Will TURP be outdated and Will Prostate Artery Embolization be the accepted way to treat BPH
Posted , 19 users are following.
I ve had BPH for about two years and now it's getting worse. I'm only on alfuzosin and not anything else.
Alfuzosin effectiveness seems to be declining and I would be a candidate for TURP. However I am hoping and waiting for PAE to be offered in Canada. Hopefully in the next few years. Is this a strategy that anyone else has thought of?
0 likes, 52 replies
kaypeeoh johnny90372
Posted
My understanding is that Embolization blocks the blood supply.Kills tumor cells as well as prostate enlargement.
gene97713 kaypeeoh
Posted
Yes, it's used by some doctors in late stages of inoperable prostate cancers to prolong the life of the patient
dale75649 johnny90372
Posted
I suspect, because of the number of new procedures for BPH, it will take even longer for a newer gold standard to be established.
I wish there were more Dr's interested in the Israeli hypothesis of the retrograde testosterone flow from the testes to the prostrate. (Yigal Gat)
Nothing seems to work for everyone, but some of the newer procedures appear to have better overall outcomes when you include the impacts on sexual health.
gene97713 johnny90372
Posted
It was tried in US but without much success, There were reports about terrible failures and side effects when one US doctors tried it. Maybe the technique was not perfect, maybe Ygal Gat's theory is not entirely valid.... It appears that BPH is a syndrome with a complicated anatomy and growth in different areas of the prostate. Ergo, some have median lobe, some don't. Adenomatous tissue vs different type of pathology, often combination of PC and BPH. Not all BPH are equal, not all are due to high level of dihydrotestosterone. Not all BPH sufferers have varicocele, as Dr. Gut et al claim.
Probably works for some, resembles PAE but much more dangerous if an error was made. Probably won't be ever approved in US. I started learning about their method 5 years ago and wound up with PAE. It costs up to $30K to go to Israel and get operated by. Dr. Gut.
lee56659 johnny90372
Posted
My responses to your 2-part question are: 1) not in our lifetime and 2) PAE is "an" accepted way but will likely never become "the" accepted way to treat BPH. PAE doesn't have the success rate to become "the" accepted way to treat BPH.
There's a reason that the decades old TURP is still the "gold standard." In the vast majority of cases (like mine), it is effective with minimal side-effects. TURP-like procedures such as Greenlight (PVP) and HoLEP are effective also but haven't overtaken the traditional TURP for various reasons. And the traditional TURP has evolved from mono- to bipolar and from a loop electrode to a button (or loop first then button) electrode. Yes, retro ejaculation is a common TURP side-effect but many TURP candidates experience that already due to medication. As one who has it, I can say it's no big deal assuming you don't want to father any more children.
I managed my BPH for several years with medication (doxazosin) but eventually it did not provide the relief I was hoping for. My only regret about the TURP was that I didn't do it sooner.
dale75649 lee56659
Posted
I've heard people say RE is no big deal, but I had RE when I used Rapaflo (Silodosin) and it greatly diminished sexual enjoyment for me. Orgasm was minimally enjoyable. Now I've had a PAE and am off the alpha blockers and enjoying sex most of the time now. So I think that we have differences, and I see TURP as a huge potential risk to my sexual health. I've read too many horrible stories about TURPs that weren't so great for me to think it should still be the gold standard. I'm not sure what will replace it, but I expect something will.
russ_777 dale75649
Posted
TURP itself is just a method of removing excess tissue that serves no good purpose -- by resecting it. Other procedures simply use other techniques of removing adenoma tissue. PAE starves its cells of O2. Rezum causes the cells to necrotize by heat distributed throughout a volume of tissue. Greenlight and plasma button vaporize. UroLift uses mechanical compression.
What makes TURP or any of the above harmful from the RE perspective is which tissue is removed, how much is removed, and what tissue gets "collateral damage" from heat conducted away from the area it was intended to treat. If someone performing TURP doesn't destroy the inner sphincter muscles, the seminal vesicles/ejaculatory ducts and the musculature around the verumontanum then the patient is unlikely to get RE. But all of those parts of the prostate anatomy can be harmed by any procedure with the possible exception of UroLift.
It seems to me that whether a procedure known as TURP causes those kinds of issues is entirely in the hands of the surgeon. My sense is that they are creatures of habit to a fault and their default approach is to maximize urinary efficacy with little or no regard to sexual outcomes. It's not that they can't...it's that they won't and don't unless the patient forces it. And even then most will not stray from their routine...possibly for insurance reasons.
lee56659 dale75649
Posted
One of the problems with internet forums like this one, it that it's mostly people with problems who post and then people extrapolate that "data" to make generalizations which aren't valid. If you look at clinical trial data, there are really no other procedures that are statistically superior to TURP in terms of patient outcomes or complications. If there were, the TURP would lose proponents and other procedures would take over.
There have been many posts on this forum about successful TURP outcomes (including mine) but most of those gentlemen have left the forum because they no longer have anything to share. The only reason I've stuck around is to share my experience with those who haven't made a decision yet. In the end,the individual BPH sufferer makes the decision he feels most comfortable with and should do that based on all the actual data available. On this forum, the only actual data is from someone who has had a particular procedure. Everything else is anecdotal and worth what you paid for it.
tom86211 dale75649
Posted
Dale,
" I've read too many horrible stories about TURPs that weren't so great for me to think it should still be the gold standard."
Most of the TURP reports here have been very positive (mine as well), so if you have read "horrible stories" it wasn't here. Maybe you aren't aware of the newer forms of TURP (bipolar and plasma button), but the older form (monopolar) is being phased out, and the newer forms have much better outcomes.
Tom
Marty02 lee56659
Posted
You make a valid point, however I do suggest people consider Aquablation, a new more precise TURP like procedure that promises comparable outcomes with less sexual side effects, based on controlled studies. I believe it will replace TURP as the "Gold Standard." Ive established a separate discussion about this procedure, hoping to get input from others who have gone through this procedure.
dale75649 johnny90372
Posted
I have read about the newer versions and many positive outcomes. But combined with the statistical data I've been able to find, I'm just not yet willing to take the risk when I had an option with no reported cases of sexual disfunction.
I agree that many urologist's seem more interested in improving flow rates than preservation of sexual function.
And yes, most men who think their problem is solved quit posting online and those who have ongoing issues are more likely to keep posting.
Personally, my issue is solved, for the time being. But I continue to try to learn more as I'm not certain if my problems will return, eventually.
I have not yet met a urologist that I have enough trust in for most of the available procedures.
And I'm not just looking at this forum. I've spoken in person with many men who have had different procedures, and yes, some if these were more than a few years ago.
But I have my personal fears about physically reaching the tissue to be destroyed via my ureatha. I considered the cooled microwave TUMT for a short time, but the data on durability was depressing.
For now, I've gotten off the alpha blockers (that I believe were the culprit behind my worst issues) and I'm comfortable with the flow, retention, and nocturnia levels that I'm currently experiencing.
gene97713 johnny90372
Posted
Pretty much correct description of TURP, except that the surgeon doesn't see much through his endoscope, except some tissue to cut, blood, and and smoke. Prostate capsule can be easily overheated, surgery is pretty much limited to the urethral part of the prostate, amount of tissue removed per minute is limited by heat supply. So, it's more like "burning through", where as PAE shrinks the whole prostate by 30% and removes that extra pressure from the central lobe on the bladder neck and releases this artificial valve created by enlarged central lobe. PerFactEd PAE is a bit more precise and can deliver embolization to very specific arteries. Don't forget, IR before PAE creates a high resolution angiogram of the arteries supplying blood to the prostate and studies it. During the PAE procedure he used subtraction X-ray fluoroscopy with cone scanning technique. He sees a lot on a huge TV screen. PAE works best on huge prostates, in which central lobe is still modest. In fact central lobe shrinks on average by 35%. MRI is a good control imaging tool only when a 3T MRI with high strength magnetic field is used. CAT and standar NRI don't have good resolution for soft tissue. Ultrasound is better but not easy to read and using TRUS is cumbersome.
Anything with robotics, high intensity US and MRI controlled sound very high -tech, but I'm afraid can overheat the capsule. Again, we are back to invasive, slow healing surgeries with using different "knives". Where is knife present, look for a butcher... 😃. I don't like the idea of butchering my prostate, urethra, and bladder neck with all the ducts. Slow drying out of my prostate sound a bit more secure to me. Could be painful but will preserve all teh functions. Butchers can be very skillful, although.
william59988 johnny90372
Posted
I have had two Urolift procedures, each time 6 implants, about a year apart. Unfortunately, very little improvement. I have now consulted with a doctor in Austin, TX about the PAE procedure. From the consultation, he thinks the PAE can improve my symptoms significantly. I asked about the Urolift implants, considering that PAE shrinks the prostate, His answer is that the implants will not be an issue. I am not even sure the implants could be removed if needed. Any thoughts/experiences??
russ_777 william59988
Posted
William, that is a common issue for those of us who've had urolift implants who then need ablative surgery when the tissue has outgrown the implant's ability to restrain it. I also got a similar non-answer when I asked the IR I consulted with last Summer what happens with the implants when the surrounding tissue shrinks away.
NeoTract has a procedure document posted on their website that explains how surgeons should remove the urolift hardware if it comes to that. There's a caveat to it though - there's one piece that can't be removed without at least laproscopic surgery -- cutting a hole in the abdomen. That is what they call the capsular tab which is the part that is shot from inside the urethra out to the capsule that then deploys to serve as the anchor on that end. The procedure calls for the surgeon to cut the nitinol suture that binds the two restraining devices together, and then remove the urethral tab and the "fishing line" that was just cut that it is tied into.
I suspect the reason IRs don't have a good answer for that question is that they are not qualified to do the transurethral procedure, nor would it be possible at that time. The surgeon who does the ablative procedure later on would be the one who deals with it.
DaveCanPee johnny90372
Posted
Hello, Johnny (& Community):
"Accepted way?" Interesting question. Interesting in that it questions the many options BPH sufferers have to control a prostate that grows too large and then causes us problems. The many ways are shrinking it (PAE), squeezing it (Urolift), "Roto-Rootering" it (TURP), or removing it (SRP, HoLEP, etc.). So, I ask the community:
One more variable. What about short-term gains versus long-term gains, and does it matter as long as I get relief today?
Dave