Prostatic Artery Embolization procedure

Neil, I was on tamsulin for a couple of months before the procedure, nothing else. It would have been wiser to have been on it, or to have done the procedure earlier, since I had a bladder diverticulum that the urologist said very likely arose from acute urinary retention.

I found out by good fortune when I ordered a US of the abdominal wall on myself late in the Spring because I thought I had somehow gotten an inguinal hernia doing endurance cycling. 

The morning of the ultrasound the inguinal pain was gone, but since I knew that the imaging center had reserved that time for me, I did not want to just not show up. I thought it was the right thing to do, and also thought that things happen for a reason, so why not do it.

Thanks for sharing your experience Gary. Could you please provide a little background on your BPH like the prostate size, median lobe, psa. How long did it take for your BPH symptoms to go away after your PAE? Did your doctor go through the femoral artery and did you have much pain/bleeding in the days following your PAE? Thanks for sharing.

So happy for your Gary, when we are younger we take things for granted. I never knew how happy I would feel taking a long relaxing pee until all this happened!

Hi Neil,

I've been seeing my uro guy for about 4 years. My treatment was Finesteride and Tamsulosin. My prostate size was 200 and my psa was very low, like .75. The Uro guy wanted nothing to do with the PAE, not even discussing it. He wanted me to have the Supre-prostalectomy, which I believe is the same as a TURP. Anyway, when he talked about a week in the hospital with a catheter, bleeding, incontinence, etc., I told him forget.

My peeing 6 to 8 times a night was history almost overnight with the PAE. My interventional radiologists went in via the femoral artery without anesthesia. After the 5 & 1/2 hour proceudre, I laid on my back for another 5 hours. They then took out the catheter and I was released. I had no bleeding, no contraindications from the procedure, and have experienced continuous recovery from the BPH symptoms. a week after the procedure I was off both Finesteride and Tamsulosin.

Men with B.P.H. need to get out of the stone age of T.U.R.P. and enter the new age of P.A.E. being done at a Medical Centre near you. If not, then go find one. Your on your own cause your Urologists ain't helpin' you at all!!!.

Hope this helps.

Thanks Gary for your response. It is good to know about another success story. Hope you continue to improve every day. Neil

Hi Ken,

Funny you should ask about what he said, since I was not going to talk about it specifically unless asked. I have just written a book about healthcare and about the necessity to investigage, question, and freely ask doctors about their recommendations.

This wasn't just a urologist; it was the Chief of  the Urology Department in a well-known and very regional large hospital. He was visibly upset when I told him I wanted to do it.

First he said that he did not know about the PAE procedure, so I showed him the systemic review article, and I added that there was other promising short and mid-term research, and that UNC, Stanford and other prominent places were doing it.

He said it was experimental and that it was, his exact phrase "bulls..t"  He used that term three times in the conversation. When I pointed out that respected clinics around the country were doing them he said they were just out to make money. 

I picked my jaw off the floor at that one, and proceeded to tell him that an interventional radiologist in his hospital/health clinic had been given the ok by his own hospital  to do them, that he had been doing them for two years, and that I had talked to this radiologist, who said he was getting research-level results.

My urologist was still upset, and said his colleague was just giving anecdotal evidence.He said that TURP was the gold standard and that is what I needed, that I would eventually come back to him for it.

Needless to say, I moved on and had the PAE done.

Here's an ironic coda to the story, one that I have detailed in case it helps those  reading this who have a tendency to follow an authority figure's suggestions without really checking it out: the urologist did a cystoscope on me before we talked about the TURP. The cystoscope  gave me for the first time in my life, a UTI. The culture showed it was due to colonization, which came from the cystoscope.

Perhaps life was sending me a message not to follow his recommendation.

 

Yes some of the urologist say the same thing and try to force you into The Gold Standard.  I like the one about when they tell you about the turp they kind of surgar coat the reply and say you may get retro but everything else will be the same.  How do they know.  All men are diffrent.    I ask my urologist alot of things and he is very good He told me that is a text book answer because that is what they learned being all men are made the same way  My urologist also told me about the turp procedure He will not do one unless there is nothing else.  He all ways trys other things first.  My prostate was stuck together He did a uro-lift on me in 2015  works greats.  I trust him but he knows how I feel about my prostate It is staying right were it is.  Life is to short to give up one thing for another.  Take care  Ken  PS  I also told him that sometime a urologist forget that they are men and what they are doing to another mans body.  My urologist smiled and did not say a word    

Hi 333health

Hi Gary,

Just want to know if your cystoscope showed any enlargement in the median lobe. Do you think exercise after PAE would delay improvement. Do you think frequent sex would delay improvement. I noticed that you have both the profound knowledge and the experience of going through PAE procedure and your contribution is so invaluable

Fouad

Sadly, I had  a similar encounter.  I mentioned PAE and my urologist claimed to have never heard of it.  I briefly described what I knew of it, and a young female urologist who was with him to observe spoke up, and said she knew of it as it was being done in Boston where she was previously.

Unfortunately, I went ahead with Green Laser TURP and six months later, I have extreme/total incontinence still. ( After the GL procedure, he had to do a Gyrus TURP to clean up after the first.)   I do kegels, core exercises, and use a stimulation device (via an anal prob) and nothing seems to make a difference.

My urologist refuses to discuss the AMS 800 artificial sphincter, say that it would mean that "we've failed."   Every day I go through 6 to 8 heavy duty pads and Depends pull ups doesn't speak of success to me. The practice is apparently wanting me to wait at least a year before considering the AMS-800.   A reference I found in a urology journal article in 1989 says that 99.5 percent of patients have partially or fully become incontinent.  I wonder if data exist for the unhappy 0.5% as to what happens after two months?   Is there a longitudinal study  for this cohort?

EDIT: Sentence in last paragraph should read: A reference I found in a urology journal article from1989 says that 99.5 percent of patients have partially or fully recovered continence after two months.

 

Glenn  I am so sorry that you are going through this problem.  Maybe you should not have let your urologist talk you into the turp and went and talk with athe people that do PAE  Maybe you wou have has better out come  Ken 

Hi Fouad,

My doc said post procedure that I could exercise a week after it, although he said some recommend 2 weeks of waiting. He said don't use a bicycle for 6 weeks because of the pressure it puts on the prostate. I don't know about the frequent sex thing, it was not mentioned as part of the usual post PAE routine.

Glenn, it's obviously your call on this, I just wonder why a physician denies moving forward when a procedure has not worked because of what seems an ego issue.

Neuromodulation has shown to be effective in severe incontinence. It's been half a year since your failed procedure. If it were me, I would want to work with a urologist, and soon, that would be looking forward to trying something else to help you. Best of luck, let us know

Thank you for making me aware of that option.  I would think that among the 12 other urologists at my doctor's location, one of them will be aware of this.  If not, there are three university teaching hospitals within an hour of where I live, and I know that one of them uses neuromodulation for pain control.  Neuromodulation would, on the surface, seem a less invasive option than the AMS 800.   

I wish I could find data from longitudinal studies for individuals who were significanlty incontintent two months post TURP, showing how many resolve at 4 months, 6 months, 8 months and so forth.