Should I Have Urolift or Something Else?

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I've suffered from BPH for 30+ years. Had a TURP twenty years ago. BPH keeps coming back. Bad LUTS for years. Medication for a long time that no longer helps. Recently diagnosed with minor prostate cancer on which no one will operate. Fully familiar with catheterization. Question now is: Urolift or something else? My uro is backing urolift. I know there are people here who are for it and against it. I know there are (as with everything) potential bad effects, side effects and unhappy sequelae.

Of course, I do NOT want to wind up with a catheter for life, or any of the other myriad miseries that can result from prostate surgery/treatment of any kind. But I'm sad to say those things can happen with every single procedure about which I've read for twenty years and more. What say you, brethren? If I want relief from LUTS, if medication no longer works, what are the options with the largest upsides and the smallest downsides?  

 

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  • Posted

    FIrst, be glad no one will operate on your minor prostate cancer. Those surgeries are completely unnecessary 95% of the time and rarely end without impotence, incontinence or both.

    What procedure is best will depend on the size of your prostate, where its growing and whether your prostate is the only problem you have. To diagnose all of that, you'll need to be scoped (to gauge the size and shape of your prostate) and a urodynamics test to determine if you have bladder issues as well. Long term BPH often impacts bladder function and no prostate procedure can help that.

    If you don't have a median lobe, urolift could be a good option for you - if you do, then its a no go (literally). Rezum will work on pretty much any size prostate and while there is a size limit, many docs are performing it off label with good results, although the big ones take longer to shrink down so the benefits take longer to present themselves. There are plenty of threads on Rezum on this forum that you can use to educate yourself.

    Also, FLA (Focused Laser Ablation) is a prostate cancer procedure that they are now testing (with excellent results so far) for BPH because many of the prostate cancer patients who also had BPH reported that their symptoms were gone after the procedure. There are threads on that one here too. One downside of FLA is that it isn't FDA approved for BPH so often you have to foot the bill yourself. But because you have a small cancer, you might be able to kill two birds with one procedure and have the whole thing covered. I would look into FLA and see if you qualify for coverage because of your cancer.

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    • Posted

      Thanks, oldbuzzard, I will check out both Rezum and FLA. I hadn't heard of either of them.

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    • Posted

      Good morning Robert.  You need to take control of your body.  Don't let your symptoms rule.  What OLD is telling you is true don't be rushed into any surgery.  You said that your prostate is 70 grams so UROLIFT may work for you.  it would open you up like any of the other surgery.  There would be no cutting and you will heal faster.  Your problem may not be the prostate it could be your bladder or even your kidneys.  Find out first  Take care  Ken

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    • Posted

      Good morning Robert.  You need to take control of your body.  Don't let your symptoms rule.  What OLD is telling you is true don't be rushed into any surgery.  You said that your prostate is 70 grams so UROLIFT may work for you.  it would open you up like any of the other surgery.  There would be no cutting and you will heal faster.  Your problem may not be the prostate it could be your bladder or even your kidneys.  Find out first  Take care  Ken

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    • Posted

      I agree with everything that the Oldbuzzard has said, except to clarify the fact that Focal Laser Ablation (FLA) is approved by the FDA for BPH. The issue is not FDA approval. The issue is the payment of the cost by insurance. This is for both PCa and for BPH with regard to FLA. 

      This is changing. I personally received $4,700 reimbursement from Medicare. Other men have reported partial payments from private insurance companies. The fact of partial payment or not is all in the number coding of the procedure when filling for reimbursement. Again, this is not an FDA issue. It is solely an insurance issue. I boils down to the fact that if this was a Urological procedure it would have the power of the Association's lobby behind it. It does not. Interventional Radiologist are not of the numbers to have a powerful lobby representing them to the insurance providers.

      I know that Urology tries to say that this and PAE are not FDA approved but this is just not true. The question needs to be why do they continue to say this? Do they really not know? Or, maybe they want you to believe that FLA is inferior to the laser procedures they do preform? Facts are the facts. If you do not believe me, pick up phone and call Dr. Karamanian in Houston TX. and he will explain it to you if needed.

      Once again, Focal Laser Ablation is approved by the FDA for the prostate procedures preformed by Interventional Radiology.  

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  • Posted

    How large is your prostate?

    There are several options; you definitely should have ultrasound sizing of your prostate, as well as a cystoscopy to rule out things like urethral strictures. Urodynamics may be beneficial, as well.

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    • Posted

      Doc, I'm scheduled for either a Rezum or a Urolift at the beginning of 2018.  I am 66 years old, and the prostate is approximately 45 g.  It is controlled with dutasteride.  I've heard from guys who had a Urolift procedure.  Some of them raved about - for two or three months.  We're told that we can give up prostate medications.  Though I could be wrong, my assumption is that, once a man gives up a 5-AR inhibitor, the prostate may resume its growth, thereby negating the beneficial effects of a Urolift.  If that is the case, I'd rather have the Rezum procedure.  My question is this:  In your experiences, how many men - give or take - were indeed able to give up their prostate medications, once and for all, with minimal issues?  Final note:  We're grateful for your opinions on this site.  You've cleared up a lot of issues for us.

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    • Posted

      A large portion depends on the prostate anatomy.

      A large median lobe would likely preclude a successful urolift procedure.

      The prostate would continue to grow without the medication, but keep in mind that the prostate grows even on the medication- the amount of shrinkage is fairly minimal from the 5ARI's.

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    • Posted

      Extract from BPH News.

      Researchers examining diagnostic tests and treatment patterns from a large database of newly diagnosed benign prostatic hyperplasia (BPH) patients observed that the clinical care provided these patients largely followed guideline recommendations, although, unexpectedly, therapy with 5-alpha reductase inhibitors (5-ARIs) was underutilized in patients with large prostates and overutilized in those with small prostates.

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    • Posted

      Jersey   I just read a trail on Urolift that is being done on men with median lobes and they are working fine.  Have you heard anything more on this trail  Ken 
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    • Posted

      Hello Alan:

      I had the Urolift around 6 weeks ago and so far it has been a complete success.  My prostate was 32 grams on finasteride.  At my one month checkup, I asked my doctor about the prostate growing larger now that I'm off the meds (what a blessing to be done with those).  He said it's a very good question and they're not exactly sure why,  but the prostate does not grow back in the area where the procedure was performed.  He said it can probably grow back in other areas but typically does not affect the "money" area.  My Uro is a pretty sharp guy and keeps up on all the latest data.

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    • Posted

      I am from a remote island in S.Asia.  I had BPH symptoms since several years ago.  As most of us I was very reluctant to discuss this openly and scared of surgery.  About an year ago my lower abdomen was scanned and it revealed my prostate was enlarged (80cc?) and post void volume was over 300 ml.  My urologist suggested surgery but I dragged it on in fear of surgery and possible damages.  Few months later, I experienced a complete retention which was tackled by catheterization in emergency room.  Since, there are no better treatment options (i.e laser ablation) available here I decided to have TURP in the hands of a reputed local urologist.  I stayed only 2 nights in hospital and minor discomfort and bleeding completely disappeared by 14th day after surgery.  Now, after nearly 05 months later I am happy that my flow is strong, no urgency,  no night time visits to bathroom and I can hold it for 4-5 hours.   Only negative effect is RE.  My scan 3 weeks after TURP shows some trabulation of bladder wall.  I believe this is wall thickening under to pre-TURP conditions.  My questions: (a) Is the trabulation a serious condition? (b) Can I expect my bladder to become normal with time? Grateful for your opinion.
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    • Posted

       I’m glad you’re doing well I cannot answer your last question Hopefully you retain current condition, however mine grew back within a year in addition to scar tissue

      so don’t be discouraged if you have to have a another one   I’m interested in the ans to your quest as well. 

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    • Posted

      Thanks, george18730, for taking the time to respond.  I give serious consideration to your opinion.  Not quite sure what I'll do at this point, but I'm leaning towards Rezum.  Will definitely keep you posted, and speaking of updates, do let us know how you, yourself, are doing say, six months post procedure.  Your current post, and your future update will help a lot of guys.  Thanks, again!

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    • Posted

      "the amount of shrinkage is fairly minimal from the 5ARI's"

      I did not know that.  I was of the (mistaken?) opinion that 5ARIs help to shrink the prostate by 25%+.  Thanks also for the your expertise.  I'm sure I speak on behalf of many.  We're [u]grateful[/u] for your expertise in this forum.

       

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    • Posted

      You’re actually not that far off. Average change that I’ve seen in most studies after taking it for a few years is around 18%.

       The problem is in the  World of BPH,  size isn’t everything. Also, a 17% reduction in someone who has a 100 g gland probably won’t lead to a satisfactory result

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    • Posted

       The healing process after any sort of prostate procedure can be in excess of six months. So, hang in there!

      The trabeculation is a finding of the bladder demonstrating that you have had obstruction for sometime before your procedure.

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