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Undergoing preliminary consults at Inova for PAE procedure. Was told I would be on Prednisone following surgery. Problem - I can not and will not take the prednisone regime of building up dosage and tapering down. I did this about 5 years ago for another problem and had EXTREME anxiety for over three weeks. I did not think I was ever gong to be normal again. It is NOT an uncommon problem. What did the rest of you take post procedure?? Surely there must be something other than prednisone. If I just have to take the prednisone, I will not go through with the procedure.
0 likes, 24 replies
richp21 vigneron
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Waffalobill vigneron
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mike588 vigneron
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vigneron mike588
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The way I understand it is that if it does not work then the other procedures can be tried. On the 2nd of this month, I had a procedure at VA where they went up into my urinary bladder and laser busted up TEN bladder stones that were as big as 2 cm. They were causing me to have hematuria. It is not fun peeing blood at least once a week. From what I read, this is probably the result of my BPH and incomplete voiding of the bladder and hence the formation of stones from the concentrated urine. The VA does not do PAE but the "other gold standard" sounds not too great either and that is what they offer.
mike588 vigneron
Posted
I did do another procedure, FLA and I believe the delay having a good procedure and extra stress to my bladder from PAE (because the first week or so it's almost impossible to pee) made the procedure not as effective as it would have been. If you are getting it for free I suppose it's not a big risk, though like I wrote before there have been reports of damage when the material they inject does not go to the target. I don't understand why they don't recommend wearing a Foley catheter the first week after PAE, apart from maybe they are not Urologists and don't know how to help with that. If you can afford it FLA is the way to go I believe, or maybe Rezum which is more affordable and has less sexual side effects than TURP.
richp21 mike588
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My experience with and understanding about PAE is very different from Mike's. There are risks with every procedure, and depending on your condition, there are risks with doing nothing. I was able to pee right after my PAE, though it did burn when I peed for about two days. Re: the microbeads ending up where you wouldn't want them, be sure (as with any procedure) to choose an IR or urodoc who has done many, many of the procedures that you will be having. Be sure to research all options, as they all have pros and cons. If you are considering PAE, I believe the most experienced IR's in the US are Dr Bagla in VA and Dr Issacson in NC.
mike588 richp21
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Rich, I know PAE works for some, I spoke to someone in person who had it done by the same Docs who did me, he was only the 6th patient and had perfect astounding results. That was the reason I took the chance on something new.
Here is some info I gleaned from a medical abstract which had I read before my PAE(s) would have pushed me away. Basically it's pointing out besides the risks that after 3 years it is 64% less effective, if I am reading it correctly. This makes sense as the body has the ability to re-route blood supply. I suppose with any of the traditional surgeries the prostate can grow back, but probably not as fast as blood supply.
See below - if you search on internet for 'Minimally invasive surgical therapies for benign prostatic hypertrophy' you will find the whole article which is quite interesting reviewing some other procedures.
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Contemporary literature highlights considerable failure rates as high as 19% with 15% of patients requiring TURP within the 1st year after treatment. Uptake may have been limited due to these factors and availability of specialist interventional radiologists required to perform the procedure. However, increasing experience with PAE has led to improved procedural success rates. PAE has gained interest recently with further studies showing acceptable outcomes in IPSS scores at 24-months' postintervention. Despite this, TURP results in significantly better (P = 0.029) outcomes in IPSS scores and quality of life scores at 1-months' and 3-months' postprocedure.38 Another large prospective series by Pisco et al reported a 63% reduction in IPSS at 36-months' follow-up with PAE.Complications of PAE are not insignificant and include failure of the procedure, dysuria, hematuria, hematospermia, rectal bleeding, and urinary retention. Although rare, risks of inadvertent embolization and untargeted ischemia of the bladder, corpus cavernosum, or anus do exist and pose a significant compromise to patient outcomes. A recent meta-analysis identified six cases of bladder ischemia. More long-term data is necessary to define the safety and feasibility of PAE.
richp21 mike588
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Mike,
Interesting article. I didn't see where you saw 64% less effective after 3 years. The closest text that you might have been referring to says a "63% reduction in IPSS at 36-months' follow-up with PAE" which is actually the opposite of reduced effectiveness. A reduction in IPSS scores means alleviation of LUTS symptoms, which is what we are hoping for.
Rich
mike588 richp21
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Regards,
Michael
joe74831 vigneron
Posted
If I had not had the prednisone, for several weeks after my PAE procedure, there is no way I would have been able to empty at all.
Not to mention my procedure was a complete failure. My prostate is exactly the same size as it was before the procedure after 6 months. Total wate of money for me. But seriously you need the prdnisone, and antibiotics.
Considering FLA here, just wish insurance would cover it.
Good luck
j12080 joe74831
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But I Did pay full for mine and it has been a total success for me. Well worth the debt I incurred. But I am pleased I will get some of that money back.
As someone else said, it is truly a product of picking the right practitioner as that is the key to success because this procedure is an art as much as a science. FLA is very accurate and very controlled in the tissue removal where PAE is totally random in tissue removal. It has worked well for a lot of the men on this site. I know currently of no failures.
joe74831 j12080
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Its funny I was the first patient ever that got approved for PAE thru BCBS at UNC. Perhaps I can get luck again lol.
Thanks again for the info.
Joe
tom86211 joe74831
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Joe,
Sorry the procedure didn't work for you. I am now 10 days post PAE and have been able to control the side effects (prostate swelling) with Flomax and a minor amount of Tylenol and Ibuprofen. Kaiser did the operation and I only had to pay a $250 copay. In the past few days I have not even had to take the Tylenol and Ibuprofen as the swelling is going down.
Why be concerned with prednisone when Flowmax works just as well (at least it does for me).
Tom
j12080 vigneron
Posted
vigneron,
i would say that if you cannot use the Prednisone then you will have to have an extended foley cath in the PAE procedure. Another possible and helpful anti inflammatory is Aleve 220 mg twice a day. I did use this.
I did not do PAE even though I did go visit the two most experience doctors in that field. I instead chose FLA and that choice was a blessing for me. I did not do the prednisone dose as the later men did when they should have and I think it would have helped me but I don't like what steroids can to to an immune system so I was fine in the FLA as you wear a foley cath for at least a week anyway. With FLA you will have the foley cath for at least 7 days anyway and it was not that bad for me.
Good luck In your choice and if you need any more detail information, feel free to personal message me by using the "envelope icon" above and next to my name in this message and we can then communicate. I will tell you what I know about both PAE and FLA.
john
nealpros vigneron
Edited
Neal
richp21 nealpros
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