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PAE — Upcoming Procedure 9/1/2021

Posted , 8 users are following.

autks
autks

I just scheduled a PAE with Dr. Clark, a Penn Interventional radiologist. Had the consult with him and PA last Friday.

Thoughts at this point —

  1. 73yo, history of heart disease and stroke. Am active, and in relatively good health now.
  2. Had been to a PENN Urologist for 20 years. He suggested I check out PAE when symptoms got bad, mainly due to it doesn’t have any of the RE and ED side effects, recovery time is hopefully less than other surgeries, and less bleeding also. Current IPSS score = 25.
  3. My prostate is big, MRI showed volume ~140ml (grams). Central gland enlargement was “severe”, I think that is the “median lobe”?
  4. Dr. Clark is very active doing minimally invasive surgeries 4 days a week, and has excellent reviews at PENN. He has only done about 75 PAEs in the last 2-3 years, possibly a cause for concern, but after a Bagla and Isaacson interview on YouTube, I think it was one of them, or possibly the moderator, who said “Dr. Clark from PENN is the most talented IR he knows.” This coupled with wanting to stay, during Covid time, a few hours maximum from home, made my decision easier. He was also one of the very few to do PAE within a few hours from home.
  5. He gave me the option of either radial or femoral incision, but added he has done almost all femoral. At 6’2” tall, I am going with femoral, even with the reported longer recovery.
  6. No robots involved, he does the procedure along with possible intern helping.
  7. Unilateral vs bilateral, he said that 75%+ are bilateral, even though the unilateral is nearly as successful. He measures successful as being 1/2 of the original IPSS score post procedure.
  8. Patients have a 90% success rate.
  9. Has a 100% rate of only hitting prostate arteries due to experience and 3D cone-beam.
  10. Outpatient, non-surgical, about 1-2 hours procedure time, 3-5 hrs total, twilight.

Will fill this in with the results in a month.

Any thoughts, comments, are welcomed!

0 likes, 20 replies

20 Replies

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  • CarlosZ
    CarlosZ autks

    Posted

    It's important he uses cone beam (CBCT).

  • autks
    autks

    Posted

    I had the PAE procedure yesterday at Penn-Presbyterian with Dr. Clark, IR.

    Day 1

    Went smoothly, about 1.5hrs procedure time, recovery time about 4hrs.

    Felt no pain during procedure. Bi-lateral, he did the main 2 arteries, left and right. I could urinate after PAE, even though a very small amount, doctors were not worried about retention. After release then it started, the sudden urgent need to urinate (thanks for the heads up Pete, but I now know what you meant.) But I had pain when I was urinating, and had to go again within about 5 minutes, over and over again. I got to the point where either I could not go, or just a few dribbles came out. I was worried about retention, and went to the ER where they did a bladder scan and temporarily inserted a straight catheter. Scan was negative for retention,, and they were only able to get maybe 50-60ml of urine with the cath, wow what a relief!

    I believe the doctor should have stressed that the pain and urgency feeling was due to the prostate in a state of shock and inflamed. He did mention it a month ago, but apparently it did not sink in with me. Got ~1 hour sleep last night.

    Day 2

    Was better. Pain while urinating has subsided a fair amount, going quite a bit more than a few drops, and the drugs I took late the first day have kicked in. Going every ~15 mins, an improvement over 3-5min yesterday. Drugged up today also. Drove to the local market and back.

    Gently feeling around the groin area, nothing really stiff or sore. No hematoma, etc. I’m scheduled for tennis Friday, but think I’ll pass. He said that by day 4 or 5 I’ll be playing normal tennis, the gym, etc.

    Will update again in a few days. Overall I feel pretty good 2 days after procedure.

  • autks
    autks

    Posted

    Update --

    Day 3

    Noticed a mildly reduced need to urinate as often. Still taking LUTS drug for pain while urinating. Slept 1 hours straight thru last nite.

    Day4

    Terrible nights rest. Up to pee every 5-10 minutes. I think mainly due to inflammation, and hopefully not due to a UTI (taking heavy dose of antibiotics for possible UTI anyway.) Later in the day I noticed I was going more, and the frequency was less.

    Day5

    Much better sleep. Around 4 hours. Off of all meds today, including pain pills for LUTS, antibiotics, and inflammation. I went this AM for about 15sec with moderate stream, first time in a long while. Still have severe UTI “symptoms”, not really UTI, but just symptoms due to inflammation.

    Day 6, Day 7 Mon + Tues

    Still have lessening symptoms. Sleeping better.

    Day 8 and 9, Wednesday Thursday.

    Better sleep, less urgency, stronger stream, lower frequency. Overall much much fewer UTI symptoms. From day 5 with severe UTI symptoms, until day 9 with basically mild to no UTI symptoms. This PAE procedure appears to be working!!

  • autks
    autks

    Posted

    6 weeks after PAE —

    IPSS Before 9/1/2021 PAE = 25-30

    IPSS 10/15/2021= 14

    A great improvement, with “no” side effects! Stream is constant and, like a previous poster said, was p*****g like a race horse again. My PAE was basically tri-lateral, doctor embolized the right side of prostate, left side of prostate, then the middle lobe (central gland) as well. I think I still have middle lobe issues. Maybe at the 3 month checkup, which will include an MRI with contrast, it will have improved, along with the IPSS score.

    A few thoughts:

    1. You need to stay on Flomax, that is because initially the prostate (mine was 140ml) needed Flomax to relax and soften up, but when it starts to shrink, eventually you reach a point where it doesn’t help, about 3-6 months post procedure my doc says, then can get off of it.
    2. Sleeping much better now, used to be up around 8 times per night, now it is 3-4x per night.
    3. The long term history of PAE, while not studied that much due to the newness of the procedure, really doesn’t matter that much to me. it will probably last me at least 5 years, and if I have to have it done in 3 years, given the short recovery time, and low risk in the hands of an experienced IR, I would gladly repeat it.

    All in all, I highly recommend PAE to sufferers of BPH. Find an Interventional Radiologist, who has successfully done it at least 25-50 times, as it is too difficult a procedure for anyone else. By the way, I suffered with BPH for 20 years now, and never was a fan of the urologist’s preferred operations. I am glad I waited.

    Tedd

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