There are many different BPH surgical procedures and I believe most urologists are probably only comfortable with a few of them. To those of you who have had a procedure, and especially if you traveled to another location or changed urologists to get a procedure your urologist could not do, how did you decide which one to get? And how did your local urologist react when you told him you were going to someone else?
Lee were you offered anything by your urologist. What is your problem. Is the problem your prostate or is it your bladder. Then you have to research each procedure. 9 out of the 10 top procedure cause retro. And many other side effects. Retro, dripping and some others. Do you pros and cons. My problem was my prostate so I had a urolift done. That is the only procedure that does not cause retro. You have to do your research because you are the only one that can pick for you. Good luck Ken
Kenneth asked prostate or bladder? I think that's a very important question because it seems to me that many men get procedures done at the recommendation of their MD without knowing what the real problem is. As my urologist told me: if prostate drugs don't help much, it's probably more than a prostate issue. He told me my problem was prostate, bladder, and sleep and that surgery probably wouldn't help much. Too many men get surgery without being aware of what the consequences might be and many of them don't get relief from the procedure (some are worse off). It's your body; you have to do what's best for you and don't worry about offending a doctor.
Like Reg said, don't put the cart (surgery) before the horse (proper diagnosis). Surgery is too often a reflex reaction by urologists. And the surgery they recommend is often the one they do, which may or may not help, or even be the best for you. Have to do your research. If unsure, or if you don't like what's out there today, there's self catherization. Does everything the best surgery can do without the risks and consequences of surgery. Probably not for everyone, but everyone should at least consider it. Bet 9 out of 10 docs don't even mention it as an option.
Jim
Hi Ken,
PAE also does not cause retro.
Rich
I travelled to Virginia to have the PAE procedure done by an interventional radiologist who had performed hundreds of them. Both urologists that I had been seeing at the time were, to put it mildly, very dismissive of the procedure. One of them was all set to do a TURP (the supposed "gold standard". The other urologist didn't have a problem with my choosing PAE, but even after I had it continued to talk only about how the procedure could have very bad outcomes... an opinion not even remotely supported by research.
I selected PAE as it seems to be the least invasive of all the procedures, and I had responded well to Tamsulosin which was an indication that the PAE could be an appropriate choice for me.
Good advice. You have a good doctor. Hank
" .. if prostate drugs don't help me much, it's probably more than a prostate issue..."
Hi Reg, can we also say "if prostate drugs help, it's probably a prostate issue. " ? Hank
My BPH is currently controlled fairly well through medication. Just increased my 2mg Doxazosin to 4mg and that resulted in symptom improvement. I have a large median lobe which rules out Urolift. I usually get up twice per night unless I drink too much after dinner. Daytime frequency is more of a problem, especially when traveling.
My uro thinks TURP is the best, he's been doing it for 30 years. Seems like you can find anecdotal evidence in favor of or opposed to just about everything. I prefer clinical studies. I have recently developed retro (perhaps due to a couple bladder tumor surgeries) so that's not really a concern at this point.
Here is another thing you have to be aware off. This is what my urologist told me. Most urologist will do many test to fine out what the problem is. If they can't figure it out they assume it's the prostate and tell you this is the procedure you need. That is when you get another doctor. You have to stand up for your body. Ken
I had been dealing with LUTS of increasing intensity/aggravation since my early 50s. At 57 (5 years ago), I was diagnosed with low-grade prostate cancer. During my research of different cancer treatments I became aware of FLA, which over time has shown some effectiveness for helping with BPH and other LUTS. I was on active surveillance for 4.5 years and continued with annual MRIs. During this time I continued to look into different treatments for LUTS, including PAE, Rezum, Urolift and all of the TUxx methodologies. I visited 6 different urologists in 3 different states and each had their own biases and prejudices (as one would expect), but only one was open minded when it came to treatments other than those offered by urologists.
Over time, my PSA slowly ticked up and the MRI was showing some small growth of the one visible lesion. My urinary symptoms continued to be problematic as well, so in Dec 2017 I opted for the one treatment that would hopefully address both issues- FLA. My urinary symptoms are better and time will tell on the PCa. For me it was a combination of one treatment addressing both issues as well as my ruling out all of the others for various reasons (primarily due to incidence of complications, side effects and their probability of addressing my urinary symptoms [not all the same] ). This does not mean FLA is without it's own issues. Some men do have some complications after the procedure and the number of practitioners and relatively small number of cases make tracking results difficult, but the same can be said of all new procedures.
Since most insurance does not cover FLA there is also the issue of cost - approx 21 to 25k plus travel expenses, as such it is not even possible for many men to consider, which only increases the time for results/improvements in the treatment.
As for your urologist question - all but the one were either unsupportive, dismissive and/or skeptical when discussing what they considered to be 'alternative' treatments. My only suggestion is learn the specifics of your situation - not all LUTS is caused by BPH, though many urologists seem to follow the same protocols for treating these symptoms (antibiotics, alpha blockers, 5a reductase inhibitors, etc) and not all treatments are best for all conditions.
If it's possible to find a urologist who has personally undergone a BPH procedure he would know what the feelings of a patient really is. Most doctors believe it is unprofessional to discuss their own medical problems with their patients.
This was exactly the kind of information I was looking for. Thanks!
I think that's quite likely the case Hank.
Hey Rich, what is PAE?
Whoops, sorry Lee. Disregard that question about PAE....Amazing what a simple Google search will produce...duh....
Lee,
As there are many different BPH procedures, the best way to decide is to rank them in terms of most effective vs least side effects. On that scale PAE is first, then Urolift, then possibly REZUM, then Greelight, FLA, Holep (the laser procedures) and lastly TURP, although TURP using the plasma buttom tip is less traumatic to the prostate tissue than the cutting loop. After most of these heating, cutting procedures there might be retrograde ejaculation that is permanent.
In the end, research shows they are all about equal in effectiveness.
The PAE is not done by urologists, but by interventional radiologists. No cutting or heating, so relatively benign procedure and fairly fast recovery. Urolift just ties the prostate tissue away from the urethra. There is recovery time and some bleeding. The various laser treatments heat the prostate, so there would be prostate swelling, some bleeding, and possibly a Foley catheter for a time after the operation. TURP is considered the most aggressive treatment, and again, depending on the type of tip used, might require an overnight hospital stay.
Your decision also depends on where the various procedures are performed (would you have to travel), the cost involved (would your insurance cover the procedure), and, if there is recovery time, how much time you would be able to take off from your job or normal activities.
So, do your research and don't just go with the first procedure your urologist recommends. It is highly likely he will NOT recommend a procedure he doesn't already do.
Lastly, it is possible that none of the above procedures will solve your issues if they are being caused by your bladder. Many here have had one or more of the above and their issues were not solved. So, you have to be clear about what your issues are - slow flow, can't empty the bladder, frequent trips to the bathroom at night - so you never get a good night's sleep, frequent trips to the bathroom during the day, incontinence issues. Too frequently we just assume these problems are being caused by the enlarging prostate, when that might not be the case. Try to get as much information as possible about what might be causing your problems. Is it an enlarged prostate, median lobe blocking the urine flow, or something else? if you can get your urologist to order yo a 3T MRI that would be very helpful. Many uros will just do a cystoscope. I had one and ended up with bleeding and a bad UTI, so won't do that again, so this is not necessarily a totally benign way to see what's going on. I prefer external imaging to shoving tubes into the urethra and bladder.
Tom
Excellent post, Tom.
Thanks for the detailed reply. I am pretty familiar with the various BPH procedures and based on information available on Google (actual clinical studies, not anecdotal evidence), I don't think you can say they are all equally effective. I have found no long term clinical studies that indicate the durability of some of the newer procedures such as FLA, PAE or Rezum. OTOH, there are clinical studies going out to 5 years post-op that indicate Greenlight, (plasma) button TURP, and recently, Urolift, are as effective as traditional mono-polar TURP. Urolift is not currently useful with a large median lobe (which I have) although there apparently is a study in progress that may change that. I have read on this forum that PAE is also not effective with a median lobe (anecdotal evidence from someone who had it.)
Unlike some here, I am not afraid of retro, having had it when I was on Flomax and having recently developed it again, apparently as a result of two recent surgeries to remove bladder tumors. Having a Foley catheter for a few days also does not bother me since I had that after both bladder surgeries. And I've had 2 cystoscopies which were no big deal either.
At this point, doxazosin is working well enough (especially after the recent dosage increase to 4mg from 2mg) that I do not have an immediate need to have a procedure done. I suspect I will eventually need something more than drugs and that's why I'm asking questions of those who have been down that road.