How did you decide on a procedure?

And did the TURP solve your problem?  Were there any lasting negative side-effects?

Don  I am very sorry for you.  He should have told you that there were other procedure that you could have had.  I hope it went well for you.  I also hope you can deal with any of the side effects that will come up.  God Bless   Ken

"One thing I have learned so far in my research is: stay away from the Foley catheter."

Having had a Foley catheter 3 times for a total of 10 days, it's really not a big deal.  Since I'm retired I didn't have to leave the house with it in place (although I have done so.)  Is it inconvenient?  Sure.  Is it painful?  Not in my experience.  I removed it myself each time and it there was no pain, just a funny feeling for second.  I was amazed the first time how long it was.  The only painful thing was removing the tape from my hairy thigh!  Now that hurt.

"Didn't like the idea of losing sexual function with TURP."

Lest anyone get confused, we should be careful equating "losing sexual function" and retrograde ejaculation (often referred to in this forum as "retro" or "RE".  There is no loss of sexual function with RE unless you plan to father more children or consider the ability to squirt semen as a sexual function.  Although there is certainly a possibility with TURP, instances of ED where it did not exist before are low.  RE is pretty common after TURP, clinical studies indicating about a 50% rate.

Thanks for the very informative reply.  Your guy sounds like my guy; about the same age and the same preference for TURP based on his experience.  My prostate (his estimate from DRE) is only about 50g and I am not suffering from retention.  The meds are working pretty well so I have no immediate need for a procedure.

Jim  Seams like you have a very understanding Urologist.  He did not push you into a Turp.  Stay away from it still to many side effects and healing take longer  Good luck  Ken

Thanks for the info.  How did you find the radiologist doing PAE?

Hi Lee,

    There are many interventional radioligists doing the procedure. Based on my following of other men's posts on these forums over the past two years, and on my personal experience, two excellent choices are Dr Sandeep Bagla at the Vascular Institute of Virginia in Woodbridge, VA and Dr Ari Isaacson at the Univ of North Carolina School of Medicine.

Both Drs were very available to talk to me on the phone prior to my deciding what to do, and both have done many, many of the procedures (Dr Bagla hundreds). I think it's extremely important to choose a doc that has a lot of experience with the procedure. I eventually had the PAE done by Dr Bagla. He and his staff were incredible, and continue to be available by phone a year after my procedure.

Rich

 

Thanks Rich.  With the procedures that use a "device" (e.g, greenlight or plasma button), the manufacturer usually has a "find a physician" on their website.  Since PAE doesn't really use a device (as far as I can tell), finding a radiologist doing the procedure is a little more challenging.  If I should decide PAE is right for me, I would prefer to have it done closer to home.  Chicago is about 2 hrs away so if anyone has the name of a radiologist in the Chicago area doing PAE, send me a message.

Through this site I found that Dr Nutting was doing the procedure in Denver. Looked him up and found he was with RIA Endovascular. Called them up and found out he had left and that Dr. Tyler Green was doing the procedure instead. I went in for a consult with Dr. Green and was a little concerned that he had done only about 10 PAEs, at the time, which concerned me. But he made the case that he had done a couple hundred similar procedures on other organs such as the liver. I liked that he was very open about his experience and willing to answer all my questions. I also liked that the procedure would be done only a little over an hour from where I live.

During the PAE procedure Dr Green also had another radiologist in the room which gave me more confidence that processes would not be overlooked.  I was also happy that I received a comprehensive write-up of the drugs used and procedure accomplished including videos of dye flowing through my prostate arteries.

Interesting info.  Did your urologist send him your medical records that indicated this was an appropriate procedure for your BPH?  Or did Dr. Green have you examined by a urologist he works with?  I wouldn't expect a radiologist to be able to diagnose BPH and the appropriate treatment so it's the information transfer from urologist to radiologist that I'm curious about.

Jim  Your doctor seams to be very open.  Out of the ten that he did would you be able to talk with them about there results and see how it worked out for them  Ken 

Yes, my radiologist got all my records from my urologist who said I had BPH and that a procedure such as TURP or PAE would be appropriate. My urologist also said I could continue to take tamsulosin and finasteride and that it was up to me and my symptoms whether to have a procedure done. I had an emergency room catheter visit and the drugs really were not doing much for me so I decided to go the surgical route. My urologist was recommending the button TURP procedure that he performs but my research found PAE to be lower risk with less side effects and decided to go that route.  My radiologist does not pretend to be a urologist and after the PAE monthly follow-up says I should be seeing my urologist again. My radiologist is providing all my PAE procedure records back to my urologist.

Ken, I did not ask to interview any of the ten. I did offer to be a reference if someone else asked to talk with one of his patients.

Jim

In the US, HIPAA laws would prevent the doctor from giving out the names of his patients to anyone without their permission (probably in writing.)

Yes that is true.  I live in Orlando Florida.  I have giving my permission to talk with anyone that wanted information on the Urolift which I had over 3 years ago.  I have talk to about 20 men that were looking into it.  I also have talk with men that had other procedures because I have a lot of information from about 4 doctor's that do Urolift, Turp, Laser From the UK and Rezum. I have gotten e-mail and phone calles.  My urologist turn that one down because of the damage it done to his friend. His friend want against his advice and had it done  We all have a right to what every procedure we feel is best for us.  Even if you have a close friend that is a urologist. They did repair the damage.   But there still friends.  Take care and I hope all goes well  Ken   

You appear to have had a good experience so far.  Hope you will continue periodic updates for those of us who are interested in the PAE procedure.  Everything you've reported has been encouraging.  Thanks.

   My experience about information transfer from uro doc to IR doc is quite different from what you expressed. The uro docs that I mentioned PAE to were not at all open to discussing it or being involved. The IR docs that I spoke with who had done dozens or even hundreds of PAEs were quite knowledgeable, to the say the least, about BPH, and whether it would be an appropriate treatment for me. I would recommend going to the Vascular Institute of Virgina's website and reading their PAE info pages. That's Dr Bagla's institute, and the place where I had my PAE.

 

Re: Chicago and PAE. I did a quick google of "Chicago Prostate Artery Embolization" and there were some hits. I don't have any knowledge of the two that I glanced at, but it could be a good starting place for you. As mentioned before, you want a doctor who has done many, many of these procedures. I chose to travel (350 miles one way) so that I could have the procedure done by Dr Bagla.

Hi Rich, I checked Virginia's PAE page and while they mentioned no instances of incontinence or impotence, they didn't mention retrograde ejaculation, which says a lot. Other searches only yielded "lower than TURP" with retro, which is not very exact or reassuring. I also seem to remember reports here either of retro or reduced ejaculate after PAE. What was your experience and what did Dr Bagla tell you about the chances of retro prior to the procedure?

Jim

Thanks Rick.  I just did that and will look at the results.  I must have worded my recent search poorly because I did not get the same hits.

Hi Jim,

     I never discussed retro with Dr B as it was not a concern of mine. I haven't had retro, and haven't noticed reduced ejaculate, though that's not something that I pay close attention to.

Rich

 

Yes, when I used "PAE" instead of "Prostate Artery Embolization", I got a lot of unrelated hits.

Is it common for a urologist to remove bladder stones and do a Button Turp or Holep at the same time in one procedure? 

Or do most break up and remove the stones first as one procedure? 

It is not necessary to do a Turp or Holep to remove the bladder stone.  They like to do it that way because it is easier to remove the stones.  But you can say no to the other procedure.  Don't let them forced you do to it that way if your not having a problem with your prostate.  Just say no  Ken

Lee,  I had PAE done in December 2013, by Dr John Kaufman, at Oregon Health and Science University, OHSU in Portland.  He had only done two at that time because it was very new.  However he had done many Uterine fibroid embolizations for women, that are very similar.  He wanted me to be evaluated by one of their own urologists.  The urologist didn't do much testing since my records were sent from my regular urologist, which included cystoscopy, flow rate, DRE, and ultrasound size measurement indicating 70g.  Residual volume tests showed about 180ml residual.  The procedure took about an hour and I was twilighted, so was not bad as far as any pain.  I asked to have a catheter put in figuring it would help the doctors with their imaging, which they said it did.  They put in a foley cath, which looked about 1/4 inch diameter when it was removed.  The catheter also helped during the 4 or 5 hours laying in bed after the procedure, so I didn't have to get up to pee.  They put a heavy bag, maybe a sandbag, on the artery, while it was healing.  About an hour after the catheter was removed I got up to pee and could pee alright with some blood due to the cath,  after three times peeing the blood cleared out. I went home that evening. Next day I got some aching in the prostate area so started taking the antibiotic that was prescribed, aching went away in one day. I went back to work in about two days and had no problems after that. PAE caused no side effects including no RE.

As for the success of the procedure, it did not help me much. I have stayed on flowmax until now, 4 years later. I had an enlarged median lobe maybe that had something to do with it.  MRI showed that the prostate shrank about 20%.  PSA went from 2.3 to 1.75,  it was alteady low from taking Avodart for 1.5 years.  The OHSU urologist wanted to do a urodynamics test on me which I refused at the time because I didn't understand the need for it, and was paying for 20% of everything my Bluecross insurance didn't cover including the PAE.  Now I understand that they wanted to see if a bladder problem was responsible for the poor response to PAE.

Here I am 4 years later and having too much retention, so am looking for a new procedure.  I am considering Rezum, but FLA looks good too.  Before I do anything I will go through the tests again, especially cystoscopy, ultrasound size, and urodynamics, which may point the way to go.

I don't know if it's common or not but it is done.  I recently read a paper that said if stones are discovered at the start of the button TURP procedure, they can be removed and the procedure can continue.  That is not the case if a bladder tumor is discovered.  To find this paper, search on this phrase "Same day discharge for transurethral resection"

I was not clear. 

I need a procedure to reduce my prostate size (it’s approximately 3 times lager than normal). 

The surgery might be a Button Turp, or Holep.    

Due to gross hematuria I had a CT scan that showed 6 small bladder stones. 

They need to come out. 

The question: is it more common for a urologist to do two procedures, one to remove the stones and another to do a Button Turp/Holep? Or both together in one procedure. Thank you. 

Phil  I asked my Urologist before.  If you do have bladder stones they can remove them without doing a Turp or Holep.  The prostate is just moved on the side.  They blast the stones and the urologist will flush them out.  You can have a less evasive procedure done.  Urolift, Rezum or PAE. These 3 are much better to heal from faster.  Get a second opinion  They can remove the stones with out doing the other procedure  Ken

My prostate is too large for Urolift, so far it seems PAE doesnt yield the same positive outcomes as a Holep or B. Turp. 

I need to. Look further into Rezum. 

I realize Turp is not necessary to remove stones. Again, my question is if one wants to have Turp AND they bladder stones, is it more common and wiser to have both done as one procedure or separately.   

They would do it all at one time they would do the Turp to get the prostate out of the way and then go into the bladder to remove the stones. You say that your prostate is large How large is it.  Urolift can be done up to 100 ml  Why have a Turp when something less evasive would do the same thing.  Rezum would be next.  Ken