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Retry Urolift?

Posted , 8 users are following.

dbhumie1
dbhumie1

Has anyone had Urolift repeated and was it successful?

Had a Urolift done in March (2018), some initial success but it didn't last. I'm catheterizing less and peeing better when I take Rapaflow now, but if I stop it only takes a few days for the prostate to shut down the flow. No noticeable side effects.

My prostate size is about 49. I had high retention, unknown to me, and have been catheterizing for over a year and a half.

I had another cystoscopy and my Urologist thinks adding more pins might help. 

He said his success rate is about 75% when he repeats it. I had 6 pins placed initially which is all the insurance allowed, but he thinks adding a few more might do the trick (my insurance allows repeats).

I asked him about Rezum and he doesn't recommend it. He tried doing it for a while and didn't like the results. He mentioned he had talked to a Urologist recently that does them and he doesn't have the first follow up until four months.

I follow this forum regularly and have looked into the different procedures. I chose Urolift initially because it's covered by my insurance and seemed like the least invasive and least side effects. Not interested in a TURP or anything that causes RE. FLA too costly and seems not always successful. My prostate is about 49 so don't think PAE is a good option and not done anywhere near me. Seems like HOLEP needs someone with a lot of experience.

I asked him about aquablation, he said a hospital he works with is trying to get one and I might be a good candidate, but of course there is still no insurance code for them yet.

We also have a gentlemen's disagreement on catheterizing. He thinks I should try to do it as little as I can (maybe once a day or so), I'm still doing it 3 x day when I take Rapaflow, 3 or 4 the days I don't. I want to keep the bladder emptied regularly so hopefully it may keep healing. He thinks it's healed as much as it's going to and I shouldn't have it interfere with my life so much.

A brief summary of my Urolift experience below for anyone interested:

- 6 pins placed, very uncomfortable to say the least with the rigid scope/placement tool. Feels like a prostate biopsy needle for anyone who's had one, but through the urethra (ouch!) 

- Filled me up with about 600 ml at the end of the procedure and I peed most of it out, the Urologist was very happy and so was I.

- Stopped catheterizing and continued taking Rapaflow, had a lot of urgency and pushed out a lot of clots for the first week.

- Stopped taking the Rapaflow after a week at the Urologist recommendation and by the time I saw him for the two week follow-up was retaining 300 ml. Very discouraging.

- Started taking Afaluzin for less side effects and continued with the no catheterizing. Didn't seem to work as good as the Rapaflow and when I went in a month later retaining about 300 ml still and had a UTI for the first time.

- Started catheterizing again, hard starting again after a 6 week break.

- Tried various things with taking days off with the Rapaflow because of the RE and other side effects and am now taking it a few days on few days off, day on day off, more or less depending what's going on at work and in life. I can pee better and catheterize less when I do the Rapaflow now but still not emptying and I don't like the side effects. If I did the Urolift again and could get to only catheterizing once or twice a day (or less) without any medications I would consider it a success at this point, but of course would like not to do either.

0 likes, 39 replies

39 Replies

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  • hank1953
    hank1953 dbhumie1

    Posted

    Hi db, how much retention did you have before Urolift and did your uro know it ? With so much retention, some uros may not recommend procedures until retention is improved. Also, Urolift may not be the best choice because it's designed to alleviate symptoms only, not to improve significantly like many more robust procedures. Of course, Urolift is great at not causing sexual side effects so it's a trade-off.

    Success rate for Urolift is between 60 to 70%. Hank

    • dbhumie1
      dbhumie1 hank1953

      Posted

      I had been going to another Urologist when it was diagnosed, after catheterizing for about 9 months my pressure increased (doubled) but still not where it needs to be. Retaining about 300 - 400 ml prior to the procedure, about 200 - 300 ml after. My original Urologist wanted to remove my prostate so I started looking around for other options. 

      He mentioned the procedure works better if the problem is discovered earlier and the bladder is still strong, but thinks it can still help.

    • hank1953
      hank1953 dbhumie1

      Posted

      "Urine stream is improved by more than 100% after TURP while it improves only by about 30% after Urolift.

      Post-void residual, the residual urine in the bladder after urination is not significantly changed after Urolift, but it is significantly decreased by close to 70% after the TURP procedure. A decrease in post-void residual urine is a significant benefit of Urolift which leads to less frequent urination and greater ability of the bladder to store urine."

      Urolift isn't the best way to deal with retention. Hank

    • dl0808
      dl0808 hank1953

      Posted

      My recollection is that after HoLEP and TURP, PVR reduced from 150-over 200 mL to less than 50 mL.
    • hank1953
      hank1953 dl0808

      Posted

      Sounds about right. Both TURP and HoLep are very effective in reducing PVR. Hank
  • dl0808
    dl0808 dbhumie1

    Posted

    In general. Resective technologies are much more effective than non resective.

    Would  u be willing to accept procedures to solve ur problem that may result in RE?

    if i had such serious BPH illness, it would be unwise for me to consider Urolift.

    • dbhumie1
      dbhumie1 dl0808

      Posted

      If only they could come up with a resective technology that didn't cause RE they would answer every BPH sufferer's prayers. Seems like they're getting close with aquablation.

  • dl0808
    dl0808 dbhumie1

    Posted

    U seem to have made up ur mind not to consider all the resective techniques.
  • john41956
    john41956 dbhumie1

    Posted

    One other consideration for getting the extra clips that occurred to me when I made my decision to do it is the time it gives me for other options to appear and get some real-world data about their effectiveness.  I figure if the new clips give me five more years, something better might come to light.
    • dl0808
      dl0808 john41956

      Posted

      Logical thinking. May I ask Which technology u are interested in and what kind of advancement u are waiting for?

      5 yrs is a long time. In another thread, a patient waited for too long to get treatment and let his prostrate grew to over 200g. He is now suffering surgical complications which he may not have suffered should he seek treatment earlier.

    • dl0808
      dl0808 john41956

      Posted

      Also have u considered for the majority the average clips are 4, if the initial implant used 6 and is almost immediate becomes ineffective, that means the patient  actually needs 8 or 10 clips, possibly exceeding the capability of Urolift. furthermore, according to the urologist, even with  that number of clips, the chance of able to relieve the symptoms is only 60-70% as oppose to HoLEP, which has a success rate of over 90%. Given the situation, would u go for the second implant? Even if it would be successful to moderately relieve symptoms, u may not get the 5yrs u wanted.

      not sure if u agree.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      Good afternoon.  We all pick what we feel is right for us.  Urolift is the only procedure that give you 100 % of your sexual function.  Why should you take a chance on side effect when you can have a procedure that give you relief. There are more men in today's world that do not want to end up with any sexual problems.  I for one would not do that.  As long as I'm able to pee I'm fine.  I don't have to pee like a teenager.  With FLA & Aquablation.  They need a lot more data and trail's Right now I would not do either.  But I feel FLA is much better because you are involed in the mapping and the doctor will show you what he want to get rid off.  You have a right to know before hand so you voice your concerns. Now with Aquablation.  Telling you what is going to be done is not seeing it on a paper.  The mapping is done while you are out.  And you cannot vary from getting rid of of the whole prostate because the jets goes back and forth in a way there is no control of the jet.  I hope they both will improve with more trails.  Only time will till  Ken     

    • dl0808
      dl0808 kenneth1955

      Posted

      Good afternoon, Ken.

      i agree with u that for those who want their sexual function 100% preserved and who don't mind having moderate symptoms  relief, Urolift is the perfect answer.

      what would be ur options if Urolift could not relieve ur symptoms or ur insurance declines to pay (BCBS did decline payment.)?

      ?also what would u do, if u know in advance that the chance Urolift will work for u is only 10%? Will u go for Urolift?

    • john41956
      john41956 dl0808

      Posted

      10% wouldn't be enough for me to go though the pain and hassle.  My uro didn't give me a percentage, but he did say there was a pretty good chance I could get what I needed out of the procedure since it was fairly clear where the remaining restriction was. I have BCBS of Texas and they covered the first round, but I'm not sure yet that they'll cover the second.  If not, I'm probably going to go ahead and get the button turp.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      If your prostate is the problem then the Urolift would help you because it does the same as any procedure.  It make a tunnel to help the bladder without cutting.  That is what all the other procedure do is make a tunnel.  I would not agree with any procedure that would take away any of my sexual functions.  I can put up with a lot.  I am very strong willed and no doctor will ever tell me that I need my prostate cut out so I can pee better.  Every man is different and we have different concern's My insurance paid for both of mine.  All I had to pay for was the surgery center.  We all go in to a procedure thinking it is the best for us and something it not.  There have been many men on here that had to have many procedure.  I know of one man that had to have 3 procedure in 10 years thinking that the first one was going to be it.  There is only so much of the prostate you can remove.  It will be 4 years soon and If I had to have a few more clips put in.  I am ready.  Because at 63 I may not be having kids but I will never give anything up.  Have a great day  Ken

    • dl0808
      dl0808 john41956

      Posted

      BCBS Policy is not uniform across the nation. It is whether it accepts the CPT code or not and not how many times the procedure has been performed.

      BCBS in my state has laid down impossible to meet medical necessity requirements for Urolift, one of them is that I can not be put under anathesia.

      however, it accepts CPT codes for aquablation and HoLEP.

    • dl0808
      dl0808 kenneth1955

      Posted

      I admire ur determination. There is an opposing view, however.  Some patients prefers durability instead of preservation of ejaculation. They want a procedure that has outcomes that will last for more than 10 years , yet has acceptable complications. HoLEP is one such procedures. More than 90% of patients are happy after HoLEP.

      best to talk about statistics and not individual special cases.

    • dl0808
      dl0808

      Posted

      I would like to state it again ejaculation preservation and the BPH technology or techniques are two independent and orthogonal issues.

      one could have HoLEP , TURP or GLL and yet preserved ejaculation with 90% chance of success. They are not mutually exclusive.

      the problem is with urologists, they don't want to do it for unknown reason.

    • dl0808
      dl0808

      Posted

      More:

      i only kown one urologist in NYC who offers green light laser with ejacualtion preservation. Unfortunately, he does not accept my insurance.

    • kenneth1955
      kenneth1955 dl0808

      Posted

      Yes I am very determined but all men have different concerns.  Yes every man goes into a procedure thinking this is the one and I only need one.  But some men's prostate grow faster then others. Then your in for another procedure.  90 % is good for a procedure but it all depends how good your doctor's is  It's that 10 % I feel sorry for.  No man should ever give up on his body.  Life takes enough away from us as we get older.  And when we get older we should be able to enjoy everything Sorry but that is the way I am.  My doctor call's me his challange because I keep him on his toes.  Have a good day  Ken   

    • kenneth1955
      kenneth1955 dl0808

      Posted

      DL  Yes them procedures are out there but you have to fine the Urologist that are doing them.  A lot do not what to do them because it take time to do it right.  ken 
    • kenneth1955
      kenneth1955 dl0808

      Posted

      If that is the procedure that you want there has to be a doctor somewhere that will take your insurance.  Don't give up.  Ken 

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