Therapies that balance sexual function with relief from pain and discomfort...

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The various procedures for LUTS / BPH are mind boggling.  That said, I'd like to hear from others who have an opinion on which therapies / procedures come closest to maintaining sexual function while, at the same time, offer relief from the nagging symptoms of BPH.  Case in point; as I understand it, a TURP works to relieve symptoms, but the results have the potential to be devastating on a man's sexuality.  In other words what, in your opinion, is the Goldilocks therapy of choice that balances the quality of a sex life with minimal symptoms?  Final note:  Gentlemen - WE MUST NEVER GIVE UP HOPE.  Thanks, alan1951

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  • Posted

    What are your symptoms? Have you had any tests? I would love to have PAE or urolift but I don't fit the criteria 

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    • Posted

      Hey there buddy  Why do you say you don't meet the criteria.  Don't let them bully you into something you don't want.  You tell them this is what you want to try If they say no find one that will Ken  

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  • Posted

    Rezum is the least invasive and has the least sexual side effects.

    I believe it is less than 0% ED and 3% retrograde.

    It is done in the Urologists office, with local rather than general anesthesia.

    It was FDA approved in the US about a year ago, not many doctors offer it.  There are two in Florida.

    I have it done last week.  It was quick, relatively painless, and I drove myself home after.   I was told it will take a month or two before I know the level of success.

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  • Posted

    Alan, this is a great post because it speaks to the quandary that all of us are in suffering with the symptoms of BPH.

    I underwent PAE as part of a clinical trial back in 2013 in VA with Dr Bagla. He remarked at the time on the size of my prostate which measured some 100g with a pronounced median lobe. My results immediately after the procedure were noticeably improved and ever since, I rarely wake more than once a night, a vast improvement. But my BPH symptoms have deteriorated slowly over the last three years to the extent that I have recently been researching alternative treatments.

    Rezum therapy is something that looks very promising indeed but currently is only approved for prostates smaller than 80g. Trials are currently underway for larger prostates but I am disqualified because of my prior PAE. My prostate according to my latest scan is measuring 130g. TURP is for me also out of the question as is any procedure with a high likelihood of any kind of sexual dysfunction. I’ll be following this thread with interest and appreciate any input from those with much larger prostates and median lobes who have benefitted from alternative/new procedures that they can share with this forum.

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    • Posted

      It's a good question! My urologist has told me (without specific reasons) that PAE is a bad idea. I will quiz him on this next time I speak to him. I suspect that this might be something to do with a concern that radiology is trespassing on the role of urology. But I also realize that that would also be a cynical view.

      ?I would consider a second PAE, but perhaps I am looking for something that truly makes a difference in quality of life for someone with as big a prostate as I have. Size and median lobe are my challenges. But perhaps I am looking for the holy grail and a second PAE might just do the trick. I am open to anything that I might get meaningful benefit from. Rezum seems to be getting a lot of positive comments.

       

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    • Posted

      Yeh let's hear why a Urologist thinks it's a bad idea.

      I would say if you can afford it get a second PAE especially because it helped the first time, and Dr Bagla will have had  a lot more experience and will do it even better next time.

      This seems to be a problem, let's say PAE works for 70-80% of people, and sometimes has to be redone, the FDA will never approve it because TURP and other of procedures have a higher success rate. The FDA and insurance companies don't care that PAE has no side effects, they just look at how expensive it is and Urologists obviously are not going to advocate something that hurts their livelihoods.

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    • Posted

      "...My uro said mine was too big..."

      The contraindicators specifically spelled out on the NeoTract site say this:

       "Are there any contraindications? The primary contraindications are an obstructive or protruding median lobe of the prostate and a prostate with a volume of greater than 80cc."

      Now, your Uro may, in fact, just like to sell something else. But it might be prudent to allow for the possibility that he understands that if the results are perceived to be less than satisfactory, there can be little complaint if the procedure was done outside the parameters designated by the maunfacturer.

       

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    • Posted

      Urologists don't make any money from PAE, therefore, never recommend it. Check with an interventional radiologist,who does it to get results on second PAEs.

      Neal

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    • Posted

      Hi Ross

      You should first know the reason why your PAE didn't work or worked for limited period. Then you could decide on the next procedure. Probably another PAE will be a good choice especially if targets the enlarged median lobe.

      I also noticed that your previous PAE disqualified you from undergoing REZUM procedure. Is this what you think or what your Urologist thinks. Regards

      FJ

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    • Posted

      Hi FJ,

      I am not saying it didn't work, I am merely saying that the improvements were limited and three years later, my symptoms are starting to deteriorate again. I am concerned that that PAE isn't robust enough and not the ideal procedure for enlarged median lobe. 

      As for the disqualification, it was from a Rezum clinical trial for prostates >80g. You are immediately disqualified from these trials if you have had any other procedure.

      Ross

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    • Posted

      "Check with an interventional radiologist,who does it to get results on second PAEs."

      I will! It's definitely worth investigating.

      Ross

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    • Posted

      Hi Ross

      How do you know you are disqualified for REZUM and what is the reason? I was thinking it would be the best minimally invasive choice after PAE especially when you get the prostate downsized to something between 50 and 80cc.

      FJ

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