Greenlight or TURP for BPH?

Hi David, did you have a large median lobe ? Thanks. Hank

I don't know if I did or not.  I asked the IR what happens if I do.  He said if it doesn't work the first time they are successful 50% of the time on the second  try, and that a prostate larger than 80 usually have the entire prostate enlarged.  As IR's do more of these I would guess they are finding out what embolization techniques to use on large median lobes.  So 80% plus half of the 20% equals 90% with no side effects.  Urologists hate this procedure since they don't do it.  I used to communicate with a urologist who when I emailed about PAE wouldn't email me back.  I believe many of the posts on this site who criticize PAE are disgruntled uros, who see their surgery money going away.  Who wouldn't try something with no side effects with a 90% success rate.   

This is a 2012 description of PAE from Southampton Hospital in England that will need to be passed by the moderator.

http://www.uhs.nhs.uk/OurServices/Radiology-scansandimaging/PatientInformation/Prostatearteryembolisation.aspx

 

So what's the point?  Posting something 6 years old?  Da!  There are much better current descriptions on the web including videos.  The tiny risk of the hazards are strictly theoretical and if you have an experienced IR are almost zero.  How about the risks of Turp, Holep, etc that the uros do.  The screw up the lives of many men.  You might be a urologist in danger of having your livlihood endangered.  Whatever happened to the ethics in medicine?  If you put all the procedures side by side PAE is the lowest risk and least invasive, and importantly doesn't impact doing any other procedure if it doesn't work.   

What's the point? Has the basics of the preparation or the procedure changed since then ?  Obviously Southampton hospital have not felt the need to update it and they were the first UK hospital to do trials of it.

Calm down you seem to have a bee in your bonnet about fake news from endangered urologists:-)

David, the PAE sounds like it's the best option for me, followed by HoLEP and FLA. Can I ask you, what was the procedure to get a referral to an IR? I've already resolved to get a 2nd (and possibly 3rd) opinion from a urologist, but I don't know where to start in getting a referral for a PAE. I don't really even know what an IR is...

I should have said followed by REZUM, THEN HoLEP or FLA. I've got a new appointment with another Uro on the 30th to discuss these options. t will take some very heavy pressure to even consider TURP or Greenlight at all. Thank you to ALL the respondents! 

If all you're offered is TURP or Greenlight you should resist the pressure and find another doc IMO

TURP is barbaric.  For you is the Best FLA.  Im going for FLA at April 3rd.  Stan

It is thanks to all you gents that I’ve realized that. I’m really grateful for the responses.

If you are pro HoLep why are you against GL? I don't see a great deal of difference between them apart from HoLep saving tissue for a histology report. HoLep is evidentlr a more difficult skill to learn.

What will the next Uro be able to say to finally sway you? The Uro at the UK hospital where I had GL in 2004 said in 2012.

"As far as the laser options are concerned, there have been 2 major upgrades to the Greenlight laser from the machine I used for your surgery.  We have had one of the latest machines here as part of a study which has allowed us to look at it and the consultants involved have been keen for us to continue with this latest machine.  Generally however in the department the view has been that we should adopt the HoLEP procedure and so that is the direction in which we are moving currently. For yourself both laser options should be OK.  The key will be that the team looking after you have the laser that they are happy with". 

So many procedures, I get them a bit mixed up. To clarify, my money is currently on Rezum procedure, with all others taking a back seat. I’m sure you’re right: HoLEP of GL are essentially the same? My plan: 2nd and 3rd opinions, then go from there. My sexual abilities take highest priority, that and recovery time. And I have the luxury of having time enough to do all this SLOWLY. Thanks so much for the input. All of you are doing me a great deal of good. I’m finally less of a nervous wreck about the choices. 

UK hospital not updating tells us how poor medicine is in the UK.  I can assure you techniques, equip and embolization particles have advanced dramatically in 6 years.  The procedure worked great 6 years ago and even better today.  It is difficult to debate the luddites who want to protect surgery rev $.  Turp, GL, HOLEP and all barbaric.  Cutting, trimming, torching, etc.  I have no ax to grind except the success I had with PAE.  I want more men who desire sex life preservation to get the help needed.  Over the years I've had urologists tell me things like your sex life should be done at 65, your prostate is the size of a VW bus-we will have to put you under a general to extract it, and many other horrible things.  How can these practicioners who remind me of the torture chambers of the mid ages actually call that medicine and then not want to explore the clean, non invasive, simple procedure of PAE.  A mystery to me but just want to encourage many others to look into it.  Good luck to all.  I am not an IR or Uro.

Southampton was one doing trials on PAE so it is surprising that part has not been updated as Southampton are usually to the fore with most medical procedures.

The local private Spire hospital is still doing PAE.

Imperial College Hospital in London are now using an endovascular robot for PAE but is 70% having improvement ground breaking or 40% reduction in size really ground breaking.

Dr Hamady added: “Following prostate artery embolization, over 70 per cent of men gain improvement to symptoms with 30 to 40 per cent shrinkage in the size of the gland. Using robotic technology in this way will enable interventional radiologists to further increase the safety and efficacy of the procedure. The introduction of robotic prostate artery embolization is a remarkable milestone that widens the scope of treatment options offered to patients suffering from prostate hypertrophy.

Yes I belong to these 30 %  unhappy men  with  poor effect  even after  some months with  radical  worsening.   Be aware, if you have  big median  lobe, especially  IPP ( median lobe  protruding to  bladder ),  PAE has no, or minimal effect.   Going to FLA in  2 weeks,  Stan   

 

I did a bunch of internet searching and came up with two IR's in the USA.  I am not supposed to give names but you can find that from searches.  One is at Un of NC in Chapel Hill, NC.  That's where I went and had great success.  Price is only about $6500 and now covered my medicare and many insurance co's.  The other is an IR in Virginia.  Both have done hundreds if not thousands of procedures.  If you live on the West Coast of USA there is a dr who I believe was trained by the UNC dr who works at UCSD.  Very convenient for Western US but don't know how many he has done.  Good luck.  IR is an Intervention Radiologist.  Work with Fluorscopes and tiny catherters as opposed the UROs who work with cutting, laser, burning, etc.  As I've said before, success rate of 80-90% and a simple 2 hr procedure.  No bleeding or muss or fuss.  If it doesn't work all the other stuff is doable.  On the contrary, what if you had a GL. HOLRP or Turp and have Retro Ejaculation for LIFE.  I tried drugs for BPH that gave me RE.  Organism is weak, nothing comes out and it doesn't fully empty prostate which gave me Prostatitis or LUTS symptoms.  

Thanks, David.