PAE w/ Dr. Bagla 9 Days Ago (Nov 2019)
Posted , 16 users are following.
I used the experiences a several men who posted on this site to make my eventual decision to have PAE done and have Dr. Bagla do it . I thought I would recount my experience in hopes it might help someone else.
I am 55 y.o. and I've had gradually worsening BPH symptoms since my early to mid-forties. While I was never in as bad shape symptom-wise as many stories I read here, it affected my quality of life and I wanted something done. For instance, I could always urinate on my own, never had to cath, I just had a weak stream and a frequent urge to go. Sometimes when I hit that bathroom, I would pee out literally a couple of cc's of urine and that was it. Other times, it was a "normal" amount. I could never tell how full the bladder was based upon how the urge felt.
I highly endorse Dr. Bagla. Professional, courteous, competent. The staff is efficient and competent. Like another post I recently read, I really felt like I was in good hands.
Because of my height (5' 10"), Dr. Bagla gave me a choice of having the catheter inserted in my wrist versus my groin. He said it made zero difference to him in terms of difficulty or effectiveness. But the benefit to me was a better recovery. Less restrictions on walking post-procedure. I chose the wrist. Side note: I was at the upper end of the height range to choose the wrist because of the length of catheters available.
Day 1, I walked out of the office and felt more normal, not groggy or drugged, than I have with any other surgical procedure. They use a 'twilight' sedation versus a general anesthetic. Didn't feel much, if anything, day one except I was winded, out of breath, walking back to the hotel after dinner. I had to stop 3 times to catch my breath.
Day 2, I began to notice my urine stream was noticeably stronger. Not working with high pressure yet, but definitely an improvement.
Days 3 and 4 were the worst, recovery-wise. I had an unrelenting urge to pee, even if there wasn't anything in my bladder. It was worse sitting than standing. So, I stood for 3 - 4 hours in the airport waiting for my flight. I ran out of pain meds for the urination Day 4 (Sunday) and had to suck it up until Monday to get another Rx. This was the worst of it for me. In hindsight, it was not that bad. I may have had a little blood in my urine initially but it's hard to say because the pain meds turn your urine a deep orange-ish yellow.
I am now 9 days post procedure and I feel normal. Stopped taking the pain meds day 6 though I could have done without starting day 5. My stream is stronger but I still get up at night a couple of times to pee. I do believe I evacuate more urine from my bladder during the day so that is an improvement.
Why I chose PAE: Every other procedure I read about mutilates the prostate and requires a catheter. No thanks.
Also, I may change urologists. My former urologist retired so they assigned me to a different doc in the practice. He's really young. Probably a smart, knowledgeable guy. But he was really negative on the PAE. He really tried to persuade me not to have it done. He kept pitching Rezume. My assumption is he pitched PAE as a negative because he couldn't do the procedure and make a buck off of it, not because it was best for me or what I wanted. Being more charitable, maybe he's just not knowledgeable about PAE? I don't know which it is, but I don't think my well being and my wishes were upper most in his mind. He would have happily mutilated my prostate with a laser if was willing. Again, no thanks.
I am happy to update this as I put more time post-procedure behind me. Also willing to answer any questions.
Mark
0 likes, 60 replies
andrewcalgary mark770
Posted
you said: "My stream is stronger"
have you measured it in ml/sec? and got average measurement?
mark770 andrewcalgary
Posted
Andrew,
I have not measured it. Just my subjective estimation. But to be clear, I have no doubt. My stream is definitely stronger. I just can't tell you, objectively, how much stronger.
derek76 mark770
Posted
Have you ever watched a Youtube video of GL or HoLep ? It does not mutilate the prostate
gene97713 derek76
Posted
Derek,
GL or Holep is mutilating by a laser knife. Burning on stack is not much more gentle than hanging or cutting in four pieces. Burning (ablation) is just less bloody, but the trauma is the same. HoLep is particularly similar to TURP. Cutting prostate in pieces an sucking it out through urethra. Heat and trauma are substantial. Results often unpredictable. PAE just makes part of the prostate to die and shrink. Painful a bit but it happens naturally and on the whole organ, releasing the the pressure on the capsule with those sensitive nerves bundles and receptors, doesn't destroy seminal ducts and sphincters. How many times that simple fact should be repeated?
derek76 gene97713
Posted
I have posted my laser experiences many time here and that of friends and none of us had problems post GL nor I on my second Thulium Holmium laser. No post op bleeding or pain and life back to normal. When I went to the races on day three people asked if my operation had been cancelled. I said it's hardly an operation just a procedure.
derek76 gene97713
Posted
My UK NHS Uro performed a GL on a 92 year old patient with a large prostate as he said it is a very gentle procedure.
gene97713 derek76
Posted
You were lucky and have a brilliant Uro. My Uro, chief of Urology of an American HMO in accordance to the recommendation of AUA refuses to perform GL on prostates larger than 60g. He comment was, "Are you kidding me?" He doesn't do HoLep either due to the lack of laser equipment (Holmium laser). At 92 (if the patient can survive general anesthesia) the patient doesn't care about RE or ED, or even incontinence, which is normal in most 92 year males. Foley fr, 20 catheter by itself at age 92 is not a joke. Maybe your operation didn't involve a large part of your prostate. Mine was 120g and chances for complications were too large to neglect them. I was offered only simple TURP and choose PAE instead You will never convince me that cutting prostate in pieces doesn't qualify for the Webster's definition of mutilation. Another proof of the superiority of UK's NHS vs American expensive insurance industries, particularly HMO, which is very much as UK, just more expensive for the consumer.
derek76 gene97713
Posted
I've been there had it and got the T shirt. Presumably you are reading and quoting failures you have read of.
Google Fernando Gómez Sancha a Spanish urologist who lectures around the world and has many Videos on his site and Youtube who like my original 2004 GL uro now does Holep like my original Uro whose team on a split decision went to HoLep although still satisified with GL.
mark770 gene97713
Posted
Gene wrote it much more eloquently than I could have but his summary fits my thought process. That said, maybe I have skewed view of laser ablation or TURP. I just felt like PAE was the method I wanted to try to achieve the desired results with minimal negative consequences.
Also, I figured it was the best opening gambit. If PAE didn't give the desired results I could have gone with one of the more aggressive interventions.
So far so good in my case. With 9 days of hindsight, I believe I made the right decision for me.
derek76 gene97713
Posted
My GL was performed when it was being trialled in the UK in 2004 and my prostate was 75 grms. The Uro who did it was the 'staff urologoist" not one of the senior ones and I was his 8th patient. The lasing time was 57 minutes. It was done in the late afternoon and my catheter was removed at 6.30 the next morning. It took me until about noon to pee on my own with an initial rush of red wine. After that it was just a bit pink with an initial spurt of red from the trauma to the urethra but as I was not fully voiding and as I had a fairly long train journey home and away from support they kept me another night. It was a bladder neck sparing procedure and my problem was with the lateral lobes more than the median lobe.
gene97713 derek76
Posted
According to my knowledge GL is being phased out in US (so is LASIC) for too many failures. Some URO claim that in many cases prostate looks like a prune after GL. 15 years ago you were much younger and stronger and had a younger prostate. Bladder neck sparing surgery helped too. Again possibly only a small part of your prostate was removed. No wonder you had a HoLep later on. You are definitely a success of laser surgeries, which as a laser scientist I'm a great fan of...
Best of luck.
It's never late to have any type of TURP after PAE...
derek76 gene97713
Posted
GL is old but till a good option. Certainly two of of the original uro's doing it here still do it with newer versions of it. At one time it was the preferred NHS treatment
As I said the team who did mine went over to HoLep around 2013. It takes longer but at least you save tissue for histology.
I doubt if someone left with a prune would have a functioning prostate. I don't how much tissue was taken away the first time.The one who did my last procedure when going back over my history reacted violently to the mention of GL/PVP. I’ve forgotten the actual word he used but it was to the effect that PVP is a money making commercial procedure and not a cure !
He removed 80grms of tissue and sent 37 grms for testing. That left me with 55grms that is evidently not anywhere it can cause trouble.
dale75649 mark770
Posted
I can imagine dr McCoy on the original star trek calling all of these procedures barbaric. But somehow I see clogging up a portion of the blood supply as being a little more gentle than some of the other methods of killing or removing prostate cells in mass. Someday perhaps we'll have the knowledge to prevent the excess growth before if becomes an issue. But the word gentle may be too kind, as there is clearly a massive adjustment to the prostate that is generally felt for a number of days. My main goal was preservation of sexual function and enjoyment. And it worked for me, sex is better now than it had been for the past few years as my LUTS symptoms got worse and I needed alpha blockers to reduce my urine retention. I think the drugs were a big part of my problems, but they lowered my retention from over 400 ml to around 100 ml. Now post PAE, my retention is 20 or 30ml without a prescription, just taking saw palmetto extract.
gene97713 dale75649
Posted
Does saw palmetto help?
derek76 gene97713
Posted
I took Saw Palmetto in tincture form from a herbalist for several years while waiting for something better than TURP to come along. While it did not stop my prostate growing from 35 to 75 grms it did help my flow and frequency problems.
gene97713 derek76
Posted
Subjective... The flow and frequency is defined for the most part by the size of the prostate and its anatomy (central lobe). Saw Palmetto doesn't help to shrink the prostate, the rest is is anecdotal. Such reputable site as WebMed claims that there is no scientific evidence that it helps with BPH. Read on... Here is a brief citation from the site:
Saw palmetto is most commonly used for decreasing symptoms of an enlarged prostate called benign prostatic hypertrophy (BPH), but some scientific evidence shows that it does not work. Saw palmetto is also used to prevent complications from prostate surgery and for treating certain types of prostate conditions.
derek76 gene97713
Posted
How can it prevent complications ?
Saw Palmetto is like homeopathy in that it works for some but the medical profession don't like it. Rather odd that with the best of medical people available our Queen and Prince Charles carry a box of homeopathic remedies wherever they go.
Jezzaman dale75649
Posted
Hi Dale
Unless I missed it you didnt say which procedure you actually had?
Thanks
Jeremy