TURP and Retrograde Ejaculation

 I had a good surgery. Spent a week to recover. Absolutely followed all the  rules After waiting three weeks, was somewhat shocked to experience this. After looking at over four dozen interesting studies, these covered the range of results.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085618/

100 patients 71 years old (plus or minus 7 years) with a 1 year followup - study

Retrograde ejaculation rates of 70% to 100% after TURP and of 96% after HoLEP have been reported.

https://www.everydayhealth.com/mens-health-specialist/retrograde-ejaculation.aspx[/b]

Written by a Doctor:   [/b]newer laser treatments such as greenlight, retrograde ejaculation is common...

These symptoms are not likely to resolve on their own after such surgery

Sciencedirect.com with a smaller and younger sample claims:  Among the 56 men who were potent prior to the procedure, 27% experienced retrograde ejaculation but none of them experienced impotence.

Sciencedirect.com on a larger study a few months ago reported: A retrospective study examining sexual dysfunctions of 264 men, 48% of men experienced retrograde ejaculation. The change in erectile function was small, with 5.8% of men with good erectile function pre-TURP experiencing a worsening function after TURP [32].

Not  listed are several sites from doctors in medical groups that had >90% because they did not publish the complete study or how it was conducted.

j12080: The procedure that is showing the least chance of any sexual side effects is the Focal Laser Ablation. (FLA).

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To put this in perspective, focal laser ablattion for BPH is an experimental procedure with no trial data to data. Anecdotally, here, we have had around ten patients reporting back, and out of that group here was no retro ejaculation but one was left with an erectile issue and had to take viagra which wasn't required before. Overall results seemed mixed, like Rezum, with the best results where there was no significant retention, also like Rezum.  It's a promising procedure, but IMO still not ready enough to bank on. Hopefully, we will have more published data when the small trial Dr. K. is running has published data.

Jim

Thanks Jim. To add to your perspective, I don't consider focal laser ablation to be an experimental procedure and neither does the FDA as it is approved by the FDA for prostate procedures.

 It has a been over 12 years now that FLA is approved complete for prostate treatments. I think you are maybe considering your statement with regard to prove of efficacy through trial standards which is correct by your traditional methods. But the treatment is approved as much as it will ever be by the FDA. I am very pleased with my decision a year and half ago. I feel I made the best one and got a lot more than I thought I would ever get.  It should be noted that doctor K has done I believe  20 case now for BPH with one this week other than Jim's redo and two other case last week. I will point out that I only believe this as I can not call up and ask that question. He is way too private to provide any information.

It is important to point out that most cases NOW do not come from this web site or report into this forum and the ones that did come from here and have been successful, have moved on with there lives and do not follow this forum any longer. They are happy and do not feel compelled to follow patient or report and they are not in need of this forum. I personally try to stay in touch with a majority of these men out of curiosity. I also chose to continue to follow this site to continue to report my results and hopefully report a satisfied long term success pattern. Also, it is my desire to be a testimony to men who are looking for what all is available in every realm, as I have been there and want to help them if I can. My only request is that men looking for a treatment do the ALL the homework as it is available.  The treatments offered by all doctors are available to research completely instead of trusting in the urologist who has the "flavor of the month" from his industry to push on us. The technology and the process are not hard to understand and if logic is applied it should affect the decision that is available to each man on the treatment of choice. A systematic approach to the analysis is very obtainable. Quite frankly I do not believe or trust the efficacy testing of the Urological industry. Again, this is each man's  prostate and it is his decision and a urologist does not have the power to tell you he is the only game in town. Let's be honest, they provide only selective information. As you have stated many times all treatments have the failures and successes. FLA looks and in fact is very favorable. As Jim stated tonight, I believe the difference is Dr. K. 

This, as you have pointed out will still not be 100% but his efforts and expertise are far more outstanding than the others and unless one as experienced with him they will not understand that fact or feel as Jim stated tonight.

Again,  in you statement of: "focal laser ablattion for BPH is an experimental procedure with no trial data to data", I disagree that FLA is experimental. Yes it is not as wide spread as other procedures offer by urology but I feel that your comments may be confused with the feeling that FLA is not approved for safety with FDA approved when in fact it is.  This has nothing to do with insurance coverage approval which I wish could happen for the men who cannot afford the procedure. Insurance approval will be hard to ever come by as there is no powerful group pushing insurance companies to approve the procedure as is the case with the Urological Association. In fact it is quite the opposite as they are working very hard to keep PAE and FLA as unapproved by insurance as long as possible. They have a tremendous amount of leverage over the insurance companies. WE all know why this is the fact.

So my points in closing is that I do believe that FLA is the procedure that produces the least chance of sexual side effects and the logic is very clear as to why. 

FLA is completely FDA approved. 

The amount of FLA procedure by the limited Interventional Radiologist that perform FLA for BPH and specialize in Prostate procedures are more than you have been made aware of as Dr. K is only one and  3 other IR's are currently doing them in addition to him. None of them come from this site.  I doubt any of doctors have his success rate in anything they do. But even as good as he is, no one can be 100%.

An "experimental" procedure (FLA for BPH in this case) by definition simply means a procedure that iis both not widely accepted by the medical community and insurance companies and therefore needs further study both in the form of peer review studies. That describes FLA for BPH and you can't use the FLA for PCA studies because they have different aims and end points.

I think if you asked Dr. K. himself, he would admit the same, or if not, why is he currently do a study trial on FLA for BPH, the first that I'm aware of.

An experimental procedure is not a bad thing, but it is what it is, and I think it's important to point this out here, especially for those new to forum, so that they don't think it has gone through the same phase III studies like some of the other newer procedures such as Rezum and Urolift. It's not a value judgment, it's information.

Jim

But not widely insurance approved. From what I've read here (from MikeSkier) FLA for BPH got its FDA approval because it's not technically a surgery. That doesn't escape the fact that FLA for BPH has zero peer reviewed trials. Again, not a value judgement, but some here may get the impression that FLA for BPH is as widely recognized and peformed as Rezum and Urolift, but it's not. No data that I'm aware of from Dr. S. and only 20 performed procedures from Dr. K. with no published data as of now.

Jim

I'm more thinking that if uros don't do it why would they suggest it. If they can't make any money why recommend it.

It b's if you ask me.. Dr. K more like 25 Fla. I would tell anyone Fla should be there first choice. If that doesn't work let the uros

Cut it up. Just my opinion..

Your description... "experimental" procedure, by definition simply means a procedure that iis both not widely accepted by the medical community and insurance companies and therefore needs further study both in the form of peer review studies. Is not something that I fully agree with and my only concern is you are stating something that would actually scare off a man from pursuing this treatment if he is as you say a "new" participant to this site. 

Insurance companies are not paying because they will and do resist paying as many treatments as possible until enough pressure can and is brought against them by the associations and lobbyist. that does not mean that clinic trails is not a valuable tool to use by these groups but Interventional Radiology does not have that interest level in the prostate  realm of the treatments. We (men in general) are very lucky that we at least have a few IR doctors would will pursue PAE and FLA treatments as Urology cannot do this procedures. Insurance companies do acknowledge and accept that both FLA and PAE are completely FDA approved as prostate treatments and it does not have to do with BPH. 

I know this because Medicare paid two check on my FLA for a partial total of $4,700. It was not an issue of FDA approval or clinical trials. They usually do not even pay for PCa on this treatment but FDA approval is complete and has nothing to do with it. The medical community you speak of is the Urological community and they are not in favor of anyone mess up their play ground. Realize that the blind 12 needle biopsy is a 10 minute procedure in office and it is a $1.3 billion dollar product for the Urologist industry. It is horribly inefficient and yet the Urologist will frown on any mention of a MRI follow by an focal single needle biopsy which is extremely efficient. These are just the facts. Your clinical trail theory should be reapplied to the TRUP that is their gold standard. My fear of you over stating this is that you will scare men who need to understand that another cash offered product is fine for their consideration and if you continue to say it is not FDA approved when in fact it is, this will cause them to do what the Urologist are trying to sell them rather than consider the alternatives. 

The 20 to maybe 25 men that Dr. K has done in the last year are only  a percentage of what was done and I believe that more have come from other sites than this one. Below is an email I received today for one of those men who does the majority of communication on those other sites. No it is not 100 percent as you have point out several times and that is good that you have. But it is much more predictable and very controlled and the success rate percentage is climbing. The clinical trial must be kept very stringent and pure in its selection. Men who have tried other treatments are never included. This is one such person. Also he is even more evidence to me that the success is due in large part to who you chose to do the treatment. I am not complaining to you I just don't want to scare men off from researching FLA.

Received today:

" Focal Laser Ablation for BPH"....Yes! That was the headline on a Google website that more or less has changed my life. I will admit, it is still a little early to completely define my experience but for the benefit of others who suffer from this condition with or without cancerous lesions, I thought my journey would be interesting. 

My prostate size was never really large. Just 50 grams, but it wasn't about size. It was about location. A very large median lobe had engulfed about 2/3 of my prostate interfering with my urination and literally as I was told, forming a plug around my bladder neck. Of course, getting up at night to pee multiple times interfered with my sleep and my energy levels. I had tried multiple holistic solutions including saw palmetto, nettle root, hormone balancing, green juicing etc etc. all to no avail. I even traveled to Israel, spent $17,000 for the Gat Goren procedure which embolized my internal spermatic veins (ISV's) but to my consternation I later learned this promising procedure did not work for those with a large median lobe nor did PAE.

And after 6 years of suffering, that Google website caught my attention. I learned a large group of individuals who all had the same BPH affliction were members of a club called the K Club. What did K stand for? It stood for Karamanian, a doctor who had treated each individual, with success, compassion and a deep knowlege of the affliction at hand.

On January 7th, I traveled from South Florida to Houston, Texas and underwent a 3 hour focal laser treatment at Houston Medical Imaging under the care of Dr. Ara Karamanian. Why undergo the expense of traveling to Houston and incurring hotel and airline costs in addition to the $21,000 for the surgery? The answer was simple! Dr. K not only had a medical degree but also was a graduate of Duke University with an engineering degree. When he examined the MRI of my prostate, unlike my urologist and those in South Florida who do FLA, he found two other areas that needed ablation aside from the median lobe. It was both his engineering and medical experience that convinced me (despite my initial objection) that to do the job right, as much as 50% of the prostate tissue needed to be removed. The facility was Houston Medical Imaging. In all of Houston, I learned that there were only two Siemens Skyra 3T MRI Magnetom imaging machines. Just about the latest technology with each machine costing $3 million dollars. Obviously, if surgery were to be done on my prostate, I wanted a machine with the latest web technology that was MRI compatible, unlike the older GE machines that some doctors use at more that half the price.

Approximately 30% of my prostate was removed. Intravenous IV conscious sedation presented a higher level of care. At no time during the 3.5 hours of surgery did I feel any pain or discomfort. I have heard of patients that have had oral valium sedation with nerve block. This I learned is less costly but can involve some pain for the patient.

It is now 18 days since I have had the operation. For a 75 year old man, having a catheter in his bladder for 8 days was no fun. I was warned of spasms and though I took uribel (?) to ease the discomfort, the spasms which occurred several times a day initially, can make a grown man scream like a baby. Throughout this period I began to understand why a fan club grew around Dr. K. When it was an unusually cold day, below 15 degrees in Houston, Dr. K came to my hotel not once but twice to check on how I was doing. I did not expect that level of care as most doctors do not provide home visits anymore. Not even 30 minutes in an office before you are rushed out for another patient. Today it is hard to fine optimized clinical care, much less a doctor who is willing to speak to you for multiple hours and even be on call at any time of the night. Dr K was the exception and I am very thankful.

Results so far have been beyond my expectations for such a short period of time. Of most concern to me was that my pipes were all working well. No damage to the neuromuscular bundle or the ejaculatory ducts etc. Yes, this 75 year old previously had a perfect score on a sexual health questionnaire and I didn't want that changed. After 10 days, ejaculation was better than I expected....A climax that a 30 year old would relish!!! Imagine that! Ejaculatory fluid actually increased. Hard to expect that when 30% of your prostate is removed. No retrograde! Those poor naive TURP sufferers. They forgot what they are missing. I currently release close to 200 ml upon urination, double the increase before the surgery. I have been told the best results come after 30 days for which continual improvement will happen for 6 months. Yes, their is still some blood in the urine which I was told can be expected for a while as the prostate inflammation goes down and healing progresses. 

I hope I haven't bored anyone with my journey. Good luck and success to all of you!

Will said. Thank you..

Day 4 and back home. Looking forward for day 8

Jim

j1: Your description... "experimental" procedure, by definition simply means a procedure that iis both not widely accepted by the medical community and insurance companies and therefore needs further study both in the form of peer review studies. Is not something that I fully agree with and my only concern is you are stating something that would actually scare off a man from pursuing this treatment if he is as you say a "new" participant to this site. 

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Not my definition, it's the accepted definition by the medical community. As far as scaring off people, I try and give a balanced overview and have stated that the procedure is very promising but there just isn't any peer reviewed trial data. Do you think it's responsible to omit these facts. Your presentation makes it sound like a new established procedure. It isn't

Jim

Ok Jim, I understand your comment but I fail to understand you seem refuse to acknowledge that I said directly that you are correct about clinical trials and their importance in the standard process. I am sure those clinical trial on TRUP helped it become the wonderful gold standard that is is proclaimed to be.

Again regardless of your comments, the insurance companies that I dealt with said to me it was a fully FDA approved as a procedure or course, I did quote the FDA file document location to them in the conversation.  

The medical community you speak of is of course the Urological association boys (and girls) who do not want it paid for and they do lobby hard against this as much as possible as they do with PAE. If you do have written "medical community" standard of this "accepted definition of experimental if not peer reviewed" that says without accepted clinical trials, a procedure remains classified as an experiment, I would really like to have it shared as I could learn from this. I also do think you actually know why and who does these clinical trials. For the most part, as with all of life, follow the money. Who pays for these peer reviewed trial data scenarios? The equipment and pharmaceutical companies not the doctors and in a lot of these trials, the doctors are paid by them for the trials. Why? Medical associations and medical lobbies. They set them up, they get the money arranged to add the procedure to their constituent for them to "practice". This does not mean they are not important, they are. But let's be real honest about them and the full issue of the motives. The Catheter manufactures might set up a test of a 1000 men who could self cath for 2 years and see the results. The "Medial Community" you are referring to would still not heartily support the effort. Again, follow the money.

I think it is responsible to share all the facts of all the procedures and especially the successful events that can help men. I think the urology community in most part is very irresponsible as they continue to dismiss and disregard men if the man indicates he may do any procedure that they do not specifically provide. Including your CiC regiment. Why would a doctor if he was a good one, not be involved with a patient and work with the IR doctors for the benefit of the patient? Is it because he just says "well this is not trial tested"?  Why would he not help the man research the options? I assure you with regard to FLA and PAE the Urologist does not have the qualification, training nor any knowledge of the procedure to do what the Interventional Radiologist is doing but he is needed by the patient for post procedure support and to be on the team for continued checkup and testing relationship. I doubt that very few of the men who have tried an alternative to what their Urologist was selling, are NOT still in any relationship with that Urologist. Especially after the urologist has stopped just short of calling him "Stupid" for even considering another procedure.  

You can claim this is because of "no peer review trial study" that they can approve of if you like but I believe you know as well as everyone knows why they immediately turn their back on the patient if he does not take their treatment. You are a vey smart man as is evidence by your work on CIC.

I am sure as a majority rule, there are a lot of doctors who would tell men that your process of having a man self catheterize for an extended period of time was not wise and not supported. They would say it leads to urinary infections and to possible internal damage. You however, had great success and you have help several other men also but I wonder, would the so called "medial community" as a whole be able to show a clinical trial on this CIC routine that had extensive peer review to support this procedure? And don't  they probably frown heavily on your technique for a lot of the same reasons they feel that way about PAE or FLA or any other situation that do not go into their practice coffers. What is it you think they serve, their practice or the patient?  I realize all doctors are not of this ilk but sadly most have become this way. Please make note, the number three leading annual killer in this country is "medical error and mistakes". 

What I think is responsible is to give all the information, and facts along with some hope encouragement. To a concerned scared man (as the one who started this tread) and is looking sadly at a TRUP and being told by the Urologist " don't worry, it will be ok I got something for that". He should be given the stories on all the actual cases he can find and he should make the decisions on what he wants to do and he is fully capable of determining if PAE and FLA are "experimental" or not. Likewise he is fully capable of determining if CIC is dangerous or not and could it help him or by him time. And clinical trials or lack there of should play into his analysis and research as it did in my decision. But in mine the research and the logic along with the wonderful partitioner I found, strongly out weighted the fact of no clinical trial. It was a no brainer with regard to that. 

The system is rigged and it is in their pocketbooks and in their favor. I think it is most responsible to support these men and not to use the fodder of the so called industry to miss lead of miss-direct these men. I have always known you to do that and that is why it stresses me to hear you continually call PAE and FLA "experimental and thereby not accepted by the insurance companies ". The facts are good but they must be correct. FLA and PAE are completely FDA approved. 

Wow, great news. Congratulations! Stay calm, positive and patient. It takes time for the amount of swelling that is in there to go down even though it does not really feel like it. I say it takes 5 weeks on norm and then it starts getting really good. You will see daily progress now. I felt it was two steps forward then one back on a day to day basis but it becomes exponential as the success continues. 

On a person note I only got up once last night which is fantastic and a function of how late I drink the night before but my volume that one time was a little over 450 cc. Yes, I still measure from time to time mainly out of curiosity but also because I get to keep the light off in the bathroom and then I don't mess up the toilet which make my wife happy and I love the sound of the rushing urine hitting that plastic bottle. Call it weird but it helps me go right back to sleep!! 

I am very happy for you and Dr. Karamanian not to mention Donnie they really care about our success. 

Have a wonderful relax weekend. 

John

Thanks John,

I really hope it works for both me and Dr K. It'll be a good day when catheter comes out. 4 more days..

Jim

I know I am very interested in your experiences and comparisons so please feel free share this. Or you may contact me or pm me if you feel it more appropriate. We are all just learning and trying hard to get by this situation. Together maybe we have a chance and we can hopefully help others. Good Luck.

John,

You make some good points and again I haven't criticized you for making them. But I believe in full disclosure, be it the short comings of the urological community or incomplete information given in a post here. So, when I see something posted to a new person here about FLA for BPH that fails to mention it's a very new procedure, with no peer review trials, etc, I'm not making a value judgment just giving more complete information. That's what this site is all about. The men that come here, come for all the facts, all points of view and are intelligent enough to figure out what's best for them.

Jim

I'll just add two points. First, let's not throw out the baby with the bath water. To me, it's quite evident, and I think you will admit a distain for the urological community. Well, I share some of your thoughts, however without them I doubt many of us here, myself included would be in half the shape we are now. As you know, I don't like any of the current procedures (for me) however it was a pioneering urologist, Jack Lapides, who invented the modern self catheter, and to him I owe so much, as do so many others. The second point is that "experimental medical procedure" is not my term, it's a medical term. Please look it up. It fits FLA for BPH. The first one who used that term was the Jersey Doc, and that's when I looked it up. We use medical terms here all the time, but in the future when I use it, I will include some definition, as "unproven by peer review trials". And btw this is not necessarily a bad thing. Many people have had their lives saved by expermental procedures either in trial or even pre trial. But again, let's give the men credit here to know all the facts before they make their decision.

Jim

JimJames -  Yes I agree with some of these points and I will look up and see what and who's with regard to the exact definition.

With regard to your Urologist, he sounds like a Dr. K type in urology and we need more of that. I will keep his name. He may be able to provide a reference. I would love to have a Uro in Texas. I would like to ask, did or does your doctor have proven and published peer review trials for your extensive modern self catheter procedures? This is not questioning the technique or the results it is only asking for the facts on the procedure. 

With regard to the Jersey Doc. I truly question this person as I did openly to ask him several times to please provide information of his identity and verification that he was in fact a Doctor with a name as all the other Doctors who have been on this site have willing done. He refused and instead hid behind his anonymity yet making claims that should be stood front and forward on as a professional.

My point being he trolled the site and in was all hours of the day (and night) for extendedly long period of time as I am positive you noticed. He engaged in seriously long conversations to make a self directed point. He refused to give his name which could be so easily verified a number of ways including through the practice he named that he was represented.

He could have been an assistant an RN or a medical clerk tasked with marketing efforts. Yet all of these question that were raised openly to him, and not just be me, could have been easily answered and the record substantiated to a satisfied degree if this person would have done, as all other medical professionals did when on this site and proclaim he was Doctor ( name ?) with that particular practice.

And by the way this does not mean this person was not correct in that fact of that definition nor does it mean you are. It simple smells very strange and not like a true professional doctor and  at the suggestion of disclosure he went dark when he could have gain credibility so easily. Be him right or wrong on "experimental procedures" I put little stock in any of his sales pitches. 

I do however agree as usual with a lot that you say above and we are in common agreement on wanting all and full disclosure to men on this site, along with complete support that they may need in recovery. 

In closing I would like to point out that insurance coverage of FLA, PAE or other procedures outside of one that can make money for Urology will probably never gain payment acceptance because the insurance companies will not receive the pressure of a large medical group. This doesn't matter how much better FLA is proving out to be in results. Urology out numbers Interventional Radiology in the hundreds to one ratio. Unfortunately that is the way things work. It's all about the money, FDA approval is not an issue for these procedure and that is documented. 

Get well I am also trying. 

Dr. Jack Lapides is not my urologist, never met him. He did in 1995. He is what you might term the father of modern day self cathing. You can google his name, an interesting and brilliant guy, a pioneer.

I value everyone's privacy here, so without giving details, I am fairly certain he is who he is. And really not sure why you doubt his identity, because even without verification, everything he states is pretty standard for board certified urologists. Rather than make these ad hominem claims against him, I think it best to either contact him yourself through PM or the site administrator with your concerns. Maybe they can vette him to your satisfaction.

Jim

I have PMed him to no avail and I have ask him on the site. Though you find his comments appropriate, I believe any of the positions I mention in my explanation of concern,  would be completely familiar  with the medical vernacular he always used. Vetting him is no longer a concert. If this site chooses to allow him to present himself as an unverified doctor that is their choice. I am not that concerned. You in fact are the person who chose to use him as your point of athority on the issues of approved "experimental medical procedure". If you have vetted him and he has honestly disclosed to your satisfaction who he is and that he is actually a Urologist that is a good thing, but he refused the others of us who did ask. Not an issue here, if you are happy, I am happy. We simply disagree on the one small aspect of agreeing on FDA versus insurance approval on FLA. 

ENTRANCE EXAM FOR MEDICAL SCHOOL, WHEN STUDENTS TOOK THE ENTRANCE

EXAM FOR MEDICAL SCHOOL.  THEY WERE  PERPLEXED BY THIS QUESTION:

"REARRANGE THE LETTERS P-N-E-S-I TO SPELL OUT THE PART OF THE HUMAN

BODY THAT IS MOST USEFUL WHEN ERECT."

THOSE WHO SPELLED SPINE BECAME

DOCTORS...THE REST ARE IN CONGRESS.

I have read better to pick up the catheter off the rest room floor than skip a cath. Personally, I'd skip and head home for a new one! I was only familiar with Lapides' involvment with CIC, but I will look him up now. He sounds even more interesting and learned than I thought. So, here's the question. Is Lapides as respected through the entire urological profession as you seem to regard him? If so, how come CIC is given short change by the average uro much of the time?

Jim

Jim

The FDA blocked the 'approval'  of 81mg Aspirin for Heart health for decades.

It is just another government agency. The "approval" is noteworthy. Yet, medical doctors don't automatically accept FDA Approved (fill in the blank). That is why we each find our own doctor.

Regaring studies on TURP and Retrograde Ejaculation; many studies stressed the safety and healh aspects and don't consider retrograde ejaculation outcomes part of the health results.

I am not judging, just makeing an observation.

Rx  Don't know how much you read the article but doctors do not consider a man ejaculation a sexual function.  They feel when we grow older we are not having kids so we do not need it.  Some men that have prostate procedure or are on med end up with retro and there orgasm does not change.  But the other half.  there orgasms are not worth the time.  Your orgasm after a procedure the feel can go down to a 1/3 of what it was before.  I was on Flomax and Rabaflo before I had my Urolift done 3 years ago.  The built up was there but when the orgasm hit  I felt nothing.  It was like I did not do anything.  I can't explain it but it left me on finished and empty.  We need a change  Take care  Ken