Had a PAE last year. Due to median lobe issue it didn't help much with my nocturia and frequency/urgency issues during the day. One option is TURP - plasma button or other. For those of you who have had this procedure did it cure/help the nocturia/frequency/urgency issues that are so common with BPH?. I have to get up to go to the bathroom at least 5-6 times per night. I haven't had a good night's sleep in years.
Good morning Tom. Sorry that the PAE did not help you Why are you looking at the turp. My doctor called it the last resort procedure. Why not look into Urolift. They are working on clipping the median lobe to the one side. Or the Rezum procedure, Depends on how big they can do a few injection on both side and a couple in the median lobe. Both have less side effects. I do wish you luck. Look at everything before you pick. Make sure you can deal with any of the side effect before you have anything done. Have a good day Ken
Yes it did cure for me the same problems. Before the procedure i had to go 5-6 or more time per night and every 1 hr during the day. I’m 6 month post PAE and have no nocturia and can wait up 3-5 hours during the day. No strong urgency. I don’t think your problem is median lobe, probably your PAE was performed not correctly. Have you seen any improvements 30 days after PAE? Have you experienced strong pains after the procedure? If not, your procedure was not successful. First 30 days wer very challenging with pain and urgency but totally debilitating. According to some sources the stronger the pain in first days after PAE and higher PSA in a week after, the better results afterward. What is your prostate size? If it’s too big or too small, PAE won’t work well. PeRfected PAE takes care of the median lobe. Find another radiologist
Hi Tom
I had a TURP about three years ago which was very successful - now have a normal stream and only have to get up once a night at the most. I have retrograde ejaculation but at my age (73) it is not a problem. Only one night in hospital and my PSA went from 4.4 to 0.5 and has stayed down since the operation - so I am very happy with the outcome. See a good uro - all the best.
Tom,
Many old school urologists will suggest a TURP because that’s what they’re familiar with. But with TURP, you’re almost guaranteed to have retrograde ejaculation and the chance of other complications such as ED and/or incontinence. Rezum is a new procedure that works very well on enlarged median lobes.
my real life experience is this: 3 weeks and 1 day post Rezum and still not even back to baseline. worse then before procedure. still waiting fur improvement. very frustrated.
Gene,
I’m a little confused by what you wrote: “First 30 days were very challenging with pain and urgency but totally debilitating.”
Did you mean to say “not totally debilitating”?
Would you know if Perfected PAE is done by Bagla, Bhatia or Isaacson?
Why are strong pains and PSA spike indications for success? Is that something you came across in a study, or based on anecdotal evidence from guys on this forum?
Thanks,
Michael
Tom,
I’m sorry to hear your PAE hasn’t worked. After 12 months, PAE results are pretty much equal to TURP. TURP has faster results but PAE catches up.
Link here:
Where did you have your PAE done? How many procedures did your doctor perform prior to you?
In going forward, as Ken suggests, look at alternatives to TURP, and weigh the risk/benefit of each procedure.
Wish you future health,
Michael
Tom,
My reply is held up by the mods.
I tried to provide a link. Google PAE vs. TURP and look for an analysis of each over a period of up to 2 years (it compares IPSS, void rate, PVR, etc. post surgery).
It’s informative.
Wish you the best,
Michael
Kenneth,
We have both been on this forum for a long time so I am very familiar with all the procedures. My PAE was easy, but am now 14 months post procedure and it didn’t help me. I am getting up every 1 to 1 1/2 hours per night so I never get a good night’s sleep. I have studied and considered all other options. REZUM is not covered by my insurance and is not offered in my area - also some report pain and complications. Urolift is possible. My uro does a TURP using the most advanced methods. I am aware of the potential side effects, But, I really need to get some sleep. Last night was really tough. I get to sleep, then my bladder wakes me up, and I have to get to the bathroom, then back to sleep, then an hour later, the same thing - all night. I have to get this problem solved. A second PAE is an option - my insurance fully covers it, but I don’t know if this would have the same result as the first PAE.
Thanks for responding,
Tom
Gene,
My PAE was performed 14 months ago - very easy, little pain after. However, it didn’t help me. My IR is top of the line. Fully covered by my insurance. Some on this forum do not get results from PAE due to prostate size and shape. Mine is about 50gm. It isn’t the size, but it is definitely restricting urine flow and I just can’t empty my bladder, so I have to run to the bathroom every hour day and night. Haven’t slept well in years.
Thanks…
Tom
Mark,
Great to hear about your results…
Tom
Ken,
REZUM is not available for me locally or covered by my insurance. Also, many here report complications, pain, etc. The TURP is just an option for me, not suggested by my uro. I am aware of the side effects. But, I already have some incontinence and ED issues do to prior treatment for prostate cancer (radiation). I just want some relief from the constant need to run to the bathroom day and night. I need some sleep!!
Tom
John,
Having read of the post procedure issues with REZUM here I am not thinking of doing this. It isn’t available to me anyway (not locally or covered by my insurance). So, for now, it is not one of my options. Sorry to hear you are still having issues. Hope these issues resolve for you soon!
Thanks,
Tom
Michael,
Yes, have done the comparative research previously. That’s why I went for the PAE last year. Procedure was fully covered by my insurance, went well, little post operative discomfort. However, didn’t do much to help me. Urine flow still restricted, have to run to the bathroom every hour to hour and a half, day and night. Can never fully empty my bladder. PVR shows 170ml still in the bladder after voiding, so it’s always 1/3 full. Yes, TURP does have side effects. PAE little or no side effects and it works for most men, just not for me, unfortunately. When I had it done last year I was really hoping for a positive result. I may go in for a second PAE, but I know a TURP can get results fairly fast. I have this dream that before bed I will be able to empty my bladder, then sleep for at least several hours before having to get out of bed again.
Thanks, Tom
Hey Tom Sorry that you are having a problem. Have you talked with your doctor and ask him why it did not work. What was the size of your procedure before the PAE and what is it after. Did it get smaller at all. And what does he say about a second PAE. Before you have any procedure that cuts away at the prostate. Take the time and think about the Urolift maybe that is all you may need. 2 to 4 weeks healing time. And if it don’t work you can all way have something else. Maybe a laser procedure less bleeding. I know my Urolift is going good. 3 1/2 years and still wide open.Take care Ken
Tom,
It’s hard to give you the right advice without knowing your data. I went trough the same woes but PAE helped me dramatically. I don’t know what will be at 14 month, though. What is the size of your prostate currently? What is your residual volume. I have practically zero after PAE, 300 ml before. Urolift works only for prostates les than 70 g, Make sure that you qualify. I doubt that you have such a moderate size given your symptoms. Most likely you need TURP or RESUM. Cutoff for a successful TURP or green laser is 100 g prostate. AUA recommends below 80g, but many URO will tell you that they can go above that limit. Don’t trust them. Operating on a larger prostate takes longer time and dramatically increases the chances for complications, ethylene glycol poisoning, bleeding and possible blood transfusion. Let alone standard 90 days of inability to hold urges and need of diapers, wic very few URO will tell you in advance. Mine warned me about these possibilities.
Given what you describe, your options are: Another Targeted PerFected PAE or suprapubic open surgery with preservation of all nerves responsible for erection and sphincters , bladder controls. Very few surgeons perform that operation but you can find them. It will take at least a week in the hospital. I’ve seen patients undergo such surgery 40 years ago and not in the firts world country, living after it till mid 80th with good erections and no incontinence whatsoever. Your nocturia might be related to the anomalies of the bladder rather than current BPH, but stemming from a previous severe BPH. You need a more detailed diagnosis at this point. In my view as long as PAE is covered by your insurance ( a rare case in US) go for another PAE, maybe with a different radiologist. Try to find a radiologist with less X-ray exposure equipment. It will be you second PAE and radiation has cumulative damaging effect.
Good luck.
Gene
Ken,
Good advice. Yes, I did speak with my IR about the failed PAE. He believes he can “fix” the problem with a second PAE. That is encouraging. Just wanted to have my frequency/urgency issues solved and the sooner the better. Urolift option is still possible.
You said your Urolift is still “going good”. Does this mean you are able to get some sleep at night?
Tom
Gene,
Excellent advice. My prostate was 56g before, not sure what it is now. PVR 170ml, so my bladder won’t empty, which is likely the reason I am up so frequently at night. I wouldn’t do any procedure that would put me in the hospital for any amount of time. I have responsibilities at home, and the boredom of just lying in a bed staring at the ceiling or watching some TV isn’t anything I would be willing to do unless I had no other choice. My IR is head of the department - thought he was excellent. As you suggested, if my nocturia issues are bladder related then another PAE wouldn’t help much. I did have a cyctoscope earlier this year and my uro found nothing unusual.
Tom
When I do sleep. I’m a night owl I go to sleep at 2 or 3 in the morning. Most of the time I get 5 to 6 hours. It may be worth doing the second PAE and if it does not work you could have the Urolift . Take care and let us know what you decide Ken