision laser doing the work, is the only way to go.  I think once there are some trails going that they will see that this is a more permanent solution as well, vs Urolift, itind and possible REZUM, which is done farely blind and PAE could fall short if the prostate arteries that are blocked off form colateral arteries like I have all through both of my lower legs.  No blood flowing through the 3 main arteries from the knee cap to my feet.  I see a vascular surgeon about the PAD and I am a model case for it because I have had this extensively for over maybe 50 plus years and have a full system of the small arteries that my body has created because of the blockage.  

What is nice about all of these, FINALLY NEW Procedures is that they can be re-done or switch to another procedure, vs the permanent oblideration of the prostate like the urologist have been doing for years.  Many men refused to get those done and just lived with their BPH for the rest of their lives like my dad did.  I am still amazed that in this country with all of the medical breakthroughs, and a problematic sympton that over 80% of men will have to endure, that it was just a little over year or two ago there were no alternatives to possibly carving up your prostate and have loss of sexual function and maybe be stuck with a colostomy bag for the rest of your life.  That is our worthless health care system we have had in this country since shortly after WW2, when most of the 1st world countries started their socialized national medical systems for all their people because there so many people that needed it the demand created their national health sytem due to the huge number of people in need, NOT US!!! For those people out there that think our system is not Socialistic, they are serously wrong, it just is a system that they do not admitt it is socialistic, because our system is designed for the FAT CATS TO GET FATTER, Drugs and Insurance System, we pay more than 5 times the going rate and more.  (What medical system we had before, or the Affordable Care Act - Obama Care) makes No Difference.  Every sytem that we will have in this country is ALL about the MONEY - Not the PEOPLE and their needs!!Mike        

Hi Ken

You must be a Night Owl.  You are in Florida?  

Yes, I have tried them.  They are only convenient when you can dispose of them properly.  The men's restrooms are not like womens where you can dispose of the pants, diapers and feminine napkins without everyone seeing you and if they do not empty the trash regularly, those thing stink up the whole bathroom  They are part of the problem when the idiot men try to flush them down the toilet and overflow it all over the floor.  Almost as bad as the people that put a 1/2 roll of toilet paper all over the seat and then either leave it or plug the toilet.  We have turned into such Germaphobs it is unbelievable.  They ought to take a trip to a lot of other countries where you squat over a hole in the floor, this is in a marble floored modern bathroom.    

Hi Mike,

From what I’ve read here I am very impressed with FLA and Dr. K.  Are you trying to get into his trial or will you be a private patient like John? How much does Dr. K. charge for the procedure?

The only other procedure that might interest me would be iTind but I believe it’s still in trial with a placebo arm. Did you research iTind at all? I believe having a median lobe (we both have that) would exclude us from the trial but that doesn't necessarily mean it wouldn't work after they get more data.

You said your prostate was pinching your urethra. What symptons are you  having other than frequency? Do you know what your PVR is? Have you had urodynamic testing done? Urodynamics probably not pick up anything new, but if you’re going this far you should get all the information you can. The best urodynamic testing is Video Urodynamics where in addition to just getting numbers, they can see and record the voiding process real time from the inside.

I agree FLA will not be in the mainstream soon. Insurance is one issue. Another is the what I would imagine to be a lack of trained doctors. Not to mention that urologists probably won’t even mention FLA to their patients, so that would limit it to only motivated and well researched patients like you and John.

Good luck moving forward, and until the procedure check out the condom catheters I mentioned. I think you will find them more comfortable and versatile than Depends, or at least a good complement.

I would also self cathing (CIC), what I do,  but if your FLA is around the corner probably not worth it. However, if it’s going to be months away, CIC could potentially help with your urgency and other issues until you get things fixed plus it will give you bladder a bit of a rest which can only help things.

Jim

Yes Mike I am a night owl.  I don't go to bed sometimes till 2am or 3 am.  That day that I use the pad I took a plastic bag with me.  I was going to a american Legion I was glad I had them.  That was the only day I use them.  I have had other purcedure that I had a catheter but never needed them like that.  Right now I use them when I go to some places.  Over the last couple of week I have had some leaking.   My doctor think it 's my stricture I will be having a scope done to check it.  Men should know you con't flush them.  It tell you that on the package.  Please keep trying to get your friend to the urologist for a check up.  We have to help our friends.  Take it easy.  Going to the gym for a little work out.  Your Florida friend  Ken 

Mike, I can say that I was very typical to a younger fast moving guy. I did not think I should do anything at 55 when my symptoms started. Plus, being a “Stoner”, (I have had more than a dozen kidney stones in my life) since 2001, I hated to go to Urologist. I had had 4 Lithotripsy procedure and one removed by scope. Then I just decided I would pass them on my own. I had gone through several Urologist with this condition and now pretty much hated them all.

 I change my life with regard to my diet because of a diagnosis of atherosclerosis by a cardiologist and was told I would have a major cardiac event within 36 months. I had a 72 percent block of the left anterior descending artery and it could not be stented so Baylor Heart Hospital wanted to do an open heart four way by pass. This was four years ago and, unlike BPH, very serious.

 I told Baylor NO and as I did with my BPH I started researching options. I went to Cornell University and met with the famous Dr. Collin Campbell. I went to UCLA and met with Dr. Dean Ornish. To New York at Montefiore the Albert Einstein Hospital and met with Dr. Robert Ostfeld, then I went to the God Father of them all Dr. Caldwell Esselstyn at the Cleveland Clinic in Ohio. These are the best of the best world class Doctors who saved my life without any surgery and by a radical change in my diet and lifestyle. Now my cardiac issue is gone that was 4 years ago. I am telling you this because as a side effect of all that, it also stopped my Kidney stone issues. It did not however stop the BPH. I never had a diagnosis of BHP in dealing with the Stones and always though it was the stones but now I know my urination problems were actually BPH.

As my symptoms got worse and about 2 years ago, I went to a new urologist that was highly recommended. He did a DRE first and then told me my prostate did not feel very large and it was “soft and supple”.  Nice compliment but wrong diagnosis. He said let’s take you PSA. It came back as 4.2 and he said that was too high. He claimed that 4 was the number to start getting concerned with and we need to do a quick biopsy. He said it would be nothing to it and he would do it in his office and it would take just 10 minute. I could at that time of my life tell you anything you needed to know about the Cardio Vascular system and heart disease or kidney stones but I knew NOTHING about the prostate. I did not like the sound of the word biopsy, or blind, or 12 needles and I told this Urologist I would get back to him. You pretty much Know the story from there on.  And I pray every night to thank my God for giving me the patient, time and commitment to find the doctors I found.

So I can tell you I had BPH for about 10 years. Did not recognize it or understand it until about 2 years ago because of the conditions and circumstances I explained above. I fought it off and lived with it while researching for about 20 months now. I did not ever take their TRUS biopsy after I looked into this so called “Gold Standard” procedure. They really fail to tell you that is only called then GOLD Standard because it is a single 10-minute procedure that the quickly do to 1,200,000 men a year. The average charge is $1,100 and to the math that is a single product industry of it’s own yielding over One Billion Three Hundred Million DOLLARS each year.  Just in Blind Biopsy’s.I got a 3T-MRI in October of 2015 instead of the Biopsy from the procedure. I had it read by the Baylor Radiologist, and also I sent it to, Dr. Busch, Dr. K and Walser, Sperling, Bagla and Isaccson and this is what I worked from. I also went to three Urologist on TURP, Greenlight, Urolift and Rezum.  All the radiologist I traveled to their location and visited and all agreed I had a suspicious dark area that needed to be actively watch with another PSA in six months and next MRI to check it in 12 months. The volume of my prostate was 125 in 2015 my density of the gland was .030 which is excellent. So I guess the original, urologist DRE was right, I was soft and supple he just missed the size when he said small. More to come.

Hi Jim,

   Curious: if the LUTS responds well to tamsulosin, would that be an indication that BPH is the cause of the LUTS?

Way to go.  Get all the information you can and don't rush into any thing.  That is why I changed my Electrophysiology all he wanted to do is put another monitor on me to check my A-Fib.  Had 2 on last year in 6 month's which cost $2700 each time. Had 5 attacks was tired of hospitals.   I went an saw another doctor and he did the ablation within a month.  It has been over a month now and i feel great.  Even started going to the gym.  Life is to short to ruch into anything.  Research everything you can to get the best results  Take care  Ken 

Rich, excellent question. My unprofessional thinking is that the answer might be a "yes", which is the answer I assume by the nature of your question is your hunch as well.  My reason being that a good Tamsulosin response seems to suggest a functioning bladder meaning the main problem lies elsewhere. Have you had your bladder looked at/examined via ultrasound, cystoscopy, urodynamics, etc.?

Now in my case, I never had a very good Tamulosin response, but at the time I took it, my bladder was very stretched with very little tone. Later, after several months of CIC, I tried Daily 5mg Cialis and had a better response. I had figured the difference was the drugs, but now that you bring this to my attention, the difference might have been that my bladder was simply in better shape after months of CIC and therefore a better response. 

I'm assuming you're on Tamsulosin? If so, what are your symptons and IPSS score both on and off Tamsulosin?

If Tamsulosin is working well, might be the best thing for now until some of these newer procedures get sorted out with more data points behind them. Alternatively you could try Daily 5mg Cialis which has a different side effect profile. If in more of a rush there’s CIC which may accelerate bladder rehab and possibly get you off the drugs with good bladder emptying as it did with me. And if even more of a rush, there’s Dr. K. who you mentioned you spoke with. I’m not big on being the first on the block with these kinds of things, but John’s story with Dr. K. is very compelling.

Jim

 

Hi John,

Don't like to go off topic, but since you brought it up, did you end up with Dr. Esseltyn and are you on his diet? If not, what diet did you end up on and do you take statins with it? How long did it take to resolve your cardiac issue and do you know how much your blockage has regressed?

I was on the Esseltyn diet myself but only lasted 4 months for a number of reasons. Tempted to go back or to something similar.

Jim

Hi Jim,

    Yes, I suspect that a postive reaction to tamsulosin might indicate that the LUTS is due to BPH. When I spoke with Dr Bagla many months ago, he indicated that a postive repsonse to tamsuloisn was a positive sign for PAE working. At the time, I hadn't read your posts, and had no idea of the intracacies of the all the plumbing, so I didn't have a follow up question for him.

      I haven't done a formal IPSS scoring of on and off tamsulosin, but the difference in symptoms is quite dramatic.Unfortunately, I also have a dramatic sinus reaction to tamsulosin, geting extremely congested and having a persistent cough and nasal drip. I switched to every other day, and the bad side effects as well as the improvement in LUTS are very dimiinished on my dayy "off".  I considered switching to daily Cialis, but I also had a sinus reaction to Levitra and long term didn't relish the idea of being on a med for the rest of my life. Finally just made a decision to have the PAE (it was a decision between FLA w/Dr K, PAE with Dr B, and trying Cialis)

Rich.

 

Then I had a follow-up MRI in October of 2016 with the feedback from these same doctors over the phone that there were no changes to my condition expect for more pinching off of the Urethra. Also I had three of them tell me I had bladder trabeculation starting but it was minimal at that time. Isaacson told me I better do something sooner rather than later. Make a decision. I did not use or need any of the data from the urologist. I had copy of my next PSA which was 5.7 up from 4.2 six months before. The 3T MRI gave the FLA and PAE doctors all they need. I had my PSA and Free PSA numbers, and Testosterone current number Everything else came from the current MRI in October of 2016 I got again at Baylor and all doctors I dealt with got a copy of that.

So I don’t know the size 8 or 9 years ago I only know that symptoms started. And, I cannot tell you the grow patterns of the prostate as I also believe it is different and random among each of us. I can tell you I know the symptom and how they started and changed and grew over time. I know the start of the “dribbles and the hard to start peeing phase”. Going more frequently and the “this is not right” feeling but remember, I because I was having stones then also and they never looked or thought about my prostate. There was just too much money to be made on those stones for them to worry about how I peed.

I have learned as you said it is all in the 3 TMRI pictures. They can see the bladder the urethra the stricture at the spot of the blockage problem, the size each internal components and how to miss it in the procedure, any lesions of cancer and a really good IR Dr. can be pretty certain of the Gleason and aggressiveness of a tumor even though they still need a focal biopsy of that. Yet guys go to a Urologist and take the treatment of the month where the doctor has no training and no eyes on the procedure. They should at least take their time and talk to both types of practitioners and they would quickly see the difference and the common logic as to the best option. It is great that you have all that supporting data but I did not have it or need it. They saw what they had to do they drew it up on the MRI and computer and then they saw everything as they actually did it. This is one on the big reasons I went this way.

Yes, I stayed in a hotel it was down on south end near the causeway as that is where my Dad wanted to stay because he had turned this trip into a vacation. He is 85 soon to be 14. I don’t know if you ever watched the TV show “Everybody Loves Raymond” but that is my Dad except he  always wears suspenders. He made my procedure his vacation. I love him dearly and we lost my Mom in August. They had never been apart in 58 years. It has not been easy on him and he is in fantastic health. He still lives on the small farm home place in East Texas by himself.  I would do anything for him and in this case, I did. Trust me when I tell you take Dr. K’s advice on that one. I am glad your wife is going to be with you. It will be more comforting the first few days. That is much better than my traveling companion, my Dad, I assure you.

  I can also assure you that you will not find a more involved, caring and attentive doctor than this man.He is smart and has done mean ablaiton s on the prostare.  I have Known a lot of Doctors as my story above should tell.

I am so happy that you spent some time with your father.  I lost my mother when I was 30 and my father when I was 40.  I was the younest of 5 I think I remember you telling me something about you running around with your father a few days after.  I still think you did the best for you and I hope they start doing more of them with the FDA   Ken

Hi Rich,

Interesting that Dr. Bagla uses the association between a positive reaction from Tamusolin and a positive PAE. When you study all the dots the way they connect is less of a mystery!

I am curious, however, how much Bagla and other IR's, factor in bladder tone prior to their procedures. This is not to say that most urologists do it, but for example did Bagla do or ask you anything about urodynamics for example or discuss the amount of your retention, etc?

Be it TURP, GL, PAE, Urolift, and now FLA -- we hear both positive and negative stories here and elsewhere of the procedure working or not. And, after factoring out known disqualifications such as median lobe with PAE for example, probably the largest common denominator in whether a procedure is going to work or not is the condition of the bladder going in to the operation. And yet, the focus is always on the prostate. It's the ole, "the operation was a success but the patient died" thing.

Anyway, good luck with the PAE and let us know how things work out. 

Jim

Hi Jim + Rich,

I have positive response to doxazosin (a cousin of tamsulosin) and really don't need to CIC (IPPS of 7 with doxazosin) but I chose to do it as an insurance for my kidney because of retention (about 250ml during the day).

However, after 4 months of CIC, I can see an improvement in urine flow. Now I have a steady stream vs only squirts before CIC. Natural void volume also has gone up and cath volume also has gone down a bit.

Hank

Sounds like you caught it earlier than a lot of folks, including me. That's great. Keep up with the CIC and you might find yourself off of the doxazosin with acceptable PVR's. Over time, if your experience is similar to mine, you might be off CIC as well. My PVRs currently, without CIC and drugs, are now mostly under 100ml and much of the time under 50ml.

Yes Jim I have been very strickly on it for over 3 years now. I do not take any staitins anymore or blood pressure meds. The first results were that the angina pains left in 60 days with in six months I was no longer winded when exerting my self like walking up stairs. I have not had another angiogram as I dont feel a reason to do so when all symptoms are now gone have passed several stress test. I have lived this way so long that it is all I know. I live Whole Food Plant Based with no oil. Its just another strory but i am a real hound for researching. I did the same with BPH. His book Prevent and Reverse Heart Disease has the Diet and the 12 year study done on it at Cleveland Clinic 1985- 1997. Very compleing evidence. 

John

John

John,

You are to be commended. I did read the book, but much earlier read all of Nathan Pritikin's books starting in the late 70's. I was actually on the Pritikin diet back then for about a year and while unlike in your case it was proactive, I was amazed at the differences in cholesterol levels and the way I felt. All versions of the Pritkin diet weren't vegan but it was probably the first low protein, very low fat (under 10% of total calories) designed to reverse heart disease. Not sure why, but he doesn't seem to get as much credit as he should from the newer wave of reversal diet pioneers such as the fine gentlemen you have mentioned. 

Did you go off the statins from the beginning, or did you wait till your angina went away? How low were you able to get your cholesterol on the diet? I assume you do your own cooking 95% of the time, or have someone cook for you?

Jim

Jim

Mike, I agree with Jim and I also know that your 3TMRI read by someone who actually know what he is reading from experience call not only know with that MRI the root of your problem and why but they can show you the condition aND size of the bladder as they did in my case. The key is the 3TMRI and the right person reading it. Most standard at an imaging center don't know what they are seeing. You need the guy who is an IR working on prostates. You are on the right path with your pelvic 3TMRI.

No, Dr Bagla didn't ask me anything about urodynamics or the amount of retention, Actually, over the years I've seen 4 uro docs and talked to 3 IRs, and none of them have brought that up. First I heard of it was your posts. Thank you!

Rich

Rich,

Hopefully they knew your retention from your charts, but disappointing that none of them mentioned or wanted to do urodynamics. There are papers/studies out there emphasizing the importance of surgical pre-screening through urodynamic testing but unfortunately it appears that too many doctors skip this important step. Probably more forgivable for the IRs (over the Uro's) because this isn't their main field, but if they're going to start fixing prostates they really should learn how to screen them better.

Jim

Hopefully they knew your retention from your charts,

What charts would those be?

I've been the 3 different uros, I've never had ant tests regarding flow rates. The only uro that bothered to ultra sound me for retention was a PA.. They're all ready willing to operate though.

Have you ever had an ultrasound bladder scan either with a portable device in the doctor's office or as part of a bladder/kidney scan at the hospital which is often combined with a voiding study where they scan you with a full bladder, then ask you to void, then scan you again? If you've had either of these, then the results should be in your medical records/charts for other doctors to see, assuming they looked at your records.

Jim

Uncle, It's unfortunate. Every uro should have an office bladder scanner, capable of real bladder imaging, and make it an integral part of their workup for BPH related problems.

I recently went to a well known uro at a major medical center and the PA was using what I consider a sub-optimal unit designed to be used by someone with no sonographic skills. H*ll, I want to be scanned by a doctor or nurse WITH sonographic skills before making important decisions about my prostate! And yet, this office seems better than many of the offices reported here that don't even use the sub-optimal units as part of an exam.

Jim

 

Get you in, get you out, get your $ Thats all that matters.

Never had those. I've only had kidney scans (for kidney stones) which expressly did not include the bladder.

I know this is off topic but wonder how the heart ablation went. I have been having a lot of PVCs and the medication is only marginal so the doctor is suggesting a cardiac ablation, but I am a little nervous of the whole procedure and possible complications.

Good evening Richard.  All went well.  I had a 6 hour ablation.  I just saw my doctor the other day.  Check my monitor that is in my chest.  It's been 2 month's no a-fib at all. As far as he is concerned I have no more A-Fib.   I see my heart  doctor next month and if he said it is ok I can go off one of my blood thinners.  I feel great.  Last week I joined LA Fittness and have been working out 4 times a week.  Starting slow.  Richard I would go for it you will feel much better.  I was in the hospital 5 times with A-fib last year.  I am glad it's all over.  If you like to chat just e-mail me  Ken 

I had an awful time with PVCs quite a few years ago. Went through all sorts of tests. This is goingt to sound crazy. It was a dehydration problem.

ok, I got in. It just would not let me in at work. who knows? Anway to answer you question?

Unckle, good to hear from you, yes I am doing very well, I played golf again for the last 4 days. Thank goodness they are all closed today. I will work all day today. Thank you for asking about me. I do not want to be one of those guys who gets great results and then waves good bye to all the others still fighting the diease. 

I am doing wonderful in every aspect of my past BPH symptoms. There are several guys who are talking about going to see Karamanian so he is probably getting a lot of people asking him questions. 

Funny thing is I do not really know how to act yet. I still have fear of the symptoms but I don't have the actual symptoms. Like Saturday, on number 12 hole. I suddenly had the urge to pee but instead of peeing on myself a little or stopping the game and finding a tree, I held it!!! I could never do that before. I held it like I was young again for 3 more holes. Then I invited my playing buddys to watch me pee because I am so proud of the stream!!! They declined my offer so I could not show off. See, that was not the proper thing to do so I have to learn again how to act. 

Everything else is also working just as good in fact better in the sexual area. That is scary. I ask my wife if only for the purpose of medicine, would it be ok to maybe have a girlfriend to help out. She said, it would be ashame to spend all that money on FLA only to wind up with a amputated penis from dull scissors. So that idea has been snipped in the bud,  so to speak. 

Yes sir I am very pleased and would have spent a lot more if I would have only known. Thank you for checking on me. I will post this to the site so you may get it twice in an effort to cover up my neglect on posting. I certainly do not mean to neglect the communication, as I did promise God that I would not do that and I would keep up the fight to help other guys who need input.

I hope you are doing well and finding a path that will help you. I am here for anything I can do. You have my phone and email and you can call me any time for anything including just to talk. I enjoy our conversations even if they are about our BPH.

John 

Uncklefester, checking in on you. How are you doing?

 

Doing well j12080. I writing  a PM to you so keep you eyes peeled  

You took the word right out of my mouth  I was just  thinking of him  Ken

Hi J, 

Just found these forums. I have been under active surveillance for low grade prostate cancer for 6 yrs & also have BHP. Without going into the whole story, about 3 wks ago I had (was going to have) a PAE but unfortunately the artery that ran to my prostate was also connected to my bladder & the interventional radiologist said that if he blocked it my bladder would become damaged & I then I would be worse off than I am now. So after 2yrs of trying to get this done I'm back to square one. One of my problems is that although Tamsolosin helps a lot, I get v bad side effects so I've just recently stopped it & am trying Cialis 5mg a day but after 2 wks it's a bit of a struggle but do feel much much better off the Tamsolosin. I will give the Cialis another 3 wks.

Having looked at all the alternative options to deal with my situation FLA  would appear the way to go. We have a good family friend who is a consutant interventional radiologist who we are seeing on Sunday so I will talk to him about it. I live in the UK so your Dr Karamanlan is a little far away. If you have a chance I'd be extremely grateful if you could ask him if there is anyone in the UK he has contact with who is considering or carrying out FLA to relieve BPH. These Consultant Interventional Radiologists all seem to know each other.

Saw my urologist for my 6mth check up last wk, who said,  '...best thing for you is to have a prostatectomy which will solve both your problems the cancer & the BPH'. I have been dodging this for 6 yrs now!

Anything you can do in giving me anymore relavent info would be much appreciated.

--Peter.

Peter

Mike here.  I am going in April for the FLA / BPH procedure with Dr Karamanian.  So that means John and I will have both had it done.  You know that John had a fantastiic result on his procedure and I am hoping for the same thing.  The cancer cancer you might be able to live with the rest of your life.  Most men, when they are near 60 and over, have over a 75% chance for BPH and  have a high probabilty of l5% of low grade cancer and a rising incidence of microscopic foci of prostate cancer is found in men with increasing age. Results of autopsy studies have shown that almost 30% of men over the age of 50 have histological evidence of prostate cancer.  So I guess we all have a good chance of having it.  At least yours was diagnoised and is being monitored.  Most men never know they have it.  I just had a friend of mine at age 55 come down with I think grade 5.  He had barachy radiation treatments along with hormone therapy.  He just had his 6 month and so far so good.  According to what we have read, FLA is the best thing going right now for smaller prostate cancers and now BPH prostate shrinkage along with the procedure.  I think they started using this procedure in England with the latest 3T-MRI scanners in Real Time about 5 years ago.  Dr Karamanian specializes in prostate cancer using the FLA procedure.  

I have not been diagnoised with cancer yet, but I only have had the truss biopsy (dart shooting 12), so when I go for my prostate scan next week for my procedure, who knows they may find caner.  It did not show up on my biopsy.  We just never know.   It maybe possible the Dr Karamanian may be able to find someone in England that is doing this procedure for you.  

Good Luck

Mike  

Mike I know all will go well for you.  Dr K is good in his field  Take care  Ken

Mike,

Just read an interesting on Medscape about prostate cancer & Aspirin (I have been taking a low dose daily for over a yr) saying it almost certainly helps against prostate cancer & it's progression.

I'm going to check out what is going on with FLA in the UK, almost certainly something. I had no idea I could get PAE on the NHS in a hospital in London until I really checked things out.

Thanks,

James.

Peter, this is John, just read your post. I will call and ask Dr. K if you has anyone he knows in the UK>

Really, you can just do both at the same time as I did. I did not have cancer but I had a suspicious spot and they decided to just treat it as cancer, take it out while they did the FLA to the tissue for BPH.  Don't listen to that Uro. If need be, fly to Houston and get it done. 

Give me a few days and I will get you an answer from Dr. K. 

John

Hello Mike - just wanted to add my thoughts here.

Twenty years when PSA tests were new mine was 0.5 and my uro then freaked out and did a 12-core TRUS on me which was negative. But he gave me acute prostatitis which I believe is what started my BPH.

Over the years 3 uros have given me 3 more unnecessary biopsies since my PSA is high due to my very large prostate. But my PSA density is very low and that is what counts when you have BPH.

The last blind TRUS I had in 2011 was fine but my uro said in a prostate my size there is certainly cancer lurking and he wanted to take my prostate out. Size was 150gm then.

This past summer I had PAE at UNC because I heard it was great and I was the perfect candidate. It didn't work so I learned CIC but that is another story.

Last Fall I had a mp3T MRI to see why the PAE failed. But instead I opened the radiology report file and read that a small lesion was seen on the outer peripheral zone and it was almost certainly cancer (PIRADS 4).

So I freaked out and called my current uro who offered to do a robotic simple prostatectomy on me and rid me of the cancer and BPH (and my quality of life).

He also scheduled me for a saturation MRI-guided biopsy at a local famous hospital. I saw the radiologist who again said it was cancer and they would do a ultrasound TRUS biopsy using the old MRI images as a guide to the lesion. So it was not a real in-bore MRI-guided biopsy - very misleading!

He also told me that the chance of me having prostate cancer is equal to my age. So at 67 I have a 67% chance of having cancer - nice guy!

So at wits end I posted here for help and John (of FLA fame ) answered me and told me about Dr. K in Houston who would read my MRI images for free. So I spoke with Dr. K right away and uploaded my files to him. He did confirm that it likely was a cancerous lesion but that he could ablate it easily since there was only one that was small (7mm).

But first of course it needed to be biopsied using his targeted in-bore MRI procedure. He also laughed at the statements my uros made to me about needing to remove my prostate. He said the needle biopsies are useless because all that matters is clinically-significant cancers which are visible and well-defined. The needle one only pick up microscopic cells which are not important clinically since they may take 100 years to develop.

Anyway, a month ago I had the biopsy and it was fine - just inflammation.

Also a week earlier I spoke with an IR who had biopsied another man and the IR told me he definitely had prostate cancer because his PSA was rising and he did not have BPH. Yet the biopsy was also negative - just some chronic prostatitis flareing up.

So please only focus on clinically significant cancers and not microscopic ones at the cell level. The uros just want to take out your prostate one way or another. Be informed and confident.

Good luck.

Neil

Thanks Ken. From talking with Dr K twice and many talks with John, I have 100% confidence that all will be Great. I go the 13th to the University of Michigan for my 3T-MRI, then they will send a disc or email it to. Dr K to analyze the scan. I am shooting for April 5th for my procedure. I am glad to be through with relying on urologist for their evaluations and guiding me into one of their procedures, in my case they wanted to do a REZUM procedure on me at the same time refuting the newer Non urologist type procedures, like PAE and now FLA / BPH. There are quite a few very intelligent men on some of these forums that are educating themselves in all that is available out there instead some urologist doing a Turp on them, leaving them with problems the rest of there lives.

Thanks Mike

Hi Mike,

Actually, there are two other members here (besides John) who have had FLA with Dr. K. There's Mike588 and one other fellow. It's too early to tell how they're doing but my understanding is that their recovery was not as fast as John's. You might want to reach out to them. 

FLA is very appealing to me because of its precision and lack of sexual side effects. That said, outcomes for all of the prostate reduction surgeries and procedures are highly dependent on the condition of the prostate and bladder. So even a great procedure, with a wonderful doctor, can fail if the patient is not screened properly. 

Unfortunately, proper screening is not the standard and often the exception. I don't know you're specific history, but if you've had a history of significant retention,  it would behoove you to have urodynamic testing run prior to any prostate reduction procedure or surgery, including FLA.

-- Jim

Neil

Thanks for the feedback. You have definitely been around the whole prostate block so to speak. So far no diagnosis of cancer yet. My 3T-MRI on the 13th should let me know if there is possibly cancer or none. They will send the scan to Dr K to analyze it. If nothing suspicious in the scan, other than my 108 grm Prostate, with 30 to 40 being about normal. I am trying to set up my FLA/BPH procedure on the 5th of April in Houston. After talking to John an Dr K, I am 100% confident that it will be a complete success. It is not cheap, but the results should be well worth it.

Thanks. Mike

Hi Mike - just want to ditto what jimjames wrote here. I too had 100% confidence that my PAE would work. I was told by the doc who did my PAE last summer that I was the perfect candidate and there were several guys on this forum who had good results. But while it was a technical success it was a clinical failure. We are all different and nothing is 100%. Every uro/VIR I spoke with over the years said he had the solution to fix my BPH. Consider what jimjames wrote.

All the best

Neil

Mike,

Just to add what I said before and what Neil said...

It's true that John had an excellent outcome. And given his enthusiam and obvious gift for writing, it's very easy to come to the conclusion that FLA is the promised land we are all looking for.

And maybe it is but maybe it isn't. 

John is only one case. And if you take some time, you will find almost identical stories -- perhaps not so well written --  of incredible life changing results from almost every surgery and procedure including TURP, GL, PAE, Urolift and REZUM. But at the same time you will find others that have had not so good results in the same procedures, and often with the same doctors. 

So, I really suggest you reach out to the two others here that have had FLA so at least you will get three data points instead of one. That, and do whatever testing is necessary, such as urodynamics, to make sure that you are a good candidate for the procedure.

I hope I don't come off negative on FLA because I could use the same words for almost any procedure as each has had great results and not so great, again dependent in most cases on the prior condition of the prostate and bladder.

All said, if your prostate and bladder are in such condition that suggests a good outcome, I think FLA appears to be an excellent choice, again because of the precision and lack of sexual side effects. Just wish we had more patient data to look at.

-- Jim

I know where that is nice place.  Born and grew up in Michigan.  I know you will be fine  Take care  Ken

Jim

I thank you for your frankness. I don't know how far you have followed myself and John On THIS forum, but there has been thousands of hours put into the research. I have been searching for well over 4 years and John over 3. I have personally contacted the various Doctors and companies., John and his wife personally have visited, spent money to consult with several that charged. I have been following the Clinical Trail sites very close for over 3 years. I have 2, classified very good urologiststuff as my doctors. They are qualified to do all the urological procedures, itind, Urolift, REZUM, plus the surgical procedures. Both of us have been in touch with Speeling, who claims to have done between 80 and over 100 FLA/BPH procedures. My problem with him is I think he likes the way he is doing it now, charging over $22k each regardless of getting an approval. I have not been able to get the patient Contact information from him. What is really amazing is that I only met John about 3 months ago. It is so amazing how he has went the.same route almost exactly that I have been on with all the same doctors, procedures and only about a year less in time. Johnson situation was driven by more need than me. He could not wait to do the trail, so he had his done the 19th of December.

We are both technical type people, so we are strategically evaluating all of this. I was originally going to go with Urolift, even before they were approved, because it was so Minami ally invasive and approaching approval. All of this to give me down the road if needed, PAE after they get approval. They are now well over 400 documented patients now with anywhere from 83% to over 94 % success rate over 6 years of testing. You still can get it redone or try something else with no sexual dysfunctions. So along comes FLA/BPH , that has been done for years for Prostate cancer and tumors of the brain, where percission is paramount in areas where you may not get 2nd chances. So when you say that there is not much data, that is only lacking on being applied directly to BPH. When they have been doing prostate cancer Ablation, where they are destroying cancer tumors, at the same time abating tissue to clean up and make sure they get all the tumor, it was found that what they were doing on patients that also had BPH , made significant improvements for that condition. They were doing what other procedures were doing, reducing the size ofor the prostate taking pressure of the urethra

Mike,

Yes, I followed Mike's journey as reported here, and I was very impressed with his homework and road work. 

You said: "So when you say that there is not much data, that is only lacking on being applied directly to BPH."

The data you are talking about is procedure data, how well the laser works, not BPH outcome data, and that is what is the concern here.

As a procedure, I am very impressed what I've read about FLA. But as I said in my last point, even the best BPH procedure is highly dependent on the pre-existing condition of the patient's prostate and bladder.

It's just not how precise and accurate the FLA laser is, as in the case of getting rid of a tumor -- but whether or not, for example, a patient's bladder is elastic and strong enough to empty itself even when the prostatic obstruction is removed by FLA. In other words, what you want to try and avoid is the "operation was a success but the patient died" syndrome. 

To avoid this, it's important that patients are properly screened, in particular to their bladder elasticity and void pressure through for example urodynamics. 

Again, you mention John, but there have been at least two other men I know of here who have had the procedure and I think you should at least talk to them if you haven't. 

Just to be clear again, I think FLA is perhaps the most promising procedure I have read about so far. But if it's performed on someone with the wrong prostate/bladder profile, then I don't think you can expect a good outcome. As in the case of any prostate reduction procedure.

Jim

 

Meant to say -- first paragraph last post -- "...followed John's journey....

Jim

I am trying to do this on a Dumb Phone.

With this procedure they are not going through the urethra, which has caused most of the issues with REZUM and several of the laser procedures. They can't really see what they are doing and the problems come and go down the road with things like having to go through emergency because they can't pee and or Cath problems.

The Urolift and ITIND do not logically have long term benefits. On the Urolift forums this is the problem, many repeats to put it in more stint spreaders. They also don't tell you that part of it has to stay in and still get it redone. PAE, based on a condition I have in both lower legs, pad, where the 3 main arteries from the knee down are not carrying any blood, but my body has made 100'some of collateral arteries, apparently because I have been so physically active my whole life. My thinking with the PAE, which was my number 1 procedure, depending on your condition, could actually make new arteries around the blocked ones and allow the prostate in time to start growing again. If you look on this website, several of the PAE people have had to do a redo, either they did not get the arteries all blocked or only partially blocked. Key is you can have a redo or even try something else. The FLA/BPH can be redone, they can see exactly what they are doing with percission, and they are not going through the urethra, which is a big issue.

I have gotten winded. I think right now, this procedure gives you the best chance for success and it is repeatable.

Over this last 2 years, I now need to get something done, otherwise I would wait for this or PAE to be approved by the insurance industry. I totally trust this doctor. He is doing this very similar procedure almost everyday. He has decided to specialize in the prostate only now, so this he is doing everyday, that is more than the IR PAE people.

Right now with what is going on about BPH, this is the only procedure in the near future, looks like the best chance for at least semi permanent resolution, with the least chance for complications. They have tried different types of lasers through the urethra, hot water or steam with REZUM, stints to prop it open, surgically cut away the prostate, starve the prostate for bloodwe are

Mike,

That's quite a post on a dumb phone! Hat's off to you!

I'll make this short on my keyboard computer Then to bed.

If what you're saying is that FLA is the best prostatic reduction procedure out there, for discussion's sake I will not disagree with you for all the reasons you gave.  I also don't disagree with your take on the other procedures. 

I am trying to make an entirely different point.

My point is that even the best prostatic reduction procedure out there will not work, if for example one's bladder is too stretched out or atonic. It won't work because the bladder will not be strong/responsive enough to empty completely even if FLA removes the obstruction with great precision. 

There are papers on this. It's not just my opinion. 

-- Jim

Jim

We are left with a very precise way of surgically removing excess tissue, can go around the the urethra without damaging any of the ducts. You only have to Cath for 2 to 3 days, so the urethra is not inflamed, the tissues is a later a cauterized, minimal Chace for infection, almost immediate improvement for BPH.

Jim, I totally agree with you about there is all different levels of success with many procedures. This is repeatable percission, that eliminates many of the others. I wish that our medical people have been so slow to develop a low risk repeatable procedure for men that if they are over 60, affects over 80% of us, cuts our sexual rite short and with some procedures, leave men totally sexual dysfunctional and or with colostomy bags.

I think there are many knowledgeable people on these prostate forums, this is all good to show how concerned and fed up with this affliction that men are. I just think that from an engineering problem solving perspective, this procedure is the best thing out there with the least risk factor. I just pray for an alert doctor and luck that there are no complications, and God is watching over us.. That is the best that I can hope for.

Thank you Jim for your concern, but it takes some pioneers to get this worked out so all can take advantage in the future. I am evolved in risk factor analysis with most of the programs I am on and I feel this gives me the best chance for a. One Off.

Thanks Jim

Mike

Jim

Sleep tight. I forgot to mention that in my post. You are totally correct, even John is going through a training process. He was getting up 8 to 10 in a night, now maybe 1 or 2, but not cause he has to, he physically is so use to having to pee that he feels he needs to, but he finds it is not necessary. He has more trouble during the day sometimes. Although he can go 3 to 4 hours now. He pees like a race hourse now and his sex life has gotten much stronger. I have had several ultrasound voiding studies and I have a retention of over 180. I have had a recent cycoscopy and it was deemed my bladder is in good shape and my urethra is pinched by my 108grm prostate. The doctor even said that I may have to go through some retraining.. There is some medication they can give you to help, but there are exercises that work once your prostate is heeled. It is a fluid system with muscle contractions and muscle controls with a pipe and spinkters to act as shutoffs most of this sytem is controled by our involuntary muscle system that needs to be retrained like a baby. I am looking forward to the adventure compared to the current day to day.

Jim

It is Mike again. You mention there were 2 other people that have had FLA/BPH by Dr K. Which ones are they? I am not on here maybe once or twice a week. I must have missed them. I would be interested in what they have to say.

Thanks Jim hope you got a good night's sleep.

Mike

There is a clinic in Florida that does FLA, does anyone know anything about them?

Front page today in the UK, The Daily Mail (newspaper). New Prostate procedure on the NHS. (PAE)

Have a good day,

James.

 

John, thanks that would be extremely useful.

You could also ask him if he knows of a consultant interventional radiologist called Miltos Krokidis who works out of Cambridge in the UK as they seem to know each other, it being a dept of medicine that is expanding very fast.

Do you or anybody else know about the clinic in Florida that does FLA?

--Peter.

Peter - Dr Sperling is in Florida (and I believe still has his NY office). He has done more FLA procedures for prostate cancer than anyone. There is also Dr Walser at UTMB in Galveston, TX and Dr Nour at Emory in Atlanta, GA. I have visited or spoken with Nour, Walser and Karamanian over the past 3.5 years.  There are others doing FLA as well, but Sperlink, Walser and Karamanian are the ones that most talk about on the different forums I visit.

Hi Mike,

Motoman had it done by Dr. K. on February 13th. You can follow his story here: https://patient.info/forums/discuss/had-fla-for-bph-done-feb-13-568652?page=0#2592284

The other fellow had it done on February 14th. Because he's still on a Foley he hasn't had much to report. I believe they will take the Foley out today or tomorrow and see how well he can void. I've been in touch with him via PM, but will withold his name and respect his privacy until he wants to post more on the public forum which I'm sure he will when ready. 

There may have been one other fellow, can't remember, but maybe John or Dr. K. could update you.

Slept like a log till 8am, no bathroom trips tonight, although didn't get to bed until probably 2AM so that's cheating Probably would have had one bathroom trip had I gotten to bed earlier. Thanks for asking.

Please keep all of us updated on both your and any other cases of FLA for BPH that you hear about. The more information the better.

Jim

 

Mike - I hope it is ok to mention this to you but did John tell you that Dr. K. was NOT the doctor who actually performed his FLA. It was Dr. Wasler who did the actual procedure because Dr. K was busy doing a big cancer procedure though Dr. K was nearby in another room and advised Dr. Wasler. Still - credit should be given where it is due.

Neil

Neil - I agree.  John did tell me that Dr Wasler, his assistant, and he was pretty explicit about it and how good a job he did.  John was an emergency situation almost, he could not wait for the trail, and he and his wife had put lots of time and effort in trying to find out which procedure would meet his needs.  Sexual dysfunction was a huge issue for him and that and the demener of Dr K is why he rushed to have it done before he ran out of vacation time.  So, he was not picky once he made his decision and it just so happened that Dr K could not perform the procedure.  I have not talked to Dr Wasler, but before I finish up with my procedure, I am sure I will meet him as well.  Who knows, when i get in for my procedure, Dr K maybe busy on that day too???? From what John told me, I would be happy with either.

I did find out that there have been at least 3 now that Dr K has done, but none of them yet for his Clinical Trail.  Jim filled me in about them.  Everyone is starting new Forums, it won't be long and we will loose touch with everyone.  I told Dr K that he needs to monitor these forums and I gave him the links to several of them.  If he wants to get this procedure approved, it will be through sites like this that that will happen.  Otherwise there is no source to get the information.  My 2 uros would barely concede that this procedure is a viable option for BPH.  Look at PAE, they have done probably over 400 under Clinical Trails over the last almost 6 years and it is still not approved by the Insurance companies, but Dr Bagla is doing many under the severe LUTS condition and the insurance companies have paid in many cases.  

Thanks

Mike

Tim, thanks for that, those are the names that come up, although no one on this thread has mentioned Dr Dan Sperling who apparently has done more FLA's on cancer than anyone else & he does promote it for BPH on his website. Saw my friend the Int. Radiologist yesterday who didn't seem to know a lot about FLA but mentioned HIFU. Does anyone know the diference between the two & why FLA might be better? I'm presuming the cost for the FLA BPH procedure will be much the same whoever carries it out.

How are you doing now John? Did you manage to have a word with Dr K & if he had any contacts in the UK?

Peter, Sterling was mentioned by John and some others. The issue as I understand it, is that he wasn't very forthcoming  with info, patient data and referrals. Dr. K., on the other hand, appeared very accessible. Dr. K. charges 20K for FLA and Sperling I believe a little more. If you're thinking of FLA, you might want to wait a little until the results from his small study group come in. Right now we don't have too much information to go on except John and Motoman. The other fellow, Mike, is still on a Foley so too early to tell.

-- Jim

Jim, thanks. What specifically should I be asking any Inter Rad that does FLA/BPH? What type of Info data & how many referrals? Yes, we need to wait to see if they all have a positive outcomes, although it is sounding positive. I'm presuming HIFU is an inferior procedure?

Hi Peter,

Regarding FLA, I would ask among other things:

1) how many procedures have you personally done over the last year.

2) what kind of outcomes did you get.

3) is any of their data published

3) any incidence of retro ejaculation, incontinence or impotence

4) Do you use real time MRI guidance (Sterling and Dr. K. do, but not sure if everyone does)

4) Names of three or four referral patients

Not as familiar with HIFU but definitely worth investigating and then comparing to FLA both in terms of procedure and side effect profile. Unfortunately, I think to get the data you might want on both of these, you might have to wait until more procedures are done or more studies published.

Just don't lose track of the whole picture as it's easy to get focused on which is the 'best' procedure as opposed to what is the best way for you to proceed. We have seen here fantastic and not so great outcomes from practically every procedure available, and often the contradictory outcomes are from the same doctor. 

Multiple reasons for this, but I think the primary reason has less to do with the procedure and doctor and more to do with the preexisting condition of both prostate and bladder. If your bladder is healthy and elastic, than almost any procedure will produce a good outcome if the needed amount of prostatic obstruction is removed. On the other hand, if their is a history of significant retention and the bladder is atonic, then I wouldn't expect any of the procedures to help that much.

Jim

 

jimjames-"On the other hand, if their is a history of significant retention and the bladder is atonic, then I wouldn't expect any of the procedures to help that much."

I disagree with this statement. And your own example of rehabilitating your bladder proves this. You just used catheters. Are you saying that a bladder that is atonic cannot be rehabilitated by any other method?

All the experts I have talked to said removing the obstruction if there is one should help me urinate easier. 

And then there is my example. I was diagnosed with an atonic bladder 3 or 4 years ago. As Dr K reviewed my MRI before the FLA procedure, he thought my bladder looked fine and elstic enough. So I was either wrongly diagnosed in the first place, or it was rehabilitated, or removing the obstruction I had has made it to where I can urinate on command now. 

So I would not give up on having a procedure because you have been diagnosed with an atonic bladder. What is the alternative? Catheters?

I would not want to face that future without trying to do things to fix the situation. 

Jim, good one, I will put these questions forward. On this & other threads we have heard a lot about Dr Karamania but nothing yet, I don't think, from anyone who has been treated by Dr Spirling.I think my bladder is in good health & about a year ago one urologist performed a slightly painful investigation to check out my bladder & the opening to my prostate. I'm afraid I can't remember the name for this procedure, but I'm sure there is one, anyway he said it all looked good. 

It’s really case by case, or more accurately bladder by bladder.

All I’m saying is that someone with an atonic bladder should not expect the same result as someone with a more elastic bladder. Yes, removing the obstruction should help most people urinate easier, but how much easier depends on among other things how strong their bladder is.

In your case, there obviously was something to work with, and apparently, because of your first procedure and possible with some CIC, your bladder now stands “fine and elastic enough” according to Dr. K.

But with some, whose bladder is less flexible, that may not always be the case, and that has to be factored in and could result in a decision not to have a procedure. I don’t think this is “giving up”, just factoring in the whole picture.

And yes, CIC can be an alternative for some, either short term to see if their bladder can be rehabbed, or longer term as an alternative to today’s procedures.

On a personal note, maybe tomorrow there will be procedures with less side effects where the risk of removing my obstruction will be so minimal that I wouldn’t hesitate to do it. I don’t see that procedure yet for me.

Jim

Jim

My wife and I just got back from the U of M for my 3T-MRI for the FLA/BPH Trail.  Because I have had bypass Surgery they wanted to give me a couple of chest xrays first and because when I was in the Air Force and a grinding wheel exploded in my face, they wanted to make sure that there were no metal chips of filings in by eyes, so I had 3 head xrays.  So now I am all aglow.  That MRI was really loud for almost an hour.  I just went to sleep for most of the time.  I had foam earplugs and headphones on top of that.  Everything went very well and the people were really nice.  They gave me a disc with everything on it for me and are mailing a duplicate and paperwork to Dr Karamanian.  I tell you that hospital is so big.  Their Eye Research building alone is a big building and it is 10 stories tall, the Kellow Eye Research Center.  For a couple of miles in all directions is nothing but speciality research centers and hospitals.  Anyway, the first part is done and I have my procedure the 1st week of April.   

Mike, you sound as if you have 'been in the wars' & a minimally invasive procedure like this sounds 'just the ticket'. I will be following you & have no doubt you have made the correct decision. Any other procedure except for PAE (which is not for everyone) is much more invasive & damaging.

 

Hey Mike congrats on getting started . Just curious is you insurance picking up the tab for at least the 3T MRI? And did DR  K order that for you at U of M?

Also since you are in the trial, any idea what your total cost might be?

Thanks and I am excited for you.

Joe

Mike,

If you can sleep through an MRI, then FLA should be just a walk in the park!

Crazy, a ten storey building for eye research, and only a handful of doctor's performing innovative prostate procedures like FLA and PAE!  Maybe we need a prostate march on Washington.

All the best with the FLA trial in April. I'm sure you're going to have a great result.

Jim

 

Thanks for your PM, I have sent an email to Dr. K & also spoken to someone at Dr Spirling's surgery so am waiting to get more info back from them.

Peter

No real wars lately.  I agree with everything you said.  As far as minimally invasive procedures, I have been researching for almost 6 years now along with some of the other senior forum members.  I have watched new and realitively promissing procedures come along and get approved, and I came to the conculsion that FLA/BPH looks like my best shot to some sort of tentative permanentcy to resolve my BPH, which is now getting to the point that I need to do something about it.  There does not appear to be much of a risk of sexual dysfunction, if there is more prostate that needs to be removed at some later time this procedure does not prevent that from happening, and the several patients that have reported to have had the procedure are very happy with the results.  Also, another key factor is that some of us have been told that we have prostate cancer through a truss biopsy, and have had cancer procedures done.  This FLA/BPH procedure requires that you have a 3T-MRI prior to the procedure and at this time it is one of the very best ways and backed up through blood tests to see if you have cancer, where it is and what it looks like and the procedure is capable of Ablating the cancer as well, all done minimally invasive.  Try that at the Urologist Office.  This is not a New Gimick procedure, the 2 doctors that are now performing FLA for BPH have basically been doing the same procedures for cancer for probably 3 to 4 years.  So it is not new, just the application of a truely successful procedure that in time will get approved.  These 2 doctors have more experience than the doctors that are currently doing the relatively new REZUM, Urolift and itind procedures.  These procedures, other than REZUM appear to be a Temporary fix to a problem that most likely will keep growing.  If you check all of the forums about these procedures, they are not without problems, yes they are approved, mostly because the large Urological business that has money and the access to the patients is popularizing them and there are currently many patients having these procedures.  An Interventional Radiologist that is performing, either PAE or FLA or FLA/BPH is most likely to be more skilled at doing these procedures than a urologist is in doing his procedures, but a urologist has access to the male patients through the progression of when a man gets older he will most likely have prostate issues and through seeing his General Practicianer he will be referred to a urologist for at least a checkup and consultation.  Where would he see and Interventional Radiologist in this process?  Not unless the individual like us is finely fed up with what the urologist can provide and starts searching the internet for Alternative Procedures.  My FLA/BPH procedure is the 1st week of April and I will be reporting on this forum about the road to recovery and BPH FREE! Just as some of the others that have already had the new procedure.

Mike  

Mike, just checking - did you look at PAE but decide FLA/BPH was the better procedure? Good luck in April, from everything I have read you are definitely doing the right thing

Hi Peter

I has been following PAE for over 5 years waiting for it to be approved. That was my procedure of choice out of all procedures, for a near permanent solution, being minimally invasive and maintaining all your sexual functions. My only questions I had was how will you know if the doctor embolization all the prostate arteries, was it the prostate artery that got embolized and not an artery feeding the bladder or something else, if the seeds are securely in place properly to keep the artery abated and my last question I had is will the embolization artery reroute itself to make a collateral artery. This last item I am very familiar with is because I have PAD in both lower legs from the knees down. The 3 main arteries in both legs have virtually no blood flowing through them. Because I played lots of sports and stayed very active, my body fighting to survive made hundreds of collateral arteries to supply the blood needed to my lower legs. I was not aware of any of this until I had open heart surgery and they discovered this phenomenon that was going on. I now see a world class vascular surgeon as one of my regular doctors to help me keep my legs so that in the future they do not need to be amputated. Not all people have this ability normally, so when it came to PAE, my vascular doctor said that in my case, my body might start making collateral arteries to repair the blockage.

It was then I started doing more research and saw Dr Sperl. g's procedure in New York and started trying to find out as much as I could about it. My problem started with that although he had this new great procedure, I was never given any of his many patients to chat with to find out what their perspective was and how successful was this procedure? Then I met John on this site that told me about Dr K in Houston was doing the same procedure and that he was in the process of having it done on himself on December 19th. We stayed in touch and his success became my pathway into this procedure for next month. I hope that I have made the right choice, but another determining factor was talking to the doctor himself. Very open and informative. He will explain everything to you and the fact that he is doing almost the same procedure every day to remove cancer tumors. He is very successful with this procedure specializing on the prostate and even though the recovery and percautions are different, because it is not cancer that we are dealing with, that the success of this procedure applied to sculpting the excess tissue away of the prostate to relieve pressure on the urethra or however your prostate is interfering with your urinary and or sexual functions. Real time with high definition to see every thing he is doing with great percission from a special percission laser. Instead of a near blind proceduress that you hope for that it was done thoroughly and correctly to improve and cure your problem of BPH.

I hope that answered your question.

Mike

Mike, an informative article on Medscape today:

'Partial Gland Ablation in the Management of Prostate Cancer'.

Discusses all the differrent types of Ablation including FLA & some I know nothing about. Interesting for everyone I think.

Mike, do you know anything about Irreversible Electroporation of the prostate (Nanoknife). This is used to destroy cancer but I'm wondering if it could be also used to releive BPH? Maybe I need to start anothere thread.

James.

Hi James

I have come across this process / procedure (IRE) a couple of times over the years, but it always related to cancer of the prostate or the pancreas, etc.  They have been working with this for 5 or 6 years now.  I think because it is so selective on what it destroys only the degenerative cells, like cancer tumors, that I don't think that the way it is now, that it could be used for the prostate tissue unless they infuse a reactent into the tissue itself to destroy that tissue.  Yes, it does stay away from muscle fiberous tissueIt is designed so that it stays.  It looks like the next big advancement for mimimally invasive cancer treatment.  Right now I have not run through their Clinical Trials, but when something is this selective and cancer can remutate so rapidly, how are they going to know that they got all of it?  Where as laser ablation actually destroys all tissue that it comes in contact with.  With the ability to see in Real Time with this procedure or FLA/Pca, the ability to avoid destruction of functional tissue and vascular vessels.  So for ablating prostate tissue, I did not see where it could do that.  So, not disrupting Ejaculatory Ducts and Semenal Ducts and the Spinchter to the Urethra, the doctor can see what he is doing to avoid damage to those tissues.  

I have some paperwork I have to do right now, but I can send PM you some links if you are interested.  Do you have Prostate Cancer?  Is that why you are continuing to pursue procedures down that line of treatment?

Talk Later

Mike   

Hi Mike,

Yes I have low grade proste cancer, which has been under active surveillance for 6 yrs, so FLA could 'have a go' at that as well as trying to sort the BPH out. I am interested in finding out more about IRE, any PM links would be welcome.

Thanks,

Peter.

sorry to interject her. I jusy foiund out my PSA is higher than last year looking more on possible future evalkuation options and inetersted in FLA. One interesting question in who would be better for intervention Dr. K or Dr. Wasler. Looks like they are now separate, one in Houston and one in Galveston. I see K started pracicing about 2-3 yrs ago but Wasler for few decades but don't know who has most experience with FLA. Any inputs?

Nice user name!😅

I am guessing that Dr K worked for or with Dr Wasler before going out on his own. He mentioned living in Galveston before moving to Houston and starting his practice. I think John J12080 would know more, as he has seen both of them. Maybe message him?

I get the feeling that the two doctors work together at times, but Dr K seems to be building a specialty practice around prostate issues.

Wasler did John's FLA, not Dr. K.

? I know that. Dr K did everything else.

Didn't mean to direct it to you alone, but the fact that Dr. Wasler did the actual procedure gets lost unless you have been following John's journey from the very beginning. I think the actual surgeon is an important piece of information. 

Jim

Yes., thaty was my exact question because now they have 2 different practices. It looks to me Dr. Wasler has the most experience. I don't mean Dr. K is not as good but just trying to figure out outcome would be hard without knowing who done it.

 If I were considering FLA, I'd contact all three of them -- Dr. K., Wasler and Sperling and ask each about how many procedure performed (for FLA and for FLA for BPH) and outcomes, as well as to get to know their bed side manner.

Jim

Hi Mike, did you have the FLA done yet. I am following all these discusdions in an attempt to decide on a course of action. My urologist suggests green light laser, which seems like a little newer turp to me, along with the side effects. Another doctor in his practice just started doing Urolift, but I don't know if I am a candidate or not---my doctors notes just say "severe prostate hyperplasis" whatever that really means. PAE is another procedure I am considering.

The FLA sounds like a good choice, again if I am a candidate based on prostate size. I woulf love to follow your progress after the procedure to see how things progress.

Rick

Rick

I am doing GREAT!  I am almost (week 5) and it has been a constant improvement.  Peeing medium stream now consistantly, no blood in urine for the last week.  No pain ever.  Frequency at night dropped from 4 to 6 and now it is 1 or 2.  Urges are getting manageable.  Daytime frequency improving to almost 2 hours sometimes.  No sex yet, but I did have some ED issues before the procedure and the doctor said that this procedure might help it some, but no guarntee on that.  I will be curious about possible Retro-Grade and to see if my ejaculate flow improves.  My prostate was very large at 175 grams.  So he had to remove a lot of tissue.  

I, like John and several others on this website have checked out just about everything that you can imagine that is currently available.  Until I decided to go with the FLA / BPH, PAE was my top contender.  I would check out some of the PAE forums and some of the guys that are doing FLA now that have had PAE.  Dr Bagla in Virginia is the very best for this procedure and he is getting some people covered by insurance.  There are quite a few people that are getting redo's or getting another procedure done.  So the true success rate is falling off some.  Dr K did mine and now about 8 or 10 other people on here.  All so far have had very positive results that I know of  and some had other issues as well and have had other procedures prior to.

Mike  

That is great news! It looks the way to go. PAE does work but it would appear not for everybody.

Congratulations!

Hi Mike,

I can't remember - did you have an enlarged median lobe?

Thanks and I hope you continue your excellent improvement.

High Arlington

Yes, I had a very large 175 grams prostate with a large median lobe.  That is almost standard with a very enlarged prostate, i think almost 85% of the time.  It is just part of the prostate, but it gets talked about quite a bit because it is in the middle and it pushes up into the bladder and down onto the urethra, thus bladder and peeing issues from BPH.

Mike

Mike, I am SO happy to hear how well you are recovering and hope you have a full and lasting recovery as the healing continues.

I am all set for my FLA. I will be in Houston next week for FLA with Dr. K on the 18th. I will keep you all posted. 

Good Luck Ross

You made a good choice.  I think you will appreciate the fact that you do not have to wait up to a yeart for possible results.  You should be all good to go in about 3 months.

Keep us posted.  You will throughly enjoy Dr Karamanian and Samantha.  They will treat you like one of them.  

I don't know what your physical health is like, but you should be able to do limited sight seeing the next afternoon.  So you and your wife ehjoy yourself.  I am sure that the ocean will be no big deal because Galveston is only about 50 miles away and they have some good restaurants down there.  But there is lots to see in Houston.  Get a City Pass and it will cut your costs to see like the Science Museum, Art Museum, NASA, etc.  Coming from Long Island, Houston will be cheap.  When you come into the airport ask for all their maps and travel information.  They have quite a bit.

Good Luck

Mike   

Thanks Mike for the kind sentiment and travel tips.

Sadly I went into retention again on Sunday evening and will be arriving in Houston on Tuesday donning a Foley. My symptoms seem to have fallen off of a cliff in the last week. So glad I am getting FLA next week.

The MRI revealed that my central issue is a runaway median lobe pushed up against the urethra and as you well know, with so many other urological procedures contraindicated for BPH sufferers with median lobe, I feel confident in my choice to go woth Dr K and FLA.

Super happy for your amazing improvements Mike.

Keep us posted and I promise to do the same.

Be well,

Ross 

Mike any idea how big your prostate is now?

Hi guys I am back! One, I have had some trouble with this site again and two, my 85 year old DAD has hit me again with another surprize.

He decided to sign up and schedule a double knee transplant for May 22. He told me this weekend and I had to go see him today to discuss his rehab. He is 2 and a half hours away so it is 5 hours of drive time. I am going back Monday to talk with his Cardiologist about him doing this with noone to rehab with him at home. He has a bad heart value that really needs replacing and I bet the Cardio says, No Way until that is done.  

Anyway let me clear up some things. Jimjames is correct as usual. I did want  Karamanian to do the laser on me but he could not meet my specific demanding schedule so at that time he and Walser where thinking about hooking up with each other in prostate services and had worked together at UTMB. So we split the duty. But Karamanian is my man. He did my pre and post op care and laid out and explained how my ablation would be done. In my opinion, he is absolutely the best out there. He was with me the whole way through post op and I could not have made it without him.

With regard to Walser he is a brilliant Interventional Radiologist in all procedures of IR. But more than that he has evolved into a major admistrative Doctor who in tasked with running one of the largest Hospitals around. He is he head of Radiology for UTMB (University of Texas Medical Branch) and is the boss of all Radiology not just interventional radiology for all their banches of this major Hospital. More than that he is Chairman not just the head of the department. This is a medical hospital and school of the University of Texas and is 125 years old. He is much more than a Doctor and he is paid to run the department and the hospital. There probably not 2000 people in the whole country that have hospital operational jobs like this man. He can easily be the President of this major hospital in the future. But those jobs are not medicine they are business. You just can not serve two masters so you have to pick one eventually. I know that and so does he. 

Yes he and Karamanian are friends and colleagues and work together closely.  Dr. K admires him greatly. Karamanian left that hospital to focus strictly on Prostates instead of focusing on all the many thing done in Interventional Radiology. This was Doctor Karmanians specialty and calling. He studied and did his fellowship in this calling. The two worked side by side on cancer treatement with focal laser and I was their first under the label of FLA for BPH. I consider them both my doctors.

I did not hear back from Walser after my procedure. He is an important business man and has a big company to run. But he is also a mentor to many great IR's and in my opinion Karamanian is the the greatest of them all. Several other men on this  site have talked to Karamanian, worked with him, and now have been treated by him for BPH. I am sure they will confirm that there is no other medical professional they have ever dealt with that is like Dr. Karamanian. He really does put the patient above all else. I can not tell you how hard he works to study each individuals prostate and produce a strategy for that procedure. He is totally dedicated to that individual's success and not to trying to do as many procedures as he can. It is not cookie cutter with him. And, he is with you completely through your recover. Not a PA, he himself. When he meets with you the day before your procedure and reviews the detail, you know you have the right person to do this job. 

I wish he would have run the laser for me but he had a very critical cancer procedure that demanded action when I had to have my procedrue done. I really gave up nothing because Walser did exactly what needed to be done and what had been discussed previously. then went back to work running that mammoth business of a hospital. I think they are both great Doctors. I cannot say enough about how successful FLA  has been for me. IT is absolutly the best money I ever spent.

I also went to see Dr. Sperling and would have used him except for a few things that bothered me. One, He charged me $250 and want cash only, for a 35 minute consultation on which I flew into meet him in his office and then flew home. Karamanian chagred me nothing a spent 2 hours after work with me in a consultation. Sperling told me he had done over 100 men with this FLA treatement specfic to BPH and 900 for cancer. So, I ask could I please get the number of 4 or 5 of them to call to discuss their feeliing about the procedure. I also said I do not expect you to give me a bad reference, that is not what this is about. He said, yes, of course you can. Then he instructed Lillian to get me that. I left and then I call their office for almost 5 months trying to get that list. I call and talked to everyone I could untill they would not take my calls anymore. I never got a list. Not even one. That bothered me as I felt that with over 100 patient, someone would be willing to discuss their experience with me. I know this, I think motoman, mikeskier, neil, j12080 and soon to be ross, victor and several others would be happy to help guys know about our experience. But I could not get one from them... I also wonder, if you have over 100 patients for BPH, why no white paper of clinical trial or collaboration efforts with other IR's to try to get this approved by insurance to help the poor guys who can't afford this? Something just does not add up. Last but not least, I did not like the valium and pain pill protocol he used versus the conscious sedation used by the Interventional Radiologist. Also I was told I might could leave that same day with no catheter. I assure you and so will any of the guys on this site that have done FLA. You do not want to do that. However, with that being said he was the pioneer and he built a booming business in Florida and New York. I am of the understanding that his base price has now increased to $25 K. I was quoted $22k with 7k worth of add ons. My other quotes were $20K all in. I did not really care about the money I only cared about success and no sexual side effects.

My advice look at them all if you want. I took 20 months of reserach and vistits and I look at all of the procedures.  I changed my mind 2 times, but after all the study, FLA is in my opinion the best option going right now. If you have to do something as some of us have had to, FLA has the logic behind it and so far no sexual side effects five months out. I am looking to get 5 to 10 years out of this and there is logic behind that also. 

Good luck in what ever you chose. If I can help, I would be honored. 

Unckle

It would be hard to tell because I am sure that for another couple of months that it is still swollen, even though I can not feel that it is.  Then over several months it will start re-shapping itself into it's new size and shape from having the inside cleared out.  So I would not be able to give a fair accessment for at least a year.  From having this type of procedure, this is one time where size does not matter, at least as much.  Theoretically, my prostate could stay the same size, but inside where all the obstructions were, it is cleared out and away from the key functioning features, like the Urethra, Seminal Ducts, Ejaculatory nerves.  Dr K kind of hinted that as long as I am not having any problems then that is what matters.  I would assume that in a couple of years, I may go back to my urologist for the new lattest type of exam that is available for the time, to say check for cancer or abnormal bumps or lumps and PSA tests.  I am due for a physical in June and I may have my doctor include a PSA test with my blood workup.  It should have gone down considerably, but maybe not because of the fact that it will still be under inflamation.  That gives false readings, just like having sex within 3 days of a test.  

Did you get your Tool and Die Shop up and running yet?  Did you get a date set with Dr K or are you going to wait?  I think that shortly, Dr K will be on some of these forums.  I mentioned that Dr Sperlllllng made his first apperance about a week ago.  He found the site by accident.  He has some top IT people doing his websites and I am sure that is how they stumbled accross this site out of England.  Most of the comments on here are negative for Customer Relations.  He does not contact people, follow through with requests and on top of that, he appears to be very comfortable with the idea that it is an unapproved procedure.  With All the Money he charges, he probably does not care making upwards of near $28k plus for him to do his procedure.  Have you ever seen one of his patients on this site after claiming over 100 done in the last 2 years?

Hope things are going good for you, you literally and figurativly had a terrible winter, but now it is spring and time to get fixed.

Mike   

Hi Mike,   

   Sorry just saw this post. Posting from  my phone tonight so its kind of difficult to navigate this site. My shop is moved but unfortunately its in storage. Finding retal space with 3 phase power isn't easy so in the interest of getting out of the building on time I moved everything to storage. Sucks, because I'm losing the income from my shop. At least I have a day time job to pay the bills. Look like I will be building a shop on my property. 

   I saw my uro a couple of weeks ago. He won't set me up with a 3T MRI. He says I don't need one at this time. I didn't tell him I was contemplating FLA. I have not spoke to Dr. K I did email him a couple of weeks back. He wanted my uro to schedule the MRI. Right now I'm in limbo with FLA surgery. Cost of the shop I'm building is about $35K Couple that with the cost FLA I think the bank may be broke this summer. I'm doing well considering my prostate is 125 cc. I pee pretty good as long as I take my meds. If didn't take them I would be in trouble. My biggest problem is pain while sitting. Its been especially bad the past couple of weeks

I did see Dr. S post a couple of days ago. I have not seen Dr K posting anywhere yet. Has he posted and I haven't seen it? I've got a feeling Dr S can't give out much info about his BPH/FLA procedures due to HIPAA. Which doc is doing the website? 

Hey Unckle, I believe that if you can find a place that does the 3T MRI, Doctor Karamanian will provide an order for them to do it. It is worth asking. Try to find a pelvic coil machine. It is a better experience. Siemens I think has the best machine. I am sure there are a lot of imaging centers aroung you. Good Luck. 

Good luck tomorrow Ross. 

Thanks John. I'm both nervous and excited. My appointemnt is today at 1pm.

Not long now!

 

Uncle .....I gave Dr. K a 10 mile radius from home and he took care of the rest!   I just showed up at the imaging center.

So, I assume the surgery is done, how did it go?

It went well.   You can pull up my updates if you go to my discussion on it.

I'll dig around to see if I can find them. Seems like more guys are.getting.FLA

Just click my username.  It will bring up my discussions.

Hey uncle, I am having the FLA tomorrow morning. I should be done before noon.

Good luck Ross! How was Goode & Co?

Thanks Neil. Didn't go yet as we got in late last night, but we intend to go Friday evening.

Thanks for the kind wishes.

Ross

Best of luck to you Ross

Thanks for the tip Trustme

Did you get to meet Dr. K today in his "penthouse"? Did he give you a PLC T-shirt to wear during the procedure? I love the colors!

LOL

Samantha tried to give me a hat. I said no thanks. Where was I gonna wear that?

Unckle, It seem that Karamanian has the most verifiable experience with FLA specifically for BPH. I think now he has done between 12 and 15 guys for BPH. His clinical trial group is not maxed out in participants yet but he should be publishing later this year. Ross will be a great guy to follow with his results. Mike Skier, Trustme, Motoman and myself are all very positive. I will be giving my six month report later this month. I want to wait until June to give the information out but it is all good. Just don't want to jinx anything. I am some what superstitious. 

 

I've been short changed! No hat or t-shirt. I got a PLC tote bag, pens, a stress ball and a water bottle. 

In about 3 weeks, I'll attempt to fill the water bottle, if I can't I'll likely be squeezing the PLC stress ball.

In all seriousness, Samantha and Dr K are warm and wonderful people. The "penthouse" visit took me on a fascinating tour of the MRI of my prostate. It was eye opening in the sense that you can truly see how this disease is impacting me and reassuring to understand how FLA can specifically treat the problem tissue. 

I'm a little nervous...

 

Good luck Ross.

Don't leave all the goodies from Dr K and Samantha in the rental car like I did! I didn't do it on purpose, and felt bad afterward. Dr K must have spent a small fortune on all that promotional stuff, and I forget it in the rental car!

Just wait till you get in the MRI and Samantha starts stroking your hair and holding your hand - just make sure your wife is in the waiting area!!!

If I had any hair, she'd be welcome to stroke it :-D

Thanks Motoman

Anyone hear anything from Ross??

I imagine he still has a cath in. 

Hi Guys! I am doing as well as can be expected. I'll be wearing a catheter until next Friday.

I feel no pain, Just sore especially when I sit for too long. Dr K was thrilled with how the procedure went, so a technical success. The pre/post MRI pictures show an extremely precise targeting of my problem tissue. I remember being wheeled out post procedure and asking Dr K if he had successfully managed to ablate my median lobe and his quick witted retort was "What median lobe"?

The first day was plagued with bladder spasms that were ultimately corrected by a latex vs silicone catheter. It appears I can't tolerate silicone and I slept like a baby last night after a rough intitial 24 hours. Dr K came to the hotel a couple of times to help with alternative catheteers and taught my wife how to irrigate the catheter should blood clots block the tube (they did several times). Such a wonderful caring man, willing to go above and beyove and beyond to make sure you are comfortable in your procedure and in your recovery. He and Samantha the nurse are just incredible people. I remember Smantha sitting with me for the entire 3 1/2 hours of the procdure and stroking my hands with each of the 8 passes of the laser.

I'll be sure to update you all as I have something to report.

Best to all

Ross

Neil

I heard that when you saw Dr K for your MRI Biopsy that you proposed to Sam and your wife was there.  How did that GO?  I had 3 1/2 hours with her because I was consenous for the whole procedure.  I had a much more embarrassing thing that happened to me.  I would tell you on a PM.

Ross was a little nervous, but he will be OK.  He went through a lot in the last 3 to 4 weeks and even changed procedures at the last minute.

Thusday I was at 6 weeks and doing great.  I am peeing a FULL stream now with volocity and no blood color.  I get up once to none per night from 4 to 6 times.  It is great being able to walk around in society without having to look for restmoons all the time.  

Have you decided to go with the Gat?

Mike 

Ross

So it looks like you made ok.  Now you can go out and do some site seeing or are you leaving for NY today?  Just take it easy with that cath, you don't want to dump yours like I did.  

Have a good trip home and you are now on your road to recovery.

When that cath comes out next Friday, you will be so happy and with the ability to pee almost normal again.

Mike 

I will be in your shoes on June first.

Thanks for the update..

Jim

Mike, yes heading back to NY this afternoon. I must say, when I was having cath problems, I took one out pending Dr K swinging by with the latex one that I am now comfortably wearing. This was day 2 after the prcedure and during that 90 minutes, I felt some urgency and actually managed to pee a couple of times albeit drips and a brief stream. I was able to fend off accumlation of urine in my baldder wjile waiting for Dr K despite the imflammation. It makes me exremely hopeful for a great outcome. Haven't had a chance to do any sightseeing but I hope to have lunch at Goode BBQ  ( Neil's recommendation ) today before heading to the airport.

I truly hope you are right about next Friday.

Ross

Good luck Jim, you're in great hands.

Hi Mike,

Congratulations on your continued great results.

Actually after I proposed to Samantha (still feeling the effects of conscious sedation ) my wife proposed to Dr. K and she DIDN't have any sedation!!

I am still pursuing the Gat procedure - please see my thread on this.

Great news about Ross!!

Take care

Neil

Neil did you have FLA? If so why are you pursuing GAT

FWIW My above deleted post was asking what PLC stood for. I guess t referenced the name of Dr K's paractice

No - I have not had FLA (only PAE). Dr. K did a biopsy on my prostate in Feb following an MRI last Fall that showed what was interpreted as a cancerous lesion on the prostate periphery. He did a great job and the biopsy was ok.

But at that time John had been Dr. Ks only BPH patient. Dr. K showed me how he would do FLA on me using my MRI images. He said I had one of the worst cases of severe BPH he had ever seen. He also said that if the lesion were cancer it would cost $20000.00 to ablate it but that he would throw in a "free" BPH FLA!

It was tempting but I was just starting to get good at CIC so will wait and see if a less invasive procedure like Gat-Goren can be perfomed in the US under insurance.

Neil

Yep - it was cut!! Just google Dr. K and you will see what PLC stans for - his business.

Forgot to add that Gat is the only procedure to offer a possible cure for BPH rather than just treating the symptoms. At the very least it will seal my varicoceles (which Gat claims is THE cause of BPH) and end the misery from these things. Gat claims ALL BPH sufferers have varicoceles.

Neil

Mike and Motoman I want to let you know what might be just ahead. I thought you would like to know this. 

Neil, Roy, Tim, Keith, Victor, Ross, Jim, Mike and Mike and anyone else in the "K CLUB" or those who are just interested. I have had a change in symptoms that I was not expecting. I am now 5 months post FLA procedure. I felt that I was finished with my recovery last month. I was happy. I felt my new freedom for the last 3 months was becoming the new normal. Little did I know it would change yet again and the would come over night again as yet another EUREKA moment. But it has now happened again this last week. 

At first it concerned me because the feeling was a change inside my pelvic area. I woke up Tuesday and I felt different. I have done Kegel exercises to increase my bladder strength  for the last 60 days. As I do them I can squeeze and feel the sphincter muscle as I close around it with my muscles. It was a verypredominate feeling in the prostate. Overnight Sunday of last week, it went away and the urine urges went away also. It was like the last piece of swollen part of the gland had gone away. This is five months out of procedure!!  I was not expecting this.  

I did not know what to do or what it meant. I did not know if it was really positive or if it would even last. I did realize that the urine stream  became much more of constant in the flow stream and the flow seemed to have improved some. It was already good enough to be very please with. But now, the control of the urges is what really stabilized  and became like when I was  much younger. It is now easy to hold my urges and the times between urination has greatly increase to the point that now I go all eighteen holes without stopping to pee while drinking water and an occasional beer. But start very easily when ready. It seems that my remaining tolleralable left over symptoms all improved over night.

I did not tell my wife or say anything to Dr. Karamanian until Friday afternoon. As I am superstitious and felt that if I bring it up it may go away. I could not detirmine for a couple of days if the change in feeling was even a better thing or not. I had to see how it related to all the different symptoms of BPH. Yet again it seems they all improved! I still do not know exactly how much they improved but I am now observing this latest change and keeping notes. Dr. Karamanian said he is not surprised as he thought it would be in 4 months but 5 months can be the point for me to finish the inflammation reduction and the reforming of the gland.  

Prior to Sunday a week ago, my night time urination trips were still some what caused by urges after I would just wake up as this typical sleep patern I have, and I was now down to 2 to 3 times a night from my pre-FLA occurrences of an average 8 times a night. I was happy with that results. With this latest anatomy changes I am now down to 0 to 1 time a nigh for this last week. I wanted to tell all of you all about sooner but just wanted to make sure I was not dreaming. I now feel more confident not only about this results but about the hope for longevity of symptom relief from the FLA procedure. The difference in how I feel is night and day difference. And the change happened Sunday night, May, 14 and May 15. This is as new to me as it is to the rest of us doing FLA but I wanted to share this information as it is all very good results. I finally feel normal,  totally normal. I had actually forgotten what that felt like - feeling normal. I was very happy before this recent Sunday change. I will try to keep everyone posted as or if something else happens or changes occur. 

I am sure I was not the first ever but I feel like I was the first in the FLA for BPH category.  I remember being concerned and questioning while I was recovering. I could only talk to Karamanian about things then. Though that was excellent as there is NOONE who cares more and is as post procedure involved as this man. He is totally commited to successful treatment and to his patients. (I bet everyone now in the K CLUB would testify to that being true)?

At my procedure time I had no one that had this procedure to talk to. It was "cold turkey" so to speak.  It is so easy to be led astray in trying to find help for BPH. I am very blessed and lucky. I ask God to help me find a right answer for me. Please just give me wisdom and patience to look and find the one right for me. He did giver me that and I did find it. Now it pay back time to do what you can out of respect, thankfulness, and joy. Help others who pass this way. 

We all must stick together and not forget as more men will come and will suffer this condition.  Only those who have walked this road know what it does to our lives in the most important and personal situations and condition.

I always found it puzzling how even the Urologist that treat this condition have no real compassion for the men with BPH. They for the most part look at us as an opportunity. They will present a solution but they actually do not know or care if it is the best solution for the patient. They are not treating this as a Doctor should. They are treating it as an urologicial opportunity to sell their flavor of an answer with little regard to the best thing for the patient. Most of medicine is that way.

Lots of things have changed from the days of "create no harm" oaths that were at one time more important than money. This is why Karamanian was such an interesting person to get to know. He is very unique as a person and a doctor and it is hard to believe he existed. What a throw back this man is. 

Now I want to help any and all who go through this procedure to get back to the good side of this condition we live with. Dr. Karamanian now, I would guess he has done 10 to 15 of these FLA procedures and he will have  8-10 more coming  along in his study.

I hope this help someone asking questions about the FLA recovery and results tonight. I will help you all I can with information for a procedure selection or any recovery from Focal Laser Ablation. 

Sincerely John

Thanks for the update John. ITs amazing you're still seeing improvement. God Bless

Right on John,

Your giving me inspiration. I am happy for you. Must feel really great. Can't wait to get to were your at.. I'm in ....

Jim

Hi John,

Before the procedure, did you have hesitancy ? How has it been improved ? Thanks. Hank

John very happy for you  Ken

Hi John,

Congratulations on your excellent results. I'm very happy for you!

I've been suffering withBPH for several years now; ended up in the ER last August, with retention, had a Foley for a week and now doing CIC 4X per day. Looking for a lasting solution, so your results sound attractive to me. Can you tell me if they injected a "contrast medium" into you for the MRI?? 

Thanks in advance,

Fred

John, 

I am glad to hear you are still having improvements. I was starting to worry, as I have been getting up more than my once per night the past two weeks. But I have been taking Melatonin to help me sleep, and I read where that causes nocturia. So maybe that is my problem. 

I don't have the urgency I did earlier, and sometimes I confuse that with an inability to pee. Maybe it's just the same changes you are seeing, where my Bladder is not full yet, so it's not time to go. 

Good to hear you are doing well. And thanks for being the first to tell us about this procedure. It helped me a lot in my decision, and also during the recovery.

Hey Fred.  Don't rush or talked into anything until you get all tthe information.  John did that with FLA and it worked great and no side effect.  Take care and good luck  Ken 

Hi Motoman,

Do you know how Melatonin causing nocturia ? By increasing urine production ? Thanks. Hank

Thanks, Ken. You are 100% correct! I am doing a lot of research and not jumping into anything, but meanwhile, having to do CIC 4 or 5 times a day is somewhat limiting, though by now I've done it in airport restrooms and just about everywhere else except actually on an airplane. I'd like to get some relief from this. Have tried just about every supplement known to man and am still in the process of trying the ones I haven't gotten to yet!

Thanks for the good wishes,

Fred

Hank, I had this BPH for 9 years. My symptoms changed a few times and directions over the time frame of 9 years.  I did not have hesitancy as my top symptoms. Yes I had some hesitancy from time to time but my issue was bigger with the fact that when I had an urge, I better not ignor it. If I did I could go all over myself. Nothing is more imbrassing than being in a meeting, which usually, you called. And, have to stop the meeting and rush to the bathroom. Only to not make it and pee on yourself, then have to return to start your meeting again. Hank, I had gotten that bad. It is not fun when you realize that your employees and co-workers have pitty for you. NO, it is not a manly thing to have invade your work environment. 

My wife says I am the new definition of stubborn. She is wrong, I was scared to make a choice. Nothing offered by urology made since to me. Not even the horrible medications that are offered by doctors who know they would not take them because of the "side effect prision" they put you into. I would never take those meds. I refused. Not being medicated, I suffered my symptoms. But the side effects from every solution offered scared me. I did like FLA and PAE, I felt because of the logical facts that showed FLA is by far the best choice for me. 

I know a couple of the guys having FLA now, the ones I refer to as "K CLUB" members, had hesitancy up to the fully blocked issues and these were at  the top of their symptoms list.

I forgot to say, I have NO hesitancy now. I can go quickly or hold it longer without any issues. 

I am one of the ones who had hesitancy. That is mostly solved now. It depends on how bad I have to go. I think I still try to go too often, just habit I guess.

Thanks Jim you are correct I am so pleased it humbles me. I only hope this can be this good for every man. I think MikeSkier has done much better than I did and I have a good guess as to why but no need to explore that now. We are both doing great and Mike is about to get a lot better. I know that because I am ahead of him by a few months. I also hear Motoman is doing good and I am confident he will see what I just had happen at 5 months. The answer are out there Jim it is just knowing when it is time. I had to go when I did. I wish I could have waited.

I will tell you when it hit me. During my 20 months of travel and discovery, I went to UNC to interview Dr. Isaacson the Interventional Radiologist that does the PAE treatments. After about an hour of discussion, we stood to leave and the Doctor followed us to the door. Isaacson place his hand on my shoulder, I turned around and he look me in the eye and he said "John, I know you are researching and trying to pick a right soluion for you. My only thought for you is to tell you that you really need to do something with someone SOONER rather than later, or you will possibly have more serious issues to deal with".

That scared the BELL out of me. (dont want to get moderated). Once again, I felt pity. I dont like that feeling especially when I am scared. If I can help you in any way Jim let me know. I may not know of your solution but I will tell you what I know. 

 

Hi Motoman,

How did you solve your hesitancy What do you mean by "depends on how bad I have to go " ? Thanks. Hank

Keep pluging ( No Pun )  you will get help soon  I will put you on my prayer list  Ken

I had the FLA done. That made me have to go right away due to the surgery.

But as that has healed, the urgency has decreased,I can wait longer before needing to pee. But at the same time, I am used to going as soon as I feel an urge. 

So now that the surgery is healed, I don't really need to go as often as I think I do. So that is the hesitancy I am seeing now. When I really have to go, there is no hesitancy anymore.

Good to hear from you. I still tell people about this crazy man I know who had his prostate lasered and then went to Japan and rode around on a motorcycle!! You may become a legend. 

I did not know that about Melatonin. I take 1 mg of liquid Mela. each night and have forever.

I was up to pee 2 to 3 times a night by average until this last 7 days. I had no issue with 2 to 3 a night but this last week, when I felt this change, it is now 0 to 1 time at night. I went to bed at 11 last night and I one trip was at 4 a.m. this morning so it is improving as of last week. We will see. We are all a lot different in this area. 

Good Luck and stay in touch. thanks for input to help a guy with hesitancy issues understand that you got relief from that with BPH. Your a good man.

Thank you, Ken. I appreciate the prayers. I believe it does work!

 

Correction last line, not BPH I meant Focal Laser Ablation FLA

Sorry Motoman must be time for bed.

motoman, I must ask you do you measure your urine volume? I Know this sounds strange but I have regularly measured my volume and I know that my night voids will be 300 to 500 mils each time I get up. I have watched these volumes increase over the last 4 months. I cant measure the volume unless I am home. I dont worry about it when I am out but at home I like to see what volume feels which way on my bladder and the accompanying urge  feelings happen. It seems to help me learn when it is the right feeling now to trust and then go. I know it sounds strange but it is almost like relearning the normal urge feeling and not react to those that are caused by habits from the past. It helps me stop running to the bathroom out of concerns but to hold it until I really did need to go. Now when I know what the real deal feels like, Then I go and I measure the volume to stay in touch with the urges.

Light One, they did both contrast and non contrast during my 3 TMRI with a pelvic coil.

If you have an issue with contrast, they do not have to do the contrast version. The key is the person reading your MRI who has a great deal of prostate experience. The right Interventional radiologist can deal with both or either MRI stiuation.

Congratulations John for this great report and thank you.

Since you have gathered everyone in one place I wish to ask everyone the following question:

I never read anyone here discussing problems with their varicoceles. I too never thought about it until a few years ago I noticed my scrotum hanging lower and feeling heavier. This was very gradual over time but eventually reached the point where I have to pull my scrotum up to avoid sitting on it (ouch!). There is a joke around this aspect of getting older called "when the balls fall" but there is nothing funny about it.

This problem is caused by varicoceles and can be very painful depending on their stage of development. It can be visible as ugly worm-like veins under the scrotum.

Dr. Gat claims that all BPH patients have varicoceles. Indeed he maintains that varicoceles are THE CAUSE of BPH. So once these annoying things are embolized then the BPH should resolve over time.

I finally had a scrotal ultrasound last month and confirmed I had bilateral stage II varicoceles.

The thing about FLA and other procedures that treat the BPH symptoms is that the varicoceles remain intact. So apart from the link that varicoceles may have to BPH we still have to live with this problem.

So I am just wondering if all of you too suffer from varicoceles? I only recognized it as a disease that I have recently but looking back at my symptoms over the years I now know what caused the symptoms and would like to get rid of these things regardless.

Do any of you have similar symptoms or ever been diagnosed with varicoceles? I discussed this with Dr. K but he didn't seem too interested and said that FLA would not address it.

Take care all.

Neil

Thank you, John. That's exactly what I needed to know.

Best wishes,

Fred 

Hi Motoman, you said :

.. been taking Melatonin to help me sleep, and I read where that causes nocturia. So maybe that is my problem.

From what I've read, melatonin is actually used as treatment for nocturia.

Hank

Motoman : " When I really have to go, there is no hesitancy anymore. "

What you mean is when your bladder is very full, you have no hesitancy. But when the bladder is not very full, you still have some hesitancy. I wonder if it is normal for every body to have problem like that (hesitancy when bladder is not full ) Thanks. Hank

Neil

I think Sam can do a lot better than us ole farts.  I am sure that you are not alone in your proposal.  Most of the guys are talking about her.  Your real problem is your wife.  Did she propose first or was it you?  Dr K has 3 little ones at home.  Being conscious for the whole thing I spent a lot of time listening to what she had to say.  My problem was getting comfortable for the 3 1/2 hours on the table with my feet bent under. 

My embarrassment came from the demonstration of the catheters to my wife.  I was sitting up on the table and there was Sam, her assistant, Dr K and my wife.  My little Mikie was being handled all over showing the cath and showing the night cath and then how to take it out by Sam.  This demo was almost 10 min because my wife was asking questions about all the transitions.  She did not seem to mind that another was holding me, Ha just me.  I could not have done anyone any good.  Especially with that long straw coming out of me.    

Boy, John has written so much on this page, I think he should put in for the secretarial pool.

Later

Mike    

Hank

I have been taking melatonin for a couple of years to allow be to sleep at least 3 to 4 hours.  Actually, low melatonin is one of the possible causes of nocturia.  http://www.renalandurologynews.com/urology/nocturia-linked-to-low-melatonin/article/328699/ 

Mike

Light - if you can tolerate the contrast it is important for detecting lesions/tumors on your prostate.

Neil

Hi Mike - you made me laugh and I can sure use one. Did you have much pain during the laser passes?

Neil

WOW John that is amazingly good news, things just  seem get better and better. I am so happy for you.

I have not contacted DR K yet, since I had a VERY failed PAE last Jan. I am not sure if he will be open to trying to fix another Docs mistake, My kidney function has dropped drastically since I had the procedure done.I am only 54. I plan to ask my primaty  care Doc if he will order a 3T MRI based on all of the touble I have had. I am hoping the 3t might show exactly where those beads went. I am befininng to think maybe they could be causing the kidney problem.  Plus that would give Dr K something other than a standard MRI to look at and see if he can do anything for me with thoise beads being in there.

Thanks again for the udate buddy..

Joe, There are several guys who have had FLA now that had previously had PAE and it did not work. I think someone even had two PAE procedures before trying FLA? 

You should ask Dr Karamanian if he can work with the MRI you have and if your doctor will not call in an order for a 3TMRI then Dr. K might order it for you so you can get it done near your home.  He has in the past for other guys. 

Joe, Dr K pointed out to me exactly where my PAE from 2013 had worked and where it hadn't. The 3T MRI will tell the entire story of what happened to you when you had PAE and more importantly what it didn't do and whether or not FLA can help you.

For me, my 3T MRI revealed that my enormous median lobe had not been touched by my PAE. I did have short-term relief but with the median lobe left unscathed, my PAE was a techincal failure as this protrusion continued to grow and caused misery in recent weeks with a couple of episodes of AUR. 

Dr K showed me exactly how he could successfully ablate the offending tissue with amazing precision and that's exactly what he did. 

PAE has helped many men but let's face it, it is an untargeted procedure that is a gamble as to  whether the embolization addresses your specific BPH tissue.

John is right as always that Dr K will be able to tell you the whole story from a 3T MRI. It's so worth getting and sending to Dr K.

best

Ross

Might be worth a try John. I have a feeling I am peeing less in the middle of the night, and not completely emptying. When I wake up in the AM I have a much stronger stream, and seems to be much more volume. This is a recent change. It takes longer to start a stream in the middle of the night for whatever reason.

Hank,

you might be right. Looking again, I can find things online that say melatonin cures nocturia, and other things that say it causes it. I looked online and found some examples that said it caused nocturia, after a recent change in night time urination. I also began taking melatonin around the same time. 

I thought there must be a correlation, found something online to confirm it, and stopped right there. I had a similar problem in the past with Tylenol PM (Benadryl). Made it more difficult to pee. 

John,

I wonder if all the time on a motorcycle seat over the years has caused my prostate problems. I had a smaller prostate, but it was "hard" according to Dr K. I have been racing dirt bikes for 40 years, so a lot of jarring in that region of my prostate.

I think the crazier thing I did was go skiing 2 weeks after my procedure. Dr K said to take it easy, and no Black Diamond runs. Of course, following my buddies, I ended up on a long Double Black Diamond right away on the first day by accident. No way out but to ski it. I didn't follow those guys after that and stuck to the easier runs.

Joe, I just asked a doctor about your theory.  To a layman it seems like the two events occuring at the same time might be connected but my doctor friend says it's highly unlikely that the beads caused you're kidney problem.  

I'm telling you this so maybe you'll worry a little less about a possible mistake.

PAE does not often help with BPH if you have a large median lobe. My PAE was unsuccessful as the urologist was only able to do the right side. Since then I have had an MRI so will see later this wk if it has made any visible change to my prostate. It as yet has made no difference to my BPH.

I'm using ambien to put me to sleep plus rivotril to keep me in deep sleep.

So far less interruptions, feeling rested during the day, less naps, more gym.

 

Ross so he was able to get rid of the median lobe to help you pee better.  did he stay away the the sphincter and the ejaculatory duct so you will not have retro Just asking  Thank you  ken 

Hi Ken,

Yes, he showed me the before and after MRIs and the median lobe had been completely ablated. It was part of the strategy going in and he was thrilled atht he was able to get the exact angles for the laser to reach the offending tissue and deal with it completely right up to the bladder margins. He made 8 passes with the laser over approx 3 1/2 hours. I am not sure how many passes it took to ablate the median lobe entirely.

Dr K always avoids the nerve bundles and the ejaculatory ducts. The fiber optic laser is accurate to 1mm and the 3T MRI provides HD imaging of precisely where the laser is and also a heat mep of the tissue as it is being ablated thus giving him fine tuning control of location and how much energy to use.

Ross

That is great for you.  I am glad.  I know he did the same for John   I have seen his before and after MRI of his prostate. It is good to know that this procedure works that we don't have to lose anything that we don't want to Did Dr K say how long will it take for the prostate to reform.  Take care  ken

Thanks, Neil!

Ken,

He gave me an approxiamte timeline for healing but of course we all  heal differently. But from John's amazing posts, it appears that things are still improving after five months.

I've spoken to a few of the guys that have had FLA this year and it seems that 5 weeks out is a magical time.

I am a long way off of that as my catheter comes out this Friday. I am somewhat nervous about it right now tbh. 

Im happy for you.  I bet you will be glad when that catheter comes out.  The first time I could not wait.  Not the most comfortable thing to have.  Yes all men have a different healing time.  Good luck.  Has the bleeding stopped yet or are you still getting blood in the catheter bag.  Ken  

Ken,

The blood stopped after 24 hours and I haven't seen any since, although it wreaked havox with my catheter causing blood clots galore that blocked the catheter. Dr K came to the hotel with irrigation kits and taught my wife how to clear the line should she need to. This saved a couple of potential trips to the emergency room and removed the blood clots that had formed in my bladder. Such an amazing man!!

I really haven't seen much blood at all. I feel great except I am kinda sore sitting for too long and have bought myself a donut cushion.

 

ambien is too much for me from all the potential side effects. Thanks anyway. Hank

I occasonally smoke electronic cigarettes. They stopped my nocturia completely. The literature backs this up as nicotine stimulates the pituitary gland and increases the production of ADH (antidiuretic hormone).

And to be very clear, NO, I am not recommending nicotine in any way, shape or form as a way to deal with nocturia. I just thought I'd pass this observation along, as we are all adults here and can take information for what it's worth.

BTW potato chips at night  (high sodium content) also have helped my nocturia in the past but that works on a different mechanism as sodium retains water. I'm not recommending potato chips either btw!

Jim

 

Make sure you put some kind of water base lube at the tip put some on the catheter it will help.  Rest up and good luck  Ken

Thanks Jim,

You have the strangest soulutions to problems. I will consider it . Hank

Haha Before this gets too far (and part of the reason I have been reluctant to post this info) -- I didn't start smoking electronic cigarettes to deal with nocturia. It was purely observational tin hat I noticed my nocturia went away when I smoked them. Then I did some research and think I now know the reason, ie that nicotine release ADH. 

As far as "considering" it, this is not advice, but an observation backed up by some research. FWIW there is other inconclive literature out there on nicotine helping with Parkinson's and Altheimer's but I'm not recommending it for that either.

Jim

Neil

I think we all create our own humor.  The people on this site have decided to take all the bull from the uros and take our own path to what we feel is the best thing for us.  So through this long trip that we have all been on, we have to use humor and the ability to laugh, because of everything we have been through is worth the laugh that we can give to someone else and ourselves.  

Consciousness was the key difference between me and most of the other patients that have had the procedure.  When your out, you don't care and can not feel these discomforts.  John will attest to that.  He felt absolutely nothing nor was he aware of anything during his procedure.   I had to be conscious due to my blood pressure being a little high, but more importantly, my blood oxygen level was a little low at 96% to 98%.  He wanted me at 99% to 100%, so we made the decision that I would be conscious for the procedure.  

I think I had 8 passes maybe more, because of the size of my prostate at 175 grams with a large medium lobe.  A large medium lobe is almost consistent with an overly enlarged prostate with BPH from the studies I have read.  Because I was conscious, I could feel pressure, but minimal, and when he got close to my rectum a couple of times I could feel some slight temperature changes, but then there was the water flushes to cool everything down.  I tell you, I would go through this again anytime before I would have my teeth cleaned.  No pain just a little pressure.  Sam was a diversion to my conscious awareness, because she was talking to me.  My biggest issue with the whole process was the time spent, 3 1/2 hours plus, with my legs and head in a tedious position sometimes, with toes bent under and lower legs not elevated off from the table.  Also, the way my head was where I needed to be looking out at Sam to answer her questions with conversation and then keeping my head in a comfortable position so as not to cause flinching or tension in my spine that could translate into movement where Dr K was using the laser.  This will be an issue in future procedures that he does, that comfort is imperative to maintain absolute stillness during the lengthy procedure.  Especially, because most of his patients are going to be 50+ in age and some with physical quirks and limitations that would prevent them from staying totally still for the length of the procedure.   

Because Dr K and I are both engineers, we had this problem solving conversation the next day and we worked out what kind of pads, cradles, supports or cushions were needed for my comfort.  By going on the computer and searching in the orthopedic sites we found exactly what I was talking about and they would work for most of his patients.  I do a lot of human factors / ergonomics engineering studies in the vehicles that I am design responsible for, aircraft, military vehicles and automobiles.

So, to your question about pain, NO!  It was a piece of cake.  No one that is in anticipation of having this procedure, based on what I went through, you have nothing to worry about.  This is not to say that patients that have other complications will sail through this like I did.  But, I tell you, this procedure, no matter what problems you might have coming in, Dr K will make sure that you are fully comfortable with your concerns paramount to his process.  He is very caring and mindful of his patients.  He has plenty of experience and any problems that he anticipates, he will discuss this with you first.  He is not like the uros that I have talked to.  Oh, don't worry, everything will be all right and there will be no problems.  This is what my uro told me about REZUM that he wanted to do on me.  Then I started investigating the post procedure issues from many of the REZUM patients.  There are plenty of them on this website forum.  

As easy as John has so eloquently described his procedure, mine might have went even better.  

Neil, If you ever decide this is the way you want to go, I would not hesitate.  As far as I know, the BPH only patients that have had this procedure, it has been a breeze.  There are a couple of Dr K's patients that have had previous procedures and or cathing issues that created some issues outside of the norm.  Even these patients, I have not heard anyone that has not benefited from it and has been greatly improved over their previous condition.  Dr K is definitely a humanitarian and he will make this as pleasant as possible.  Most importantly, he is very honest and willing to discuss any of your concerns prior to.

Sorry Neil, I got a little wordy.

Supper day to yah,

Mike     

Ross...he ALWAYS avoids the most sensitive areas and, after last night, I can attest to that .

Thanks Ross that is resllly good to hear thst he does not mind working on somebody thst has already tried another procedure.

I will try to get my doc to set me up with a 3 T asap.  

Thanks for the reply, I will do that. i had a regular MRi anout 9 months ago. I am close to Nashville and there are two places there thst do the 3 T

Thanks jj I had heard about other areas being embolized by mistake so I was just wondering if thst was a possibility. Also I had a severe reaction to the beads used for embolization. And I still have pain and skin lesions because of them, and now the kidney issue....

Ross

I noticed you called.  I had to go to the lumber company to get some shingles and some outside lighting stuff.  So If you want to discuss some more, let me know.  

I think John is starting a K-Club for all of Dr K's patients.  Then we know who people are and find out how they are doing.  This would be the start of Dr K patient Data log.  We have quite a few skepticle people on these forums that say they want data.  Well this forum is the best on the web for actual patients to tell all about their procedures, good and bad as well as why.  We have been asking for Sperlings patient data for a year or so now and he just tells people how many he has done, but no bottom lines.  

Let me know if you want to talk.

Mike

Joe

Just go online to find the nearest facility that has a 3T-MRI that is in your insurance network, they are very expensive and most places do not have them.  Get all the information from them on contact for your doctor, etc.  Dr K will make the the script to get the scan done and how he wants it.  I don't think your uro or your GP will do this for you.  Most insurances will cover at least 1 MRI a year and it does not matter what type it is.  No difference as far as insurance is concerned.  Have them give you a disk and send one to Dr K along with the MRI analysis.  

Mike

My uro wouldn't do a script for me. He said it wasn't needed. I didn't want to tell him I was contemplating FLA

Thanks Mike, I Have actually already talked with them and they are "in network" for my insurance. I didn know if Dr K could order it without having seen me as a patient first.. My primary Doc is great about stuff like that. But my uro had no time for me once I had the PAE done.

Joe, you may want to look for a Siemens 3TMRI machine. I think it is considered the best and I am positive that they do have these with Pelvic Coils. You may want a pelvic coil as it lays across your lap during the procedure and you do not even remove your clothes. At least I did not at Baylor Hospital where I did this MRI. 

OR, the other option is a rectal coil which as the name implies is inserted into you rectum during the procedure. Both work, both are good, but obviously the pelvic coil set up is considerably more comfortable at least I felt that it would be so I found me a pelvic coil provider. The rectal coil is not that bad I hear so do it either way. 

If you cant find one, Dr. K. has a good idea where one would be in your area. You can talk to him about it. I know he has found them for others. 

Way to go!!! Sounds like you are back in the saddle. Congradulations.

Hey Mike,

I'll give you a call later today. I like the idea of the K-Club!

Congratuations!! You certainly have those Urologist pegged!

L.

Hi Mike,

"We have quite a few skepticle people on these forums that say they want data."

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"Skeptism" is a good thing! It's not negative at all (not that you personally have inferred it is) but really part of the process of informing ourselves better to make the right decisions. Before FLA came along, the common advice here was to wait for "100 cases". I see no reason why that advice should change just because a procedure looks promising. 

Not to say I don't admire early adapters, but I think that's what those who have had FLA are, and as long as they understand that, that's fine. There is also the durability factor which is the other side of the coin of the remarkable precision FLA offers. Given the recovery period, not to mention 20-30K (Dr. S.) a pop durability is an issue.

I am very positive and hopeful regarding FLA, but there are issues that must be spoken and that is what this forum is all about. Nothing is sacred except information.

Jim

In lieu of no "edit" function on this forum, I could have phrased "skeptisim is a good thing" a little better. More to the point is that "caution is a good thing". And again, I'm not inferring anyone who has had FLA isn't being cautious, but for those thinking about it, I would hope they would view FLA (or any treatment) with caution. 

Jim

Boy to I agree with all you said Jim, and I always seem to. I would add that when it comes to BPH there are two types of victims of this condition. Those who can wait and those who have waited and have reached the end of their rope. There is nothing left but a treatment selection for us. 

Weighing all the procedures avaliable, and all the side effects of them. FLA look logical to me at the time compared with treatements that were blind and clumsy or random in their process effectiveness. 

I was in the latter group. I had to decide and CIC was not going to stop my issues. I am not yet at the time of life where I can live that way. Call it luck or God's blessing or both, I feel fortunate to have found this and the Doctor I found. 

The good news is we each get to make our decision. No one is wrong if the decision works for them. And research is the strongest weapon against both not living with the condition and treatment failure. Knowledge is power. When, in the past,  I spoke with Urologist the first six years of my BHP, I was helpless. The last three years I gained power through knowlege and I realized what ruthless, greedy, non-caring, people they are. Physician, first,  "Do No Harm" mean nothing to them.  

So all I can say is this is really a "buyer beware" problem we have. Sticking together is our only strength. I wish we could find a way to banned together and become a force to drive the marketplace. This seems it is the only way to maybe get someone looking for a cure instead of treating symptoms.

John

Always good to see we're on the same page, John.

You certainly are a great example of someone who did their homework and then made the right decision for yourself. And, reading your story, you seem to be as much as a "skeptic" as myself on any of this, and no doubt spent long weighing the alternatives.

I don't expect everyone to take your cross country, multi-doctor journey, but I do hope people just don't jump into a surgery -- FLA or any surgery -- without doing at least doing some serious due dilligence.

Because as you say, "no one is wrong". The right decision for you or me may be the wrong decision for someone else, because all our situations are different. 

Jim

Yes sir. I think we are lucky to have a doctor in this field who will speak with any man and discuss all their options honestly, and for as long as they wish to talk. I have known him to refer a patient to HoLEP as he felt after review the man's case it was the best for his situation.

He studies the films before telling a patient he is a canidate and that he believes he can help him. Then he spends the time showing him exactly how that will be done on the film of his prostate. After the procedure he shows you what was done and then explains how it is going to help. He is then at the beckoned call of the patient through recovery and he has even done house calls when needed. Try to get that from a urologist. Yes I am very skeptical and dis-hearten by urology for men. Urologist just cut away and then hope it works. Then they will tell you sorry, did my best. 

I saw Ross's films today as he shared them with me. I was not only impressed but jealous. The work that was done on his very large median lobe was something else. I saw his before and after shots. Tomorrow is his big moment and he gets to remove that cath. He has had to wear it for a while even pre procedure. I am really pulling for him and though the swelling will not be down a week after surgury, I hope he does very well.

Mike did fantastic. Much better than I did. Jealous once again!! I am happy to see the procedure improving. Dr. Karamanian now has around 15 procedures done for BPH. As far as I know, he is batting a very good average if not 1000. I am not sure exactly what it is but when he publishes we will gain a lot of data. 

Have a great holiday and we all need to remember and honor the less than one percent of American who protect us and fight for our freedom. The Military. God bless them all. 

John

Dr. K. does sound unusual, but discussing options with a surgeon who does a specific procedure always comes with a bias. Regardless of who he or she is.  As long as that is understood. Isn't that in part why you personally spoke to at least half a dozen doctors?

Fortunately results so far seem promising but at least one of his patients has not regained full bladder function and still is cathing more than 12 weeks after FLA. So while the results seem very good, not "1000". 

Yes, happy Memorial Day to everyone. 

Jim

Yes Jim I am very familiar with him and he was a very special case and I still hope he improves more. You have helped him with CIC and is progress is not finished. I will check on him this weekend. If you no him like I do you know where his special problem came from and what they told him. 

Here is to him getting better.

Hello Jim & John  I can't agree with you more.  Information is the key.  We are in control of our body's not the doctor.  We need to reseach anything we are planning to do. Pros and cons.  Anything to do with it.  Doctor kind of suger coat everything and don't talk much about the side effects.  We are the ones that will have to deal with them not the doctors.  Jim and John  you both should be very proud of yourselves.  You both did your homework.  Jim  You said no to th doctor that told you Turp was the answer.  You did CIC and healed your bladder(  I still don't know what cutting out the prostate does if your bladder is the problem )  You have help many men on here with doing CIC with the information you have given them and your kind words.  John you said no to alot of the old standered procedure.  You did you research and many phone calls to find the right one for you.  I have notice on here that after you had your FLA many men are picking FLA because of your outcomes.  You have not lost anything with FLA and ejoying all life has to give.  Many men will benifit from both of you for many years.  I am glad I found this site and have talked with many men.  That is what we need someone to talk to about our problems.  Thank god for you both.  Ken  PS  I got this in a e-mail from prostate....net a site Im on.  It was a trial that they started in 2015  It was in the American Urological Association.  It is about Testosterone and Cancer.  They found out that if you take testosterone natural or prescripton it does not trigger prostate cancer or increase the PSA.  What we have to watch is the estrogen.  They found out that estrogen is the main cause of cancer. So please have that check and keep the estrogen at a good level.  There was a big article but this is just a small amout.  Take care all leaving in a few hour for Georgia for the weekend for a birthday party Grand Daughters 5th