what question to ask uro to see if FLA, PAE or other would be right?

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I have really low flow that starts and stops and has got much worse over the last few year. i have had prostatitis for a long time and was told last year at this time that my prostate had grown but i do not know the now large.

i have an appointment for jan 2 with  the uro to talk meds and /or procedures. i do not want turps side effect , so FLA and PAE, sound like more reasonable choices.

i see that certain factors make you better candidates for certain procedures. can someone list for me all the tests i should know about and what to ask for to see if im a better candidate for one over the other.

thank you

 

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  • Posted

    First you need to find out what the problem is.  Is it your prostate your bladder or kidneys.  They you can look at the procedure.  If you are worry about sexual function and retro ejaculation then you look at them.  Just don't let your doctor talk you into something you don't want.  If it is just a prostate problem you may just need a Urolift which will open you up and relax the bladder.  That is what was my problem   No sexual function problem and no retro.  Just do you research on the med's and the procedures.  There are side effect with all of them  Good Luck Ken 

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  • Posted

    I would get an MRI with contrast, and something I did not get is a urodynamic test. Also get a cystoscopy to see if you have an enlarged median lobe. I didn't so that's why I opted for the PAE's which I think aren't as effective if the median lobe is present. Ask your urologist or talk to the doc's that your thinking of using for the procedures you mentioned. For PAE, the best is Dr. Ari Issacson at UNC.  don't know about FLA-seems like everyone likes Dr. K.

    I'm the unlucky 10% that the PAE's did not work for to well. but there is a lot of success with it and its really a simply non-invasive way to potentially cure you.they also have a really reasonable cost and you can pay it over time. I'ts hospital based so if there is any complication you are essentially right next to urology. i think that's a big plus also. Good Luck!

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  • Posted

    Most urologists will be unaware of these two options as there are not a lot of centers that perform these (you may also wish to check with your insurance to see if you have any coverage for these options; most plans will not cover.)

    I would recommend cystoscopy, prostate sizing with an ultrasound, and urodynamics (or at least a uroflow) to determine bladder functionality. You should be able to get written reports of these, to take to whichever center you would like to determine if you would wish to go through with it.

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  • Posted

    Very good ! PAE and FLA happen to be the best 2 choices and you picked both of them. TURP is probably the worst. FLA can be costly. Try to find out your prostate size. If it is too small, procedures may not help, especially PAE. You may have to go another route, maybe Urolift. Also, make sure your symptoms are not caused by bladder, constipation, flatulence, IBS, IC, or prostatitis. Hank 
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    • Posted

      Before you get yourself cut up, try some meds first. Some people hate their side effects. Some are not bothered at all. You owe it to yourself to at least try. Hank

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  • Posted

    I agree with others here who recommend PAE, FLA, or Urolift. Choose the one which will work best for you after you have had the testing recommended by others above. Bear in mind that the PAE , and the FLA are not done by urologists. As a result, they have NO opportunity to make money on them, so very few of them would consider recommending them. Those procedures are done by another medical specialist called an interventional radiologist. Dr. Issacson at UNC, and Dr. Bagla at Vascular Institute of Virginia, do the most of them in the country, and are well qualified. Dr. K in Houston does the most FLAs in the country, and received many great reports on this site. Send your test results to them, and they will call you on the phone and discuss the procedures with you in as much detail as you wish, at no cost. Also, there is a wealth of information about those procedures and doctors on this site. Take the time to read that information. Also, if you feel that your problems are urgent, and it may become impossible for you to urinate, contact JimJames on this site to learn how to painlessly self catheterize. That will give you the time you need to make a reasoned decision. DO NOT LET YOUR UROLOGIST TALK YOU INTO ANYTHING UNTIL YOU HAVE RESEARCHED THE PROCEDURES THEY ARE RECOMMENDING ALONG WITH THOSE RECOMMENDED ABOVE. HAVING THE WRONG PROCEDURE CAN MAKE YOU INCONTINENT, AND OR IMPOTENT FOR THE REST OF YOUR LIFE. Take the time to make a good decision you will be satisfied with, based upon your own research.

    Neal

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    • Posted

      make sure that unless you are very wealthy, that your insurance will cover your treatment.

      Other procedures to consider include the Rezum procedure and Aquablation. Part of it has to do with how severe your symptoms are; for instance, if you are in urinary retention, some of the minimally invasive procedures likely won’t help you.

      It is always wise to get multiple professional opinions before having any procedure done.

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    • Posted

      sorry for delay in responding as have been away without internet for the holidays.

      thank you all for your responses.

      when i first had prostititus a few years back, the uro(same one im seeing tuesday) did a cyctoscopy and another test which i think was uroflow. at that time, i was more concerned about prostatitus pain than retention, which wasnt bad. i do not have the results from back then nor do i know the prostate size or if the median lobe is large. last  january year he said my prostate had grown alot and was talking turp but i said hold off since the flow was still fine. it seems in the last 2 months flow has slowed substanially. I can still pee but what used to take 2 minutes now takes 10m or more.

      I was going to discuss trying meds but wont the meds effect my results of any tests( uroflow, mri , other?) if i start talking them before i get the tests.

      so beisde the tests, (mri, urodynamics, ultrasound), i need to ask about median lobe size, the prostate size.

      i will ask procedures - fla, pae,rezum, aquablation,

      am i missing anything?

      thanks to all.

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    • Posted

      What do you mean by 10m (10 minutes ? ) to pee ? It is a long time. You need something , to protect your bladder and kidneys, soon. Hank
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    • Posted

      for example,up until 6 months ago i used to be able to wake up, have a slow but steady pee that took about 2 minutes to feel good. now, the pee will go about 20 seconds, ill stop and start again in a little while. probably get the same amount out but its a 10 minute process.
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    • Posted

      When you see your uro, and after all the testing that he allows, don't go home empty handed. Ask for something to relieve your symptoms, until you figure what needs to be done long term. I can think of meds or CIC. You can get plenty of help from this forum, either way.

      Just curious, how much do you usually produce in that 10m pee session ? If you don't know, it's about time for you to start measuring them. They can tell a lot. Hank

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    • Posted

      hank,

      i have no clue how much comes out. i guess i need to by a pyrex measuring cup and start keeping track.

      since the test will probably take time to set up, is it ok to start taking meds(if he gives them)  right away or wait until tests are done as to not change my test result or void amounts.

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    • Posted

      It's best to do the tests without meds since you have not been taking any. Most likely he will give you a script to get it later. Ask for a retention test, you probably have retention, just a matter of how much. It's usually done with an ultrasound scan, but some uro will suggest a catheter. 

      Unless it's awfully inconvenient, I would start measuring and keep a time and volume record of all voids for a few days. Experienced people can see a lot of your bladder health from this. Hank

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