Possible BPH, looking for advice

Ron,

In my case, the out of pocket expenses for the Urolift were trivial compared to the relief in suffering and the "convenience" of not having to risk the brutal recovery and possible side effects of a TURP. I received the "guinea pig" discount from a Urologist here in San Diego, being only his second procedure. Actually he did his first procedure minutes before me!

My regular Urologist was neither knowledgable nor interested in exploring the Urolift option to be of any help. I did over 6 months of research before taking the leap (I recently retired from a career doing research in the field of medicine). Regarding insurance coverage, all I knew at the time was what my primary care doctor told me, that it takes on average 1 1/2 to 2 years for insurance to kick in subsequent to FDA approval (wouldn't suprise me).  Since I was at a point of really needing and wanting to address my BPH, I didn't have a desire to verify the validity of that time frame and just went ahead with the procedure. Glad I did.

Well, you are the third report from a post-procedure Urology patient. All very positive. I'm beginning to feel less aprehensive. My regular urologist hasn't done the procedure, actually was unaware of it until I told him about it. He has been my urologist for ten years and has done a wonderful job for me. I particularly appreciate his just subscribing meds until I decided to go ahead with TURP. I didn't want to be his first so i found another urologist who is doing the procedure, says Medicare isn't paying for it, etc. I'm scheduled to have the scoping exam this week to determine if I'm a viable Urolift candidate. I believe that if I am a candidate I may wait for my regular urologist to do a few Urolifts and I'll be his fifth or so. Since I discovered the daily Cialis routine for BPH (I cut a regular Cialis 100mg pill in half) and since it's working so well, along with Jalyn and Testosterone I may just wait as long as possible. 

My second urologist, the one I have actually never met, says that medicare will pay up to a year after a procedure if they get approval. $2500 is a lot of money to me, my wife and I are paying around $500 per month for Medicare and supplement and I want my bills covered, by gum!  All these concerns are for nothing if my prostate is too large or I have a median lobe, so we'll see, this week.

Again let me say that I really, really appreciate your reply and hope you realize that these posts will remain for years and thousands of BPH patients dreading TURP like the plague are going to appreciate your pioneering effort and my spreading this all over the internet for years to come.  Thanks a bunch. Ron      

Ron I was looking into the urolift procedure a year ago.  They were doing a clinical trial in Utah.  I decided to go with HoLep laser surgery instead.  I must say I wish I had done the Urolift.  I am very unhappy with the results especially the retrograde ejaculation.  So my recommendation is to go with the euro lift it sounds like the best option out there right now.

100 mg Cialis??? The standard tablet in the UK is 20mg.... but as they say everything is bigger in Texas:-)

Did they not warn your that retro was at least 60% certain.

I was OK with GL laser but not Thulium Laser but by then the damage had partly been done by Tamsulosin.

Yes they warned me that retrograde was 100% for sure.   But they told me that it would feel exactly the same only with nothing coming out.  That's where the falsehood lies.  For me it does not feel anywhere near the same.  As far as recovery and urination that's all fine.  But I would not do it over again.  I would definitely go for that urolift.  

Most find that the sensation is the same.

Does anyone know if urolift can be done if a persons prostate has regrown after a previous procedure.

I would have been ruled out for uroloift as my prostate was 125 grms. 

Yes, seems like most find it is not that much different.  I am just unlucky I guess.  I am very interested in knowing how people have had success with urolift.  It's too late for me but just curious.

I thought that prostatic stents weren't workable. I've read several accounts of them becoming imbedded in the prostate, blocking flow at the bladder outlet and then being surgically removed.  I thought that they were no longer even attempted. Certainly, three urologists I have seen in the last year never suggested stents. I'l admit that the idea of a solid channel for urine flow sounds like a wonderful solution but I think you'll find they don't work very long. Possibly there are new ways of doing it? I would sure like to hear about it if there are.

On the other hand, urolift is the perfect solution, in my opinion, if you have a prostate less than 80mg with some uros and 100mg with others and do not have the third lobe which will just drop into the channel created by the urolift stitches and block the flow. I am currently consulting with a uro who does urolift (there are not many), he proposes to remove my third lobe using button turp, wait a while to see  if that is not a complete solution, then perform urolift to open the channel more, if necessary.  I expect to do this in late October. So my advice is thus; do the urolift if you qualify. It is quick, painless, bloodless mostly, go home the same day or next, no catheter etc, etc. This will buy you a few years time at least to see if furthur advances come forward. There will certainly be many of them as BPH will eventually affect about 60% of males worldwide. What is that about a two billion men currently living?  My doc is in San Antonio; Dr Kella.

Good luck and keep us advised.   

Thanks for all the info! helps me have confidence I am doing the right thing as I am 54 and scheduled for Urolift procedure by my Urologist  on Wed Oct 22nd.  He is the one who suggested it, had warned me of TURP side effects last year, so glad I waited, he has already now done severa Uroliftsl, and I am lucky that my BCBS insur and gap plan will cover almost all of the cost.  I'll post with updates - wish me luck, BPH amigos!

 

Good luck with it. It will be interesting to get a first hand report on the procedure and its outcome.

Your analysis is perfect and all you have to do is find a Urologist who has done a 100 urolifts. As you are no doubt aware this non invasive surgery will be suppressed by the Medical bosses as it wipes out all the technical training and Investment that has gone into the we say "plant and equipment " and medical Colleges training these Doctors.

Consultants who are over 50 are not interested in being or wish to retrain when they have an existing gravy train. I do not blame them them either.

it is also difficult to retrain any one over 50 who is already looking to retire early and I do not  blame them for that.

I am a Brit aged 79 years old and still sexually active and scared to lose what I have.

Time will tell if this Urolft procedure is successful but if a stitch falls out it will not as bad as the other issues ie incontinent,no sex  and other issues everybody comments on.

I have to make a decision soon and I was hoping you would have yours done by now . I am a coward too. It will cost me 7500$ privately in the UK which is reasonable if successful 

Read your comments with interest but no one spotted the retraining etc and cost of wiping out the costly past medical treatments.

for example Electric Driven Cars  and Petrol Driven Cars . What would that do  to the motor industry?

When I was in Business our Patented products we kept going to get our investment payback. Ie suppressed a better product.

I have no idea how the Urolift procedure will be proven but It does seem a non invasive procedure as you have ascertained and I hope you can report to all  should you go for it.

Hope my comments make sense

Best of Luck

Arturo 

 

Thanks, keep in mind, though urolift does not remove any tissue so the entire prostate is left to continue growing. In all liklihood there will be another procedure later on. Holep, the procedure I had two months ago, removes 85-90% of the prostate insuring that it will last longer. I'm expecting a one and done result. Urolift does not cause Retrograde Ejaculation and it will probably buy some time. 

Knowing what I continue to learn almost daily if I had it to do over again i would start a thread on PAE and try to get a lot of post-op patients who had the PAE procedure done to see how it worked for them. 

Good luck, Ron

Hi Ron

You make many useful contributions re BPH and related issues but I think you have to be very careful in stating that the Urolift procedure will have to be repeated as you do a few times. Nobody knows. It is a new procedure. NICE the medical governing body in the UK approved Urolift last year and released their report based on two years of trials and data. After those 2 years there were no indications of longevity issues with the procedure. As my urologist said the procedure could be stable for many years only time will tell, I went into Urolift with my eyes open and I think others have to as well. NICE approved it, I’m backing their judgement! In many ways Turps I believe in some circumstances can have to be repeated over time. I think there are downsides or unknown areas re all these procedures.

There's no question of the value of urolift. As you can see from my posts six months ago. I really wanted to have that procedure done because it is minimally invasive, inexpensive if paying out of pocket, preserves all sexual function, gets a patient off the meds and buys time for new methods to be perfected. I base my reservations about how long Urolift will be effective on the fact that if the prostate has grown large enough to cause problems then it will continue to grow and eventually get larger than the size for which Urolift is effective, somewhere North of 80 milli- grams, I'm told.   

I have heard of studies done validating Urolift up to three years and that's a godsend just in itself if one is suffering. .

In my opinion if a person has an active sex life, a very strong fear of surgery of any kind, limited funds if uninsured, a two-lobe prostate less than 80mg etc then Urolift may be the best choice of all options. I say do it with the reservations below:     

I would have the same reservation about Urolift that I would have about any prostate surgery, a gall-bladder or appendix removal, stomach ulcer, etc. My surgeries are going to be done in a major University Medical Center or a Mayo or Johns Hopkins Clinic by the best surgeons and staffs that exist.

Surgical errors, infections, misdiagnosis, improper medication, etc etc have become a seriously increasing cause of injury and death in America. I don't care if it is a minimally-invasive procedure, I still believe that it is surgery and subject to all of the concerns I mention.

My best to you and keep us informed.

Ron

 

Very balanced and wise comments.Indeed there is always the likelihood of infection.I had laser turp eight  years ago in NYC and caught an e-coli infection which led to septecemia and etc. and nearly died.

Surgery is surgery invloving blood etc and minimal invasion is still invasion

.My turp has stopped being effective and am considrering UROLIFT on the one hand and hesitating on the other hand and thinking that I should stick to Rapaflo...

Thanks ronert, what an experience that must have been! From everything I have learned and from my own experience, I would look at Holep as a long-term, maybe forever solution. My Holep is only two months old but it went so well, my prostate was so large, with three lobes,  that I have to believe that if my Doc at the Mayo clinic in Phoenix did the procedure for you it would be as good an outcome as you could expect.

I will repeat what I have said several times in these posts; it is my life, I only have one, I have worked hard for 76 years to maintain a healthy lifestyle and along with great DNA I have been very successful. I believe that the internet provides information readily to all of us such that we do not have to buy in to the agendas of anyone, we can make intelligent decisions ourselves based upon verifiable facts.

You have only one life to live as well, probably longer than mine if you make good decisions from here on.

My best to you and let us know what you decide. 

Ron in Texas

 

Excellent comments Ron. I am considering  Urolift but after reading comments from guys who have had this procedure I am not so confident.

i expected a quicker recovery and certainly a quicker improvement in flow . My flow is 9 and prostate 40 so I am a candidate . I insisted on seeing an experienced Urolift guy in Surrey England and awaiting appointment. I am 79 and dread infections .

Hi Ron, Since I last posted, I have obtained a second opinion, was told that if I wanted Urolift, I could be referred to a practitioner in Stevenage (about 40 miles from London) but, after further tests, he informed me that it is not certain that the prostate is causing the problem. The cause of my symptoms may lie in a stricture or, more likely, a problem with the sphyncter at the neck of the bladder. He offerred cytoscopy and associated surgery to remove bladder stones (which, being embedded, should not cause me any problems) and possible TURP to "enable normal urination". Since I am well aware of the possiblity of incontinence as a result of TURP, I have not taken up his offer because that would be a worse scenario than the one I am in. I can live with a permanent catheter fitted with a FlipFlo valve which enables normal urination.  Its only drawback is that it does interfere with penetrative sex (I do not accept the claims by the manufacturers that one can bend the catheter over and stuff the whole shebang into a condom!). They do not supply catheters long enough to accomodate this solution. Hope your problems continue to be manageable, and I wish you good luck for the future. Mike the limey

 

Mike: Since I am well aware of the possiblity of incontinence as a result of TURP, I have not taken up his offer because that would be a worse scenario than the one I am in. I can live with a permanent catheter fitted with a FlipFlo valve which enables normal urination...  Its only drawback is that it does interfere with penetrative sex..."

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Hi Mike,

Are you able to do  Clean Intermittent Catherization (CIC)? If you're able, I can't see any situation where it's not better than a permanent catheter with or without a FlipFlo valve. It's quick, paineless, and nothing to wear. And does not interfere with sex.

Jim. .

 

I had a PAE on 11/21/14.  Just had an MRI and got a ~38% reduction in size.  I got a reasonably good result.  I still have to take Tamsulosin .8mg every day, but only get up once a night instaed of 4 to 5 times.  During the day is normal.  No urgency and bladder seems to empty.  I have heard from several others who have had it and their results have been much better.  Back to normal within weeks.  Recovery is a few days after the procedure with a couple of weeks of very manageable occasional discomfort.  Sex is unaffected.  Do it again in a heartbeat.

If you keep on taking Tamsulosin your sex life will be affected in time.

JD -- Did you end up getting all the coverage you expected from BCBS insurance in NC?  I too am in NC, and have BCBS, and I'm slated to have UroLift in Winston Salem on 8/18.  I haven't gotten word yet on insurance review, and I have been anxious that they will deny it.  I hope it worked out well for you.

Best, Brooke