Recommendations for someone living outside the US

Jim8

Paul,

I don't think MRI imaging alone will be that helpful, in fact it's not really part of the normal workup. The normal workup includes DRE (finger in the rectum), bladder scan (for post void residual), simple flow test, and sometimes cystoscopy. A bladder/kidney ultraound study is also a good idea. Your IPSS score is also important, and you can google it online and get a score in five minutes. More advanced but perhaps the most important in many cases would be urodynamic testing and ideally video urodynamics.

As to the procedures you mention, Urolift and PAE are good non invasive choices but don't work very well if you have a large median lobe. FLA is new with no published trial data and I personally don't see the anecdotal reports  any better than the other procedures you mention. Aquablation has completed phase III trials but just starting out so I would wait until more real world data comes in and a doctor has performed at least 100 of them. Also, it's more invasive than the other procedures so you might want to try them first. My first choice now would be Rezum It's got a lot of trial data and a lot of uro's are not performing it so it should not be too hard to find one who has performed more than 100 procedures.

But first things first. A lot of men go procedure shopping before they are confident with their diagnosis. You may need one of these procedures, or maybe there are other issues like overactive bladder or prostatitis causing your problems. Get a proper diagnosis first.

Lastly, depending on your symptons and residual, there is self catherization (CIC). It may not be a permanent solution but it can buy you time until you make the right decision and will protect your bladder and kidneys as well as any surgery. It also has the potential to rehab your bladder but that's not a guarantee.

Jim

Your plan is excellent. 

I had BPH, biopsy was negative , so I was lucky to be clear of cancer. 

Each of our conditions are unique and your search for a well trained and experienced Urologist is an absolute necessity. My situation was an enlarged prostate (85g) which was creating an inability to void and causing significant urine retention. My only symptom was increasing difficulty to urinate enough. As a result I self cathed for about 10 months (medicine did not provide relief) . During this time I did some research and my Urologist was most confident that a TURP procedure was my best option. He did not think the other alternatives, such as Greenlight lazer, HoLep, Urolift, etc., were as effective in my situation. I did get a second opinion which agreed with my original Urologist. This added opinion was critical in my decision . 

In your case , I suggest a) identify symptoms with your chosen Urologist, b) get a good measurement of size, c) have a PSA test d) if size, PSA and other indications exist get a biopsy done to determine the best treatment. 

I am not a Doctor , however, it appears my problem has been addressed and it is seven weeks since having the TURP procedure. Make no mistake, TURP is surgery , and any surgery puts stress on the body . After two weeks I was healing well and stopped any self cathing one month after the TURP. So far, I am happy with the progress and ability to urinate in a normal manner. I hope this helps, and I wish you well in your problem resolution.  

I commend you for taking control of your own health and not only relying upon the opinions from one or two doctors. When seeking opinions from anyone (doctor or lay person) keep in mind we all have our own biases, especially if we have already had a procedure. If we are happy with the results we tend to be supportive and want to tell the world how wonderful it is. When things don't go well we may hear of the horror stories, but perhaps not the so-so results.

As I worked through this process starting 5+ years ago I researched the available procedures and those in trials, spoke with many men, doctors even reps from some equipment manufacturers. The only thing I was fairly confident about was that not all 'BPH' type symptoms are alike. They can have multiple causes, complicating factors and as a result the physiology can be different. As such, a treatment that may work well for one may not for another and doctor skill and follow-up can vary greatly.

Personally, I spent years trying to understand MY condition. Unlike some, I had a 'small' gland (<30cc) yet symptomatically seemed worse than some >100cc. I had MRIs (for PCa active surveillance), CT, ultrasound and cystoscopy. I also had numerous urine tests and cultures of seminal fluid trying to determine how much prostatitis was contributing and if there was a bacterial infection that simple urine cultures could not detect.

My only suggestion to you - don't rush into anything. Evaluate the information you receive and factor in their bias. I personally don't believe there is any one 'gold standard' (and I hate that term). Any doctor that used that phrase with me was not revisited nor considered. Any of the treatments you listed may work for you and they all come with potential complications. Even though some will say the complication rate is only x%, if you are in that % it is 100%. Understand the potential problems, have a plan to deal with them should they occur so you are not left floundering/scrambling at a potentially vulnerable time. 

Good luck!