Options: Wait, PAE or FLA or Gat Goren procedure or perhaps PEMF

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Hello all,   I'm 54 years old and I've had BPH for 12 years.  Up until the last 6 months, things were annoying but not so bad. Recently, I've been peeing very slowly and retaining fluid etc... I can't say things aren't horrible but now I'm getting up more often at night.  Mostly once but twice a lot... I'm not complaining after reading about guys on this site who get up 6 to 8 times a night. my change has been mostly with the stream... I had a flow test and the qmax was an 8. My Uro said im peeing like an 80 yr old man...I also had a ultrsound recently and I have a large median lobe and the prostate was  about 55 grams. He said my median lobe was like a ball pushing up into my bladder and bladder neck...  Anyway,  I've looked at all the procedures that I could find not wanting to take any of the drugs. My Uro was pushing rappaflow and finisteride. I want to do something now before it gets a lot worse because I know it's headed there. I'm interested in what everyone has to say. I've looked at the Gat Goren procedure and to be honest, it seems to have solved the underlying cause of BPH. The backflow from spermatic veins into the prostate makes a lot of sense as the cause for the enlargement. The problem is it doesn't look like anybody besides Gat Goren is doing it and it's very expensive. I've been reading about since 2009 and the treatment hasn't taken off around the world. I have no idea why. If I had the 20 to 25k. I think I would do that but given my not so horrible codition right now and my lack of funds for the operation, I can wait until it's more widespread(which may never happen)or consider something else. I checked with Dr Bagla's office recently and the PAE operation will be covered 100 percent by my insurance, so I'm leaning in that direction. FLA looks fantastic. No blocking anything off, no beads just precision ablation with minimum side effects...But it's 20k... Now there's another treatment on the horizon..PEMF..  It looks promising but years away.  So, I'm leaning toward PAE and I figure I can still do one of these other treatments in the future if it doesn't work out or lasts only a few years... I'm pretty sure doing PAE doesn't preclude any other type of treatment in the future...like the Gat Goren procedure or FLA...My gut feeling is I should get the PAE done now even though I'm not as bad as other guys... But, I'm obviously not sure. 

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  • Posted

    I suggest doing CIC.  It's the best thing I did for my prostate and bladder.  After doing CIC, you will feel great with an empty bladder!!! I know if sounds terrible sticking something in your penis, but believe me you will get used to it quickly.  The benefits, are the best!

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  • Posted

    Much depends upon what country you are in.

    I am in the USA and went to Weill Cornell Urology. Supposeldy rated #6 in the USA. They are running two clinical trials: water ablation and iTind. I was carefully screened and chose iTind and it has worked very well for me. Good for prostates up to 150ml that have not has any surgery.

    Because it was a clinical trial there was no cost to me or my insurance. Very easy. Only 5 minutes to implant. Very low trauma. Went home that afternoon. Works well for about 85% of men. Results have lasted up to 5 years without a need to repeat.  Problems only occur with some men due to comorbidity of other issues.

    No negative side effects. It is very precise so they avoid damaging surrounding tissue when compared to other procedures like TURP. It essentially creates three "incisions" inside the prostate and bladder neck which allows urine to drain more easily so I do not believe that a large median lobe matters. The "incisions" are not cut so much as pressed by thin wires and the cells are compressed and so die off naturally like a scab falling off a wound. It was not painful. Just uncomfortable for a few days. No bike riding for sure. Then it is removed and AHHHHH ... like removing a pebble from your shoe. Go check out Medi-tate website or call Weill Cornell in NYC if you live in the USA and ask for Dr. Chugtai's office. They were great.

    I was recently told that if it had not worked then the new water ablation works really well too. They can carve out more tissue to make a wider passage. It works like a miniature pressure washer and is computer guided with ultra-sound imaging so also if very precise. One overnight stay and a catheter for one day then it is removed. Little bleeding and instant results too.

    Weill Cornell is a reserch hospital so they are on the forefront of the latest techniques. Bets of luck and good health to you.

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    • Posted

      Bobby very happy for you.  Do you know what the water ablation procedure is called Thanks  Ken
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    • Posted

      Call Dr. Chugtai's office and speak with Maritza Rodriguez. She is the Nurse Practioner who is the study admin. Super nice lady. (646) 962-4811

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    • Posted

      REZUM USES HEAT/STEAM to kill and remove cells..

      Water ablation uses water pressure to remove tissue and is followed by a blue light laser to cauteize for bleeding.

      Both are a form of TURP. It is just the mechanism of action that is different and how precise the device is so the surgeon can avoid hitting sensitive areas.

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    • Posted

      It seems as though Rezum, FLA and Water ablation use different methods to accomplish pretty much the same thing.
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    • Posted

      Hello Bobby...   Just read one of the trial that they did.  It sounds like a very easy procedure.  They call it Water Jet or Aquablation procedure It take about 38 minutes and you have to stay overnight at the hospital.  They reported that no patient experienced urinary incontinence or sexual dysfunction.   Most of the time when they talk about a procedure that is all you get.  This was also a paragraph that they added: Potential benefits of the aquablation system used ( AQUABEAM ) include precise surgical mapping with perservation of key anatomic structures while removing substantial prostate glandular tissue. They wrote: Preservation of the anatomic landmarks ( e.g, bladder neck and some tissue around verumontanum ) may contribute to preservation of sexual function by avoided destruction of the bladder sphincter.  Which in english means no retro ejaculation.  Let home we get this appoved soon.  Take care  Ken
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    • Posted

      Yes. My doctor, Bilal Chugtai at Weill Cornell in New York Presbyterian is also doing the clinical trial for water ablation and has had great results. It was mentioned to me when I was in for a follow up visit since I had the iTind prodecure last November which has worked nicely for me.

      The major difference is what the mechanism of action is, how much trauma is caused to surrounding tissue, how precise it is, how much relief you get, anfd how long it will last. They never actually cure BPH so much as treat the symptoms. If your prostate keeps growing it will eventually close up the urethra over time. If you are older it likely will not matter as you will likely die of something el;se before you need another procedure. But if you have another 25 years to live then you might have to repeat a procedure.

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      But is is good that they are coming up with new procedure that leave our functions alone.  I had the urolift done 2 years ago. Because my prostate closed and I had to force myself.  He opened me up with 4 impants and it has been fine.  I'm 61 now and if I have to have a few more implants put in no proplem  I was happy I founf my urologist hes young and he believe in the newer pocedures  Take care  Ken

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    • Posted

      Really amazing what they are coming up with. We are much better off than our fathers and grandfathers. I hope it keeps getting better so our kids and grandkids have it better than us.
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      I tried to participate in the Aquablation trial they are doing locally but it was full. Since they map the prostate its not a blind cutting procedure. Also the cutting is controled by a computer.  It'll be interesting to see how results go.

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    • Posted

      If you are willing to come to NYC for a day or two I know that Weill Cornell is still looking for patients.
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      The difference in FLA is they do not go up and then back out through the urethra to ablate tissue.

      It is done as a rectal procedrue with a hair size laser and the cauterization of the tissue is done as part of the procedrue which lowers chances dramatically of any infection. I had no rectal blood or issues and did not even realize it was done rectally during the procedrue with the conscious sedation. It was over fast and I left and went to lunch. Not sure about REZUM path of entry and delivery. The FLA was very precise.

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    • Posted

      I read 1 trial of 200 men and it went well.  I'm going to look up and see if I can learn more.  I like that they feel that retro is a function and older men still are in to it.  9 out of 10 surgerys cause retro...Ken

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      Hi BobbyT I spoke with them a while back. I'm curious how much tissue is removed with this procedure. If it's just compressing tissue with a little tissue loss how long can it realistically last? Right now I am pretty sure I'm going with FLA. My BPH symptoms a relatively mild compares to most men here. I do have a bleeding problem though. I had a cystoscopy and multiple CT scans still no answers. Tried to have a cystoscopy done last bleeding episode but uro couldn't be bothered. So much much for getting to bottom of things

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    • Posted

      Unckle, my flow rate was back to pre procedure at the two week point for sure and it improved dramtically all in one nigth right at about three and a half weeks out. I was shocking as if someone had turned a switch on. It was a Thursday night and I spept through the night completely for the first time. Also, my flow doubled. I know now it was the imflamation had gone down. It was on a Thursday and I could tell in the afternoon that day that something felt different but did not understand what it was. Then the next week I got up the nerve to have sex and you know that story. Remember, I was named the "Roman Candle"!!

      Now I am back to just being called "hey you". I guess the new has worn off and I am not a novelty anymore. But Dr. K told me it would continue to improve when I had my 8 week follow review call with him. I did not believe it could get any better at that point. What is there to get better I ask? But, I have now discovered that he was correct it has gotten better. That being said it is a kind of harmony in my urination flow. A smoother flow from before while I was healing. And, I am not thinking about it all the time now. Also, it is now much easier to resist the urge to pee if I want to. We have to re-teach ourself realize that  over the years we have given in to any urge and it is still difficult to hold when you are healing from the procedure. It is NOT so difficult after every thing is well. My voiding has gotten into a good rhythm flow which I cant remember for 10 years back.

      I am very glad I did this and now I will wait to hear of a shot that is a cure to completely stop BPH. We all know that all of these procedures are only to treat the symptoms. FLA is great for that part. And I fully accept the logic of how it will last a long time. We will see.

      keep in touch unckle.

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    • Posted

      Thanks j12080, for the information. I pee pretty good now so I'm a little nervous about a procedure that will make things worse before they get better. I'm sending Dr K an email tonight to see if he can schedule me an MRI before I make the trip to Texas.  He felt the year old CT scan was enough to go on but I would be more confortable getting an MRI to be sure. 

      Talk to you later

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