Best treatment for middle lobe?

Men's health
1

After consulting several doctors and getting very different opionions and recommendations, I am thinking that I would like to start by getting the least painful, least invasive treatment for my median lobe. 

Any suggestions?

2

Can you share what different opinions you received?

3

Sure Mike;

One urologist assured me that a bladder neck incision is the cure for my nocturia.  Another urologist assured me that TURP is the right answer.  A radiologist said I am perfect for PAE.  And another urologist said that Urolift will be best for me.

And another urologist recommended a bipolar vaporization or 'button' turp.

In 2014 my prostate was 41.21ml 

In 2015 it was 33.95ml.

In 2014 my residual urine was 40.61ml, more than 10% of the initial volume.   

In 2015 it was 40% of the initial volume.

4

Thanks, I don't understand the measurements for sure but looks like your prostate size is just fine, so I assume it's just the Median Lobe issue?

There is a thread here in patient.info, search for "Median Lobe Prostate Bladder Blockage Options?!?" - quite interesting and mentions other treatments including one from Germany.

5

Thanks Mike,  I hadn't seen that thread.  It did give me a couple of good ideas.  

I wish this forum had an editor.

Jeff

6

you're welcome, I can add it seems that from other comments, and my own experience, that PAE is not effective for middle lobe but maybe surgeons are learning how to fix that. I will be discussing that with surgeon mid September. Surgeon told me latest study shows PAE 85% success rate, and those who have it repeated because it was not effective there is 60% success reate

7

Are the 85%, 60% success rates for men with middle lobes?

Have you ever heard of  prostatic urethral lift (PUL)?

 

8

No the surgeon did not specify - just in general those are success rates.

Never heard of PUL - thanks I will look it up

9

Oh yeh PUL is also called "Urolift" ? I actually spoke to a guy who had it done, he said it relieved his symptoms really nicely but his bladder was already damaged so he still had to go often.

The thing that scares me is that if the prostate continues to grow can the implants break lose?

10

My first urologist recommended a bladder neck incision.  It seemed like it was gruesome. 

It might be the same as the p.u.l. I'm not sure.

http://www.issm.info/education-for-all/sexual-health-qa/what-is-a-prostatic-urethral-lift-procedure

11

Best thing you can do is to get a few opinions from doctors. I believed my urologist who told me that I wont even feel the difference after the operation. ""The sex will be excactly the same "I thought I am going to a specialist for specialist advice but believe me my sex life ia a total desaster after the TURP. All that he could do was to prescribe the maximum dosis of Levitra as well as testosterone injections to me . Well it didnt help at all and now the damage is done and he eventialy told me to get myself another urologist. I should have got another one before I went to him and the biggest mistake I made was to believe the man as I thought he is a specialist and that he at least would know better in his position. Of course if you are over 70 It could be ok but in my case I was 50 years old and I had a stunning life and an excelent sex life as well. Now Im a depressed angry person so dont just believe the first urologist. As somebody said  "the TURP is just the gold standard for urologists "not for the patients.  

12

I have moderate median lobe as stated in my prostate MRI report, and consulted both PAE most experienced radiologists: Dr.Bagla said he sees no problem as he can find a separate artery leading to it  and block that way blood supply to it ?, Dr.Pisco also said he can get good results treating middle lobe issue with PAE,

both had my MRI report  for review

13

You're very wise to pursue those criteria for treatment and that was my conclusion too...I'll have a "battery of tests" to determine the "least invasive procedure with the least complications" which I qualify for on next Wednesday, then, I'll pursue that treatment option...Right now, PAE seems my best option...

14

The majority of responders to my question prefer PAE over all other treatment options...Keep following our blog to reach your own conclusion..

15

I totally agree with your "last statement" re: TURP per those patients that have responded to our blog and those I've talkeddirectly to as well..

16

Sounds Good!...Thanks for sharing...

17

Please follow the blog responses...PAE seems to be the "preferred treatment" by a majority of respondents..

18

Get a penile implant and go on with your life. They work great!

Neal

19

The PAE is done by an interventional radiologist, so it will never be recommended by a urologist because they make no money from it.

Neal

20

Dear JJJJ57989,

I had my PAE three weeks ago and already witnessing quite significant improvement in many respects. The full account is detailed the dicussion forum under a title: "my PAE treatment experience on 07 July 2016 by Prof. Martins Pisco in Lisbon, Portugal". I was the 1056th patient. I sincerely recommend you to try PAE treatment. The conventional treatments have disadvantages in one way or the other. PAE is almost risk free. In case PAE fails to work, then you can consider other procedures. This breakthrough treatment is discovered by interventional radiologist, which is already implying conflict of interest with urologists. We hope the two streams of specialist will not end up in unfruitful controversy. In particular, we hope the urologists to understand the excellent results being achieved through the PAE procedure of the interventional radiologist so that it will become a clinically approved procedure for easy access by all sufferers of BPH.

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