prosthetic artery embolization (PAM) vs UroLift vs HoLEP etc.

Posted , 11 users are following.

i am 79--generally good health--had green light procedure 12-15 years ago. Necessary becasue had obstruction, went about 6 times a night, and couldn't last 1 hour during the day.  Obviously extreme.

Not that that bad now.  3-4/night.  Daytimne OK--just frequent.  Takes me a long time to fully empty my bladder and flow is often very weak. When i feel urgent need to urinate, I must respond quickly or I will leak..... But, don't HAVE TO do anything yet.

Last week, urologist said TUNA may be best procedure for me.  Tests next week to see if my anatomy appropriate and TUNA the following week.

Then I began to research alternataives and here I am.  I guess there is no way of knowing for sure which procedure will work best,  but one CAN minimize the risks and leave options open for later.

From what I can tell at this point PEM may have greatest reward/risk ratio.  High success rate and does nolt preclude other procedures.

Comments very much appreciated.

 

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  • Posted

    Weak flow is not important as long as your bladder empties properly. Do you know your post void residual (PVR). It's the volume of urine left in your bladder after you urinate and can be measured easily in the urologist's office with a bladder scanner. You also might want to do a simple void log at home. Just void into a 20 oz plastic measuring cup and record the time and void volume in ml or ounces. 

    From what you describe, your problem may be just as possible overactive bladder as it is obstruction. Or it could be poor bladder tone. Prostate reduction surgery or procedures will not necessarily help either. There are other approaches. 

    As to TUNA, it was a hot commodity years ago, but most urologist's stopped doing it based on poor outcomes. Does your uroloigst do other procedures, or just TUNA?

    Overall, before you start thinking about which prostate reduction procedure is best for you, spend some time finding out if your prostate is the problem. As mentioned, it could be bladder related which may require a different approach. In addition to finding out your PVR, you should consider urodynamic testing, if you haven't had it recently. 

    Jim

     

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    • Posted

      85 is normal. Given that, it's very possible that none of the prostate reduction procedures you mentioned will help because an obstructive prostate may not be your primary problem. I therefore think you should focus more on a proper diagnosis at this point and not on which prostate reduction procedure is best. 

      Overactive Bladder Syndrome (OAB) is one guess, but you might want to get more testing and imaging done, possibly a cystoscopy. Possibly urodynamics. 

      I would also get a second opinion from a major medical center where your doctor doesn't have an affiliation.

      Jim

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    • Posted

      He may well have overactive bladder but his weak flow isn't consistant with that - and I get the sense that he'd like to deal with that. But I fully agree he should have a complete set of diagnostics done before looking at any treatment for anything.

       

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    • Posted

      Absence of weak flow suggests no obstruction, but not necesssarily vice versa. As long as his bladder is emptying down to what it is, I don't see flow rate in and of itself need fixing

      Jim

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    • Posted

      For sure - that's very much an individual decision. Definitely no need, but he may well want to. That was my situation - I was emptying fully, but my stream was weak, it often took a long time to go and overall it was impacting my quality of life. I got sick of living my life around the bathroom and had Rezum done. I can't speak for anyone else but I'm glad I did it, despite some pain and slow going (literally) after the procudure.

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    • Posted

      My thinking was two fold. First, he's emptying so well that I think another 30 seconds at the John is a good trade off to surgery, if that's all it is. And second, it sounds like he may have something else going on like overactive bladder that a surgery like TURP won't correct anyway. But yes, the flow thing is very much an individual decision, it just appears his doctors are pushing him in just one direction without full info and a proper diagnosis.

      Was your PVR under 100 pre REZUM? I know you're happy with the results which is all that matters but just curious.

      Jim

       

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    • Posted

      You're right about his docs and they shouldn't be recommending anything until they have a clear diagnosis based on the kind of testing you described. And it's quite possible that he has both underactive bladder and some sort of BPH issue.

      My PVR was way under 100 - probably under 50. Emptying wasn't the problem, it was how long it took, how often I had to go and how waiting too long locked me up and made getting empty as much as a 5 step procedure. Every time I went to a bar or restaurant the first thing I did was find and use the bathroom. The most I could ever go between bathroom trips was maybe 2 hours and that was rare. Every year or two I'd go into partial retention, but I could handle that with self cathing and it was always a one-off - the next trip to the bathroom was always OK. It was strictly a quality of life decision. I'm glad I wating for Rezum and I'm also glad that when it became available I did it.

      Someone else in my situation might be inclined to wait for something with either better % of good outcome or less chance of RE - and that would be the right decision for them. I'm an active weightlifting, running and otherwise somewhat age defying (at least so far - one day my good fortune will end) guy and BPH (and as it turns out underactive bladder too) was the only fly in the ointment - and I'm happy to have that mostly behind me.

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    • Posted

      Underactive bladder is usually associated with poor bladder emptying and retention, but you also describe getting "locked up", etc, so what you may have had is both (overactive and underactive bladder) which isn't uncommon. I would guess then overactive bladder primary with underactive bladder secondary but it could have been vice versa.

      In any case, you obviously hit the jackpot with your REZUM with your enhancement of quality of life. 

      But as you say, "Someone else in my situation might be inclined to wait for something with either better % of good outcome or less chance of RE "

      Personally, I would fall into that that camp if I had a low PVR given that a number of the REZUM's here either didn't work or had RE. But also keep in mind that I opted to forgo surgery/procedures even with a significant PVR!

      So, it really comes down to risk/reward. How much are you willing to risk for the extent of any potential reward. 

      Anyway, again glad it worked out for you.

      Jim

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  • Posted

    I had the iTind procedure done 6 months ago and it was great. It tracks with an 85% successrate with very little downside risk, just UTI which all procedure carry. It is gentle in that it does not cause much trauma to healthy surrounding tissue. It is an impanted stent that takes 5 minutes to install and slowly causes 3 internal incisions inside the prostate. Not painful at all, just some normal stinging when you urinate. It is removed 5-6 days later and relief is almost instant. Within 2 hours I was normal again, went from 18 NV a day to 6-8 a day. Only get up once a night and no sexual dysfunction or leakage. It is made by Medi-tate.
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  • Posted

    Easy choice for me. I had similar issues and had pae bc it has same Benefits and chance of success with much less sexual risk and leakage risk. You can read my other posts here over the past year of my progression after pae, but it was very easy and I like the option without high risk and also benefit. I had mine done by dr Bagla's practice bc he and his partner have done more than anyone in the Us

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  • Posted

    I'm writing this response after reading many comments and many threads.  Rather compllicated to say the least.  Also not sure all our compatriots here are a representatibve sample.

    But I am beginning to get the impression that I should just wait.  My probelem is not severe.  I could just minimize fluids after 3-4 pm and probably significantly ease my sleeping problem---get if down to 2/night?  i could live with that-and will try.  

    Rather than go through the ordeal/trauma of a procedure which may or may not help me, why not wiat until the problem is really severe as it was 12 years ago.   I suspect the key thing will be to stay well hydrated from 6am to 4pm.  A few more interruptions during the day are tolerable.  

    Will post again after I try this for 2 weeks.

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  • Posted

    I would suggest trying CIC.  You may come to love it!  No surgety necessary. You will feel great having a completely empty bladder, as you go about your daily routine!

     

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