prostate median lobe

Hi Hank, it started with going to the toilet more and more often eventually I had a urologist identify a median lobe pushing upwards against my bladder from an ultra sound, many men,s prostate grow outwards not against the bladder but just restrict the prostate urethra, whereas a median lobe crushes the urethra near the bladder neck , this is a sad situation as a urologist only knows to cut away the bladder neck, whereas FLA does not do that but simply kills of unimportant prostate tissue from crushing the urethra but without harming the bladder neck-sounds like common sense right, and it is but urologists have not been trained to do that also Dr Karamanian in Houston at the prostate laser center is perhaps the best there is and at the end of the day it comes down to who has the skill not just knowledge.

Thanks Brian. Did Dr K confirm that you had a large median lobe, and told you that FLA would fix it good ? Hank

Hi Hank, he required an mpMRI which I had done here in New Zealand and he was able to transfer the details to his computer and saw the median lobe, I had already researched both Dr K and FLA and emailed and phoned other guys Dr K had done FLA for.

No one will guarantee excellence but he will do his best, I have never herd anything negative about Dr K only good things, he is very good and very helpful and very capable and loves the concept of being a caring good old fashioned genuine Doctor that is there for hie patients and he was that for me too.

I am now so much better off than before and without all those nasty side affects that the so called gold standard turp often inflicts upon people especially if you have a median lobe.

Thanks Brian. Hank

Glenn Your story just breaks my heart as it could be any of us led down that road. It is hard to get men to realize their options as the Urological Associations do not want these alternative presented because they don't have the training and skills to preform an MRI directed very accurate tissue removal procedure. The URO's fight anything and fight to stop insurance coverage and unfortunately they are somewhat successful in the fight as their lobby is so powerful. 

Men must research and apply the logic and theory to this procedure and all procedure and compare them. It then becomes clear how and why we are getting wonderful results. I dd my FLA 15 months ago and could not be more pleased. The doctor men select is the key to the success as it is as much a art of design of the procedure as it is a science. The doctor mention, Dr. Karamanian is in Houston and i feel he is absolutely the best there is in this field. I am so happy for Brian. 

My heart goes out to you. I hope we can help other men not have to deal with this.

Dear Glenn, 

                   WOW! I am so sorry but perhaps it might be worth having a chat with Dr Karamanian in Houston in the prostate laser center as he is extremely capable and genuinely cares you might try an email to him its worth a try and he is not about money but rather wants to help.

Glenn I am so sorry for what you were put through.  You are just one of many men that take the word of a doctor.  No matter how good they say they are.  I don't remember if you research your surgery before you had it but it's to late now.  I feel like the some of the other's guy's on here.  Talk with Dr. K.  Maybe he can help you.  Please all men on here do your research and get 2 or 3 opinion before you go under the knife.  And remember this.  A doctor can only suggest a procedure that may help you but in reality he does not know if it will work for sure until it's done.  And if it don't it's to late. Take care Ken 

Thanks Brian,

Afraid that my damage is not repairable.  The AUS works to keep the leakage under control, and I can empty the bladder quickly by using a small pump in the scrotum to temporarily release pressure from the cuff around the urethra.   If the strictures don't come back quickly, and I get 2 or 3 years, hopefully more, of not wearing Depends, then that's a lot better than the previous 2 years.  I really like the urologist who did the procedures to clear up the strictures, and then did the AUS implant.  He also does penile implants for ED, so if I went that route, I would have a second pump.  I would just have to be able to remember which side is for what purpose!  Right now, I'm not sure I'm up to another surgery.

Hello Glen,

                    I am truly sorry for men who through no fault of their own have missed out on FLA, and I know nothing about the issues you now face, I hope others in your situation on this forum can assist you and one another, I sincerely hope things go well for you kind regards Brian.

Hi  John,  I'm  in contact with Dr. K  and potential candidate for FLA .  Prostate volume 50 ml,  but big median lobe - 15 mm ,which blocks my bladder neck- seen on  TRUS . Can you give details of your diagnosis   and treatment by FLA ?  I'm  from Central  Europe , but no problem to fly  to US.  Many thanks  , Stan 

Yes Stan, my prostate was 125 cc before i did anything more than just suffer and that was for nine years. First thing the Urologist did was want to do a 12 needle blind biopsy and I told him I would let him know later. 

I started looking for a better way than the biopsy to make sure I did not have cancer. The Urologist cannot even tell you how large your prostate is or the density of the gland. Both are very important in determining what is an acceptable PSA reading. Mine at that time was 5 and that was high to the urologist but totally low and in line for a 125cc prostate with a very low density score. Then I found out that a 3T MRI read by a specialized Interventional Radiologist would be much more accurate and precise than the horrible 12 needle blind biopsy. So I went to an imaging center at Baylor Hospital and got a 3 T Pelvic MRI that took 35 minutes. They used a pelvic coil that laid over my waist like a blanket instead of the rectal coil that is inserted in some MRI's. 

I then used that MRI to be diagnosed of NO Cancer (PCa) but was told there was a suspicious spot that need to be watch. But no need for a biopsy at that time. If I needed a biopsy the IR could do a MRI focused biopsy of the exact location instead of a random biopsy where they just punch in 12 random locations. 

So with that MRI I knew the size of the gland. The density of the gland. A more accurate approach to cancer if I develop in and I learned that up to a 7 Gleason they can remove the PCa with a laser shot that would not cost me my sexual functions in 99.5% of the cases. This was all really good news and allowed me to now move on the condition I did have BPH. I studied for 20 months. GL. PAE. Urolift. TURP and three more Urological procedures being offered. 

In doing so, I realized that the chances of the treatment working without any sexual side effects was a crap shoot with the Urological procedures accept for Urolift which is temporary and I don't want the clips inside of me as they can move or need to get adjusted over time. Let's just say I am sure it works but it was not for me. It did not make enough effort to solve the problem.

I learned with my MRI journey that in a large percentage of PCa treatment with FLA, the BPH symptoms disappeared. So the IR doctors realized that tissue removal in the focused correct area relieved the BPH as a result of the PCa treatment. Why not do the same tissue removal without a PCa lesion present? It made a lot of sense and I love the idea of the doctor working on my prostate seeing in realtime what he is doing. Also FLA is precise. Up to a millimeter of accuracy. Dr. Karamanian spent a lot of time showing me on my MRI where and what was the issue causing my horrible symptoms. He diagramed how and where he would remove the tissue and this was done on MY prostate not a plastic replica that a doctor would pick up and speak to in general. I saw it with my on eyes. Before and then he showed me after the procedure was was removed and we compared the before and after. Can you get that with a Urologist? 

Urologist do not and are not trained and capable of doing a MRI guided procedure in the prostate. That is the reason after 20 months of looking at ALL my options, I chose Focal Laser Ablation of my prostate.

I am very pleased so far and that was 15 months ago. Many more men have now done the same thing and for the most part it has been most successful without sexual side effects. I am so glad to hear about these guy and to see the K Club grow. There is no doctor in Medicine like Dr. Karamanian and i think every patient out there would agree he is one of a kind. He is the kind of doctor that you want. 

I have a thread on this site called "Going with Focal Laser Ablation for BPH" that was started the second week of December 2016 just before my procedure. It has almost 800 posts on it and takes you through my updates and recovery issue. Along with other early adopters.  If you want or need more information just ask. 

 

Hi John, great reply,  Im more and more enthusiastic  . My return to life is nearby   Best Wishes from Europe central . Stan

Hi Frank,

              you asked my age I am 61, you said they said you are to old for turp so will be pleased to know FLA -focal laser ablation is easy and painless and therefore may be perfect for you but read my first comment to get an answer to one of your questions,  I found FLA to be easier than having a dentist do a filling, It was all done in 4 hours and my wife picked me up and took me back to the motel that same day, I was asked to visit the Doctor the next day to discuss it and then after 8 days I had the catheter out and that was it all finished - no hospital at all, sorry I no nothing about urodynamics, my study on turp showed me that turp is a serious involved operation that would be very hard on ones body along with much pain and also requiring a general to put you to sleep which may be too hard for you however FLA does not require that as you are not put to sleep and its easy to cope with and easy to recover from, I have not discovered anything better.

Hi Brian,

pls let me know your prostate volume  prior  FLA,  measure of your median lobe  and if it protrused to bladder .  and other details if possible.  Many thanks , Stan   

Hi Stan, initially a urologist used an ultra sound which showed my prostate was a tall shape either growing into my bladder or pushing my bladder upwards, its size was approx 6.5cm tall by approx 4cm across, which is about 50 something maybe gms or cc? it looked like it was pushing my bladder up by 2.5cm approx as a guess.

I was told by a so called well experienced urologist who was going to do turp on me not to worry about him cutting away a  cone shaped piece of my bladder neck muscle valve(to open a urine pathway) as in his experience the bladder neck does not close up anyway because the median lobe having pushed the bladder neck open for so long meant that cutting the bladder neck away will not make any difference, as it will be permanently wide open anyway.

This in my case proved to be nonsense, additionally in the process of doing so they damage the upper sphincter valve which is part of the bladder neck, this is designed to automatically shut when ejaculation happens to prevent sperm entering into the bladder which will not function if part of the bladder neck is cut away resulting in sperm going into the bladder and hoping it will be removed with the urine.

With FLA the bladder neck and upper sphincter valve do not get damaged as Dr K removes only the unwanted median lobe tissue without damaging the bladder neck and upper sphincter valve

That's the beauty of FLA  especially in the hands of Dr K with his skill and the technology now available with mri they can be absolutely accurate as they can see under live mri exactly where the small laser is and using a water cooled devise the prostate is kept safe from the laser heat.

previous to FLA I was in a bad way If I waited too long to pee I suffered horrible pain waiting and horrible pain to finally  pee, and a weak stream and waiting for it to start and unable to empty and often if I drank liquid after 6pm I would be waking up 8 times a night.

Now I can drink fluid at night and empty out better and hold more fluid longer and sleep better and have no pain if I wait or pain to pee, and this will get better as the healing takes place, something I did not realize was in my case I now need to retrain my bladder to start working again as a result of the median lobe blockage for so long, Dr K said for me to use kegal exersizes and drink more and hold urine longer and push the urine out now that sufficient time has passed since my FLA. I am glad a urologist told me long ago not to push the urine out as this will damage my bladder and kidneys but now I am unblocked I can.

Dr K will explain the FLA procedure to you so that you will know what to expect but its a walk in the park compared to turp for a median lobe.

kind regards Brian.

Brian. This is a fantastic post. So well written and clear. Thank you for spending the time it takes to share this. It will give a lot of support and hope to a lot of our brother's suffering

Thank you brian  this is excelent news for me  due to I have similar parmeters of prostate and median lobe.  I can share my TRUS scan and some interesting pics on provate base if you folks have interest, Stan

Hi John, you helped me have confidence in FLA which was not misplaced and I am happy to help anyone avoid the horrors of the wrong surgery.

HI Stan, I have little if any understanding of scans etc perhaps someone else may be able too, kind regards Brian.

Brian, i am glad it helped both of us and many more men not just with BPH but also this exact same procedure with PCa.

I am not trying to sell FLA to anyone but I also know there are forces trying to stop any procedure that does not put money in the hands of Urologist. If they were capable of doing this MRI Guided procedure with it's accuracy they would be selling it and insurance would be paying for it. They have no training in this MRI area so they want it stopped.

I did not do FLA because of some blind / control study that gets rushed through for profit taking and to h**l with the old men who are left with minimal collateral damage that in the doctors eyes they don't need anyway because they are old. When I saw the PCa history and results, spoke with many of the PCa patients and looked closely at how the procedure was actually preformed, I realized it was the absolute best shot for me to have no sexual side effects and be able to urinate again. I was not and I am not positive that it is the gold standard and it will never be allow to become that. But I was hopeful and confident it was what I wanted for a variety of reasons.

I did it because it made sense and thousands of men before me had FLA for prostate tissue removal in PCa and in many cases it worked for their BPH. I understood the logic of that point. Also because the design of the treatment made logic and common sense to me in the technique and the approach and because of the Doctor doing this procedure that I truly believed in. You have met him you know what I mean. He is the kind of man I want working on me with the other factors FLA being what they were.

Each man needs to research completely each procedure and in my opinion, each man needs to totally learn the anatomy of his prostate gland and challenge the procedures and techniques with questions on the effects of each part of the prostate anatomy. Urologist ask for you for blind faith on their procedure of the month. Yes all these procedures work sometimes but sometimes they fail usually for other reasons or because of bad doctor selection. The bad procedures, really bad ones never make it to market or fall to the way side quickly. That does not mean we stop trying. 

I am very glad this worked for you and I really look forward to your success. So many men both on this site and others and just some in general have had the FLA procedure and do not feel compelled to continue to support the men still looking and suffering. That is their choice. They spent their money and are living their lives now. Several have told me they don't have time for negative conflict and useless chatter of a web site. I don't agree. I remember feeling trapped. I remember  being treated like a number with no options except very bad ones. I remember being told I did not need the sexual function any more and it does not matter in the course of life. I remember telling my wife that based on the treatment i select to have, this could be the end certain sexual functions and then asking, how much will that effect us in our marriage? I remember peeing on myself and then not being able to finish going when I got to the mens room at work. I remember planning my whole day around restroom locations. I know how bad all this feels and though it will not KILL us, it is a bad condition to deal with every day for any man. 

The old saying of "what does not kill you makes you stronger" does not apply to BPH symptoms, regardless of what some greedy Urologist thinks.

So I guess I am very happy for both of us and the many men It has help. Thank you for becoming a supporter of any man looking at options. That does not mean to go around sell this FLA procedure it means to tell your story and listen to theirs. If they listen to all and do the proper research as you did, they will find the answer right form them. For some it is the answer of what is the lowest price option? If that is the case then FLA is not their option. 

Good luck, the best is still coming for you I believe. And, thanks again for supporting other men who are now where you have been. 

To all MEN.      I have to say something to everyone of the men on here.  We are not on here to sell any procedure.  How can any man pick a procedure with out any information.  Not all doctor give you the time of day  you have 10 to 15 minutes of time with him for you to hear what he is telling you and for you to ask question. Half the time you forget what you want to ask.  15 minutes is not enough time to put your body in his hands and that decision will change your life.  Not all men will look up a procedure and get the information they just take the doctors word.  If something goes wrong he does not return your call and wants nothing to do with you.  ( You all know it happens ) On here we talk about many procedure.  Most of the time we talk about the procedure we have had because we have gone through it and we want to share our experience with the men on here so they can pick what they feel is right for them.  Now all procedure will work on every man. Because all men are different.  So men you have to get all the information you can get a second opinion.  Try to talk with a doctor.  Even talk to patient of your doctor that have had the procedure done.  You have look at all the aspect of the procedure.  The good and the bad.  What kind of side effect will it cause.  Remember you are the one that will have to deal with the side effect of anything you have not the doctor he just move on.  I can go on but this is long enough.  Men please do what you can to survive and pick a procedure that will give you a better life not take it away.  God Bless you all.  Ken