Relatively small prostate with a prominent median lobe: what is the best surgery?

Posted , 12 users are following.

Hello,

I had PAE on July 11.

My urologist told me it did not work.

I am not so sure. Still want to wait some time longer.

However, it might be true that with my big median lobe PAE was not for me.

What could be the best surgery in my situation?

Did somebody with a big median lobe had improvements with TRUP or UROLIFT?

Anything else for my specific situation?

Thank you.

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  • Edited

    Hi, in my case my median lobe had almost completely blocked my flow which left me in agony and misery and the potential side affects of all the surgical options out there frightened me and prolonged use of drugs would simply cause more and more damage to my bladder and kidneys, FLA solved all my issues instantly the median lobe was no longer an issue at all! and best of all no side affects!

    For me the money while difficult to hand over was a concern but the relief was worth it and life is great when I think back to the misery I am now FREE! FLA is so simple and least invasive, its done in an mri machine with a 1mm laser which is so accurate they can get as close as 1 mm to a nerve without harming it, they simply delete the overgrown median lobe tissue without harming the bladder neck or valve so that there is no harm to anything important, you remain conscious and go home the same day.

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  • Posted

    I have a 28g prostate and median lobe. Tried Urolift which has left me in constant pain and only improved things for about 4 months. Now on a waiting list for a TURP to sort out the blockage.

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    • Posted

      thank you, Andrew, for sharing your story.

      It is interesting that even such small prostate could cause problems. My prostate is bigger. Not sure anybody ever measured the size. but I was told it is about 70 grams. The doctor who did PAE told me after the surgery that he believed my prostate would have been bigger. He had never seen my prostate before the surgery.

      I had no scans before PAE because I have CDK and they did not want to use contrast that is not good for my kidneys. So my IR told me that he would stop the surgery if my arteries are bad, but they were OK.

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    • Posted

      I was hoping for PAE but was told it was no effective on prostates under 50g and not so good with median lobes. People on here seem to recommend FLA (not available in the UK) though I have also read of some failed FLA's. Otherwise TURP or HOLEP, I'd say.

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  • Posted

    Alex,

    .

    PAE will not specifically target the median lobe. PAE targets the prostate overall by embolizing the arteries that go to it. GLEP (Greenlight Laser), Rezum and the various TURPS can specifically target the median lobe.

    .

    I had a Rezum for a classic median lobe obstruction. It is an outpatient procedure which is the least invasive of the various procedures available today. My second choice would be either GLEP or button/plasma TURP.

    .

    I would absolutely not do an old mono TURP today which has the highest morbidity, highest complications (ED and RE), longest hospital stay, and longest recovery period. There are more modern procedures available today.

    .

    Steve

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    • Posted

      Hi Alex,

      .

      First, I would recommend that you do your own Internet research on the various BPH procedures available today and not just reply on what guys tell you on this forum as they are not medical professionals. Some have had good experiences with their procedures and some have not. Some have axes to grind because their procedure did not work out.

      .

      When I chose Rezum, I worked closely with a family member that I have known for over 60 years who was a doctor and surgeon (otorhinolaryngologist - ear, nose and thoat) for over 40 years. Myself, I am a retired research scientist. We looked at the various procedures that are available today before deciding on Rezum as the procedure to try first because it is less invasive.

      .

      My Rezum went "by the books" in terms of both the procedure and the recovery, so no, I did not have any problems with my recovery. I went from AUR, total blockage, and 10 months of self-cathing to being able to pee again, so, yes, my Rezum did help. Also I have no RE. Because of bladder damage, my PVR's were still over 100 ml, but with bladder recovery, they are now below 100.

      .

      After my Rezum, I went out to lunch with my driver and I never used the remaining pain killers. I had a Foley for 2 weeks and blood in my pee for about a month. Blood in your pee is common with most BPH procedures. I started to open up at 4 weeks which is common for Rezum and I was well open at about 8 weeks. As mentioned above, my PVR's have gone down over time.

      .

      Finally, it is important to carefully chose your urologist. I saw 3 before the one that I chose to do my Rezum. The family-member-MD told me that doctors will push for the procedure that they do as that is how they make their money. I certainly saw that. Should you decide on Rezum, then find a urologist who has done at least 50 of them as it is a new procedure.

      .

      Good luck,

      .

      Steve

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  • Posted

    Hi Alex,

    I'm like you I suppose, fairly small prostate (about 30 cc) but mildly prominent median lobe that is causing bladder outlet obstruction. I had an unnecessary (it was not FDA approved to address median lobes) and non productive Urolift in 2015. I'm 59 so I've always put off a TURP because I didn't want retrograde ejaculation and I've looked at other options. I'm not a big fan of the procedures (like Rezum, FLA, etc.) that ablate tissues and then over the next 6-8 weeks your body processes it out. I had a miserable 6-8 weeks after the Urolift where no tissue is removed. The one procedure that I thought was really promising was Aquablation and being that I live in Southern California I went up to USC (University of Southern California) for a consult with Dr. Desai (the leader of the clinical trials for AB in USA). I had an MRI, cystoscopy, and a Urodynamics (it appears my bladder is fine) test. I was prepared to pay out of pocket for the procedure as it is not covered by insurance but unfortunately Dr. Desai said that because my platelets (needed for clotting) are low from previous chemotherapy (non prostate) he did not recommend the Aquablation and instead recommended a TURP. My longtime urologist here in Orange County (south of LA) recently sold his practice to UCI (University California - Irvine) and while he is transitioning into retirement he turned me over to two younger (each about 40 years old) doctors to see what they thought. One of the doctors does Rezum and the other does TURPs. The one who does Rezum said it is about 60-70% effective and 'you will hate me for 6-8 weeks while you recover'. He also said that the TURP is more than 90% effective. I made an appointment with the doctor who does the TURPs and she was compassionate, knowledgeable and spent over an hour with me answering all my questions. I know that I will get RE and that it is irreversible but honestly I don't think that I know of any procedure here that people talk about where somebody didn't have some side effect. So, my decision was to go for the the procedure that would give me that most durable results. My TURP is scheduled for 11/1 and the doctor told me that most men spend one night in the hospital and go home without a catheter the next morning. She said the first week or two is the toughest and not to plan on returning to physical activity (in my case the gym, yoga and hiking) for 6 weeks. I think that this is the right decision for me. I've had RE occasionally from the Flomax that I am on and while it is not a great feeling it is not the end of the world. Orgasms are like pizza in my opinion, even when they are not fantastic they are still pretty good. Best of luck.

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    • Posted

      Thank you, Rob!

      I hope you are not like me because my bladder is very bad and I have BHP related CDK.

      My urologist told me that I have only 60% chances that TURP will work because of my bladder.

      I hope that for you it will work and I wish you best of luck!

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    • Posted

      Hi Alex,

      My urologist said that she cannot guarantee that the TURP will solve all my problems because, as you know, the many years of having BPH can weaken/damage the bladder. She said that she thinks that it will be a success though. She said that job one is to remove the obstruction (the median lobe) and then depending on the results address any bladder issues after that.

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    • Posted

      Hi Alex,

      She said that the bladder gets so used to pushing on the obstruction (median lobe) that it sometimes takes many months for it to re-learn that there is no longer an obstruction. This can lead to bladder overactivity and for that there are medications (such as Mybetriq) and even other procedures such as Botox injections. She said that she was hopeful that my bladder would be ok and that we would cross that bridge when we come to it.

      I have been told by my original urologist that if the bladder loses it's elasticity from all the years of pushing or develops a thickened wall then that is a different matter and I'm not sure what, if anything, can be done for that.

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