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

I would not agree with this.  There are generally more side-effects with TURP depending on the method/energy being used.  You will need to be cathed after the procedure, length of time depending on the method used.  There are definitely more sexual side-effects with TURP.  I have not seen any TURP procedure being done under local.  It requires general anesthesia.  Being in touch with Dr. Pisco and Dr. Bagla, the success rate is in the vicinity of 85%.  Dr. Bagla stated he was getting closer to 90%.  When a procedure is done transurethrally, there is a chance of more complications.  We have members on this site that have gotten excellent clinical benefit using PAE. 

Camster,  I have the same impression as you do from reading posts on this site.

However I think we don't have enough information about the sources. For example maybe only the men that have problems with turp are posting on this site.  The happy ones are off and enjoying their new health.  I can't tell.

And was the trial completly impartial or, perhaps, like many trials, it was funded or staffed by supporters of TURP.  

Are Drs. Pisco and Baglas 'success rates' accurate?   Statistics are quite flexible, on persons 85% success can be anothers persons total failure.  

But from reading this forum it does seem that PAE has more good outcomes and less side effects.

JJJJ, Dr. Bagla has probably done in the 400 range.  Dr. Pisco has probably done around 1000 (I haven't checked lately).  I talked to Northwestern University about their clinical trial.  They were getting very good results.  I talked to RIA Endovascular some time ago and they also reported good results.  Dr. Isaacson of UNC told me he was getting around 80% or so success rate.  At that time, he reported less success with the enlarged median lobe although there was a blog lately that he re-evaluated his statistics.  Although all the clinical trials aren't in yet and PAE is in Phase 3 and hopefully these doctors are being honest with me, I would say somewhere around 80 to 85% success rate seems to be valid.  I've had offices quote 90% success rate.  Pisco and Bagla take on some pretty difficult cases too.  They are taking people that are being cathed or have very large prostates to the point where other procedures would be difficult.  So we would have to wait when all the clinical trials are finished.  I did find Dr. Bagla to be honest.  Others have found Dr. Isaacson to be honest as well. 

Many many doctors refer to TURP as the 'gold standard'.  That doesnt make it true.

It could be.  Or not.

All the sources you cite have a $ reason to promote PAE.

I have dealt with Dr. Bagla personally.  He was charging $7000 for cash pay patients.  Dr. Isaacson was charging a little less, around the $6500 area.  Dr. Pisco in Portugal was in the same area and maybe a little less.  These are not exorbitant prices.  I know Dr. Bagla had a nice size staff to support.  He also has his own expenses.  Others on the site can attest to their experiences.  I have no reason to believe that any of these doctors are solely motivated by money.  Dr. Pisco lost a brother from prostate surgery in 2008.  He has a personal motivation for developing PAE.  They are all trying to offer something different for BPH, another option.  That's all for me.

Just completed Day 1 after PAE with Dr. Bagla.  I will try to post daily with results as I can.

Day 1

Vascular Institute of Virginia is great.  Friendly staff. Patient centered.  Met with Dr. Bagla in May after 20 years of BPH.  Family genetic defect.  Both father and uncle had TURP with horrible side effects.  I was trying to wait as long as I could in hopes that a better option would be found.  Good discussion with Dr. Bagla.  I decided that day to schedule the procedure.  My current regiment was herbals and 10 mg of Uroxatrol daily.

The procedure when fine.  Twilight sedation.  Fully awake through the whole procedure (90 minutes).  2 hour required flat on back time to allow the femoral artery to close.  Went for lunch afterwards.  Minimal leakage from the puncture site.  Four prescriptions provided, Motrin, steroid, antibiotic, and one other.  I was told to remain on the Uroxatrol for another 30 days minimum.

i has some discomfort and lay back in the car on the way home.  At home I had an afternoon of needing to pee every minute or so.  Not a good afternoon.  But, you are told during the after care that increased frequency is possible.  In addition, I probably did not drink enough fluids this afternoon either.  This was another post care item to flush the contrast material.  But other than that I felt a bit tired.

After having dinner and more to drink the frequency has been reduced to an hour or more.  In addition, when I do pee I have a stronger stream.

After the procedure Dr. Bagla stated that I had a large amount of prostate in the bladder and this procedure would reduce a large percentage of that.  I do not know what size beads were used.

I will post day 2 tomorrow.  Post any specific questions you might have and I will answer what I know.

pre-approval for insurance was requested and approved.  My carrier is Blue Cross Blue Shield Federal.

 

I agree completely with Camster. There are no reports, from the any of us on this site who have had a PAE, of any incontinence, impotence (many men report improved sexual function), long term catheter use (most PAEs are done with no catheter), significant bleeding, or infection from the PAE, or significant pain. There are MANY reports of all of these side effects here from those who have had any and all of the various flavors of TURP.

Before you decide, read the posts on this site, and on the Web.

As to the "Gold Standard" bull hockey you keep seeing about the turp, that comes from a poster put out by one of the companies that makes the equipment used to do a turp. I saw it on my urologist's wall.

Neal

Thank you Vischer!  This kind of reporting of an actual procedure done at a particular clinic is so very valuable to those of us having to make a decision about which way to proceed. Having a large amount of prostate pressing into the bladder is of particular interest to many of us with the same structural problem. In my humble BUT NON-medical professional opinion, it is likley a major contributor to the obstructed voiding problems commonly associated wtih BPH. And think about what a surgeon is up against with this problem when it exists. He has to physically separate or remove part of an anatomical object (the prostate) that is intruding into and/or pressing up onto another anatomical object (the bladder) in a living human  -without damaging the functionality of the bladder that has to flexible to do its job properly  and that is already plenty stressed, irritated and handicapped from being compacted by its neighboring prostate gland that has been growing up and/or into it (the bladder) for years most likely. That's a tall order for any surgeon whether he's doing a Green Light, HoLep, or turp. Please do keep us posted about your progress. It will be greatly appreciated by quite a few of us that are in need of a procedure.

Thanks again for your input. I hope you aren't suffering much or for long from the procedure

Lawrence06345

Right on the money Nealpros.  As to gold standard, there are less TURPS being done.  Men have a bad image of TURP as the old roto rooter.

Day 2 - I was up 8 times in the night to pee.  This translates to once every hour to hour and a half.  Strong stream, just increased frequency (1-2 times per night before the procedure).  I awoke with a nice piece of morning wood, so was happy that function was still there.  I didn't do anything with it yet, but nice to see it.

This day was much better.  Not as much frequency, I could go a couple of hours without having to pee.  I feel fine.  I can tell there is something going on down there, but at the most there are some uncomfortable moments.

I was unable to have a BM this day.  This is odd as I am usually as regular as clockwork.  Tried several times with no success.  Took a stool softener at bedtime and hopefully tomorrow will be fine.

I find that I much more completely empty now.  I use to have to go, then wait a bit and would go again to empty my bladder.  Now I just go and am finished.  It will take me a bit of re-training to adjust.

No other items of note to report.  Let me know if you have specific questions.

Constipation is a problem post PAE.  Dr. Bagla now has a stool softener (Colace) in his protocol.  Miralax works also. 

I never had that problem Camster and neither did any of the other guys in Australia that had PAE that I'm aware of. First I've heard of it. 

Dr. Bagla was having constipation problems with some patients.  He added a stool softener to his protocol.  A couple of us on this site had constipation for close to a couple of weeks.  It had me concerned.  Happy PAE in Australia is not having the problem. 

The problem is NOT the PAE. The constipation is caused by the anesthetic. Always take a stool softener starting a day or two BEFORE surgery.

Neal

Perhaps in Australia the protocol, and therefore the anesthetic are different.

Neal

I don't know about that Neal. I'm naturally prone to diarrhea anyway so any constipation is a blessing to me.

Cheers 

Peter. 

Day 3 - I was up 5 times in night to pee.  The urgency and frequency is getting less.  The Pyridium still makes the color very orange, but is finished soon.

Very good day.  Able to go several hours without trips to the toilet.  I don't seem to have a fever or other side effects. 

Removed the band-aid from the puncture site.  Seems to be almost completely healed.

Still having problems with constipation.  Took Miralax again.

Day 4 - I slept the whole night without getting up to pee.  Stream is strong and frequency is lessening. First day back to work.  Nice not having to run to the toilet all day at work.

Did a 5 mile walk after work and did not have to stop and step off into the woods to pee.

No side effects from the procedure.  Able to have sex with no problems.

Improvements keep happening.  I would be happy with how it is now.

One week - I am happy with the progress.  I am back to normal urinary habits.  I occasionally have a heavy/tight feeling in my lower abdomen.  I believe this is just the adjustment the organ is making.  I expect it to go away.  It mainly occurs if I have to sit for a long period of time.

The second semi-issue is the closure.  Dr. Bagla uses a StarClosure to close the femoral artery.  I'm not sure if it is just the placement in my particular situation, but when the leg is bent (sitting).  It feels as if something is being pinched at the insertion site. I am hoping this too will go away.  If not, I will discuss with the Doctor.

Thanks for the detailed posts Vischer, my best wishes for continued improvement.

my naatomical situation involves a prostate protruding into and blocking the bladder neck as well. I had a PAE at Sydney on March 29th. When no improvement was felt, I consulted and was advised to re-do the MRI scan to figure out teh cause. The IR (great guy and a great team at Liverpool hosp Sydney)  thinks the second MRI may reveal the root cause for lack of progress and perhaps a re-PAE. The lack of improvement is surprising particularly as the gland has gone from approx 60 ml down to 36 ml as of ultra scan 2 weeks ago.

I read a lot in this forum about urologists and their attempts to protect their trade. I live in Melborune and been consulting a uro here who did a cystoscopy 2 yrs ago. His diagnosis was - no obstruction in flow, prostate normal sized, and likely pelvic floor issues causing luts symptoms. Off to a hysio he sent me and after 1.5 years of pelvic floor exercises, my symptoms became much worse. This time when I went for a re-consult, he summarily advised a TURP failry urgently. That's when I came across this forum and organised the PAE in Sydney. Back to present, when the PAE showed no improvement after nearly 3 months, my GP sent me off to a very prominent uro (president of the AUA) for second opinion. This guy's opening remark was a shocker -- "How can these guys suppose that blocking the arteries can solve the prostate issues ". There was no room left for further discussion on the subject. Based on a PVR of 250 ml seen in the lattest ultra scan, the big uro man (also a professor of urology in a prominent uni here), he signed recommendations of TURP to be performed urgently. Fortunately (I believe), I can;t afford private insuarnce, so have to wait in the state system medicare queue. This gives me enough time to fly to Sydney Friday next week for a re-MRI scan and post op assessment by the IR in Sydney. 

I find it absolutely appalling that none of the 2 urol's I consulted boetehred to do a re-cystoscopy to confirm that teh root cause is prostate obstruction. My GP is an unusually helpful and intelligent bloke (none like him) and raised doubts about whether a TURP is going to resolve my issues as the prostate has shrunk to nearly half the size post-PAE but with no improvement in symptoms. So it could be a really bad bladder issue, or a nerve-related issue, or sometjing else, we don;t know. Surely there must be a diagnostic scan method that could confirm that the flow bottleneck lies in teh area of urethra that passes thru the prostate. 

It would be an understatement to say that I am extremely p*ssed off with the big name uro's sitting in posh clinics charging huge amount of consulting fees with such rotten lack of empathy towards their patient as this bloke who calls himself the president of a national uro association. I don;t know enough to say whether his diagnosis is correct or not, but I seriously doubt (as does my GP) that enough efofrt has been made to arrive at a proper diagnosis before deciding on TURP. 

Guys, I am determined not to go through with a TURP unless there is conclusive reason to believe it will resolve the problem. I had a urinary infection last week causing 4 extermely painful days, dropping the kidney eGFR down to 36. I am hoping to live through all of this and come out the other end with some renal function intact, I am also determined to expose these fatcat uro buggers who IMHO are completely non-professional, and are only concerned about making a fortune out of their patients' misery by protection of their "trade". I don;t believe these guys should be called doctors, but I don;t have a sutiable word for their kind right now. I will take to blogs, media, whatever necessary. I can't live quietly with the thought that many like me must be un-questioningly suffering at the hands of such unscruulous "doctors". 

I am not qualified to say whether TURP should stil be the "gold standard"  or not. I am peeved off with the lack of proper attention, time and effort to diagnose the problem by the "specialists" even after charging hefty consulting fees. The system is NOT working for the patient, as it is meant to. I feel strongly driven to expose alll this and do my bit to improve the system.

Meanwhile I hope to find some positive news from the re-MRI scan next week, let's see.

 

I've also had tightness in the lower abdomen on the left side and below that in the pictineus (sp?) muscle.  Also a tight feeling a bit farther in from the insertion site (this may be the slurry that they used to keep the microspheres from coming back out.  I've had some success with physical therapy on the pictineous muscle.  We're all different, so I'm not sure if some of this is from my activities or if it's exactly the same as what you're experiencing; however, I did not have this pre-procedure.

Urologist's use TURP as a gold standard as a mantra.  We've all heard it.  I've had two urologists do this with me until I got into the side-effects, then the conversation stopped.  They expound on the benefits but minimize the side-effects.  If TURP was so great, we wouldn't be having all these alternatives being developed.  

Rama,

I think you should see what the re-MRI shows before making any decisions.

I've had two Greenlight laser treatments and a TURP in the past 4 years. (Also had the TUMT 5 years ago - a total waste of time, even the tech administering it told me it wouldn't work.)AFter the first Greenlight I developed a membrane which partially blocked the prostatic urethra. So a membrane or stricture is one thing that can block urine. Following the removal of the membrane with the cystoscop wire, I self cathed once a month to prevent any regrowth. This lasted a year. My stream was still not great and due to a hematuria I had a second GL 18 months after the first. In addition to stopping the bleeding my uro removed excess bladder mouth tissue (a resection of the bladder mouth) and removed bladder stones as well. During the year I self cathed my pvr was anywhere from 125ml to 250 ml. Prior to my first GL it was 400ml., I was able to measure my own pvr while self cathing. A year after my second GL I had another hematuria and my uro did a TURP to stop the bleeding. My stream finally has been good the past 15 months and my pvr was 32 at my last two ultrasounds. I have been taking dutasteride to keep the prostate from regrowing, as it as still 200g after the turp (it was 300g prior to the turp).

So an overgrown bladder mouth and bladder stones can also block urine. I also had the prostate median lobe protruding into the bladder. However, when I self cathed I could feel the obstruction was about an inch inside the bladder mouth, so it didn't seal it off. If it is too close to the bladder mouth it can act like a ball valve to block off the urine. Another possibility to consider.

Unfortunately we all expect our doctors to have the answers, do an extensive diagnostic of our problem, etc. The truth is about 50% of medicine (if not more) is just guess work. No doctor knows what will cure everyone because we are all different.It's unfortunate when we are the outliers that don't respond to treatments that help others, but that's the luck of the draw. I'm currently under treatment for afib (a bad heart) and lymphoma, and so far the two months of treatments aren't solving either. My doctors will try different stuff, hoping it works. That's the reality, and we have to live with it, or die with it.

Thanks for the comment.  Mine is slowly going away.  I barely notice it right now.  Probably something that had to heal or my body had to get comfortable with.

That's great news!

Hi Rama,

Did you have your re-MRI and get any results yet?

Bob

Hey Bob

The reMRI shows overall prostate reduction in size fro 50 ml to 32 ml. But the median lobe has shrunk very very little if at all. This is clearly seen in pre and post-pae scans. Dr Sclaphoff spent an hour walking me through the scans. Also showed me scan of a pre pae 150 ml gland of an anonymous patient whose size came down to 90 ml post pae but he no longer has any flow obstruction and wees like a horse. He also had me go to a friendly (not anti pae) who did a dyna uroflo analysis while measuring bladder response. The bladder is ok, so some good news.

As for a re-pae, the good doc is not so sure. He reckons my case is to be in his presentation to a IR conf in Madrid in Sept, where he will consult Dr Pisco of Portugal about chances of re-pae.

I am on state q for a turp, probably by year end. Between now and then I am trying out some alternative stuff and will post in case something clicks.

Ramakant,

I'm in a similar situation.  Had PAE on 9/28 w/ very little improvement.  My pre-PAE size was in the 50s (haven't had follow-up MRI to determine how much it shrank).  Had a large median lobe.  I'm also trying to determine whether having another PAE may help.  I'd like to see greater success w/ large median lobe patients before trying again.  Hopefully they'll figure that out.  I haven't seen many w/ large median lobe on this forum being significantly helped by PAE.  In the meantime I'm on Rapaflo and CIC.  may need to do this for at least a few more years.

Please let us know what Dr. Pisco says about your case and rePAE.

Good luck!

Hi Rama,

Best of luck. I found the alternative treatments worked for a bit but did not sustain any improvement. I tried a few commercial prostate pills and saw palmetto, pumpkin seeds, different supplements but nothing worked. As far as I know Dutasteride or finasteride will shrink the prostate over a period of 6 months and tamsulosin will relax the prostate to increse flow. They both have some side effects but they work. In my case the tamsulosin stopped working after 6 months and I had to cath until I got the Greenlight. But the Turp worked better and I have been OK for 16 months in terms of stream and emptying, but it won't necessarily eliminate getting up at night, but may improve it.My concern is how long it will last.  Let us know how you make out.

Bob

Somewhere on here is a post from someone quoting Dr Bagla as saying he can do it by finding the correct arteries and embolizing them. He's in Arlington, VA, I think.

Neal

Hey Bob, Arlington,

Thanks for sharing your similar experiences.

Bob, I hope and pray your good results with turp continue. Any initial or lasting side effects from turp ? What was your prostate size ?

I've been on Tamsulosin for 6 months or so, it seems to keep the flow going well enough to keep me away from the emergency wards. GP recently moved me to Duodart (duast + tamsul), it's much the same deal wrt side effects. Some days I can barely keep my eyes open at work. Having started late (3rd marriage etc etc), I have a young family, so gotta hang in there for another 10-15 years. Perhaps that makes me more willing to try alternative meds, including PEMF etc., keeping all options open. Most of us with any amount of exposure to science & tech. tend to dismiss alt meds. I found the horseradish root powder very effective for uti's, it apparently has active ant-bact ingredients that survive digest. sys and nip the infection in a day or tow, as effective as the antobitics with hardly any side effecst. It was recommended to me by a Thai bloke while I lived in bangkok years ago. I did some online searching and tried it.

Will keep posting if anything exciting happens.

 

Hi Rama,

Just prior to the turp my prostate was measured at 313g. On the sonogram the median lobe seemed to take up about 15% or so of the lower bladder. After the turp it measured 203g. I don't know what the condition of the median lobe was because I didn't see the sonogram, just the written report. When I go again to have it measured in a month or so I'll get a copy of the sonogram CD so I can see for myself on my computer. My PVR was just 32ml, so a big success there. The only lasting side effect of the turp was retro ejaculation. I had forgotten about it and 6 weeks after the turp my first ejaculation felt fine to me. I didn't even realize there was no ejaculate until later, when I realized there was no sign of ejaculate.

The worst side effect of the tamsulosin for me was the stuffy nose. The nasal sinuses are apparently the same sort of tissue as the prostate and tamsulosin effects them both by loosening them up. In the sinuses,  this makes them swell a bit. When the side effect of the stuffy nose subsided after about 6 months, the tamsulosin also stopped working.

The only side effect I have had with the dutasteride is a lessening of libido and lessening of the intensity of orgasms. But to me, it's all good. To quote Woody Allen in a movie he did with Beth Middler, " Every orgasm I ever had has been spot on".

It's not that I haven't tried alt meds, for prostate, and high blood pressure. It's just I never found any that worked as well as prescription meds. Good luck and keep us posted.

Bob

P.S. Rama,

I see you also asked about initial after effects of the turp. I believe the size of the prostate and amount of tissue removed may effect this. In my case there was a couple of weeks of extreme urgency and frequency after the turp. I had about a 4 second window to get to the bathroom for the first couple of weeks. There was bleeding that lasted about a month, but in my case was due to the hematuria, so it was frank blood rather than burgundy colored pee. There was pain after urination for a few weeks. I wore plastic underpants over adult diapers when going out the first month or so. With your much smaller prostate, you probably would have a much less severe recuperation. All in all, I found the turp much preferable to the greenlight laser, which I wouldn't recommend to anyone.

Bob

Thanks Nealpros.

Yes - I saw that; however, I don't think he has actually done one yet (still theory at this point).  a nice theory, thoug, if it comes to fruition and works!