Which BPH Treatment is best

Posted , 19 users are following.

I'm getting down to the nitty gritty. I have to choose a procedure for my BPH because the symptoms are becoming unbearable. And I know this subject has probably been discussed a million times on this forum but I wasn't involved in those discussions. I have a 75 - 80 cc prostate with median lobe enlargment so I'm not a candidate for Urolift. I have also heard very mixed reviews on Rezum. My first choice would be FLA (focal laser ablation) but it is very expensive and still trying to determine if it is covered by my insurance; likely not. Second would probably be PAE. Does anyone know about medicare or private insurance coverage on this? I'm thinking it is not covered. This is not to say I will not bite the bullet in the end have FLA or PAE done, but If I don't I would like to determine the best alternative if possible. I would appreciate all opinions and would really like to hear from those who have had the various procedures i.e button turp, holep, turp, pae, etc. A big order! Hope to hear from you all.

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  • Posted

    I had a similar situation. 68g prostate, enlarged median lobe, considered all the options, and chose Rezum. Medicare and my supplemental insurance paid for everything.

    To improve your experience with Rezum, here are recommendations:

    1. choose an experienced urologist
    2. learn to self-cath. This makes the recovery period a lot easier.
    3. ask for general twilight anesthesia. Or ask the urologist to work with the anesthesiologist to make sure that the local is working before he proceeds.

      Rezum should be an excellent choice. Make sure that the urologist uses some imaging of the anatomy in the area too.

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  • Posted

    In the alphabet soup of BPH procedures the longest lasting and urologists favorite is TURP. However it is the least wanted among patients because it is radical surgery, bloody and long recovery. The newer procedures offer promise but have not stood the test of time and many have to be repeated or another procedure tried. Many patients like yourself have given up and go through life using CIC catheters which is an inconvenient crutch hopefully waiting until something better comes along. Often a failed procedure will suddenly reverse itself and spring your system back into action. I had such a situation with green light laser which few people even mention any more and I would not recommend it. Good luck.

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    • Posted

      HolEp alone has stood the test of time against TURP. It also has been around for a long time, with much less bloody, shorter hospital stay, and longer durability.

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  • Posted

    Are you very concerned with RE ? If yes, first choice would be Urolift, then PAE, then Rezum, FLA. If no, then it would be HolEp, then bipolar TURP, then GLEP, then FLA, Rezum, PAE.

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  • Posted

    My insurance covers PAE.

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    • Posted

      So far I'm trending toward the new median lobe Urololift but now I see PAE is covered by insurance. If it turns out I'm not a candidate for Urolift then PAE may be next on my list. I don't think we are allowed put doctor names on the board so if anyone knows of doctors who are good at PAE would you private message me. I am willing to travel. Thank you

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  • Posted

    Hello Gary:

    I am 61 yrs old and sharing from the dark side of invasive options. I had a Simple Robotic Prostatectomy performed back in August and could not be happier. My sudden and acute full retention hit me this year. My prostate was MRI measured at 265g.

    I now pee like I was a young man and take no other medications. Erections are good, as well as orgasms. Do not ejaculate much, but never did before with my enormous prostate.

    If I get up at all during the night, it is once and it is never with urgency. Most times I sleep straight through. Plus, no incontinence problems.

    Again, I am the exception to the rule to most on this forum.

    Dave

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  • Posted

    I had PAE, mostly covered by insurance. For me, it did not work, but I blame the failure on a poorly skilled and inexperienced Interventional Radiologist. I recommend that as your first choice, and there is mixed reporting on the effect of a median lobe (also for urolift). Research the IR carefully, and don't use anyone who hasn't been doing them for at least 5 years.

    In my case, my follow up was a urolift. I'm about 7 weeks out, and can report some improvement, but it is still early. In my case, with 5 clips, I have had a lot of pain, which started to diminish at 5 weeks. The positive news is that I had been self cathing about 3 times per day, and since the urolift, have not needed to cath. My flow is a little better, but I still have problems with frequency and urgency.

    Bottom line, start with the least invasive and work your way up. Don't do TURP, period.

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  • Posted

    Gary,

    How old are you and where do you live ? Have you tried alpha blockers like Flomax or Afluzosin ? Daily Cialis works for some people. I had a PAE in 2013 at OHSU in Portland Oregon, which my Blue Cross insurance payed for at that time. Sometimes the doctors can use insurance codes that the insurance companies will pay for while some other codes they will not. The PAE did not help me, although it shrunk my prostate by 20%. My PSA dropped from 2.4 to 1.75. I had an enlarged median lobe which may have been the reason for the failure. Within the last few years some doctors have started a new PAE procedure that blocks median lobe arteries. If you do a PAE make sure the doctor has done the median lobe procedure. I know Dr Bagla in Woodbridge Virginia has done it because I asked him by email.

    If you don't care about RE (Retrograde ejaculation or dry orgasm) you can do some of the laser procedures like Holep. If you want to preserve your ejaculation, the least invasive procedures are Drugs, PAE, Urolift, Rezume, FLA in that order, in my opinion.

    Good Luck,

    Thomas

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  • Posted

    We all faced the same questions and we made different decisions based upon our bodies, our doctors and our financial resources.

    I did not like the potential downside risks of the traditional remedies so I chose to join a clinical trial for iTind whih is a very gentle form of TUIP. I was assigned to a top urologist in NYC, USA. He said I could join the iTind clinical trial or a water ablation trial but that he felt iTind was better for a prostate my size. Water ablation was better for larger prostates. Google them and look for a urologist who uses them then ask if they think it would work for you.

    Almost no downside risks with iTind. Works in 85% of patients. If it did not work I could always choose a more aggressive procedure. Thankfully it worked great for me. No pain, just discomfort for 6 days then blessed relief. I could finally sleep. No urgency. No ED. No RE, No incontinence. No more urgency. Great flow. etc. And the procedure can be repeated in the future should my prostate grow and close the incisions. BTW, clinical trials are free to the test subjects.

    But what worked for me might no be for you. Get second opinions from other urologists from another hospital. Might pay to travel to another city to find one if you live in a small community. Each urologist has a preferred procedure that he becomes an expert in using. Just like a musician who plays a violin might not be a good trombone player. Does not mean that trombones can't make music. Same with these procedures.

    Best of luck.

    BobbyT

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    • Posted

      Bobby, when did you have iTind done ? Are you sure you had iTind, not a sham arm ? I hope it will be approved soon.

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    • Posted

      Hank1953

      November 29 2016.

      Removed December 5.

      Pretty sure. I had a retrieval suture hanging out of me for 6 days and felt it in my prostate.

      Results are not imagined.

      Bathroom visits at night went from 20-25 cc's every 30 minutes to 150 - 200 cc's every 5-7 hours. No urgency in between bathroom visits. No nervous bladder feeling after voiding. The difference was stark and immediate once it was removed.

      At the time it had been in use for 5 years in other countries and they told me that no man has had to have it repeated yet. They expect results to last at least 10 years but if not the procedure could be repeated. It was so easy compared to the horror stories I hear about TURP et al, that I would gladly have it repeated if needed. It should also be a lot cheaper when approved by the FDA as it could be done in the doctor's office with light sedation like a colonoscopy. Just need somebody to drive you home.

      BobbyT

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    • Posted

      Thanks for sharing Bobby. If it is still effective after 2 years then it must have been the real thing. Maybe I should hold off HolEp and wait for its approval.

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    • Posted

      Hank1953

      I think the process is to find a urologist who has a lot of experience in a particular procedure and then ask his opinion if you are a good candidate for that specific procedure. Each urologist will have a bias to the particular process they use most. So the question is what type of patient (size of prostate, shape of prostate, family history, exact symptoms, age, comorbidity of other health issues like hyper tension, diabetes, obesity, atherosclerosis, etc. If they say you are the perfect patient for their specialty then consider it. If they say you are a marginal patient, keep looking.

      Best,

      Bob T.

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    • Posted

      Sounds intriguing, very little information on this site about the procedure. How would you go about trying to find urologist in your area who does the procedure? If not approved yet, how far along are they in the process to be FDA approved? Could you expand on these questions please? Thanks.

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    • Posted

      I was very interested in iTind until I found out that (at least right now) it's not indicated for guys like me who had an enlarged median lobe.

      However, if my prostate eventually grows back after my Rezum procedure, maybe someday it will be an option. Not worried about that now though.😊

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    • Posted

      Thanks Bob. I've had bad experience with uros. One of them offered TURP, the other Urolift, without any tests whatsoever. Now that I have Medicare, I am on a mission to find out more about my prostate. The good thing is after 3 years on this forum and with additional online research, I very much know what will work, and what will not, for me. iTind probably will not solve my problem but since the procedure is so minor, I would give it a shot. It would be good if I can get 1 or 2 years of relief.

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    • Posted

      I was looking for the way to locate uro that does iTind in USA. Is there any test trial going on at the moment ? Where do I find contact/info ? The only info that I got after googling was the main office in Israel.

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    • Posted

      Get in touch with them in Israel. They can tell you if they have been approved by the USA FDA or not and if there are any ongoing studies in USA. At very least they can direct you to top urologists in USA with iTind experience who can evaluate you and let you know if you are a good candidate for the procedure. If not they can recommend the best procedure for you.

      Also can direct you to urologists in other countries where the procedure can be done.

      Best,

      BobbyT

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