Scheduled FLA for Jan 2023

There were discussions about FLA a couple years ago on this site. Some people had good success with it. It is done inside an MRI so they have good accuracy with positioning the laser, since they can see exactly where they are. One person, named Jay, from Austria had the procedure done and flew back to Austria the next day. He had a very large media lobe (Ball Valve) protruding quite far into the bladder, He posted an MRI picture of it. He had very good success from it with no Retrograde Ejaculation (RE), no Erectile Dysfunction (ED), and no incontinence.

I communicated with another doctor, Eric Walser, from that area of Texas who also does FLA. About two years ago he said that Medicare and insurance may be paying some part of it.

Hi, i talked to the guys in houston and i think once the cath is removed you should be able to pee normally. expect that to be 7 to 10 days. you might want to have a back up plan in case it takes longer, which was not ruled out.

surprised with that much PAE shrinkage you got no relief. it's funny that all the IR docs I've consulted with say it does work with median lobes often. did you have the standard 2 weeks of post-PAE syndrome (burning, pain in abdomen or groin, etc). can you describe that?

Also, did your insurance cover the PAE? Which one if it did if I may ask since I'm having problems with blue cross covering that.

4. Gently remove the Foley catheter (like a piece of cooked spaghetti) and urinate. This will be your best urination of the day, it will get worse over the next 12-24 hours.

I smiled when I read this since it was written on the limited "outpatient" paperwork that I received after my TURPs. In a urologist's mind, removing a Foley (in the shower, that's the best place, with warm water running to distract) is the easiest thing to do. For a patient who is not comfortable dealing with the internals of his own body after surgery, it's a bit of a challenge, or it was for me.

What are the chances of having to go to the ER for acute urinary retention after having had the cath for 7 days and then removing it?

I'd say it's most common for patients to remove the Foley and start peeing right away. Wasn't true for me after the first 2 TURPs so I had to run to the ER or the doctor's office to get another Foley after retention was noted. I wish they would have equipped me with set of catheters so at least I could resolve the issue at home.

This is my update after procedure on 1-10-2023.

I’m jotting down thoughts as they occur so this may not flow as coherently as I’d like.

First answers to my following questions during pre-op visit:

1 – How long after procedure till you can pee normally?

Dr. Fallon told me around the 2 month mark, but full recovery is 3-6 months!

2 – How long after procedure till you know if you can pee better?

If procedure enable this (an there’s no guarantee) this would be the 3-6 month mark

Both Dr. Karamanian and Dr. Fallon were present during procedure. Dr. Harman was the hands-on for me.

Dr. K authorized a little versed and 25mg? of fentanyl PRIOR to catheter insertion. This is something which should become standard operating procedure in my book.

You are pretty well sedated for procedure however I did rouse a bit and felt one burn cycle. They immediately pushed a little more fentanyl and that took care of any discomfort.

Went back to hotel after procedure and slept 4-6 hrs.

I don’t know how it is for others, but having a catheter in place is for me about the closest experience to unrelenting torture I have ever experienced. I stayed at the hotel 10 days suffering though this. It was awful. At this point, if I knew now about this I might have opted for a different procedure which had faster recovery & less time with post procedure catheter.

The fact that there is not a team comprised of BOTH a top knotch urologist and interventional radiologist is one of the sad facts of medicine in the US. Every specialty is pigeonholed and protective of their own turf. The focal laser ablation radiologists need to work hand in hand with a urologist to find a workaround for needing to have a catheter in place for 10-14 days post procedure.

My feedback on the doctors is not so glowing. They may be skilled at the procedures they do, but they do not make you feel compassion or care. Basically it felt like you paid do the FLA then are kicked out the door with post-op printed instructions. I guess I was expecting more of a concierge medicine experience given the large cash amount which was prepaid. ($23k in my case)

Hotels

There two recommended. We chose the Marriott Courtyard since it was closest to the imaging center where the procedure was done. We were there for 13 days as I wanted to stay close enough to deal with any adversities which might arise. If you do this, there is a Residence Inn right next door to the Courtyard in (both are Marriott). I would recommend doing that so you have a kitchen. There are two grocery stores within walking distance and a load of restaurants too. Walking with a catheter sucks (a lot), but I felt mild exercise of walking a bit would be healthier than just laying in bed.

Procedure was on a Tuesday, the following Friday I removed the catheter in the shower myself. It was painful but manageable and I was so happy to get the instrument of my ongoing torment removed.

It is now very hard to pee and the stream is much weaker than prior to the procedure. Small clots come with most times I pee. I view this as good. In my mind this is getting junk out which might be progress toward easier peeing/evacuation.

When you think about the massive amount of trauma inflicting to burn away so much tissue inside the prostate and how long it takes to heal burns in general, it’s no wonder recovery from this procedure takes so long.

I am biding my time hoping I’ll slowly start to see improvement. I’m waiting another week or so before rubbing one out to find out if retrograde ejaculation was avoided. I’ll report back with results.

The future will either bring happiness (if things get better), or disappointment and the need to seek out yet a 3rd procedure. (so far I’ve had a PAE which did nothing to help the LUTS and now the FLA.)

Given the knowledge which is available to doctors I don’t understand why all the alternative procedures are not done with ejaculation preservation techniques.

So the long and short of it is focal laser ablation may be one of the better procedures available if you are trying to avoid impacting your sex life. But it is a long hard road to endure.

I solicit your comments and questions.

Cheers.

Thought I'd try to add a weekly update. It's now 8 days after catheter removal.

Urethritis / burning when peeing seemed to slowly increase. Called Dr K this morning and he advised getting something called AZO which is over the counter. He expected things to get better within about a week, but said every patient is different. It's still pretty difficult to pee. Feels very restricted. Still getting a smattering of miniscule clots when I pee. I take this as a good sign.

Preliminary test indicates no retrograde ejaculation.

Fingers crossed for the future.

This is one week from last post.

Pretty much a week from hell. Still have extreme burning on urination and strong pain in penis for about 5 minutes or more afterwards. In other words, AZO didn't do squat to alleviate this. I called the office and Donnie (rn) returned my call. My initial lab results showed no infection so I'm wondering "Why so much pain so long after catheter removal"?

Donnie spoke with one of the drs. and they prescribed something call "uribel" on Friday (it's Sunday today) which was supposed to work better than AZO.

I've now been taking it for 2 days and maybe it's 5-10% better than with AZO. (or it could be getting just a wee bit better due to time)

Stream still sucks, way worse than before procedure, but I was told it would take 2 months till I was back to ground 0 and improvement would start after that.

I'm still hopeful this was the right decision.

You do need to understand that going in and burning/ablation killing so much tissue is going to take time to heal. It seems like (from my reading on this site) recovery from most of the trans-urethral procedures is WAY faster.

2-7-2023 Update:

It appears I DO have an infection. Urine test was negative, but when they cultured it, it came back positive. So I will be on bactrim for the next month. Hopefully burning symptom will disappear within the next 48 hrs. I should have complained earlier. I'm also thinking they should do routine labwork for this within a day (or few) after catheter removal.

Good luck Alberto, it sounds like you are going through a tough time. We're rooting for you and I will certainly add you to any prayers.

Are you still in Houston? Did you manage to get out in the 10 days as expected?

Antibiotic seems to have knocked down pain/irritation about 90%. Flow has not yet started to improve. According to docs this should start happening in another 3-4 weeks. Not enjoying an entire month of antibiotics as it's interfering with my social drinking. I stopped taking the alfuzosin and uribel a couple/few days ago. Am enjoying having my bp back closer to "normal" for me 110-120/70-80. Having wave of dizzeness when standing abruptly is no longer a thing. Also, now that I'm not in discomfort am more optimistic about the whole process/event/procedure. Still hoping final result will be a noticible improvement in flow, as well as less trips to john when sleeping.

My final thoughts 3 months & 10 days post procedure is that FLA was pretty much a complete bust for me. I'd say if there was any improvement it was at most 5%. Sort of sucks to blow $25k .