Prostate options

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Hello all. I really appreciate all the  info you provide. I am 60 years old and struggling with enlarged prostate and growing symptoms over the last eight years or so. I have gotten to the point where I have to do something due primarily to being up all night every night. If I don't go to sleep within 15 minutes or so of urinating, then the feeling builds to the point where I have to get back up. I also have to get up 95% of the times when I wake up during the night so the combo of those mean very little sleep.  I also have trouble on my long auto trips being able to last very long between stops and of course it is a pain to go all day every day. I am in generally very good health except for this. Not overweight, exercise a lot. My uro recommended the Uro lift but when I tried to schedule they told me my insurance did not cover it and that he could instead do the TURP procedure. I am wanting to avoid that. My thoughts are to do the lift even though paying out of pocket and get five years down the road to medicare insurance and new procedures maybe being available.  I am in the Memphis Tennessee area. The uro office also said they could not give me a self-pay price. I know the there is a big discount for the insurance companies so I don't know if self-pay would even be a realistic option. I have had trouble finding out info on who else locally does the uro-lift in any event. I am at the point where I think if I need to travel somewhere to use someone good at a good self-pay price, that is what I need to do. Thanks for any insight you can provide. Raleigh Sanford.

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  • Posted

    Options,options,options. There are many but beware "all size does not fit all" you will hear some with stellar outcomes and other's where same procedure was a total failure. As for me, after discussions with three Urologists I elected to go with HoLEP and have been very satisfied with the outcome. I have been where you are now plus four visits to the ER due to retention. That's day's or longer with a catheter strapped to your leg which is the most uncomfortable atachment man has invented. Do your homework! You will get alot of good information from this site.

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  • Posted

    Do you have an enlarged median lobe?  Find out because, apparently, the Urolift doesn't work in such cases.

    Best of luck!

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  • Posted

    Have you looked into Prostate Artery Embolization (PAE)? Probably the least invasive of any of the procedures. And have you researched FLA?

    Also, have you tried any meds (tamsulosin,finasteride,et)?

    Rich

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  • Posted

    I have found by being on this site , the outcome seems to depend on the doc you choose. Have seen as many success stories as failures for each procedure.
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  • Posted

    Hi Res,

    As stated, there are good and bad outcomes on all these procedures. Even from the same doctor. A lot has to do with the specifics of the case including the architecture of your prostate and the elasticity of your bladder. 

    What kind of tests have they done? PVR (office bladder scan)? Kidney/bladder scan? Cystoscopy? Urodynamics? These are some basic tests that will help you decide on both the correct procedure and also helpful in predicting outcomes. 

    Also, have they tried the medical route yet? This is usually tried before surgery. I'm not a fan of the prostate shrinking drugs (Finesteride/Avodart) but Tamsulosin (Flomax) or 5 Mg Daily Cialis are worth a try.

    You also mentioned TURP. Again, good and bad outcomes. But keep in mind that TURP most probably will leave you with permanent dry orgasms, which may or may not be a concern. If you never had a dry orgasm, ask your doctor to prescribe Tamsulosin and you will get an idea of what it's like.

    Jim

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  • Posted

    To respond to some questions and ask some of my own.  So far it doesn't seem like I have had any serious retention issues. I have tried both Tamsulosin (Flomax) and 5 Mg Daily Cialis on a very short term basis because they both caused pretty substantial side effects. When I go to the uro, they do (I assume an ultrasound) scan to see if the bladder is emptying. I think I have had some kind of flow rate test done a while back. I have looked into Prostate Artery Embolization (PAE) and FLA. Again on those, Memphis is a big medical center but I haven't come across any interventional radiologists performing these. And I think I would have the same non coverage issues and the costs on these is substantially more I believe. I am planning to call my insurance company (Humana) first thing Monday and clarify some things.  What tests should I be looking for to show an enlarged median lobe or elasticity of the bladder or to more correctly point me in the right direction. Do the uros refer patients to radiologist. Are they going to say our tests indicate a PAE would be best for you.  That seems unlikely. Thanks again for the help.

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    • Posted

      Part 2:

      ...and Dr. Bagla in Alexandria in northern VA.  Dr. Isaacson is less expensive and a great guy (very patient).

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    • Posted

      Cystoscopy should tell you if you have a large, obstructive median lobe or not. Just make sure you tell the urologist in advance that you would like this specific information because they can be in and out very fast and their focus might be elsewhere. 

      Your office bladder scans, and a bladder/kidney scan will tell you about bladder architecture and combined with urodynamics (video urodynamics is best) will give you an idea on elasticity and functionality.

      You mentioned you have had bladder scans in your uro's office so you should get the results of those scans and keep them for reference. 

      Uro's don't do PAE's so often they will talk against it or play dumb. Check the PAE threads for who to see. Most here have gone to just a couple of them.

      Jim

       

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  • Posted

    Hello. First off I very much agree that different procedures work differently for different guys. My problem was also urgency and frequency, and not retention. However, it does not sound as bad as you are experiencing. I had been on tamsulosin for many years and it was starting to be ineffective.

    I was similar in age to you (58) when I had the urolift. My uro explained how I had the best situation for success with the urolift. Plus, i was told that being fairly young it would help with getting the best results. My insurance also would not cover the procedure and I was told my cost, without insurance, would be $2k if I had the procedure in my uro's office under local. I kept researching and eventually decided to do the urolift. The rep for the urolift was in the room for the procedure and instructing the tech about fastener number and placement. 5 fasteners and a very quick recovery and its been over a year with very good results. Again, that was my experience. Best of luck. Bob

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  • Posted

    Res I am on Medicare and I had the urolift done 2 years ago.  I only paid $200 for the surgery center the rest was covered by my insurance.  Don't let the insurance company tell you what you can have have them check into it Thell them no.  It is  all in the codeing  Good luck Ken 

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    • Posted

      Can you give a breakdown of the results of the Urolift procedure. I am still trying to decide between PAE, FMA, or Urolift.

      My urologist office offered Green Light laser trestment or Turp--neither one of which do I want to go with. I recently noticed their website has been changed to show theg off ef Urolift so I want to go in and see if they think I am a good candidate.

      Rick

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    • Posted

      No problem Richard.  I had my urolift over 2 years ago.  Had 4 implants put in.  Never feel them at all.  I did have a catheter in for 3 days because I have a problem peeing on demand so my doctor felt it was best.  Me too did hear of men not being able to pee after and had to have a catheter put in.  I would rather the doctor put it in while I'm asleep then when I'm up.  They say that it take about a month to see results but I was good to go in about a week.  The day they removed the catheter I did have burning evertime I peed.  All was find did not get a infection from the catheter and no retro which I was looking not the have.  9 out of 10 procedure cause retro.  I don't care I'm 61 and I'm not getting rid of any function.  Doctor will side step that and tell you that you don't need to have a ejaculation because your not having kids.  But why should I have to give it up.  I would do the Urolift first and they try the PAE ken

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  • Posted

    Probably best to find another doctor. Not giving a cash price and even suggesting a TURP rules him out IMO. Second, often they can appeal to an insurance company and get something paid for. Urolift and all of the other procedures people suggested are far less expensive with fewer complications than TURP - when outlined, often carriers will relent.

    IF you have an enlarged median lobe, Rezum should be looked at too. THey spray the prostate with steam, and much like FLA, the tissue is killed and gets gradually absorbed by the body and the remaining smaller prostate allows you to pee better. They can aim it anywhere they want, including the median lobe. If you don't have that issue - the other procdures are all good viable options.

    IMO - find a doc who does most or all of them, will review full diagnostics and recommend the one that fits your situation best - one who will go to bat with your insurance carrier if need be. And don't consider anything that involves anesthesia until you've done at least two of the ones that don't.

    Even when TURP and Holep work (Holep is BY FAR the better of the two) they involve hospital stays and can leave you with a diaper for months until things get better. And both all but guarantee RE.

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  • Posted

    Instead of buying a procedure, Raleigh, buy yourself some time; and here's what I mean by that. A TURP procedure isn't buying time.  Don't get me wrong.  For some, it's definitely beneficial.  It's also invasive and extreme.  Do what you need to do that is commensurate with your degree of symptoms.  A Urolift - at least as I understand it - is pretty much benign - and not as invasive as other cut and burn procedures.  Moreover, the Urolift staples can be removed.  Notice, didn't say the PROCEDURE is reversible.  The most salient point you made is that new procedures will be available [by waiting].  That's right!  And not only will new procedures get pipelined, old procedures will (hopefully) be improved upon.  Takeaway:  Don't fire a cannon ball when a BB will do.

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  • Posted

      Thanks for the info so far. The last few weeks I am pretty much getting up at night every hour. I am leaning heavily toward the Urolift and just accepting I will have to pay cash. I know that at least 3 responding to this thread were strongly recommending the Urolift so I would ask them for names. I know I read somewhere on this forum of a recommendation for a doctor in San Antonia who was highly recommended and had a cash price of around 2,000.00. Does anybody know that doctor and are there any other recommendations for doctors, the closer to Memphis the better but a little travel for a better outcome is no problem.

     

    My second question concerns the issue of required pre surgery testing.  I know there is the issue of an enlarged median lobe. What testing is required for that. Are there any other tests that are typically done. I am due a visit to my urologist so hopefully I could have the tests done locally and shared with an out of the area doctor that I may select. Thanks a lot. Raleigh.

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    • Posted

      Res  I had mine over 2 years ago was paid by medicare.  All it cost me was $200 for the surgery center.  I live in orlando florida.  My urologist is great and he has had good result with pinning back the median lobe.  You should be fine  Have a good day  Ken
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