Has anyone out there had a "Prostate Artery Embolization??

I'm not a doctor but a patient and I'll share my experiences.  My first biopsy was transrectal.  I developed septacaemia and was admitted to the local hospital as an emergency, where I spent four ghastly days.  Of the 16 cores, one showed some Gleason score 6 (precancerous) so I had a second biopsy - transperineal.  The consultant was incompetant and I had to be catheterised, from which I got an infection.  I had a persistant UTI for three months trying every antibiotic in turn until I ended up with daily home visits from a nurse to give me Gentamycin.  I'd need a lot of persuading before I had another biopsy!

Since then my cancer (or pre-cancer) has been monitored by MRI annually, and I'm glad to say no change has been seen.

I can't comment on BCBS because I had my PAE done under the NHS in the UK.

In spite of what I have written above, the PAE was a huge success in every parameter: flow rate, urgency, hesitation and frequency all fixed.

Good luck!

My PSA was 9.8. I had no trouble urinating getting up only a couple of times at night. My GP convinced me to see a urologist.  Of course he reccomended a biopsy. So I had a 30 core transperineal biopsy. 

Good news was that there was no cancer. Bad news was that was when my Prostate problems began. 

After the biopsy I couldn't pee very well. 6 times a night. I had to go onto Flomax and am now on 2 per day. 

Im having a PAE shortly. 

My advice is yo be very careful about getting onto the Prostate conveyer belt. 

I believe there is a blood test that is much indicative of cancer than the PSA. Can't remember the name...sorry. 

You are probably just as safe to do nothing. I have met two GPs and one specialist who refuse to have their PSA tested. 

I believe the blood test you are referring to is the PCA3. Not conclusive when its negative. So one is still left  guessing. But not invasive. Conclusive when positive for cancer. But not recognized stiill. I had one 5 years ago which gave me some peace of mind. My symptoms however did not. All pain burning. Let me know how your PAE turns out. And I think the first and second and third biopsies  created most of my problems. High PSA - biopsy. biopsy- high PSA. 

As I understand it, a 'clear' biopsy is of course good, but it does not mean the prostate is completely free of  cancer, just that none of the cores taken hit the spot.  Transrectal and transperineal biopsies sample different parts of the prostate.  Of the two the transrectal is the least unpleasant but has supposedly a 2% chance of causing an infection.  The transperineal is even less likely to cause an infection, but if you have to be catheterised afterwards the chance of infection is very high indeed.

 

You're right about that but one would think that 30 cores would be sufficient. Of course the only accurate sample is a 100% one but then it wouldn't be a sample.

In hindsight I regret having had the biopsy.

My oncologist (I previously had lymphoma) told me that he refuses to have a PSA test. ..he'd prefer to take his chances.

Large studies show that the mortality rate is virtually the same for large cohorts of men who have no testing at all and those who go the PSA/biopsy route.

I've read that biopsies often cause other problems.  Also, if you do have cancer it's possible to spread the cancer to other parts of your body.  I think most men will die of other causes before prostate cancer kills them.  Even the inventor of the PSA has said the test has been grossly misused.

Totally agree Mike, I wished I'd have thought longer and harder about having my biopsy.

The urologists are very blase about the side effects...he told me...don't worry ...it's nothing.

The fact is he's making money out of it...Pretty hard for them to he totally unbiased.

I had to pay for my PAE out of my own pocket.  I had to fly to Virginia.  The cost at the time (Sept. 10th, 2014) was $7,000 but as I understand it they have no raised their prices to $13,000.  Iam 64 and BC-BS considered it "experimental" and wouldn't pay a dime.  I did not have a biopsy so can't comment on that.  I did have a preliminary MRI and some blood work.  Iam still getting up on average 4 times a night to pee.  But Iam "finally" off that damn Avodart and Tamsulosin.  I hated what those 2 drugs did to my sex life.  My sex life now is great.  No problems at all.   Iam going to start a new discussion and ask if any one out there has had a "TURIS".   That is what my urologist is recommending to solve the 4 times a night to the bathroom.   Good Luck to You and To All.

I can't find my last post so will start here. 

Well so far so good .....I have had my two prednisone injections. One was yesterday and one today. No stomach upset whatsoever!!! Yes!!! PAE will be tomorrow in Sydney at 9.30am. I was never worried about the PAE process itself, just the oral prednisone I had that caused me so much grief. 

Im really confident about tomorrow now that the prednisone issue is resolved. 

For those of you considering this process but like me are allergic to contrast dye, insist on IV prednisone rather than oral. 

The contrast dye is essential for the preliminary CT angiogram which maps out your arteries and for the process itself which allows the radiologist to follow the roadmap right into your prostate artery. 

The prednisone diminishes the risk of an allergic reaction.

For anyone living in Australia, Dr Glen Schlapoff of Liverpool Hospital is the guy to contact. Contact me privately for his contact details.

I'll be brief....I had PAE yesterday. All went well. Doc says it was technically perfect...beads place right where he wanted them. No prednisone issues or allergic reactions. I stayed overnight but am home now. 

First reaction on waking from Anaesthesia  was II strong desire to urinate. Strong stream initially but then it degenerated to strong urgency with only small spurts. I was a bit worried about this but improved this morning to strong but urgent flow...can't stray far from toilet but hey...it's only 24 hrs.

Penis is very sensitive at end of flow...Doc thinks there may have been some irritation caused by catheter during procedure. 

I have dull dull pain in area of prostate but of course this is caused by all my prostate cells screaming in unison..." what happened to our blood supply" :-)

All in all I'm pretty happy....just wiped out by whole thing. 

Ill post a day 3 update. 

Had a very similar experience.  It can take a while to see results sometimes.  Three weeks for me.  Had some dull ache in the prostate area about two week out as well, but theat passed quickly.   I also had a lot of bruising but that cleared up in a couple of weeks.  Get some rest and good luck!

The evening of the day after I had the PAE I had a fever and rigors for just a couple of hours.  I called my consultant and he said it was my body getting rid of tissue that had died.  But it soon passed, and that was the only side effect.

Good luck!

Thanks Bruce and Roseland....very encouraging.  I think I'm as good as can be expected in 24 hours. I even managed to do some useful work with clients over the phone. They didn't know I was in hospital or they wouldn't have called. Come to think of it Roseland, I am feeling a little feverish with chills...nothing serious. 

Caringbah,

Glad to hear you are doing well. I had minor burning when urinating combined with a strong urgency for about a week after PAE. Then everything started to work beautifully. I am six weeks out now and could not be happier. I had mine done in a clinical trial at UNC Chapel Hill NC. It did not cost me anything for the procedure. Medicare picked up miscellaneous tests and the procedure was free as part of the trial. I would be interested to know where others have had their PAE performed.

William , thanks for that . When I experienced the burning I was convinced something was wrong. Turns out that it's common. 

Im already experiencing a strong flow at night which I haven't experienced for  a long long time.

I had mine free as well courtesy of Australian Medicare. 

Im looking forward to getting the first week behind me. 

Well it's 7 days now and I declare my PAE to be a complete success. Very strong flow whic quite frankly amazes me...I thought I was going to blast a hole in the bottom of my urine bottle last night. 

My wife and I have test driven "the equipment" and everything is AOK with no retro. I'm sure glad I persevered with the PAE despite the early prednisone problems. 

I'm a very happy camper!

Yay! Congrats!

Outstanding!

Caringbah,

welcome to the PAE success club. If yours goes anything like mine, it will only get better. 8 weeks for me now and I feel like I am a new man. No pain, no side effects, just some great working plumbing. I hate it that some may be discouraged by negative comments on here and recommending other procedures that have a lower success rate.

I totally agree William....it's the least invasive, no impotence, no permanent incontinence, no retrograde ejaculation, no bleeding and quick recovery. 

I would recommend it to every man suffering urination difficulties due to BPH. 

I certainly would not consider TURP or laser before PAE. I mean why would you?

I think there must be a growing number of worried urologists out there. 

I have a friend who has had 3 Turps. Can you imagine being butchered 3 times? Unfortunately the Urologists just don't know any better yet. Hopefully as more and more of us have success with PAE it will become the new gold standard and be readily available everywhere and covered by insurance. I feel sorry for those who just accept what their Urologists are telling them without doing hours of research on their own. There are some other pretty good procedures, but they all had limitations that kept me from being able to try them. Thank goodness or I would not have found out about PAE. 

It defies belief. There are a lot of uninformed urologists out there. Personally I don't have much time for them. I was referred to one female urologist who told me because my prostate was over 100cc she would have to do open surgery on me ....told me it was the gold standard!!! I just looked at her and walked out. 

You really have to look out for your own health and check on what your GO and specialist tells you. I even check all the prescriptions....it's amazing what you find but that's another story. 

Thank God for google is all I can say. 

Congratulations! You are an example for us all. Where was your surgery done? Who was your doctor?

Neal

Thanks Neal . I had it done in Sydney, Australia at Liverpool hospital by Dr Glen Schlapoff.

I highly recommend him....great guy, caring and competent.

No doubt about the advantages of PAE, Peter!  As you know, this is what I wanted to do in the first instance, but as I had no flow at all and had been wearing a catheter for some weeks, I realised quickly that PAE was not going to work fast enough to be useful for me.

So in the end I went to an excellent urologist in Sydney, Australia who gave me a HoLEP.  The results were pretty good after the first few days of discomfort, some bleeding etc, and the flow returned like that of a 20 year-old.  My GP said "you'll be able to sign your name in the snow again" - but my handwriting is nowhere near fast enough!!

I actually thought the procedure was pretty effective bearing in mind my prostate was "exceptionally large" and took three hours of surgery to blast away.  The urologist says he extracted about 70 gms and calculates he would have vaporised 50 gms more - and that's in addition to what he left behind! 

The prostate had my urethra completely blocked, but that's sorted now.  Three weeks later an infection (UTI) began to develop and has been with me ever since.  I don't think it's much to do with either the urologist or the procedure.  Just something that happens to people in hospitals these days.  I'm busy working my way through the range of antibiotics while I wait for the pathology people to grow a culture that should tell me exactly what to take.

Anyway - Peter's news is great and should be an inspiration to all

I guess what I'm saying is, Don't close your mind to urology, especially if your prostate is very large.  TURP wouldn't be my first choice, but HoLEP seems a viable alternative.

Caringbah,

I'm delighted to hear your news.  Mine was 21 months ago and I'm still enjoying the benefits.  It has been life changing.  I hadn't appreciated how much sleep deprivation was affecting me!

It does seem there are some patients who get excellent results (as you and I have), some see no benefit, and only a very few seeing a small improvement; it seems almost binary.  Does anyone know why it only works in some patients?

Well it's 3 weeks now since my PAE and this  will be my last update. It just gets better every day. No problems whatsoever...strong flow., only getting up 1-2 times a night now and that's probably because I drink two mugs of tea before bed. 

I really think that PAE is the best way to go....so much easier and less invasive for most cases of PAE. I would strongly urge anyone considering TURP or laser to check out PAE before you do anything. No incontinence, no impotence and no retrograde ejaculation. Can't get much better than that. 

Thant,s great Caringbah, welcome to the PAE success club. I am at 9 weeks now and my symptoms are still great. Strong flow, no urgency, rarely have to go more than once at night, many nights no at all. I am a heavy coffee drinker and still have these good results. Also like you I have had no sexual side effects. I hope that this procedure will soon be more readily available for others. 

I totally agree William ....everything just gets better every day. Night time get ups are fewer and fewer...it will be interesting to see where the improvement will plateau. 

I feel sorry for the poor guys who need this procedure but don't even know about it but instead are getting butchered by urologists performing "gold standard " TURPs. 

I make a point of telling guys my age about it ( I turned 70 a couple of weeks ago but still working full time)

I told my GP about it today and he said he would study it and most likely reckoned it to guys with BPH.

Totally agree...TURPand laser surgeries are barbaric, had one and they suck.

I just had a PAE and it was a breeze compared to my TURP 2 and a half years ago.

Urologists are totally out to do these procedures for money and they  often don't help much. The recovery time for me was 3 months plus with little improvement.

Hi

Your experience sounds horrendous but sadly not that uncommon!

I have  BPH and am going to have PAE under the current trial in UK.

Re the PSA test I have no intention of even having that taken to be honest, as from my research if it came up high I would then presumably be facing a biopsy which I would refuse. PSA levels can be raised for all sorts of reasons and is wildly innacurate. I have a had an MRI as part of the exploratary pre tests for my PAE and I believe that will show if there is any PC present. My question to you is did you have the PAE after or before the biopsises and diagnosis of PC? And can you tell me which hospitla you had your PAE done at?

MAny thanks

Jeremy.

Hi again

I hope you saw my question to you as I notice your post is 8 months old

thanks.

I had my PAE done at Southampton in August 2013, under Jon Dyer (Urologist) and Nigel Hacking (Inteventional Radiologist).  I was patient 31 on the trial.  The procedure was actually done by Tim Bryant, under supervison from Nigel.

I had a large prostate (150ml) and Jon Dyer wanted to rule out PC, so I had a transrectal biopsy.  That lead to septacaemia and an in patient stay at the local grim NHS hospital.  It showed one core (out of 16) to be Gleason score 6, so I had a second (transperineal) biopsy.  That caused my prostate to swell, and I had to be catheterised, and from that I got a ghastly UTI.  That showed all clear, so then I was accepted on the trial.  My PSA went from 12.6 to 2.4 after the procedure, although it is slowly climbing (now 3.6 over two years after the op).  PSA is meaningful only as a relative measure.  The number should be assessed against prostate size (a large prostate will always give a higher PSA).  My prostate shrunk from 150ml to 74ml, as assessed under MRI.

I think a 3T MRI is a far better way to monitor PC, but it is expensive.

If you go to Southampton please give the guys there my regards.  If you want to discuss it, then PM me and I'll phone you.

The PAE procedure was a walk in the park and gave rapid and dramatic improvements.

Good luck.

Andrew

Hi Andrew,

So it sounds like it came down to money then , otherwise from what you are saying they might have done a 3T MRI (is that different to a normal MRI?)

to establish whether there was PC.

I went to Oxford Churchill under Dr Ross Tapping last week, also under a trial and  had MRI and CT scans. NOt had results back yet but hoping they are all good so I can go ahead with the PAE.

I would like to chat on phone  so will PM you.

regards

Jeremy

Did not ever find out if BlueCross BlueShield covers Prostate Artery Embolization?  I also have BCBS.

It has been over a year ago hopefully you will reply.

Thank

Hey Ron, just to let you know BCBS of TN paid for mine last January. It still cost me about $2200 out of pocket tho. The hospital/ Dr wound up charging the insurance around $32,000 as opposed to the $6,500 quoted for cash price. But either way for me personally it was money wasted.  Glad it works for some but if you have the median lone I would look further. Just my opinion.

Joe,

   Did the PAE help you in anyway?  It had no affect on the median lobe?  My median would be my main reason to have a PAE? Who was your doctor?

Ron

Ron I really can not say that it helepd any at all. My prostate was only 24 cc so it was not enlarged greatly. Most likely most of my symptoms are caused by the median lobe, which is why I am very interested in the new FLA procedure . My DOC was Dr Isaacson and I really thought the world of him and  his staff. But as soon as he decided it was a failure, thats pretty much that.. He told me I could have another PAE, a Turp or have prostate removal.

I really do think it is a good procedure, but not sure if it is really for guys with the median lobe.

Hope that helps J 

Joe I had the exact same experience with Dr. Bagla.  He was terrific until he saw that the PAE was a failure.

I've been actively looking at BPH treatements for about a year, I still am not clear on what causes the problems.  Many men without a median lobe suffer with BPH problems.  My uro says I have a large median lobe, but Dr. Bagla said it shouldn't be a problem. 

What did have a remarkable effect was the steroids and pain killers that he gave me during the procedure.  I did great for about a month.

Are you considering a different procedure?

I'm kinda pondering addressing my inflammation before cutting or drilling or burning any body parts.

JJJ,

Google "Role of Inflammation in Benign Prostatic Hyperplasia" by Bilal Chughtai and others, for what I think is a fascinating 2011 study about the relationship between prostatic inflammation and bph. Also, some interesting tidbits on saw palmetto which some studies debunk although after reading the study I think it might be worth a try if I fall into that part of the bph population with an inflamed prostate.

On a personal level, some of the conclusions seem to correlate  my own experience with occasional bouts of dysuria and acute urinary retention, where I have felt for some time that an almost asymptomatic form of prostatitis/inflammation may be involved.

As to the "remarkable efffect" the steroids had on you post treatment. (btw what exactly did you get and how were they administered) -- there are only several studies out there with mixed results but at least one of them suggests some temporary benefit (one doesn't). The conflicting results could be that the different patient populations had differing degrees of inflammation per the first study I cited. 

I also wonder if you possibly suffered a steroid rebound effect post PAE. Would you say your LUTS symptons after the steroids wore off were better, about the same, or worse than before the procedure. Because if it were the the latter, then you might actually have been better off not taking them in the first place.

Jim

 

Steroids definetely deal with inflamation. I have an enlarged spleen and it got really painful several months ago, protruding into my ribs so I couldn't sleep on my left side. I had an infusion (an IV bag) of prednisone which shrunk the spleen and eliminated the pain.

Joe,

I'm starting to get the feeling that while the IR's are very good at doing their procedure, not so good in terms of pre-screening patients as well as overall knowledge of voiding mechanics. This could account for great results for some, not so great for others. Also accounts for the discrepency between "technical success" and "clinical success". The former simply means the procedure went as it should have. The latter means it actually helped the patient. Obviously, clinical success is the only thing that interests us.

But giving the IRs a bit of a break, the same criticism could be leveled at many uros. Seems like they are all satisfied with their *overall* success rate but not too interested in digging deep and reviewing the failures. In other words at the end of the day they are more technicians than clinicians.  So that just leaves many of us at a sort of medical dice throw. 

Jim

Joe,

  I am 69 years old.  How old are you?  My prostate is 40cc.  My prostate is enlarge but moderately.  I guess 30cc is high normal for age 69.  I also believe the main blockage is due to the median lobe.  What is the FLA procedure?  Will urologist remove prostate that do not have cancer?  Every urologist I have talked with only remove prostate if it has cancer.  I would really think toward having mine removed usind Da Vinci Robotic system.  I know two guys that had cancer and had their remove using Robotic and they both came out of it without any complications/

  It really scares me to think about having to have a TURP due to all the problems I presently have going on.  Initially it was called interstitial cystitis.  Today it is call Chronic Pelvic Pain Syndrome.  Been told that it involve all the inflamed nerved of the urinary track which involves the bladder and prostate.  I am constantly in pain in my bladder area and at the some time I have constant rectal pain.  It is not fun.  If I have TURP is most likely will be worse due to inflaming it more with removal of bladder and prostate tissue.

I am slanting toward TURP but I may end up in a pain clinic.  It is a roll of the dice as one of my urologist told me.  Roll of the dice in the favor more pain.  I have considered having cather installed into my bladder and urinating like that the rest of my life.

Ron

Hi Ron,

Depending on your specific symptons, consider self catherization (CIC). It will give you similar benefits to having a catheter installed permanently but allow you to live a more normal life because the catheter only goes in a few minutes a day. You don't have to do it permanently but it will buy you time to consider other procedures including some of the newer ones like FLA. It also may turn out that it solves your problem in and of itself. I've been doing CIC for three years now and found it to be a very good solution to my obstruction caused by an enlarged prostate.

Jim

Jim,

   You have been doing CIC for 3 years.  If the catheter installed permanently does it have to be removed at some point and replaced with new catheter?  I do not know anything about catheter expect the time that I self cathed for anti inflammatory medication.  You said something about the catheler only goes in a few minutes a day?  What was FLA? Do you cath everytime you have to urinate.  Do you get bladder infections often cathing?

I am responsing to so many that I get somewhat confused at who is who unless I go back through the blog.

  What was the size of you prostate?  Do you have median lobe enlargement?

  Chronic Pelvic Pain is caused by the nerves that run throughout the bladder, prostate, and pelvis.  Anyway that is what one the urologist I have talked with that has done much research in chronic pelvic pain syndrone.  There are all sorts of nerve pressure point within the pelvis that tighten up become tender and inflamed.  Pressure on the pressure can be relieved by pressing and holding for some amount of minute.  This has to be done by a physical therapist trained at doing it.  One of many things that I have tried throughout the years.  It did not help me.

Thank for the return response.

Ron

Hi Ron,

"Permanent" catheters are either through the urethra (Foley) or through the abdomen (suprapubic). Both have to be changed I believe every few weeks. 

With self catherization (CIC) you put the catheter in yourself which takes only seconds. Then the urine comes out into a bag or into the toilet. Then you remove the catheter right away. You're done. With practice, the whole process takes only around a minute.

As to frequency, it depends on a number of variables such as how much you are able to urinate on your own, if at all. Most people do this from one to six times a day. If you're currently retaining urine and get UTIs then you will probably get less infections with CIC because you will have less stagnant urine in your bladder which can breed bacteria. But yes, CIC can cause an occasional UTI but if your careful with technique it can be either minimized or eliminated. There is more info on the self catherization threads or feel free to ask questions here.

FLA has nothing to do with CIC. It's a new procedure for BPH that uses an MRI guided focused laser. Very promising but not that much data on it yet. There is a small trial coming up where some of the cost will be offset. I believe it would cost you 14K to be part of the trial. Your insurance will not cover it. One doctor charges 20K for the procedure out of trial. 

Don't have a current ultrasound but last one showed prostate size around 60gram. According to the uro that did my cystoscopy last year I have a large median lobe although not 100% sure he remembers correctly as he did the procedure very fast and I wasn't able to ask him the question for another week since he bolted the room as soon as the scope was out! Just gotta luv that TLC, huh

Don't know a lot about pelvic pain syndrome, but do know that some in the IC community do CIC. You might want to try it and see if it helps some.

Jim

 

Jim you are absolutely correct I just signed up for the FLA study in Houston I had a great conversation with Dr. Karamanian

And sold me on the procedure. I was going to get PAE Had all my work ups. And I was going to W. Verginia however I felt that the seccess rate was a little problem. And talking with John who had the procedure done. And the accuracy used in the procedure is what attracted me. I didn't like the fact of have beads in my prostate for the rest of my life not sure what complications that would cause me later in life . So. FLA it is.. 3 weeks 10 men only in the study..

Hi Victor,

Congratulations on joining the study! I'm curious what is the condition of prostate going into the study? Whatever you want to share would be great, including: major symptons and IPSS score, size of prostate, median lobe or not, Post void residual (PVR), any instances of acute urinary retention (AUR) or near AUR? Cystoscopy? Any urodynamic studies? Did you do a trial on Tamusolin (flomax) or other drugs, and if so, what were the results?

Also, curious how many of the aforementined Dr. K. asked you about, what records you gave him, or he asked from you to review, and anything else that might be considered part of his trial's screening process. 

Good luck on the trial and please report back how it went.

Jim

Jim,

Why does't someone somewhere come up with a stent?  Something similiar to stent usied in the veins and arteries for keeping them open.  Stent from base of bladder to end of prostate gland.  Is there something like that out there? Maybe in another 50 years!

Thanks for sharing your info. with me.

Ron

 

Victor,

   I will have to google to see what comes up in regards FLA study in Houston and find out more about it if possible.

Thanks for sharing you info.

Ron

Ron,

There have been several. I have read about the Memokath stent which I think is available in Europe only. Not sure what the current status is.

Jim

The memokath stent is used in the U.S. but is considered a temporary measure. I think they are abut 50% effective. They need to be changed after about a year due to side effects of stent migration, formation of stones at the entrance to the stent, etc. They are mostly used for urethal strictures, but have also been used for bph. I don't know if they are covered by insurance. I believe the cost is similar to the cost of a turp.

Thanks for the info.  I made an inquiry and  may be getting info. about memokath stents.  After what you have said it doesn't look like it is something that will work for me.

Ron

Good morning Ron, sorry for the slow response.  I am 53 now, but was 52 when I had the PAE done.  I had a rare complication from my PAE, I as allergic to the beads used during the procedure. And even tho it was not explainded prior to the procedure the beads are permanent, and are also embedded in the prostate itself. So the only way to ever get rid of the beads is to have the prostate removed. My allergic symptoms have gotten somewhat better, so I am not considering having the removal done. The FLA procedure removed just the blockages, such as the median lobe, with a laser . There is a very nice guy on here named John who has had it done, and he has had very good results so far.

I agree completly about what you say about any of the procedures causing more inflamation and pain. I was miserable for about 6 months, and stayed on several steroids and antibiotics before things at least settled down some. 

Not sure if it is true, but the doc who turned me down for the Eurolift provedure told me that if I had the TURP he would all but guarantee I would bever have another prostate infection. It is certailnly tempting if for no other reason. But I sure do still enjoy sex lol. That is the main reason I am very interested in the FLA procedure.

Hi Jim

IPSS score was about 23 poor,

Prostate size 40cc

I had a urodymaics do and I was retaining

About 20cc

I have not done the cystoscope

I am getting up about 5 times a night.

I was on flowmax for about 3 months and my body got use to it and it stopped working. So I changed it to rapid flow

It seem to work better, and I am still on it.

Dr Karamanian is going to do a 3T MRI

And he is able to pin point with out guessing where the obstruction is and focus On that area, with the accuracy of less then 1 mm, using real time 3T MRI data. I like the fact tha there is no guessing. He maps out the software

And enters through the rectum. No artery

Entrench that's why the procedure takes 1:30 min very fast.. I think it seems to be the best procedure for me..and I live in Houston. Which is a big plus!

Joe,

  Removal of the prostate via Da Vinci Robotics worked very well for 2 individuals that I know.  One of them was a doctor.  They came out of the operation with little or no complications.  They both had prostate cancer.  There are not a doctors in my area of the country that will remove the prostate for other reason other than cancer.

From what I know, if your have a radical TURP then there most likely will not be infection because there isn't any prostate tissue remaining.  Much more complication with a radical TURP though.  Incontence, impotent

I have been told that Urolift would be a good choose if the only enlargement is the 2 lateral lobe.  Urolift pulls the lobes apart to open any blockage.

   That is bummer that you were allergic to the beads.  Go in to have something done that is suppose to help and come out worse off.     Anyone going in to have anything done never knows how things are going to turn out after it is all done and have wish for the best.

   Another thing,  I am finding out that anytime the doctors say it will take a certain amount of time to heal it most likely will take twice as long.

   I have really learn allot on this blog about PAE and it positives and negatives.

   Thanks for you input Joe.

Hi Victor,

Yes, "23" IPSS suggests time to do something. Other than getting up 5 times at night, what were your other symptons? Also, when you did get up at night, did just a little come out each time or did the void volumes seem normal? If you're uncertain, a voiding diary/log is always a good idea. Will also help you track progress if you do a procedure. You just void into a plastic measuring beaker you can find in the supermarket, noting time and volumes. 

20cc is for all practical purposes no retention, especially for seniors. That means your bladder is probably still quite elastic which favors a good outcome for any prostate reduction surgery or procedure like FLA, with a big IF. The "if" is if your symptons are actually being caused by an obstruction (your prostate isn't that big) or possibly something else such as prostatitis, overactive bladder syndrome or IC. 

Did you discuss the results of your urodynamics with your uro? Did they tell you if you had high pressures consistent with an obstructive prostate or did they say the pressures were normal?

Also, I assume Dr. K. will do the 3T MRI in advance of the day you are scheduled for surgery? Not that familiar with the imaging, but from what I heard it should give you a good look at any obstruction.

It's great that you're in the Houston area, should make things much easier. And FLA sounds like a very good and sound prostate reduction procedure.

Just make sure that prostatic obstruction is the overriding problem before solving it. A step that apparently many doctors don't take, according to some of the stories here.

Jim

Hi Victor,

Let me offer my two cents as someone who has had 2 greenlight procedures, one turp, and two serious bouts of hematuria requiring blood transfusions and surgery to stop.

I just took the ipss test and scored a 25. I get up 3 to 5 times a night to urinate, and use a couple of 1 liter bedside urinals in a basket next to my bed. They have ml markings and a flip cap. They cost me about 75 cents each because I buy them in bulk (150 to 200, a couple of times a year). This lets me urinate by sitting at the side of my bed in the dark,

and get right back to sleep (no lights, no walking or aiming).

Most bph procedures are good for removing obstruction that will lead to a high post void residual (mine was over 400ml before the first procedure, and about 125 to 200 mls before the second one), but will not necessarily eliminate night time urianation. In my case I now have a post void residual of 32 mls, so there is no obstruction. I don't strain to go, and I have a moderate stream, and there is no burning, so there's nothing to do about it. 

In your case, with a 22ml post void residual, it sounds like you have no

obstruction either. If you are not burning when you go, and don't have to strain, then you definitely have no obstruction, so I don't see how a procedure could help you.

 

Hi Bob and Victor,

Bob said: "In your case, with a 22ml post void residual, it sounds like you have no obstruction either."

----------

I don't agree that a low PVR (22ml) necessarily means no obstruction, if that is what is being inferred.  It's possible that in this case, Victor's bladder is simply strong enough to push through the obstruction. That is my current situation right now, where I have an obstruction with mostly low PVRs. This came about by rehabilitating my bladder through CIC from when my PVRs were over 350ml, with the same obstruction. 

Now this isn't to say, however, that FLA, or any prostate reduction surgery, will necesarily help Victor.  Bob is one example, where he has no obsruction, a low PVR, yet gets up 3 to 5 times a night to urinate and has an IPSS of 25. In fact, Bob's symptons and IPSS seem pretty close to Victors. And there are other cases like this. 

So while such a low PVR doesn't necessarily mean no obstructtion, It does seem to beg the issue of what exactly is going on. As I mentioned in my previous post, part of the answer at least should be in the pressure studies from urodynamics and part from looking at the MRI. Either way, obstruction or not, there still could be other causes for Victor's symptons such as nocturnia, prostatitis, overactive bladder syndrome or IC. The challenge is finding the right person(s) to put the puzzle all together and helping you decide if prostate reduction is the way to go. 

Jim

 JJ I agree, the steroids make you feel like everything is perfect. I would give anything if I could function off of them the same as on. I had to stay on an extra long course due to the allergic reaction. I thought I was gonna get a realy good result from the PAE, until I had to come off the prednisone, and reality set in.

I am taking an herb now called black seed oil, that reduces inflamation, and that seems to be really helping, but only time will tell/

Hi Victor,

I am concerned about one aspect of the FLA. Perhaps you might be also. Since he enters through the wall of the rectum, how does he deal with what looks to me like the high possibility that he will introduce bad germs from your rectum into your prostate and give you a hell of a prostititus. Antibiotics normally don't work well in the prostate, because it is very fatty tissue. If they did, it would be easy to cure the prostate infections that many of us have. It isn't.

Please ask Dr. K about that since it also may well affect you, and share the answer with us.

Thanks,

Neal

Very good question Neal. I am sure most of us on here have had our share of prostatitis. And just the manipulation of the prostate for the procedure most likely causes a great deal of inflamation, which usually leads to an infection on its own.

 

Hi Jim according to the urodynamics

My

Yes great question I will ask him and let you know..thanks let me know if there is anything else ..u need me to ask..

The more the better !

Sorry Jim my phone started going crazy

My Uro. Show that my blatter pressure was good. My problem is mostly in the evenings

At night when I have to use the restroom

It is a struggle and I am sure that I have a lot of retention left in the blatter I don't know how much because I never self cath.

But I know it's more then the uro dymanics showed.. I find that if I am driving and there is no where to use the restroom and

My blatter fills up. I have a really hard time

Urinating, sometimes I go then wait five min. And go again...

Hi Victor,

I guess all I'm saying is that given your very low retention, that the symptons you seem to be exhibiting could be caused by something other than obstruction by your prostate. Other causes could be prostatitis, overactive bladder syndrome, age related nocturia caused by hormone deficiency or IC. And if your symptons are not caused by prostatic obstruction, then a prostate reduction procedure like FLA will not help, no matter how well it's done.

If it were me, I might have my symptons reevaluated by another urologist before doing any type of surgery. 

Jim

Victor,

Regarding your urodynamics. I assumed your pressure was "good" because of your low retention. The issue is not if it's good, but if the pressure is higher than normal which would then be consistent with the bladder trying to push urine through an obstruction. Did your uro discuss this with you at all? 

Jim

Thanks Victor. I'm looking forward to the answer.

Neal

Bob,

  Have you tried Myrbetriq?  My doctor gave some that he had as samples.. Do you know anything about the drug? Have you used it before?

Ron

Hi Ron, I haven't tried Myrbetriq. At one time I got a patch for bladder spasms after a procedure, but I got dry mouth so I discontinued using it. Using a bedside urinal in the dark lets me go right back to sleep so I don't have a problem with getting up 3 or 4 times a night. At one time I was getting up 7 to 8 times a night which was a problem because I never gotr to sleep properly, but didn't take any meds for it. My urologist never suggested anything. Luckily after about 8 or 9 months it just subsided on it's own.

Jim,

   I also agree that a low PVR does not mean no obstruction.  I have been to the urologist on two occasion where I had not drink any fluid before the appointment so I was ready to urinate and measure PVR.  Appointment were both not planned so I was not ready with full bladder.  Since I did not have to go my PVR was low both times.  If my bladder would of been full to begin with then most likely there would be much more PVR. 

   I also believe that Victor's bladder was strong enough to push through the obstruction.  I believe that is the way my bladder is workiing.  I never push, but relax my bladder mentally as much as I can and it happens.  Slow but it happens.  If I push it mostly likely would not happen.

   Just see if I am normal, I constantly hurt in my bladder area and through the rectum.  Have very slow average urinary flow of about 4 ml/second.  Are my symptoms any different than others with blockage?

I have other urinary problems and maybe there are also giving symptoms that are not the same as for blockage.

   The next time I am in to see the urologist I am going to see about getting an MRI.

    Jim

Ron,

Urodynamic testing should help determine if your problems are being caused by prostatic obstruction or something else. A cystoscopy and imaging studies would also be helpful. You need a diagnosis first before you fix things. All the procedures you're looking into are prostate reduction surgeries or procedures. They only help if your problem is being caused by prostatic obstruction. I also see you're looking at removing your entire prostate through a robotic procedure. Sounds very extreme even if your prostate is causing blockage. Just because someone else had good results with a given procedure doesn't mean it's the right one for you. 

Jim

Joe,

   My brother had GreenLight TURP and he did not have any problems.  He had a normal BPH prostate, without prostatitis, without bladder interstitial cystitis.  It has been over 6 years since he had it done and he says that his urinary flow is getting slower but nothing yet to concern with.  He said the only thing he remembers is the discomfort of the catheter.  He remembers having very little pain.  If my prostate and all conditions were as my brother I would most likely have GreenLight Surgery.  My symptoms are much different than his I am also dealing with interstitial cystitis, prostatitits, and BPH with enlarge median lobe.

A 24 cc prostate is small.  Mine is medium size at  40cc from what I know.  You most like are a young guy due to the size of your prostate.

Ron

Thanks Ron, I appreciate the info. 53 here, so not so very young lol. But I do think I made a mistake having the PAE done, without more testing.

Jim,

   What is a normal retention?  I was never told anything about the pressure after the test were done.   I just looked at my test and found my peak flow was 62.3; flow at peak pressure was 1.1; peak pressure was 73.1; mean pressure 45.1; opening pressure 0.2; closing pressure was negative.  Sure allot of info.  This is the way they had it on the report.

Ron

Ron,

"Normal" is zero but under 50ml is not significant and if you're over 60 then up to 100 can be expected. As to your urodynamics, I really am not qualified to analyze them, but I did pull this from an article I read:

1. Low detrusor pressure and high flow rate (unobstructed)

2. High detrusor pressure and low flow rate (obstructed)

3. Low detrusor pressure with low flow rate (poor detrusor contractility).

You really have to ask your urologist what the results mean. Do you have high pressure, low pressure, normal pressure? What is your flow rate? What is his diagnosis?

Jim

Jim,Did you ever get chills after CiC? I also get the urge to CIC a lot more often now ,like 3 hours,sometimes less?My URO thinks this might be an UTi. I don't have a fever,however i did a urinalasis test . I was told by different URO that i will always show an infection in my urine test because  i'm doing CIC.

does this make sense JIM?

Thanks again JIm,

Hi Frank,

No. I never got chills after CIC. It could be a UTI. And "yes", your urologist is correct that if you're doing CIC, then you will probably show positive for leukocytes and/or nitrites and blood which some will call an "infection". Whether you should treat with antbiotics is a judgment call based on your symptons. Sounds like you might be borderline so go with whatever your urologist recommends and certainly contact him if things get worse. Meanwhile you might want to increase your fluid intake a little. 

Jim

Before I had my PAE, I couldn't get either of two urologists to do a urodyanamics test measuring pressure.  The first one said that he wasn't getting enough useful information and he quit doing them.  My present urologist also refused and he does all sorts of urodynamic tests.  I found this odd.

If your present urologist does all sorts of urodynamic testing, what was the reason he gave for not giving you one? As to your first uro, it's not the raw information you get, it's how it's interpreted. So that says something.

-- Jim

 

I asked my present uro on two occasions for urodynamic testing prior to PAE.  He felt it wasn't necessary and the blockage had to be addressed. Both uros were experienced, the present one for decades.  It appeared that both felt the information was not useful enough in clinical decision making.  

Camster,

In other words, address the blockage with a surgery that may make no symptomatic difference because the bladder may be too weak? (please note sarcasm)

I'm not saying that urodynamics are the be all and end all, but it seems that many of the doctors that don't use urodynamics are the same ones that really don't put much time or thought into LUTS other than "let's do a prostate surgery or procedure". 

For more information, "google" this article by Victor Nitti

"Pressure Flow Urodynamic Studies: The Gold Standard for Diagnosing Bladder Outlet Obstruction"

Jim

Frank,

I think it makes sense.  My uro called it colonization instead of full blown infection w/ a fever.

Also, I very often get chills when I need to go - right before I CIC.

I agree.  Urodynamics gives a broader picture of the problem.  I will ask my uro on my next visit why he is reluctant to do urodynamic pressure testing.  I will ask for a more detailed answer.  

Dr. Bagla wanted the test done.  I asked my uro on two occasions and he didn't want to do it.  I did find in my research that there are doctors who are not real keen on urodynamic pressure testing.  Maybe there is something me as an outsider am not aware of.  Dr. Pisco also believes in it.  

I will look at your article that you recommended.

Cam

As you will see from the article, urodyamics is not going to necessarily lead to an absolute diagnosis, but rather a treatment guide in the right hands. 

So, if possible, you might be better off having the testing done with someone more receptive to the process. 

Ideally you will get what is called video urodynamics where they can actually look at and record your bladder during urination. Not everyone has the equiptment so you might have to ask around a bit

Jim