Going with Focal Laser Ablation for BPH

John  Great news.  The doctor told you not to worry.  Enjoy  Ken

WOW John that is great news. Only better and better, I am so happy for you buddy.

As others have mentioned uros are going to be dismissive of PAE and FLA because they're done be intervention radiologists not uros. Urolift seems like a temporary solution because they're just compressing prostate tissue and not removing it.

Re urolift - I've had five 3T MP MRIs over the past 3.5 years and had the images read by 4 different interventional radiologists (IR). (I have GS6 PCa). When I investigated Urolift, I gathered the info and asked the urologist as well as two of the IRs their opinion on how urolift may impact using MRIs for ongoing active surveillance.  The urolgist told me - no problem, it is MRI safe. The IRs said - while that is technically accurate, both the compression of the gland as well as the tabs themselves on the interior (urethra side) and exterior of the gland would impact the reliability of the MRI for ongoing AS.

While the interior clip can be removed, the exterior one cannot. As a result of this information (and the fact that your gland will continue to grow) I no longer consider Urolift as one of my options.

Personally, FLA is my Plan A - If/when I move forward, I would have both the known/visible GS6 lesion ablated and additionaly tissue removed to help resolve the urinary issues. Two birds...one laser.

He will be because a urologist do not do them.  If he is a good doctor he should want the best treatment for you do matter if he does it or not.  My urolift is going on 2 year.  Been doing great  Ken 

Hello .. Urolift may be tempory for some men but it has been going strong for many.  Sometimes that is all you need.  My urologist has been doing them from 2013 when it was appoved.  I'm stiil in contact with a few of the men that he did the procedure on in 2013.  I had mine done in 2015.  I talked with them before I had mine done.  Take care my friend  Ken

Will Tim that is a different story.  With cancer you have to get rid of the tumor.  Urolift is only to open up the prostate.  FLA will be very good for you the doctor will map out the prostate and get rid of the tumor and stay away from the rest of the prostate.  I have heard very good results for both cancer and BPH patients.  Good luck to you and my god bless  Ken

Tim said: While the interior clip can be removed, the exterior one cannot. 

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Hi Tim, This was also my impression although some here have suggested otherwise. I wonder if you can expand on this and how having a permanent exterior clip could effect further sugical options like laser, PAE, FLA, etc. 

-- Jim

Wasn't he saying it would effect the MRI image since he has cancer in the mix.

I've heard part of the clips that cannot be removed (exterior?) may or may not preclude other types of future surgeries. Sounds like Tim has done a little research on it so wanted his input. Haven't heard about the MRI issue until now. 

Jim

I spoke with a representative of the company that makes Urolift (on the phone), as well as a urologist (in person). The part of the device that goes through the prostate and anchors on the 'outside' is in your body forever as would be most of the connecting 'wire' (suture).  The way removal was explained to me, it starts  similar to insertion. They use a tool to go into the uretrha, push in on the prostate and clip the suture, removing the interior (urethral side).

The following is from the FAQs on the Urolift site:

"The implant is made up of standard surgical implantable materials: a nitinol capsular tab, a stainless steel urethral tab, and polyester suture that holds the two tabs together. Your doctor can simply remove the implant, if needed. The suture can be cut and the urethral endpiece can be retrieved with a standard grasper. The capsular tab will remain outside the prostate capsule in place."  [emphasis mine]As for potential MRI accuracies - According to the two IR's I spoke with: any potential lesions in the area of the clips as well as where the gland is compressed may be obsured or more difficult to identify.  Both IR's had seen images of men with the device and both stated they felt it would have a negative impact on the usage of MRIs for diagnosing PCa as well as monitoring for active surveillance.

I appreciate that the number of Urolifts performed is still not that large and the number of men using MRI for AS/diagnosis that may have a Urolift a very small percentage of those, so the available data is likely very tiny. But, I do think this is something to be aware of before choosing this procedure.

Thanks Tim. Very useful information!

First of all I would cancel and get a second opioion you only have 7 days.  I would never put my father at that age through a TURP alot of bleeding and other problem.  He would be better off with the holep ot the Thulep.  Just tell the doctor no for now and get another doctor to talk with .  Ken 

Some men that are younger have a better out come but sometime you end up having another one to fix the first one.  Cancel for your father sake and get another opioion.  Your father has the right to get what ever he want not take what ever the doctor offers  Ken

Thanks for the advice, Ken. My dad's surgery was scheduled so quickly because of a cancellation.  He's thinking of postponing it.  Turns out his internist referred him to Dr. Humphreys for Holep/Thulep (Mayo Clinic in Phoenix), but my dad forgot about it until I mentioned it. Dad is calling internist right now to "revive" the referral.

I called Dr. H office, gave them dad's info, waiting for call back about possible appointment. And I'll send messages to some folks on these forums who had Holep/Thulep with Dr. Humphreys.

(Glad to hear UroLift has worked well for you)

Glad to hear you're looking in to HOLEP. Seems like a great procedure that is my second choice. I'm thinking FLA but its not covered under insurance so its quite a bit of $ out of pocket. 

You mentioned the quick scheduking of the surgery. My first uro did that to me. He had the scope stuck up my pecker telling me I wouldn't want to try fernateride to reduce size. Said you need surgery pulled the scope out and walked out of the room. I was in shock. Called to get a consultation and he wouldn't tell me exactly how he was going to remove my excess prostate tissue. HE said he MAY use laser, wire loop, heat, and a few other things. I canceled my surgerya dn never went back to him.

I'm also looking at FLA, my dad could travel to Houston. I'll call Dr. K office in the morning. I'm curious if he has trial set up yet.

I don't believe he has a the trial set up yet. I spoke to him Friday night. HE is putting the paper work together for it. 

Good to know, thank you for that info. Did Dr. K give you info about:

1. If/when he will select patients for the trial

2. When the trial would start

I'm not sure how/when he is selecting paticipants. Maybe first come first served, maybe there will be some criteria  for patient selection.

I think the trial starts in February

Thanks, I'll call his office tomorrow. If I learn more I will post it here.

Glynell  Did you cancel your father's procedure It seam they are pushing him into it.  Does he have a catheter or can he try CIC until your able to get more information from the other doctors..  Why have something you don't want.  I think it would be much easy for your father if he had the holep or Thulep Have him cancel  they is to much bleeding at his age I feel it's not safe.  Younger men have a better chance for that surgery Please think about it would you don't want anything to happen to him.  His doctor should know better  Ken

Thank God  Ken

That isvery good procedurer K cares about his patients  Did you cancel  Ken

Ken, my father is going to cancel his surgery tomorrow, or at least postpone it. He is very receptive to learning more about Holep/Thulep. His internist had referred him to dr. Humphreys at Mayo in Phoenix, but you're right - the urologist referred him to a surgeon who recommended TURP.

My dad has had a catheter for about 6 weeks. He is going to learn about doing self-cath (is that CIC?).

I learned a TON of info in a short period of time on these prostate forums. Thanks for your message.

You know if he has time it would do him good to find out about HOLEP. ITs actually a great procedure with very few side effects. Very little bleeding, short catheter time, results are very durable. If you search the internet you find almost no mention of post HOLEP complications from people that have had the procedure. If it wasn't for the retrograde ejaculation I would do it in a heart beat. My only fear of FLA is longevity of the procedure. 

Hi Glyn,

Yes, self cath = CIC (clean intermittent catherization). It will buy your dad time to make the right decision and at the same time free him from being tethered to Foley 24/7. And what many don't know --- they certainly are not often told -- is that CIC can allow you to function as well as any surgery without the risks and side effects, and at the same time protect both your bladder and kidneys. Some of us here, including myself, have been practicing CIC for years while either waiting for better surgical solutions or just as a non-surgical option for their prostate and urinary tract symptons. 

Check out the cath threads here for more information as to types of catheters, technique and optimal cath stategies. 

Jim

Unk and Glyn,

Just make sure your dad understands the possiblity of retro ejaculation (dry orgasms) with HOLEP. If he hasn't experienced retro, have him do a trial on a retro reducing drug like Tamusolin so he understands what it's like. Some men don't mind it at all and consider it a good trade off for fixing their BPH symptons. Others, aren't willing to live with it and therefore look for other types of surgeries or procedures. 

Jim

Jim, Thanks for the recommendations.

With CIC - can you run/bike/swim?

Glyn,

"Yes" on all three. Unlike with a Foley, with CIC the catheter is only inside the bladder for about 30 seconds at a time, and only several times a day. About the same amount of times times you would be heading to the toilet to urinate anyway. The rest of the time, your dad can do any activity he was able to do before he had the Foley.

In fact, he should be even more active because with CIC his bladder will be emptied completely every time he does CIC. That means in most cases, less urgency, less leaking, fewer bathroom trips and a more restive sleep at night. Pretty much the same benefits one would receive from a succesful surgery like HOLEP, except without the risks, recovery and retro ejaculation.

Jim

Great to know, Jim! I'll send you a PM to get more specific info.  Thanks so much

Yes that is good It will give you and your father time to get the information you both need.  With CIC  If you need any help They is a guy on here name JIM which he can help your father with it  Ken

Jim  I think he was on a pill that gave him retro  I think he said Flomax.  That will cauce it.  I'm glad you have came in on this one.  I think he is being rush.  you can help him with CIC to give him some time  Thanks Jim  Ken

Thanks, Jim and Ken. I am now reading the discussions jim started, i.e. self-catherization-an-alternative-to-turp-greenlight-holep

Hi Ken,

I am not that familiar with his father's situation, and it may turn out that HOLEP is the best procedure for him, but I think both you and I believe that no one should rush into any procedure without exploring the options and having all their questions answered. CIC will buy him that time while getting him off the FOLEY. We've got a growing band of CIC afficionados here to help.

Jim

Yes that is true That is why I gave him your name you know a lot about it  No man should be rush into any procedure.  I hope the other doctors can help him out.  At 82  I feel that the holep would be much safer for him then a TURP Thanks Jim  Be safe  ken

I talked to Dr. K office today about FLA trial:

1. As of today the cost for participating in the trial is $14,000

    if not in the trial cost is $20,000. As far as I could tell there aren't any cheaper options (perhaps they already have some folks who are getting $free or $cheap deal, so they need to get $$$ from other patients)

2. For my dad's case they are interested in having him in the trial IF he can stop using the Foley cath. (I will ask further questions, such as if he does self-cath will that help?) And he has to get MRI

3. They will send me more info via email. When I review that info I will post relevant info here.

I think my dad will choose to go with Holep/Thulep with Dr. H at Mayo in Phoenix. And will try out CIC with Jim's excellent guidance. 

 

Hi Glyn,

Per your #2, try and clairify if a successful TWOC (trial without catheter) is a prerequisite for the trial. A successful TWOC means that your dad would have to be able to void without any type of catheter, be it a Foley, CIC, suprapubic, etc.  

Also interested in an other exclusion/inclusion criteria for the trial such as size of prostate, median lobe, amount of PVR (retention), IPSS score, history of prostatitis, etc.

Jim

Hi Jim, when I receive email from Dr. K office I'll review if trial criteria is included. If not I'll write back and ask for it. IF/when I get it I will share it.

Thanks Glyn. I think one other important question for anyone contemplating this procedure, trial or not, would be to ask Dr. K. how many FLA procedures has he performed specific to BPH/LUTS as opposed to for prostate cancer. And, what kind of results he has gotten. Right now, I think we only have John's case which has gone very well. 

To change the subject a little, how is your dad doing and does he have a date when they will remove the Foley. Will there be an experienced cath nurse or someone else experinced in CIC to show him how to use the catheters which might be helpful although some have gone ahead with very little instruction. If so, I would try and get the catheters you want in advance -- such as the Speedicath Coude -- as many times Cath  nurses will just pull off the shelf whatever they typically use or have in stock and not necessarily the best cath for the patient.

Jim

I'll talk to my dad later this afternoon about plans to remove Foley. Yes, I agree he should have medical staff experienced with CIC show him how to self-cath, and do it with pre-ordered Speedicath Coude. I'll ask him to check with his urologist staff about this - or his internist, who is a geriatric specialist.

Glyn,

Sounds good. Since it sound like he may not be able to void on his own, it's important that before he leaves the office that he successfully does a self cath and feels confident that he can do it himself at home. Otherwise, he'll just be back at the doctor's office for another Foley. My suggestion is not to make a Friday appointment for this because if things go wrong, it's always on the weekend when the doc is away

Jim

Good advice - again.

Hey Buddy  I think that may be the best option for you father.  $14.000 is to much for a trail and they are getting the information  Let us know  Ken