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

Abstract from PUB MED

regards Lou

Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique

INTRODUCTION: 

Loss of antegrade ejaculation is a risk with conventional resection of the prostate (transurethral resection of the prostate [TURP]). The aim of this study was to determine the short- and long-term preservation of antegrade ejaculation and functional results with the novel ejaculation-preserving TURP (epTURP).

PATIENTS AND METHODS: 

Prospective evaluation of 89 consecutive patients with bladder outlet obstructions aged 27 to 78 years, enrolled from June 2001 to January 2005. Endpoints were change in objective (uroflowmetry, postvoid residual [PVR]), and subjective (International Prostate Symptoms Score [IPSS], Life Quality Index [LQI]; International Index of Erectile Function-5 [IIEF-5+] with two additional questions) measures of function. All patients received follow-up examinations at 3 and ≥60 months.

RESULTS: 

Overall, 87 and 63 patients were evaluated after 3 and 60 months, respectively. Antegrade ejaculation was preserved in 79 of 87 (90.8%) patients at 3 months. Significant improvements in maximum flow rate (+14.3 mL/s), micturition volume (+71.6 mL), and PVR (-59 mL; p≤0.002 for all) were observed at 3 months. Micturition symptoms, as measured by IPSS and LQI, were also significantly reduced (mean change of 18.3 and 2.9, respectively; p<0.001). improvements were maintained at 60 months. no serious adverse events were reported. eight (12.7%) patients received a second epturp due to the development of bladder neck scar tissue during long-term follow-up.

conclusion: 

antegrade ejaculation was preserved with the use of epturp with excellent outcome. observed symptomatic and functional outcomes were comparable with conventional turp. the results from this study underline the necessity of reviewing the old concept of ejaculation physiology. improvements="" were="" maintained="" at="" 60="" months.="" no="" serious="" adverse="" events="" were="" reported.="" eight="" (12.7%)="" patients="" received="" a="" second="" epturp="" due="" to="" the="" development="" of="" bladder="" neck="" scar="" tissue="" during="" long-term="" follow-up.="" conclusion: ="" antegrade="" ejaculation="" was="" preserved="" with="" the="" use="" of="" epturp="" with="" excellent="" outcome.="" observed="" symptomatic="" and="" functional="" outcomes="" were="" comparable="" with="" conventional="" turp.="" the="" results="" from="" this="" study="" underline="" the="" necessity="" of="" reviewing="" the="" old="" concept="" of="" ejaculation="">

conclusion: 

antegrade ejaculation was preserved with the use of epturp with excellent outcome. observed symptomatic and functional outcomes were comparable with conventional turp. the results from this study underline the necessity of reviewing the old concept of ejaculation physiology.>

Hi a8, 

Lou has answered this for you. My question is why you would want to have a TURP , EP or otherwise when there are much better options available ? 

Turp is a barbaric procedure and you still have a significant chance of incontinence and or impotence. 

I had a PAE 7 months ago and I pee like a horse again. No cutting, no impotence, no incontinence , no retro and in fact my sexual function has improved ...better erections and sensitivity. 

Check out Prostate Artery Embolisation. 

Hi Caringbah,

Your words are music to my ears. P*ssing like a horse again has been my dream for 10+ years while on the "watchful wait" bench as per med advice. 

So happy to hear of your great outcome from PAE. I wish your improvement continues.

I gather from quick read of the posts that you did this in Sydney on medicare - is that right ? 

I am in Melbourne, have been searching but found no interventional radiologists that perform this in state system.

Do you mind giving me the contact details of the surgeon in Sydney ? 

I'm new on this forum, is there a PM channel I can use to receive info ?

Cheers

Rama

I had two Green Light lasers in 2012 and 2013 and did not get retro from either. My urologist said he preserved a flap of the prostate above the ejaculatory duct that caused the fluid to travel outwards rather than back up to the bladder. However neither of these GL laser procedures did a lasting job. In 2015 the same urologist gave me a standard turp and I did get retro, but the results were much better. I was really worried about the retro but I didn't even notice it the first time it happened, until about ten minutes later when I realized there was no mess. Some people say it's not the same for them, but I'm 69 and have enjoyed every orgasm I ever had since my teens.

Hi Rama,

"is there a PM channel I can use to receive info ?"

Yes, see link below which should be used to exchange any specific details as you have requested.

http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

Regards,

Alan

I agree with Caringbah.  There was 12.7% that had bladder neck scaring which is significant and required a second procedure. 

​What is being worked on now is intraprostatic injections for BPH.  There are two companies in Phase 3 clinical trials.  Another company is using this method in South America.  This is being done in the doctor's office for a 15 minute visit. 

They have been looking at injections to kill prostate cells for over a decade. The most promising was Nymox 1207 that had made it up to phase 3 trials over about a 6 year period when the FDA flunked them. Lot's of optimistic reports and testimonials from people who got great results in the trials but then nothing. A couple of years ago I saw they were selling products for quitting smoking. There were similar trials of other injectibles like alcohol and botox in Europe and Canada but it all came to nothing. I wouldn't delay action based on the hope of an injectible getting to market. In the US the FDA can take 10 years to approve any substance. About 6 years ago a scientist found a cheap cure for malaria from the fungus that grows on an expensive plant that is used currently to make malaria vaccine. Rather than harvest the plant and extract the essence to make the vaccine (an expensive procedure) this scientist was able to grow the fungus in petri dishes, and it worked better than the existing vaccine. He sold the rights to a major US drug company that predicted 10 years of FDA trials. Nothing has been heard since.

Thanks Alan. 

I tried sendind a PM, does PM content get moderated before forwarding ?

Just a bit surprised that my PM got no reply even though the person I sent to offered to reply with info about a particular facility foe PAE.

Cheers

Rama

 

I talked to two of three companies who are working on injections.  These are all smaller companies.  I was told that it is simply too expensive to get through the FDA trials.  This is part of the reason that it takes so long.  Smaller companies don't have the financial resources like the big ones.  It is constantly jumping through hoops. 

And the big companies would rather buy the rights and then NOT bring the product to market if they are making more money on an older product for the same problem. They may be selling TURP equipment to urologists for example.

Neal

Hi Rama, 

i replied twice to the email address you supplied.,

Can you try again? Maybe it was a typo or try checking your junk mail.

Cheers

Hi Lou and Caringbah,

Thanks so much for your quick response. I had a PAE 7 months ago at UNC. Can't say enough good things about Dr. I. Unfortunatley it only helped a little, I'm guessing because of the large median lobe going into the bladder. The prostate is presenly at 117 down from 140. I've been in touch with a Dr. in Germany (Saladin Alloussi), very responsive, who has been doing the EP TURP for 20 years, I'm told with a 90 percent sucess rate. I'm also told with a large prostate it may not be as effective, but conversely if the main blockage is the median lobe then the odds go up for no retro. Not sure what else to try. Need to be cath free. Glad your PAE went well. How large was your prostate?

 

Hi Lou and Caringbah,

Thanks so much for your quick response. I had a PAE 7 months ago at UNC. Can't say enough good things about Dr. I. Unfortunatley it only helped a little, I'm guessing because of the large median lobe going into the bladder. The prostate is presenly at 117 down from 140. I've been in touch with a Dr. in Germany (Saladin Alloussi), very responsive, who has been doing the EP TURP for 20 years, I'm told with a 90 percent sucess rate. I'm also told with a large prostate it may not be as effective, but conversely if the main blockage is the median lobe then the odds go up for no retro. Not sure what else to try. Need to be cath free. Glad your PAE went well. How large was your prostate?

I had a similar experience at UNC on Sept 28.  Great Dr. but so far only a bit better.  Still having to catheter.  Have you looked in to urolift or the Gat/Goren method (recently done in secrecy for the Israeli prime minister)?

Good luck!

Hi Arlington,

My prostate is 117 which I think is too large plus the median lobe I believe rules out the Urolift. Have not self cath yet but need to try that. Not heard of the Gat/Goren... I'll look into that as well as the EP TURP.

Thanks and best of luck to you as well!

Check out Urolift.

Neal

Hi Caringbah,

I got the info, many thanks, called and waiting to be given an appointment.

The uro had done a cystoscopty 1.5 yrs ago. I need to go and dig details out of him, but vaguely recall the issue as being a tight bladder neck due to prostate growth. As of last consultation with the uro, he told me with certainty that I will lose ejaculation (not so wrried about fertility, I'm past all that at 57). I'm seriously concrend about incotinence and impotence risk.

Does PAE help where prostate growth blocks the bladder neck ? Don't know the answer to that one, but hope to find out from the good doc when I meet him.

Cheers

Rama

 

Hi Rama...that's good news. I don't know the answer to your question but I'm sure Dr Schlapoff will be able to answer that. 

Im with you...I was saw three different urologists...one reccomend TURP , the other laser and the last , a woman , wanted to do open surgery on me for BPH! I just about ran out of her rooms. 

Thank God I discovered this forum and PAE. 

Like you I was worried about incontince and impotence but PAE put an end to those fears. 

Keep us posted on how you go with Doc Schlapoff. 

thank you!

Hi Caringbah and others,

I've been reading the topic with interest. Lots of success stories, but a few with dose of reality. Some of us in the end learn to manage our lifestyles around the problem. This forum has been invaluable to me so far.

I've got an appointment with Doc Sclapoff on 1st March (Thanks to quick info from Carinbah). Need to organise ticks and p'haps a night's accommodation. I assume this is for pre-op MRI, artery mapping and all the good stuff. So I might be headed back to Melb same evening.

No details yet, but I assume the procedure will not be done same day. 

At 57 years, I'm approaching this with guraded optimism. I've had symptoms getting progressively worse for over 10 years. Diagnosis is not clear to me, different uro's have rule OAB, tight bladder neck and more recently - prostate overgrown (50-60gm) requiring TURP, that being the only option as per current uro. Few months ago, retention became bad, eGFR declined to 41 with hydronephrosis, so the GP (he is the best supportive GP I've ever been to)  suggested  Flowmaxtra to keep the kidneys in the clear. A month of precautions (emtying the ballder even if it takes long) and flowmaxtra brought the eGFR upto near normal level of 57. last ultra-sound also showed a PVR of 350 ml. Due for a re-scan and another blood test next week before apptt with Doc for PAE workup. Let's wait and see. 

The uro is definitive about TURP being the only solution, retro almost a certain consequence. Incotinence is unlikely result of TURP as per him, but I don;t know, that's the most worrying result for me. Impotence, ED are strong possibilies fromTURP. I've heard stories of men going into long term depression from these. Perhaps there is both a psychological and biochemical link to.

Flowmaxtra seems to be keeping me away from catheterisation and hopefully from kidney damage, I will find out soon.

I am looking forward to the PAE workup, fingers ccrossed.

This might be an outrageously silly question. Has anyone explored other options like PEMF ? A google on "PEMF for prostate" will bring up an article about PEMF results on dogs at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145661/

This one appears to show results on humans :

http://www.ncbi.nlm.nih.gov/pubmed/21537858

Once again, this sort of treatment could be carried out as a DIY procedure or with minimu supervision. You have to be careful, as there are several Co's trying to flog some very expensive PEMF machines, which may or may not work. 

I am out and about on the internet, exploring other avenues in  case PAE turns out to be not for me. Love to hear from anyone who has been down these streets.

 

Rama,

I was in a similar position 4 years ago. PVR of 400ml, urinating every 20 minutes at work and on the commute, frequent retention at night needing self catheterization. Flomax worked for about three months and just as the side effects disappeared, so did the effectiveness.  I had the complications of a very large prostate over 120g. a large 40 g. median lobe protruding into the bladder, and an overgrown bladder neck, as well as bladder stones and a propensity for uncontrolled hematuria. I also went into my GL procedure with hope and optimism, but it took an additional GL and an additional classic turp in the space of three years to address all the complications and give me a decent stream, pvr less than 35 ml, and the ability to go 2 hours or more in the day and only get up twice a night. I wish you the best on the PAE. Like all other procedures it works for some and not for others, depending on the actual cause and complications at work. If the PAE works you will avoid all the side effects of the surgical procedures.  If not, you will have to start over in your search.

I also feared incontinence which disappeared in about 6 weeks to two months after each procedure. It was never full on incontinence, just severe urgency (talking about a 10 second count down) and severe dribbling which required pads for 6 to 8 weeks. I greatly feared retro would diminish my enjoyment of sex. I didn't get it until the third surgery, a classic turp. I didn't fear ED because I already had it. Let me just say there are many ways to give and receive sexual enjoyment without being able to maintain a full erection. 

P.S. Rama, the one medication I never tried was Avodart (dutasteride). I wish I had tried it from the beginning, but it's impossible to know now if it would have helped. I have been taking it for three months now and it seems my stream is better than ever and it reduced my times up at night in half.

Although I didn't say it above, for me the retro was a total non event. I have no way to objectively judge the before and after retro levels of enjoyment, but as far as I can tell in the present, it had no effect on me at all.

Hi Bob120,

Thanks for sharing your journey. Overgrown ballder neck rings a bell.

Many positives there, glad to hear that you got it flowing, I know it must be a big relief, makes the long and hard journey worth, no doubt.

If I may ask, did the 2 GL's provide any improvment (albeit non-lasting) ? I did quiz my uro about GL, he advised it would not work for me. Did you end up doing anything about the bladder stones after the 2 GL's ?

I think the uro's don't have enough of a clue to know beforehand how effective the procedure might be. In my uro's opinion, only a mistake by the surgeon can result in incontinence. Chosing Medicare means I have no control over which surgeon gets to wield the knife. Could potentially be a newbie med grad plus few TURP's undr the belt.  PAE certainly sounds low risk, not the leats due to the fact that the surgeon is known and has done many succesful ops.

I am also consulting a TCM, giving it a go while waiting for PAE assessment, also continue to explore the PEMF possibilities. 

 

My PAE didn't reduce the prostate enough to stop pushing up into the bladder neck  I ahd a secnd PAE and will get a cystoscopy in a couple of months to see if it helped.

Consider a penile implant. They work great, and will more than restore your erection. Private message me if you have questions.

Neal

Hi Neal,

I'm not really concerned about the erection. I'm mostly concerned about the orgasm, and sharing intimacy, and so far, so good. Vigara and Cialis gave me erections but they removed the sensitivity and for me it felt like shining shoes. A lot of energetic back and forth but not much sensation and not much intimacy. But thank you for your concern.

Bob

Hi Rama,

It sounds like you are in Australia. In the U.S. we can choose our surgeon on Medicare, so I didn't have that consideration.

I would say both of the 180 watt Greenlight laser turps did an incomplete job. About six months after the first GL I started having problems again. A membrane had grown over my external sphincter (at the prostate connection to the urethra) which my urologist removed with the cystoscope and local anesthetic. But I needed to self catheterize once a month "to keep the channel open". During the following year my stream was weird. To me it felt like I had broken pipes. I would lean one way and the other to empty out. After the year I had my first uncontrolled hematuria. I went into the hospital and my urologist used the GL laser again. While he was in there, her removed more tissue from my prostate and the median lobe protruding into my bladder, cauterized three bleeders on my prostate and bladder neck, and did a resection of the bladder neck. While he was cleaning out blood clots that covered my bladder walls he saw a bunch of bladder stones and so he removed them as well. The following 15 months saw improved flow, but still not a really good flow after the first few months after healing.

At the end of the 15 months I got a second uncontrolled hematuria and was back in hospital. This time my urologist was unable to schedule a GL laser machine so he did the classic turp. He removed a large amount of tissue from my prostate, and removed the rest of the median lobe which was still protruding into my bladder, and stopped the bleeders. An advantage of the turp compared to the GL is that tissue is not evaporated, so it can be sent to pathology which he did, and it came back as not cancerous. But two weeks after being released the hematuria came back and as my urologist was out of the country I used the hospital urologist who stopped the bleeding. I continued to bleed two more weeks and was about to go for another surgery to stop the bleeding when it stopped on it's own the day before the surgery was scheduled. (The normal bleeding after a procedure turns the urine a burgundy color,  but I had frank blood which is more like a Marinara sauce color.)

For the past 10 months my stream has finally been good. But three months ago I started taking dutasteride to stop my prostate from continuing to grow when an ultrasound measured my pvr as 35ml and my prostate size as 203g. I really didn't want another surgery. I still have low iron 10 months later, and my hemoglobin and red blood cells finally got into the normal range about a month ago. The dutasteride put me over the top with really forceful streams like I haven't had in 20 years, and cut my night urinations from 4 or 5 to 2. If you are taking meds anyway I would add the dutasteride. TCM may work but I would be surprised if it could work as well as dutasteride an flomax together. Given a choice between a GL and a turp I would go for the turp. The recuperation was shorter (6 weeks instead of 8 or 9), less painful, and the results were better.

 

 "Chosing Medicare means I have no control over which surgeon gets to wield the knife?" This does not compute.

That was not a problem for me.

I have regular govt medicare and was able to choose my surgeon.

Are u on a medicare advange plan and stuck in a group of doctors in ur area?,

When u have the regular govt medicare u can go to any doctor in the usa who accepts govt medicare not so with the advantage plans,

To me anyone who has the advantage plans, is gambling with there health.

The Gat/Goren method is a PAE.

Similar - but different.  Check the details.

I think the PAE embolizes the arteries and the Gat Goren embolizes the veins.

Are you a diabetic? That too can remove sensation. As for the intimacy, that sounds like good counseling might be helpful.

Neal

Why would you think I need counseling on intimacy? I'm not diabetic. Sensitivity and intimacy were only a problem with Viagara and Cialis which turned my member into a block of wood. Orgasms and intimacy (before, during and after) are great for both of us as is. We can't believe we are as knocked out by them as we were 42 years ago.

I am in Oz. On Medicare here you get allocated a surgeon in the pool as per availabilty and schedules. That is what my uro told me who himslef doesnt do state system.

Hey bob120

Thanks for sharing your experience. Will investigate duasteride.

I agree with you about intimacy etc.

My own experience is that one's focus can move away from the physical aspect of intimacy. I personally think that is a great part of growing older but we are all different.

Im looking forward to apptt with doc schlapof in a week.

A bit surprised that noone expressed much interest in pemf. The paper published on humans probably conains details of frequencies and intensities but I cant find the full paper free, might buy it one off price of $39.

Hi Caringbah,

I spoke to the doc's admin assistant today (Alda). 

Dr Scahlapof has till date performed 15 PAE ops. Apparently after 20, he will start charing around 10k per op. It all depends on if I can squeeze in before his score reaches 20. She said I wll most likely make it before the golden mark, tentative op date around mid-March. Seems like the procedure isn't medicare apporved yet.

After talking to her (she was not so communicative) I felt somewhat cool towards the whole idea, perhaps I am rushing it too much.

I know you had a great outcome with the doc, but I can't help feeling a bit like a guinea pig, just my gut reaction I guess. 

Hmm I'm in two minds about this now, just want to sleep over it and may be I'll wake up feeling different.

 

It's your choice Rama. Nobody's trying to sell you anything. 

Hello Rama and Caringah,

Thought i might add that i was Number 10.. November 2015. And am happy with the outcome. No urgency, back to normal behaviour, three months on. Drs and support staff were excellent in their respective roles.

i am very happy i found out about PAE through this site and for those who were participating and offering information. The alternative treatment TURP in whatever form was too brutal to contemplate.

Rama i suggest you discuss your thoughts and concerns with Dr Catts or Dr Schaplof and they will be in a better position to address your concerns and issues. I did that and found the discussions very helpful.

all the best in your deliberations .

I met a guy in Sydney today who's having his PAE on Wednesday. He will be no 16. 

Better make your move quick Rama. :-) 

I agree with you Sam. The alternatives were too horrible to contemplate. 

In the end what swung me was this. I had to do something. Why not go with the best procedure first. If it doesn't work I could always go to Laser or TURP. 

The first study was done on dogs.  Animals are too preliminary and don't translate fully to humans.  I don't know of anyone that had this proceduire done.  For me, it is important to share experiences with others so I can have a real world opinion.

There was a discussion of PEMF on either this thread or the one on TURPs a few weeks or months back. I read the PEMF report published on line. It was a poorly done study that faded into oblivion. The study was not double blind. The changes in the dogs' prostates could have been the result of the massage and handling of the dogs as much as the electro magnetic radiation. It looked like a scam to me.

I saw this product as well and checked out the many products that do this procedure which rent for a 1000.00 plus depending on what you want.

Not sure how one would proceed to treat them self without proper supper vision.

I had my PAE last Thursday by Dr. Bagla and after 2 plus days have started to fell much better. We shall see if the proceedure works as noted by others here. I am still on flowmax and will wait at least 2-3 weeks before stopping it.

Lou

Good luck Lou. Look forward to hearing how it works out for you.

THANKS, HAVE YOU HEARD IF RESULTS CAN START WITH A FEW DAYS. BAGLA SAID WAIT 1 MONTH.

THANKS FOR THE WELL WISHES.

LOU

Hi Lou, I noticed an immediate improvement. It just got better and better even now after 9 months. 

Day four was THE day for me. All discomfort gone and improving all the time.

Hi Lou, I noticed an immediate improvement. It just got better and better even now after 9 months. 

Day four was THE day for me. All discomfort gone and improving all the time.

that great. were you on any flowmax or just taking pain meds

I took Flomax for two weeks only cause doc asked me too. Looking back I probably didn't need it. 

i didn't need any extra pain meds...pain was minor and all gone after four days. 

 

Like Caringhbah, i was back to my old self after four days. Did not need pain killers nor Flowmax.

So far the outlook has been positive for me and i had my PAE in November 2015.

thats great, I spoke to the baglas office and they said not to expect much for a month. kind worried that I did not get that kind of response. I feel much better with respect to the pain though.

thanks for the reply. Where did you get yours done?

Like Sam & Caringbah I had improvement after the first week and no pain. I also did not take any BPH medicines since the PAE. I had mine in April of 2015 and life could not be better.

Thanks, glad you are doing well. I will just have to wait and see how things play out.

best lou

I had my PAE done in Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia.

Hi caringah and sam,

My ticks to Sydney are booked for the 1st March.

Thanks for the encoraging posts.

Cheers

That's great!

Neal

Well done Rama! 

I think your chances of having a hassle free successful procedure are much higher with PAE than any of the other options plus you're getting it for free. 

What could be better.:-)

Wish you the very best.

I am sure the process will not be daunting ensure that you prepare all the questions you need to to ask the Doctors regarding PAE.