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

Thanks Michael. Good to know as I am just about to get a referral from my GP to the Interventional Radiologist to have a PAE.

This is from " [IMAGE WISELY] "  In modern systems, the fluorescent screen is coupled to an electronic device that amplifies and transforms the glowing light into a video signal suitable for presentation on an electronic display. One benefit of the modern system compared to the earlier approach is that the fluoroscopist need not stand in close proximity to the fluorescent screen in order to observe the live image. This results in a substantial reduction in radiation dose to the fluoroscopist. Patients receive less radiation dose as well, because of the amplification and overall efficiency of the imaging system.

Even better to know. I will be sure to ask the radiologist about this. I guess he is called a radiologist (rather than a urologist) for a reason.

There is a lot of info on the net about the ampunt of radiation in fluroscopy. This is from one site. Unfortunately PAE is not listed, but even very short procedures have a huge radiation dose

https://rpop.iaea.org/rpop/rpop/content/informationfor/healthprofessionals/1_radiology/fluoroscopy.htm#FluorFAQ09

 

I talked to an IR.  He said that the radiation from PAE is within acceptable limits.  During PAE, you are not getting radiated the whole time.  It is turned off at times during the procedure. The newer machines produce less radiation. I didn't ask him about the arteriograph prior to the procedure.  There is a chance of embolization of non-target tiissue.  I found in the clinical literature that this is uncommon.  The doctor will test for basic kidney function like BUN and creatinine before using dye contrast.  My opininon still remains that PAE has the best upside and least downside in the hands of an experienced IR.   

Totally agree with you Camster about PAE being the best treatment for BPH with the least amount of downside,

@caringbah: I'll soon be able to tell you as I am awaiting an appointment with Dr Schlaphoff.  

My GP said it is so focused that there is not an issue.

Great...I think you'll like him. I found him to be a great bloke.

Sounds good, Arthur.  Thanks for the informative update.  Looking forward to hearing the good news as things progress.

I had the PAE done by Dr. Isaacson at UNC Chapel Hill 10 days ago.  Great doctor and staff!

My prostate was much smaller (57).  I noticed more flow the first night but it has reverted to the pre-op pattern since then.  Apparently this is to be expected as the sweet spot for reduction is measured in months rather than days or weeks. Most of the procedure related side effects are almost gone.  I've been self-cathing for 15 months and it is still painful when pushing past the prostate.  This is probably due to inflammation from the procedure which should subside soon.

Good luck!

Hello Artheur,

I had my PAE by Dr. Bagla June 2 of this year. I can pee like a 20 year old again. I saw improvement within 10 days with no side effects, no pain to speak of etc.

Do you know why Dr. Bagla is on leave? 

Good luck to you.

Bill

Hi Bill,

Thanks for your encouraging report.  I'm so glad to hear you're doing so well.  I hope my results will be similar.

Arthur

Nealpros,

I just had my 6 month follow up with Dr Isaacson today. All is well. MRI showed 40% reduction in prostate. I never had any post op bleeding or urine leakage. Minor burning and urgency for a few days, then I started to see immediate results with no post symptoms.

I had my  PAE in November 2014.  The had me on Naprosin and cipro for 10 days.  I had very little discomfort and minimal pain. I did have a bruising (Black and Blue on my lower torso for about two weeks and then it cleared up.  About two weeks after the procedure, I had a slight discoloration in my semen with just the slightest ache that lasted about 10 minutes.  (The poor little thing had been through alot.)   If I strained during a bowel movement, a tiny streak of blood.  This occrured twice and cleared up by the third week.  Ever since then now issues at all.  Scans showed a 37% reduction in size.  I got good relief, but not enough to get off the Flowmax. subsequent cystoscopy show the prostate was still large, blocking the urethra and pushing up into the bladder.  I am having a second PAE next week.

Wonderful. Thanks for the report. What is your situation now with getting up at night, etc. ?

Neal

Thanks for the report. Please let us know how the second PAE goes. Who is doing it? Where is it being done?

Neal

Neal, 

It's too early (day 3 after the PAE) to report on symptom improvement.

In fact, the expected post procedure inflammatory reaction started yesterday and continues today.  The prostate doesn't like its blood supply being cut off.  Most PAE patient experience  one to two weeks or worse symptoms before it gets better.  Thanks to Ibuprofen, Tumeric Extract, Resveratrol, Tamsulosin(Flomax) etc......., I only had to get up only once last night.  We'll see what tonight brings.

Dr. Douglas Hadley in Oakland CA at Kaiser hospital.  Did my first one.  Fantastic Doc.  Followed up with me and helped me organize the whole process.

I am concerned about the "post procedure inflammatory process ". What is happening? Particularly, I may be bordering on needing to catherize when I have the procedure, so I'm concerned about if you're having temporary increased difficulty urinating immediately post procedure.

Thanks,

Neal

Bruce,

Good luck! I look forward to your reports. Please see my questions to Arthur, and comment on them too, if you wish. I would be interested in your take on them.

Neal

I had no need to catheterise after the procedure however the night of the day I had my PAE I was up for a pee every 15 minutes.  I got back to sleep between each trip!

The next evening I had rigors - hot sweats and shivers, and a temperature for about 2 hours, and then it all went away.  It was worrying as I wasn't expecting it, but my consultant was on the other end of the phone and he reassured me; it was just my body getting rid of the dying cells.

After that no pain at all, and no problem peeing.  It did feel as if my prostate was very cold - an odd sensation - for a couple of weeks.

It's now 2 years since I had mine and it's been a huge success.  Flow rate more than doubled, no hesitation, and I sleep through the night without having to get up.  Generally 8 hrs, but one night I slept uninterrupted for 11 hrs.

It has transformed my quality of life.  Good luck!

Andrew

I had no issues with inflamation, but I was on an antiinflamatory (Naprosin)  which may have kept it down to a dull roar.  So trouble urinating post operative, and it improved over the next two weeks.  They used a condom cathether during the procedure so no burning after either.

Typo on last post.  No trouble urinating post operation.  Just gradually improved over nxt two to three weeks.

Neal,

Inflammation is a process your body initiates when ever there is an injury or infection.  If you've ever sprained an ankle, elbow or knee, the swelling that occurs thereafter is an example of inflammation.  Courtesy of wikipedia, here's a good explanation: The purpose of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and to initiate tissue repair. The classical signs of acute inflammation are pain, heat, redness, swelling, and loss of function.  Doctors who do PAE will tell you to expect up to two weeks of worse symptoms post procedure.  You will be given lots of medication to help mitigate the inflamation and discomfort.  The most power antiinflammatory they give you is Pednisone.  Because Prednisone is a steroid that has broad system action, I have been trying to avoid taking it.  Instead, I have been on high doses of Ibuprofen (Motrin) and herbal supplements like Resveratrol.  Ask your doctor about the possible need to catheterize yourself post procedure.  If the drugs are not doing enough, you may need to catheterize.

Day 3 after the procedure,:  Last night, I woke twice to pee.  This morning, symptoms were still worse (painful and frequent peeing).  Once I started taking my Ibuprofen and herbal anti-inflammatories, symptoms gradually moderated to a tolerable level.  I only hope that PAE ultimately results in an improvement after the post procedure discomfort subsides.

Thanks for sharing this information whilst it is still very fresh, depsite no doubt feeling not very well for the moment. It is all very useful for people like myself who are intending to go the same  route.

 

I asked Dr. Pisco in an email about catherizing after the procedure because of inflammation.  In his words, "You don't need to be cathertized."  And that was during or after the procedure.

Hi Camster, I think every PAE practioner has their own viewpoint on that. 

My guy, Dr Schlapoff always uses a catheter during the procedure. The only reason for that is that it's a long procedure. Having said that I had an operation a few years ago when they just used a urine bottle. I woke up and there was this urine bottle between my legs. They used a GA on me and I was out like a light....no chance of moving. This is a lot better than a catheter ...no chance of infection and no bladder irritation. 

There is absolutely no need for a catheter after PAE.

Hi Caringbah,

You're right about the doctor having a personal preference using a catheter.  Drs Pisco, Bagla, Isaacson (UNC), Gadani (St. Louis Univ) don't cath during PAE.  Dr. Nutting (RIA Endovascular Denver) does cath. He wants the bladder flat.  The general feeling for not cathing avoids infection, inflammation, or exacerbation of prostatitis.  The opinion is that if you're not cathed coming into PAE, you won't need one leaving.  I have read of a patient coming in cathed and able to urinate on this own in the recovery room.  There is shrinkage from simply less blood supply to the prostate.  You've been through it.  You know better than I do.  

Hi Camster, 

I didn't know about the bladder being flat...I thought they just used the catheter to void the bladder while you are out to it. Thanks for the info. 

I'm not someone who really gets into the detail of things ...I just look at the end result and leave it up to the medico once I am confident that he knows what he is doing. 

Wheras others like to know every last detail. Everyone's different thank goodness. 

Andrew,

Thanks for the info and encouragement. I wonder if any of the meds you were given post op were to prevent bladder spasms. The frequent urination you had that first night sounds like bladder spasms.

Neal

That sounds like a good idea, but I'm surprised they allowed it, since the Naprosyn can cause bleeding. Did your doctor say anything about that?

Neal

Arthur,

Thanks for the info. It looks like the thing to do is to take as much applicable medication as possible a few days to stay ahead of problems.

Neal

Dr Isaacson doesn't catherize during the procedure, he uses a urine bottle - low tech, inexpensive, and effective. I'm just hoping that I won't need it post op, because I'm close to it now, but it sounds like it won't be a problem. Thanks for the info.

Neal

I think the only meds I had for the PAE were antibiotics to prevent any infection getting a hold.  From memory these were IV given just before the op.

I'm sorry to be vague, but it all went so well that I've put it out of my mind!

Thanks for the fantastic information about PAE and Dr Glen Schlapoff.

My journey began with a Urologist who after several scans and tests recommended TURP.

The unwelcome side effects led me to research alternative treatments eg UROLIFT and HOLEP.

Both treatments were discarded because of the complexity created by my midlobe. In all instances the Urologist needed to eliminate the midlobe . The resulting effect would be similar to undergoing TURP.

After discussions with Dr Schlapoff and reports from MRI and CT SCAN, I am convinced that PAE is the first procedure and probably the least traumatic and with accepable side effects. Again thanks for your discussion which has had an impact on my decision to take the PAE route.

iinterestingly the Ultrasound s ans show my Prostate

Sorry ... but continuing on. Interestingly the Ultrasound s ans show my Prostate size to be between 70...75 cc

While my MRI shows the prostate as 41 cc.

however both show the midlobe protruding into the bladder and a narrowing of the urethra.

THE MRI has removed any doubts about cancer (PSA .. 1.7, DREalso was negative). The arteries has mild plaque without aneursm formation.

the only issue is a high bifurcation of the aorta and that means the Radiologist will nee to access my arteries from both left and right groins.

i am scheduled for treatment later this month. Two days prior to the procedure i will be assessed for General Anesthetic and i have been prescribed Antibiotics (start 2 days before procedure and 14 days after) as well as Nurofen for pain). The Dr assures me that generally most patients arr back to normal activity within 7 days.

I hope to see improvents on LUTS after the procedure.

I am 26 days out from my second PAE.  This time I had no bruising and very little discomfort.  I also had a feeling of restored energy the next day that I attribute to the small amount of narcotic pain killer this time.  They shot me up every few hours the first time and this time they gave me the hand switch to self administer pain kiiler which I only used once.  I hope that I am experiencing inflammation as well because my sympotoms have actually worsened a tiny bit.  No bleeding, no discoloration of semen, no indication I even had the procedure!  Basically no side effcts.  All I can do is wait to see if things improve.

I'm considering a second and very interested to hear about your experience. 

Am curious to know why you nred a second PAE intervention?

Is it routine to go for a second?

what are the complicating factors that negate sucess in the first instance?

I am going for my 1st next week, hope not to keep repeating the procedure.

thsnks

Hi Sam,

I'm going for my first the first week of December at UNC with Dr. Isaacson. Where will yours be done? I sure would like to hear how yours goes.

Thanks,

Neal

I had my second procedure on Oct 13th.  While the symptoms we experience (weak stream, waking up several time a night and so on) are similar, each of us may have a different set of issues that result in these symptoms.  For me, I had a pre-existing weak stream from the age of 25.  When I hit my 50's, the symptoms became much worse and I started on Flomax which eventually did  not work.  Faced with a turp, I turned to PAE in November 2014 and got significant improvement in flow, but still needed Flowmax.  So after a year and several tests, it was determined that my prostate was still very large so I decided to go for a second PAE.    A little more than a month out now, I am still waiting for additional improvement.  I am hopeful.  As for the procedure, it was a piece of cake. Two days after, I felt almost as if nothing had happened.  Two is the most they will do at this point so hopefully I will get more improvement.    My plan is to wait 3 months and get an MRI to see how much more reduction I got form the second procedure.  If I'm still not peeing as well as I would like, then I'll go for another cystoscopy to see what is blocking the flow from inside the urethra and see if the prostate is still pushing up into my bladder. 

Hi Neal,

My procedure will be Liverpool Hospital, Sydney, New South Wales Australia.

I believe that my Doctor is the only one specialised in PAE in Australia. I understsnd that Doctors from Brisbane will be in attendance to observe the procedure during my operation. The Doctor prefers to use General Anaesthetic during the procedure. So i will not have the opportunity to observe what is happening during the PAE process.

Neal,

Good luck with your procedure. You will really like Dr Isaacson. I am at 7 months past my procedure now and things could not be better. No BPH symptoms at all. My last MRI showed a 40% reduction in the prostate. I do not get up at all at night and have great flow during the day. I can even take allergy medicines now. They used to cause me major problems with blockage that caused me to have to catheter. Also 18 holes of golf now with not stopping to pee. I am blessed.

Hi William

Thanks for the info and encouragement.

Can you provide any blow by blow detail about the day of surgery itself, and the two days following it? I know I am interested in it, and I expect others will be too.

Thanks,

Neal

Good luck Neal.

I'm still very happy with my PAE and I'm 7 months out. Such a relief!

The procedure is a piece of cake so no worries there. Not worth a second of anxiety.

bill

Hi Sam,

I am also interested in what the first day or two post op are like. Specifically, I am close to needing a catheter to urinate, and it seems possible that my prostate might initially SWELL a little, and I might need a catheter for a short period until that passes, so I am interested in whether or not you feel that happening, and anything else you can tell me about the first couple of days post op.

GOOD LUCK!

Thanks,

Neal

Thanks for the encouragement.

Neal

Hello Neil,

My doctor doesnt think that I will need a catheter post op... from his experience. I will certainly have a catheter during the procedure.

Reports from most participants in this forum seems to indicate that the post op effects will be manageble with antibiotics and painkillers. And that most of the effects will be over within 3 days and i should be able to carryon as normal after 7 days. This thinking is also supported by my doctor.

I hope to be fully functional well before Christmas. However the full benefits of succesful intervention from my understanding may take anything from 3 to 6 months.

heres hoping that it all works out with minimum fuss for both of us.

I had my PAE two years ago.  During the procedure you have to lie completely still for two hours.  If you need to scratch, you have to ask one of the many theatre staff to do it for you.  I was told if I needed a bed bottle I'd have to ask someone to hold it for me; happily I didn't need one!  This may be why some radiologists suggest you are catheterised while in theatre.

The night of the operation I was up for a pee every quarter of an hour or so, although I got back to sleep between each bathroom trip.

The following evening I had a temperature and shakes for a couple of hours.  This alarmed me because it was similiar to a UTI I'd had following a prostate biopsy.  But a phone call to my consultant reassured me it was just my body expelling the dying cells.  It passed after a couple of hours.

You have nothing to be alarmed about; good luck!

If you want to talk it through, just PM me.

Andrew

Thank you Andrew, fortunately or unfortunately i will be under general anesthetic during the procedure. I will also be a case study, if that is the right word, for Drs ( under training) from Brisbane, Queensland Australia.

I was also aware of reports of the fever and chills experienced by some patients after the procedure. And it is good to know that it is the normal function of the blood starved prostate and its dying cells.

Thank you for your support and information.

regards

Sam

Neal & Sam,

Good luck with your PAE. I had mine 7 months ago and life is wonderful. Everyone seems to respond a little differently. I had no pain or bleeding after the procedure. Did not require any painkillers etc afterwards. I had urgency and minor burning when peeing for about 5 days. After that no problems at all. I did not require a catheter during or after the procedure. I was on a local anesthetic that put me in twiglight land. Apparently I was able to respond to their commands, but had no recollection of what was happening. The procedure took about two hours which seemed liked minutes to me. After an hour in post Op I was able to drive back to my hotel. The next morning I was cleared by phone to drive home (7.5 hrs). The drive was not uncomfortable other than having to pee about 4 times with urgency and minor burning. The site where they entered my arteries ( left wrist ) was sore and bruised for a week. After one week I was back to normal. I was fortunate to have almost immediate positive results which continued to get better for a month and then leveled off. I do not get up at all at night now, play 18 holes of golf without peeing. Dr. Isaacson at UNC Chapel Hill performed the procedure. He is great. I no longer have to think about peeing at all. Before the procedure that was all I thought about day and night.

LIFE IS GOOD!!!

2william,

Thank you for your input.

I would love to have a similar response to the PAE procedure such as yours.

Hi Sam,

Thanks for the info. I look forward to your info on what finally happens.

I'm hoping to avoid the catheter. Dr. Isaaccson, at UNC uses a bottle during the procedure. I have had to use a catheter once for an operation gone bad, for 2 weeks. That was the longest 2 weeks of my life. Remember to put some vasoline (petrolium jelly) on the tube where it enters your penis to lubricate it. Otherwise, it will abraid the inside of the end of your urethra, hurt like hell, and bleed. Wash that area once a day with 1/2 peroxide, 1/2 water on a cotton swab, and reapply the jelly. The catheter may be causing a great deal of the burning on urination that others report post op.

I'll have good thoughts for you.

Neal

Hi William,

Thanks for the commentary. That was a wealth of information, and exactly what I was looking for. As I mentioned before, Dr. Isaaccson will be doing my PAE also. No one looks forward to something like this, but it looks like getting the PAE done by him is going to be great. I'll let you know how it goes.

Thanks again,

Neal