I have a 76cc prostate by 3T MRI. An ultrasound shows an enlarged median lobe pressing into bladder. I have been suffering from chronic prostatis for 25 years which is my main complaint. I have typical bph symptoms also but never so bad as to cause full retention. I have been on antibiotics on and off the whole time which has completely screwed up my stomach. In the end the antibiotics only take the edge off the pain a little bit but don't really help much. I have taken the full gamet of supplements, etc. I just recent consulted an IR doc at Yale about PAE. Between him and the resident they spent 2 hours with me. The most impressive Dr visit I ever had in my life. In the end he said his patients have an average of 170cc size prostate and the procedure works best for larger prostates. He had a patient with a prostate similar in size to mine with concomitant chronic prostatitis whose prostatitis symptoms did not improve much with the procedure. He wasn't too sure that it would help me. He said PAE does not shrink the prostate much and kills cells mostly in the center of the prostate around the urethra which seems to be key to allowing people with retention to pee. I also just recently consulted with Dr. Christopher DiBlasio of Bethpage, NY. He has been doing HOLEP for 9 years. He said that he has had a handful of patients with prostatitis that he treated with HOLEP. He claims that the prostatitis patients had a large buildup of calcifications in and around the ejaculatory ducts that was visible as he was doing the procedure. He aggressively removed the calcifications and the surrounding tissue around the ejaculatory ducts which inevitably caused retrograde ejaculation. He claimed that the procedure effectively cured the prostatitis in these patients. He believes this buildup around the ejaculatory ducts is also responsible for the extreme pain post ejaculation in prostatitis patients. He's the first urologist that I have encountered that claims to have actually helped people with prostatitis using some procedure. He also claims that Greenlight and Turp will probably make the prostatitis worse based on his experience with these procedures. He no longer does Greenlight. He also felt that Rezum and Urolift will probably not help or make things worse. He has also been doing Aquablation for about a year and he seemed really positive on that for BPH because retrograde ejaculation is much less likely than with HOLEP. However, he is not sure it would be helpful for prostatitis because he feels it essential to remove the ejaculatory ducts for it help prostatitis. For many years I would always pee blood when I had a major flareup in symptoms. Since I started a low oxalate diet about 4 years ago I have not peed blood when getting a flareup. In addition, the burning pain has improved a little bit. He found this interesting given his finding of high calcification in prostatitis patients. For those who might not know calcifications are frequently caused by formation of Calcium Oxalate crystals. He told me to try Finastride and Methenamine for about 3 months to see if they help before going for HOLEP. He said I could do Finastride every other day to avoid the side effects. My guess is that they either won't help at all or only a little bit just like everything else I tried. At that point I will probably have him do the HOLEP procedure. He claims there is a minimal chance of impotence or incontinence from the procedure. I live in CT and he is out of network for my insurance Connecticare so I would have to pay out of pocket. I turn 65 in January when I will go on medicare (original medicare not medicare advantage). If I do the procedure I will do it then to have it covered. I just learned that it is important to get original medicare and not medicare advantage because original medicare is not limited to a network like medicare advantage. In addition, medicare advantage plans do not cover procedures such as PAE while original medicare will. Also many Drs will take original medicare but not medicare advantage.
Thanks for sharing. Why do you need to take Finasteride before hoLEp ? Also, will the doctor take original Medicare ? What tests do you need to have before hoLEp ? Thanks.
I had PAE in 2017 and it was completely covered by my Medicare Advantage plan from Kaiser. Only had a copay of $250, standard for any procedure where imaging is involved such as MRI or CT scan.
HI Dantec,
welcome to the board. I have heard many men on this site (myself included) with large median lobes who did not get long term relief from PAE.
I had a FLA from Dr. Karamanian in Houston 9 weeks ago with excellent results so far. He did my initial consult for free. Others have reported good results from FLA as well.
Both are relatively newer treatments and we are still learning. Don't have anything to share about prostatitis.
Would suggest you learn more about FLA and consider as a possible treatment. Dr K Would probably read your 3T mri for free.
Good luck whatever you choose. Please let us know how things work out for you.
Joe
HI Dantec,
welcome to the board. I have heard many men on this site (myself included) with large median lobes who did not get long term relief from PAE.
I had a FLA from Dr. Karamanian in Houston 9 weeks ago with excellent results so far. He did my initial consult for free. Others have reported good results from FLA as well.
Both are relatively newer treatments and we are still learning. Don't have anything to share about prostatitis.
Would suggest you learn more about FLA and consider as a possible treatment. Dr K Would probably read your 3T mri for free.
Good luck whatever you choose. Please let us know how things work out for you.
Joe
I talked to my urologist about radical prostatectomy - remove the whole thing; there's an article on Prostate Clinic website recounting the happy outcome for one sufferer. But the urologist wasn't enthusiastic - said that potentially this op could make my condition worse. I don't know where I go from here - every antibiotic I've ever taken I've reacted very badly to - they're poison to my system
I have also talked to a urologist about Radical Prostatectomy, David Samadi, who is one of the best at it. He claims to have done 7000 robotic radical prostatectomies. However, he did not recommend it for BPH or chronic prostatitis. In fact, you might have a hard time finding a competent surgeon willing to do this for something other than cancer. If you do insurance probably won't cover it.
I'm probably going to do HOLEP in January timeframe and I could let you know how that turns out. It is a much less radical and less invasive procedure than a radical prostatectomy. Also, I would consider a simple prostatectomy before a radical one for chronic prostatectomy because again it is less invasive with less potential for side effects. Simple prostatectomy, however, is more invasive than HOLEP which removes about as much of the prostate as a simple prostatectomy.
Thanks for your reply. I have been reading about FLA but Dr. DiBlasio's experience with finding calcifications around the ejaculatory ducts in prostatitis patients and his theory that that could be a source of the pain and inflamation makes a lot of sense to me. I'm not sure that FLA would be able to target those areas as precisely as HOLEP. My understanding is that the appeal of FLA is that it reduces chances of unwanted side effects like RE because it stays away from the most sensitive areas such as the ejaculatory ducts. Of course the other downside is the out of pocket cost which I would be happy to pay if I knew for sure that it would solve my problem.
The Dr. simply wants to be conservative and be sure that all other options have been explored before resorting to surgery of any kind. He says that finasteride has been helpful for some of his patients. Of course, I'm not happy about the idea of retrograde ejaculation which is pretty much guaranteed for this procedure when done to primarily address chronic prostatitis especially if he finds calcifications around the ejaculatory ducts. However, given how debilitating the chronic prostatitis has been for so long, I'm willing to take a chance and make that trade off at this point. The Dr. will take original medicare. To be honest I don't know if he will also take medicare advantage but I do know that a number of other Drs. I have consulted with said they will not take a medicare advantage plan. He said that he would have to do a cystoscopy and a urodynamic study before doing the HOLEP. Possibly also an ultrasound but it may not be necessary in my case because I have a recent 3T MRI. If you only have BPH and not prostatitis you might talk to him about aquablation which he claims is much less likely to cause retrograde ejaculation.
Could you please PM me Dr. Christopher DiBlasio contact information. I am only interested in hoLEp. No bandages and crapshoot for me. Thanks.😀
You just need to google his name
It can be very difficult sometimes that way.
Very good reviews. I did find him as you suggested. Thanks. 😀
I'm several thousand miles away from you and just input his name and the first three results were his direct personal contact details.
You're right. In America the insurance giants are scared to death that they and their millions of dollars in profits are going to get bipassed by older Americans who opt in to medicare. So they've come up with medicare advantage plans which is actually private insurance that uses your medicare elligibility to get reembursed. Some of these plans may have some benefits that regular medicare doesn't have but you're still at the mercy of some insurance executive who's main interest is increase profits for share-holders.
Profitability of health insurance companies is 4-5.25%, lowest of all insurance sector companies. Public companies have a mandate to attempt to make a profit for their shareholders - no profit, no investors, no company, no jobs. Tech companies, like Apple, are much more profitable. Apple's gross profit margin is about 38%. I have a Medicare Advantage plan and it covers the 20% that Medicare doesn't pay. Costs me $44 per month plus copays.
Hi, Dantec,
Thanks for mentioning the low oxalate diet! You caused me to do some research, as I have a kidney stone. It surprised me to see how many high oxalate foods I've been eating. Two urologists that I've seen since a CAT scan revealed the stone did not suggest this diet. They only recommended drinking more water. Will be making some changes to my diet.
Stebrunner
If "profitability" ; whatever that is; is only 4 - 5.25%, then why did the Affordable Care Act in the U.S. (Obamacare) have to make a point of limiting the amount of profit (monies not spent on patient care) to 20%? Before the ACA some companies in the U.S. were making 20-35% profit.
Another point: Health care is not a widget to be made profitable for the manufacturer. There are just SOME things that shouldn't be privatized and made into a for-profit model. Medicare Advantage plans are nothing more than the industry's attempt to undermine one of the most successful and popular social programs in America.
Finasteride has done wonders for me. Thought for sure I would be having HOLEP in 2016 but after 6 months on finasteride my urinary symptoms improved. I don't think I have prostatitis though.
No side effects from Finasteride after all that time ?