You are right about Speedicath having problem navigating around the bend. It was exactly what happened to me, for 3 years, lots of bleeding. I was having problems getting a 12fr through. Now I have no problems getting a Cure 16fr. Haven’t tried 18fr yet.
Howard, I think it was Lester that posted that jimjames retention returned so he went for PAE, which unfortunately failed. Before that, Kenneth posted that Jim had other health issues.
Thanks hank. I sure wish that jimjames would post again sometimes - we all miss him!!
Hi Ramblin,
Sorry to hear of you troubles but I can empathize. One week ago I had my 3rd PAE. I’m going to type it another way so that people searching for information will find this post. Third PAE done May 20th 2019. I had a similar experience to you in that after my 1st I saw only a slight improvement. In my second PAE, I got even less of an improvement in symptoms. There was however a slight reduction in blocking the urethra. I know this because of specific testing.
I think that we need to know what is actually causing our symptoms. It’s a bag and a hose. Start with the bag (bladder) Is it getting the correct signals from the brain to cause it to contract and is the valve at the bottom (bladder neck) getting the nerve signal to relax? This can be tested with a urodynamics test. It shows the presence of these signals and the bladder pressure. If that part of the system is working, ie: the bladder is contracting and the bladder neck is relaxing and opening up to release urine, then we move on to the hose (urethra, prostate and the last sphincter muscle ). To know if the prostate is actually out of the way you need a cystoscopy, literally running a catheter with a tv camera up the urethra through the 1st sphincter muscle past the prostate through the bladder neck and finally popping up into the bladder. If the whole path is clear and the brain signals through the nerves is there, then there is a problem with the sphincter muscle or the bladder neck “function” when we’re trying to pee.
The valves may not actually be opening or opening all the way.In my situation, the first PAE resulted in almost no improvement and I had to keep taking Flomax. Disappointed, I had the urodynamics and the cystosopy and it showed that the signals were there, but two things were wrong: First, the camera made it all the way to the part of the urethra where the prostate was and you could see the channel squeezed off. Next the camera pushed through the prostate and the bladder neck into the bladder. Once in the bladder they turned the camera around and we could see that the bladder neck was being pushed upward from below. It looked like a volcano instead of a downward leading funnel. We can’t be sure, but think that it was the prostate pushing it up from below. This is not the normal position for the bladder neck so it’s possible that its proper functioning is impaired by this pushing up. My urologist say that they just don’t know. (hate being one of those “we don’t really know cases”). So two years later I had a second PAE and then tested again. This time the prostate was mostly out of the way so there was a reduction of prostate tissue. When inside the bladder, the volcano shape of the bladder neck was noticeably lower but still not a funnel pointing down. I still had to take the maximum dose of Flomax to pee. I then went on Finasteride to see if that would help, but it made no difference.
So now, three years later I decided to give it one more whack with a PAE. This one went through the wrist like yours, took about two hours and I was also awake and needed to get re-anestitized twice so I could lay there comfortably. I had no catheter either.Today I am 8 days out from the procedure. I have had pain during urination that diminishes slightly each day. Still getting up three times a night to pee, but there may be inflammation present so the jury is still out. We all know the results can take months anyway.
All this to say that you won’t be the first to go for a three-peat on a PAE and arteries can be hard to find. I suggest that you get tested for the signals and see what’s actually going on with the camera if you haven’t already. Wish me luck and I certainly wish you the best.
Very good explanation. I’m curious why you would keep choosing a procedure that doesn’t seem to work for you? I had Rezum and it worked, but if it had failed, I wouldn’t do it again.
To Arlington, I think the Doc who asked for consent for $1000 in the middle of the procedure was way out of line! Nearing malpractice! Where did you have yours done?
I feel so lucky, I am only 5 weeks post PAE and I am experiencing incredible improvements in ALL symptoms of BPH. Knock on wood , I hope it lasts. I wonder if the percentages add up as far as success rate. There are so many poor results reported on this forum ( for all procedures ). And probably those with good results never report to us, and those with poor results are back on here reporting and searching for answers.
This is a difficult road to travel and I wish for the best to all of my BPH brothers!
Bruce,
"the bladder neck was being pushed upward from below. It looked like a volcano instead of a downward leading funnel. We can’t be sure, but think that it was the prostate pushing it up from below. "
You are describing the effect of an enlarged median lobe pushing up on the bladder. I have the same thing and it could be seen with the cystoscope camera, the same way. PAE has not work well for enlarged median lobe, it failed for me, and many others on this site. Some doctors like Bagla and Issacson say they have a new procedure to target the median lobe arteries, but I have not seen data about how well they are doing.
Thomas
@bruce19007: "Once in the bladder they turned the camera around and we could see that the bladder neck was being pushed upward from below. It looked like a volcano instead of a downward leading funnel. "
.
That is what an enlarged median lobe looks like. The urologist that did my Rezum called it actually “volcanoing”. When you write “My urologist say that they just don’t know.”, instead, I would be looking for another urologist. This is pretty basic stuff.
.
The thing about a median lobe obstruction is that it is more effective at blocking the urethra than a lateral lobe obstruction because it “bends” the urethra, kind of like kinking a garden hose. Flomax and finasteride did not work for me either. Rezum did work.
.
Steve
Steve,
Do you still take flomax or similar and do you have “side effects” after the successful Rezum ?
Regards,
Michael
…and best of luck to you, Bobcats! That’s great that it worked for you.
A reasonable question. It did reduce the volcano size on PAE 2 so I chose to go for 3 instead of any trans urethral procedure.
Hank,
What model of Cure catheter do you use, Is it hydrophilic, coude, ? What material is it made from ?
Thomas
I use them all. M14, M14C, HM14, HM14C. My favorite is HM14, hydrophilic straight, but I use M14 more often because it’s cheaper. I think they are PVC. Whatever, they are what they claimed, the most comfortable catheters.
I had my second PAE, inquiring of the rate of success. I was advised it would be fine and performing a 2nd PAE would be fine. My first PAE shrunk my prostate 40% and within 2 weeks the differences were notable and POSITIVE.
My second PAE, from a different doctor, was 100% UNSUCCESSFUL. He said he had never had this result. I directly inquired about his “statistical ratios” of success on 2nd PAE procedures, and specifically how many 2nd PAE’s had he done. If a doctors face can turn white, his did. He said he, they had done few 2nd PAE’s. He was stunned he said, ZERO SCHRINKAGE fo My Prostate with the 2nd PAE.
My first PAE was so successful in every way. I had to battle my urologist in 2023 about doing a PAE–Which his quote was “WE DON”T DO THEM”., while he immediately wanted to perform a TURP. NO WAY. The side effects are more often than not, egregious and a foregone collusion. So, I sought about a Vascular surgery for my PAE, In and out, not issues and tremendous success.
Be careful out there gentlemen. Doctors are NOT TO BE TRUSTED 100% AS WE USED TO.
How much radiation did they say that you got during the PAE in MSV’s?
Hi any updates on the turP you had previously?