MRI guided FLA - Focal Laser Ablation with Dr K in Houston. 4 weeks post op and I am cured! :)

Hi Arlington, I had severe BPH with a prostate size of around 85 and a flow rate that was way below normal. I also had a small tumour in my prostate that turned out thankfully to be benign. Before surgery I was going to the bathroom about 4 to 5 times in the night and 10 times during the day, and was wetting myself at work at times. It was horrific. I definitely needed something done as it was driving me crazy. I had to do all the pulling and pushing thing to even get any urine to come out at all before the surgery. Today is in fact exactly my 4 week mark since the surgery and I awoke this morning and had a nice long relaxed pee just like I was 50 again! I am very very pleased. No I did not go into urinary retention after surgery. I wore the catheter a bit longer than one week (10 days) as I had to fly back to England wearing it on the plane, which was very wise. I personally recommend a 10 day catheter time instead of 7 days as the 10 days turned out to be just enough so I did not have to have it re-inserted. I did not get any UTI infections and have no incontence, no erectile dysfunction and ejaculation plumbing seems to be working normally. I can not thank Dr Karamanian and his senior Nurse Donnie Sartin enough for the great job they did on me! I will now spend the next 6 months paying it off but I would rather be healthy and working and feeling great for the next 6 months working than stuck with constant pain and bleeding like I hear many poor guys experience with some of the other barbaric procedures out there. MRI FLA is the future, I am convinced. This was one of the best decisions I've ever made. Best, Toby

Hi Andrew:

Would you mind elaborating a bit;

1)I assume you were self catheterizing prior to the operation. Why did SC impact your recovery?

2. Since you state numerous measurements of max flowrates, how did you measure them? Given the number of measurements you imply, it doesn't sound like you had them all done in a doctor's office. Were they perhaps average flowrates and not max flowrates?

3. Have you seen any impact on how many times you get up at night?

No, I never had to self catheterize before my FLA, but Dr.K, just before procedure showed me how to do it, just in case, he expected I will need to rehabilitate my bladder after FLA.

I have had 15 ablations, five for PCa, 10 for BPH so my prostate was quite swollen, so when I removed my Foley after 11 days, I guess this was not enough to allow for decent flow, the urine flow was minimal and painful, so I started self catheterization, which led in few days to UTI and complete retention, ended up in ER and had another Foley inserted, Dr.K suggested I keep it for 14 days, as soon as I removed the Foley after 14 days my flow was v.good and all other symptoms of UTI or any pain were long gone, as far as my flow rates, I have measured them on my own, very easy, all you need is a watch and some transparent beaker.

The urine flow rates are an average flow rates, measured typically over 20-30 sec, max flow rates are likely higher, mostly in the first 10 sec or so while peeing and pressure from the full bladder is the highest, but I never measured them.

As I indicated, my IPSS went from 25 to 1, one only because I have to get up to pee once at night, before FLA it was one or two times, depending on how much I was drinking, although I usually stopped drinking after 6PM, all other symptoms of BPH are gone.

I have very little PVR, three months post FLA I tried self catheterization three times to see how much would come out, turned out almost nothing, maybe 20-30 ml, Dr.K said don't try anymore and I also feel I am voiding fully, so it appears there is no need to rehabilitate my bladder, anyway in about 3 weeks I am planning to have ultrasound of my bladder to confirm if there is any PVR.

Thanks for the info. Yes, your max flowrate could potentially be twice your average flowrate (but deciding when a urination is over can have a big effect). There is an inexpensive device ($10.95) that you can buy on Amazon called "Uflow Meter", which will give you ranges that your max flowrate is in: 0 to 10 mL/sec, 10 to 15 mL/sec and greater than 15 mL/sec >15 mL/sec is typically considered a target where BPH is not significantly blocking flow.

I had a UTI last year, which turned out to be very ugly for me. I learned to self-cath for emergency situations afterwards. When you got your UTI and had complete retention, did you try to self cath (and perhaps fail) or did you just decide to go to the ER or..... The reason I ask is that my plan is to self cath if I ever awake at night (and these things typically seem to occur at night) and can't urinate. I've often wondered if I'll be able to get the catheter through the closed off urethra in such a situation.

Also, bladder scanners are often not that accurate when the PVR is low. They are much more accurate at higher readings. I have a bladder scanner and have struggled with using it even going so far as to self cath in order to check the accuracy (However, since my large 100 gram prostate pushes well into my bladder, I don't think that self cathing can get everything out with urine remaining in the valley). Still if you get numbers less than 50 mL with the scanner, you should be in good shape. It would have been best if you had readings before the procedure to then check for a difference even if the absolute values might be off somewhat.

One thing I've noticed is that most of the urologist aides that have taken my PVR are poorly trained. Most get a reading of exactly zero (which is suspicious). I try to help them since I have done so many scans myself. In one case I told the uro that his aid measured zero three times on two different machines. The uro shook his head and then used one of the machines to measure my PVR. He got a reading of 68mL which was actually quite consistent with the readings I got on my own bladder scanner. See if you can get the urologist to take the reading since they understand where the bladder is and how to angle the probe towards the anus. Just something to be aware of, but it sounds like your PVR will be pretty low, so congratulations.

After my first Foley post FLA, my flow was slow and painful, but I managed to self catheterize myself for seven days with no issues, meantime my UTI developed and eventually I couldn't insert my catheter, I had to go to ER at 3 AM and it took two attempts, at two different hospitals, in the first one the nurse couldn't do it, only a urologist on call in the second hospital was able to insert a size larger/stiffer catheter, it took all 10hrs when my Foley was in and draining my urine, no fun, but all is good now

Which catheter were you using that failed to insert?

beforey previous bladder ultrasound in Feb/18 showed ~450ml PVR, Dr.K/Donnie also measured it around 400ml, just before FLA, but my next ultrasound PVR will by a regular US technician, not an uro, but I will likely self cath just to confirm their measurement, Dr.K initillay suggested I should be self cathing for up to six months, expecting my bladder being damaged from 9 years of BPH, turned out I might be lucky and able to void almost completely, but this need to be verified

Wow, 400 mL. I had a uro tell me once that he doesn't get concerned until the PVR is greater than 150 mL. If you're below 100 mL, I think it suggests you're in good shape (although I'm not a doctor) and that further improvement would be a real possibility. Not sure if you should expect to already be at your minimum PVR, though. Please report what it is as I am curious and also curious to know what your uro/Dr. K think if the PVR is potentially not as low as hoped - although I'm wishing the best result for you.

Maybe you could provide a detailed post on FLA for the benefit of the board, if you are so inclined. Best regards.

Dr.K in his recommendation/report suggested self cathing three times a day or more for up to six months or longer if needed to bring the PVR to 150ml, and reduce frequency of self cathing once I reach 150ml,

BTW, there is a very large thread on patient.info with over 1200 posts on FLA, in case you missed it, the last post was 3 weeks ago,

"Going with Focal Laser Ablation for BPH"

Thanks for the info on FLA.

If you wouldn't mind, could you let me know which catheter (type, make, model, etc) you were using that failed to get through to the bladder during your UTI. Thanks.

I had a few different ones I tried, all failed after UTI,

SpeediCath 27412,

Cure HM12,

SpeedICath Flex(available only in Canada )

SpeedICath FlexCoude Pro (only in USA ), from Dr.K

and one German made, available only in Canada,

all size 12, all worked well until I got UTI and couldn't get in,

initially at ER the nurse couldn't get in the Foley size 14, was too flexible, was bending and not going in, she gave up and they sent me to another hospital where an uro on call used I think size 16 likely stiffer and managed it in,

Hi Guys, if it helps.... I had a PVR of 330 before surgery and understand it should be 50 or below to ensure the bladder is not damaged long term. I also did a lot of research on catheters and learned a few key things as my catheter experience was not great but I made it through. 1) Always use a Silicone cathether, not a latex one. Many are sensitive to latex and I was one! 2) The Coude Tip catheters are easier to insert around the bends, and 3) There is a new design catheter out there called a Duette from a company called Poiesis. It does not have a coude tip but if you can get it in its the most comfortable catheter in the world. It comes in various sizes from 14Fr on up and the double balloon technology greatly reduces UTI infections as well as being super comfortable. I also used a lot of over the counter triple antibiotic ointment on the tip of my penis every day and never got a UTI at all. Best...Toby

Toby,

have you measured your PVR post FLA or your current urine flow?

for ref:

Ages 66 - 80

The average flow rate for males is 9 mL/sec.

References:

Peterson AC, Webster GD. Urodynamic and videourodynamic evaluation of voiding dysfunction. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 58.

What is PVR?

Post void residual. How much urine is left in your bladder after you've finished peeing. You want that number to be as close to zero as possible or at least trending in the right direction.