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Retrograde Ejaculation, PAE, FLA, ETC.

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nealpros
nealpros

In this post I'm going to write about two topics. One will, perhaps be of interest to everyone, and one will be of more interest to those in the USA. I'll cover the topic of more general interest first:

I recently had a conversation with Dr. Isaacson of UNC. During that conversation we talked about retrograde ejaculation (RE). I had always thought that it was only one thing. I was wrong.

First, some anatomy. A man's ejaculate is made up of a mixture of the sperm which come from the testicals, and the seminal fluid, which is created in the prostate. There is a valve at the top of the prostate, between the prostate and bladder. Normally, when a man ejaculates, the valve closes, the prostate contracts, and the ejaculate is forced in the only direction it can go, out the penis.

If that valve is damaged, by, for example, a TURP, in any of its many flavors and colors, and the man ejaculates, when the prostate contracts, the easier place for the seminal fluid to go is up into the bladder, where it is eventually excreted with the urine. That is the first type of RE.

A PAE, and many medications dispensed by urologists for BPH, cause less seminal fluid, or no seminal fluid at all, to be created. The result is that when the man reaches orgasm, and his prostate contracts, even though the valve at the top of his prostate has closed, there is no, or not much, seminal fluid to be forced out the end of the penis. That is the second type of "RE", though it really isn't "reverse ejaculation" at all, since there is no fluid to ejaculate. We just call it that.

I hope this clears up why some of us have this happen, and what is really going on. It also clarifies why some of the medications cause RE.

Now on to the part of this post having to do with MEDICARE and insurance in the US, and why PAE, FLA, and some other promising techniques are not covered by MEDICARE nor most insurance in the US, except for those in research studies.

In order to be covered by MEDICARE or most other types of insurance in the US, a medical procedure, device, or drug must first be approved by the FDA. Once it is approved by the FDA, everyone else jumps aboard.

There are approximately 1/4 as many interventional radiologists in the US as there are urologists. Urologists do not do PAEs, FLAs, nor some of the other promising techniques. Interventional radiologists do them. As a result of that, many urologists, and then their lobbyists, who have been making a living on TURPS for years see all that money going out the window to the interventional radiologists. So, this has become a political issue, and there are more urologists. There are also the companies who make the specialized equipment used to do the TURPS. There are millions, and perhaps billions of dollars involved.

Look, for a minute at the Urolift, another relatively new technique. It was, not surprisingly, approved by the FDA, and it is done by UROLOGISTS.

I am sure that there are many urologists who have their patients best interests at heart, or who are not even aware of these new promising techniques, but....

So what to do about it? Will these promising procedures, done by interventional radiologists, ever have a chance of being approved? What can be done about it?

Well, in one sense, there is hope, and we are it. For good or bad, in this country, at this time, most members of the House and Senate are men --- old men --like us, and most of them probably have trouble with urination, but most of them probably aren't aware of this issue, and how approval of PAE, FLA and other promising techniques could help them and us. I don't know how the current election is going to turn out, but Hillary Clinton has already supported more research on men's prostate problems. I have no idea where Mr. Trump stands on this.

We can help fix this problem. We need to write to our members of congress and the senate, make them aware of this issue, point out how promising these techniques are, and ask them to support financing of the additional research necessary to get these promising techniques evaluated, and approved by the FDA if they really work out. It will help them, and it will help us. Just as it is appropriate to support research on women's health issues, we need help on men's health issues.

I apologize for being so long winded, but this is important information. Please get it to your friends, comment here, and WRITE YOUR MEMBERS OF CONGRESS AND THE SENATE.

Neal

1 like, 45 replies

45 Replies

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  • kenneth1955
    kenneth1955 nealpros

    Posted

    Yes it is very important.  That is why we have to watch when a doctor give out meds.  Also don't let them touch your bladder neck  that is want closes when you have a orgasm.  If that is destroy you will have retro.  Think before you have any procedure.  Have a great day 

  • scotty52
    scotty52 nealpros

    Posted

    Had my laser turp 6 weeks agp and still having some discomfort when urinating but very tolerable. I had sex for the first time this week and had ejaculation, it wasnt as much as past but yet i wasnt expecting any. Anyone else experienced this.
    • kenneth1955
      kenneth1955 scotty52

      Posted

      Im happy for you.  Your one of the lucky ones.  Most men that have a turp get nothing.  Your not getting alot because there is no more fluid in the prostate only the seminal vesicle and if your on any meds it will slowdown.  I guess some is better then nothing.....I have a friend that had his prostate taking out Doctor said it was best because he had cancer Never told him what kind.  Slow growing or fast.  The only way he can have sex with his wife is to do a injection in his penis.  And it takes him 1 1/2 hours to have a orgasm.  Most of the time he said he give up because he gets to tired.  Now he said he wished he waited.  Take care  Ken  
  • alan1951
    alan1951 nealpros

    Posted

    Fantastic post, Neal.  And to say it's informative would be an understatement.  Appreciate it.

  • cartoonman
    cartoonman nealpros

    Posted

    Thanks for the clarifying points, Neal.  Unfortunately, I got stuck at the mention of Trump.  "Oh, I gotta prostate!  I got a YHUGE prostate!  I GOT THE BIGGEST PROSTATE YOU EVER SAW!  NOBODY'S GOT A PROSTATE BIGGER THAN MINE!!!!"    Sorry, I'm a former political cartoonist; I couldn't help myself.  Now back to serious responses and replies...  :-D

  • grant66038
    grant66038 nealpros

    Posted

    It might help if you split the article up.

    The post hangs together in the sense of the topic 'shortcomings', both literal and figurative but really this is at least two posts.

    I wonder why PAE is included in the retro ejaculation issue when most people have the PAE done specifically to avoid this. The TURP on the other hand is known to cause this and this was explained to me by my urologist prior to consenting to the procedure. I don't experience retro after the TURP though so for me, the TURP has worked just fine and I don't regret having it.

  • don30615
    don30615 nealpros

    Posted

    Neal,

    Many thanks for this very informative post. I've been considering undergoing a PAE, with Dr. Bagla in Alexandria, VA, and have a few question I'd like to get your thoughts on:

    --How common is the second type of RE (loss of seminal fluid) with PAE? If it is common, what is the benefit of PAE? I thought the main benefit was that it didn't cause RE. I know loss of seminal fluid is not technically RE, but the experience is pretty much the same. 

    --What is your sense of the success rate of PAE? I'm sensing from some of the posts in this forum that the success rate is not as high as originally thought. 

    --Finally, have you had the procedure? If so, have you discussed your experience elsewhere in this forum? 

    Thanks again for your excellent post.

    Don

     

    • richp21
      richp21 don30615

      Posted

      Hi Don,

          I spoke with Dr Bagla several weeks ago, and he said that he has a 90 to 94 percent success rate. Higher than the normally cited 80 percent. He said that he is selective in who he considers suitable for him to treat, and that is the reason for the higher success rate.

       

    • don30615
      don30615 richp21

      Posted

      That's intereseting to know, Rich--thanks very much. Did Dr. Bagla say how he selects candidates for the procedure? Im 71, with a large, but not enormnous, prostate, that is more or less under control with Finasteride and Cialis. But I'm tired of taking the medication. 

    • richp21
      richp21 don30615

      Posted

      I can relate. I've switched tamsulosin from every day to every other day because of the nasal congestion side effects. Dr Bagla didn't tell me his criteria, but did say I'm a suitable candidate because my symptoms are alleviated by taking tamsulosin. He said that that is an indication that PAE would be effective. My prostate is 98 cc. I know that's large but, based on what other men are dealing with in this forum, not enormous. You might want to connect directly with him. He was very responsive and didn't seem to mind that I was in the information gathering stage rather than already decided to go ahead. I did have to fill out a medical history form prior to the phone call, but I'm sure he used the info in that to determine my suitability.

    • don30615
      don30615 richp21

      Posted

      Thanks, Rich. Mind if I ask one more question? Did Dr. Bagla say anything about retrograde ejaculation (or loss of seminal fluid that Neal discussed above)? I thought that that was less of an issue with PAE. What is your understanding?
    • nealpros
      nealpros don30615

      Posted

      Hi Don,

      In my discussion with Dr.Isaacson, he said that the goal of the PAE is to dramatically shrink the prostate.

      I said that the prostate has several functions, such as the production of seminal fluid. He said that is true, but when the prostate shrinks, it becomes difficult or impossible for it to continue to produce the seminal fluid. If you are planning on having more children, perhaps that could be a problem, but I bet a good doctor could help with that. I have had a PAE from Dr. Isaacson last December, and am one of those unlucky people who got about 1/2 benefit from it. I went from getting up about 6 to 8 times a night to 3 to 6 times a night. I am having another one, probably on November 3. I have RE, and I have to tell you that both my wife and I feel NO difference in ejaculation or orgasm. All the old feelings are still there. No, RE is obviously NOT a good reason to get a PAE, but there are many good reasons to do it.

      First, you don't get incontinence from it.

      Second, you don't get impotence from it.

      Third, you don't need to have a post op catheter with it.

      All of those things, or most of them do happen frequently with any of the many flavors and colors of TURPs, lasers, frying, etc. and some of them, such as the catheter happen with all of the rest. The PAE is a very benign procedure. You go to sleep with an IV and wake up with 4 holes about the same size in your other wrist, or groin (upper leg). Yes, I have written an extensive post about this. I had it last December.

      Let me know if you have more questions.

      Neal

    • richp21
      richp21 don30615

      Posted

      We didn't discuss that at all. I did not bring it up as I am not very sexually active and don't anticipate that changing significantly. Dr B didn't bring it up either.

    • don30615
      don30615 nealpros

      Posted

      Thanks for the thorough answer, Neal.  My uro in Washington DC claims that the problems you mentioned--incontinence, impotence, and post-op catheters--are unusual with the procedure he favors, Green Light Laser. But the PAE does seem to be the least invasive procedure of all. I also suffer from nocturia--I get up 3-6 times a night--and according to my uro (and some research I've read), it appears to be unrelated to BPH in some men. For these men-and I think I may be one (since the BPH medfication I'm on cures my symptoms during the day but not at night)--none of the current BPH provedures are going to solve the problem.

    • don30615
      don30615 richp21

      Posted

      Oh, I see. Well, thanks again for the information, and good luck.
    • richp21
      richp21 don30615

      Posted

      Good luck to you well. Would love to know what you decide to do.
    • nealpros
      nealpros don30615

      Posted

      With respect, Don, I think you should reconsider. How do you know if you are one of the men who have this problem, who don't have it as a result of BPH??? What size is your prostate? How old are you? Has a urologist told you that you have BPH? It's easy to give up, but at some point if you do not address this, you may not be able to urinate without a catheter.

      Neal

    • don30615
      don30615 nealpros

      Posted

      Neal, I don't know if I'm one of the men, and I haven't given up. I'm 71 and have been under the care of an excellent uro in Washington DC for 10-plus years. I've been on various meds over that time. The two latest--Finasteride and Cialis--do a pretty good job with minimal side effects of controlling symptoms during the day, but don't work so well at night. I probably get up an average of 4-5 times a night. It's bothersome but not a huge problem--I go right back to sleep. (It's probably a bigger problem for my wife, who is a light sleeper.) During the day, life is more or less normal. So compared to other BPH sufferers, I consider myself pretty lucky. My uro thinks my nocturia might not be caused--or solely caused--by BPH. For reasons that doctors don't entirely understand, some people produce more urine at night, and I may be one of those. But BPH could also be a factor. At some point, I plan to have a procedure (probably PAE) because I'm tired of taking meds. My hope is that the procedure will also help a little with the nocturia. I'd be delighted getting up 2-3 times! Thanks for your concern--I didn't mean to sound defeatist in my post.

    • cartoonman
      cartoonman don30615

      Posted

      Don, I have BPH and a blown-out bladder, that can hold over 600cc without complaining (normal is 300cc.).  I cath before bed, and almost never (maybe one time a month) get up at night.  Can you imagine being 67 and being able to say that>>>????  You might want to consider that approach; I can't tell you how much I like sleeping through the night like I was 25, even if I can't pee the same during the day!  :-)

      And yes, the type of catheter IS important: I sue SpeediCaths, only, and have, for two years...

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