Prostatic Artery Embolization procedure
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As a health professional, I was worried about the effects of a TURP procedure. Although my urologist was against doing a PAE, saying he did not know about it and that it was experimental, the research I had seen suggested it would be a good approach with no effects on sexual function and fewer complications that a TURP.
Since PAE is a relatively new procedure, the effects of it have been measured for a space of 3-5 years post-procedure in the research currently available.
I went ahead and had the procedure done 4 weeks ago. The results have been simply wonderful. All symptoms of BPH have dissappeared.
Prior to the procedure I had painful urination, weak flow, frequent urinary urges, around 100 ml of urine output each time I voided,and the ultrasound revealed that my bladder was almost full after urinating. I was concerned that it could lead to hydronephrosis in the future.
I now get up 2x a night to urinate. I measure my output at home, and my nightly volume exceeds 300 ml each time I go, sometimes to 400 ml or more. My daytime urinary output is approximately 250 ml at each urination with no urges, no spotting, no burning sensation or a need to push using a valsava manuever. It just flows out naturally with no effort.
The research on it show that results are operator-dependent. That is, the more experience the doctor doing as, the more successful and less complications.
I flew from the west coast to have the procedure done at UNC Chapel Hill since their team, and Dr. Isaacson, have been doing well over a hundred of them. Great staff.
Please note that the PAE is a procedure that urologists do not perform. It is done by interventional radiologists. I have noted in a commentary that I read in a urology magazine, and in the attitude of my initial urologist, that there can be some prejudice about exploring a PAE since it is a procedure that would be done by someone who is not a urologist. It's outside their turf. My urologist insisted that I needed a TURP - while guarranteeing me that I would have retrograde ejaculation for life afterward if I did the TURP. That is not an issue with a PAE. I positive side effect is that the interventional radiologist discovered during the procedure that I had a venous shunt from my penis to the prostate, which had an detrimental effect on maintaining blood flow when erect. He sealed it off during the procedure. It turns out that a number of men have this without knowing it.
It feels like when I was urinating 25 years ago. I am so relieved and happy about it that I wanted to share this with you in case some of this information is helpful.
I had the advantage to access to a number medical journals on the procefure, but google scholar on the internet will have good info.
A recent systematic review of PAE is titled:Short- to Midterm Safety and Efficacyof
Prostatic Artery Embolization:
A Systematic Review
Ziga Cizman,MD,MPH, AriIsaacson,MD, andCharlesBurke,MD
0 likes, 175 replies
sam19736 333health
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333health sam19736
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richp21 sam19736
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Rich
sam19736 333health
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Before I had the procedure, I had difficulty urinating without stopping in between. I felt like I always had more to go but just couldn't. I needed a catheter for a short time after surgery when i became completely obstructed. Got up to go at night 3-4x before. Now, I don't have any trouble going, and don't wake at night except if i drink a beer or two before bed. No catheter in my future!
randy_85492 333health
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Neil, Please advise me if possible....I had a REZUM procedure August 15, 2016, ~ 6 weeks ago...I've attempted 2 Trial Voids since without success...I've been on a Direct Foley Catheter since June 15th when my Flow Stopped due to my allergic reaction to the anesthsia I was given for the Lung Cancer Operation that I was going under at that time....My URO Doc states I had a Large Medium Lobe and I shouldn't try to Self Cath because of that. He says I may injure my urethra and cause infection...A patient is suppose to have a significant improvement within 6 weeks - 12 weeks aftrer the REZUM procedure. ..The URO Doc is telling me to be patient and allow tme for recovery...We will attempt another Trial Void at the end of September and, if necessary, at the end of October...Then, if None of my Trial Voids have been successful, my URO Doc intends to do a TURP which I don't want to do, because of All the complications patients have experienced,...Since I've had a lot of prostate tissue killed by the REZUM and removed by the bodt's immune system, it seems the Obstruction has been removed that has restricted my urethra and, thus, my remaining problem might be my Bladder Muscle not function as it should......What do you think and advise?...My intention was to do a PAE before I did a REZUM, but Dr. Isaacson at UNC stated I was not a good candidate for a PAE due to my small prostate, ie. 32 ml..I hate being on this Direct Foley Catheter and I want my life back....Suggestions?...
Howard31850 randy_85492
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Hi Randy - I am really sorry to hear about your experience. It seems your main problem is the large median lobe. These can be removed with a Turp without causing other complications. Many men have successfully undergone Turp. If that is the only obstacle to your self-cathing then it might be your best option. If you could self-cath a few times a day then your bladder tonicity may very well recover so you don't need to self cath after a while. There is another thread run by jimjames on self-cathing as an alternative to all surgical procedures. I will get the link and post it to you. You may want to ask the question on his thread about self-cathing with a large median lobe. I think many men do it but need a curved-tip catheter called a coude tip. That is the one I use because of my very large prostate (300gm) though I do not have a median lobe. If you could self-cath now it would really improve your quality of life. Is there any chance of getting a second opinion from another doctor or nurse on self-cathing now? I will post the link jimjames thread shortly and please visit it and ask this question. All the best to you - you are in my prayers buddy. Neil
Howard31850
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Randy:
https://patient.info/forums/discuss/self-catherization-an-alternative-to-turp-greenlight-holep--336874?page=1#2347288
Here's the link to jimjames thread. Please read his story at the start and then ask your important question. I'll watch for you over there. Neil
333health
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For those who have an interest in TURP procedures, and have been considering Bipolar TURP, in terms of safety (post-TURP, ER, incontinence, obstruction, bleeding, etc) and benefits (reduction of LUTS/lower urinary tract symptoms), it's good to look at the reseach as well as listen to what your urologist has to say about it.
The Journal of Canadian Urology published a study comparing Monopolar versus Bipolar TURP. See excerpts below:
" For over 8 decades, transurethral resection of the prostate (TURP) has been considered the cornerstone of surgical management for benign prostatic obstruction (BPO), due to the procedure’s outstanding, well-documented, long-term treatment efficacy.1 Nevertheless, the morbidity of the procedure, notably TURP-syndrome, bleeding and urethral stricture, remains significant at 11.1%, based on a prospective, multicentre study of 10 654 men.
" In this present, multicentre, Canadian, single blind randomized controlled trial (RCT), the authors compare the outcomes of B-TURP and M-TURP in 43 men with a follow-up of 6 months.7 No significant differences in operative time or mean resection time were observed between the two procedures. The functional outcomes were significantly improved by both procedures but with no difference detected between the bipolar and monopolar arms. Similarly, the complications in both patient groups were comparable.
"Unfortunately, the study by Méndez-Probst and colleagues,7 like many of the preceding trials, fails to demonstrate any clinical benefit for B-TURP.
" Considering the current body of knowledge of B-TURP, no clinical advantages have been concretely demonstrated for reducing operative time or adverse events (transfusions, retention after catheter removal or urethral complications). Particularly in a cost-aware, Canadian health care system, the economic analysis for bipolar technology must be considered with respect to other minimally invasive TURP alternatives, including Holmium and Greenlight laser systems, which have documented cost-benefit to M-TURP.
The American Journal of Urology published a study this year with this intent:
" We compare bipolar vs monopolar transurethral prostate resection safety/secondary outcomes including efficacy in patients with large prostate volume or severe lower urinary tract symptoms.
Their findings:
" Neither safety nor any secondary outcome differed significantly between the arms (Bipolar versus Unipolar) throughout followup.
Their conclusion:
" Bipolar and monopolar transurethral prostate resection show similar safety/efficacy in these patient subpopulations
I am not suggesting that people should not undergo these or any specific procedures, and every doctor has his opinion, which can vary so much that "getting a second opinion" is automatically associated with health care.
It's simply good to be informed, whether you get this information from your doctor or need to do research on your own.
kenneth1955 333health
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333 is right. What ever you decide to do you must me right in you mind to go through it. If you have doubts get a second opioion. If you have to get a third because if you go through with the procedure you are the one that will have to deal with the out come once it done you can't go back. The doctor is only telling you what he feels will work. Men please get as much information you can. Talk with your family and friend if you have to Take care Ken
333health kenneth1955
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Kenneth, the topic of second opinions is pertinent and important. The research above shows that in over 10,000 TURP procedures, the morbidity post-TURP, including Bipolar TURP, was over 10%. That's not counting ejaculation and other issues.
If you hear a doctor being dismissive of these complications, as I was, it should raise a large red flag, and is worth looking further into. Check out what others that will give you a full accounting of possibilities have to say.
You may still choose to do it, but with your eyes wide open.
kenneth1955 333health
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glenn77 333health
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The recommendation for a second opinion before ANY prostate surgery should pinned to the top of this board. I'm having a second opinion Friday; unfortunately it's regarding the terrible outcome of my two procedures to create a channel in the median lobe. I hope to find 1) whether there is an identifiable reason for my being fully incontinent for the 7 months since the GL procedure, 2) what is the probability that I still might regain natural bladder control within a few months, and 3) if number 2 is unlikely, how soon would this new doctor be willing to do AUS surgery to help me get my life back. (The second opinion doctor is a medical professor who also does AMS 800 implants.)
kenneth1955 glenn77
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glenn77 kenneth1955
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Thanks Ken, I appreciate that. I would rather have natural function return, but if it's not going to happen, I'm ready to bite the bullet and become a bionic pee-er.
kenneth1955 glenn77
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If you have to you have to. I hope I don't get flak for some of the post that I have written. I hope you get some help soon Ken