My Prostate Artery Embolization with Dr. Bagla, Jan 2017

Men's health
1

I appreciate some of the detailed threads on this site about the PAE procedure - and after reading them, that became the deciding factor in me choosing to go with a PAE procedure rather than Holep laser.  It seemed like the PAE was so much easier and less invasive...why not try it first, right?

I'm fortunate that I live fairly close (about 2 hours away) from Dr. Sandeep Bagla, one of the top IR guys in the country for this procedure (if not THE top guy).  I can tell you first hand that Dr. Bagla is a first class doctor and all around nice guy as well.  Very professional, courteous, answers all your questions, and just gives off that vibe like you know everything's going to be fine if this guy does my procedure.  After driving down to meet him in person and do the initial consult at his office, I left there thinking - YES, this is the procedure that I'm going to have.

My urologist in Winchester, VA is actually a very good guy (doesn't do any in-hospital procedures himself, only does in-office procedures) and when I asked him about the PAE, he knew about them and had read about the procedure, and thought I'd be an excellent candidate.  He encouraged me to go foward with it.

There was some difficulty getting my insurer to pay (they initially denied the pre-authorization) so Dr. Bagla had to do some follow ups with the insurance company doctors in order to get them to pay for the procedure.  

Dr. Bagla and his team at Vascular Institute of Virginia is just top notch.  There's no other way to describe them.  Very friendly, easy to work with, and very professional.  There wasn't one minute that I didn't feel like I was in good hands.  My procedure was in mid-January, I got there at 7:30am, they started my IV of solu-mederol since I'm allergic to IV contrast, and within about 45 minutes I was on the table in the surgery suite.  The sedation they use is excellent - fentanyl and versed I believe.  Enough that I was aware of what was going on (I remember thinking geez are they done yet...? during the procedure), yet I was still off in a cozy, dreamy happy land.  Weird but cool.  

The proedure was a success, took about 90 minutes.  Laying flat on my back for 2+ hours afterwards was miserable.  By far that was the hardest part of the entire procedure.  Killed my back having to lay flat on a very hard mattress, if I ever had it done again I'd bring a nice memory foam topper to have them use, lol.  

Anyway, I was out of the office by about 1:15pm and on the way home.  I passed a little blood in my urine while there at the office.  Nothing uncomfortable, no burning or anything like that.  I can't take nsaids so I didn't take any prednisone following the procedure, no ibuprofen or anything like that.  I took one Celebrex in the morning and one in the evening for several days afterwards.  This was by far one of the easiest medical procedures I've ever had done.  No problems at all.  Again the only discomfort I had was laying flat on my back for two hours after the procedure.  Other than that it was a piece of cake.

It's been nearly two weeks and I've had steady improvement.  Not a night & day difference - but definite improvement.  I'm not peeing like a racehorse yet, but defintely peeing better.  No dripping afterwards.  Getting up less at night, so my sleeping is better.  You don't realilze how much your sleep is affected because it happens so gradually over the years - but wow, sleeping for 2-3 hours at a time rather than getting up every hour or so is so much more restful.  I still get up about 3 times per night...but that's much improved from 4-5 times per night.  And it's only been two weeks so I'll still get more improvement.

I can say that without a doubt, I highly recommend Dr. Bagla and his staff.  And I highly recommend the PAE procedure.  If you are having doubts....I'd say just go ahead and do it.  It was so much easier that I had imagined.  Very happy that I had it done.

2

Fantastic, How large was you prostate? Did you have a large median lobe issue as in pushing up into your bladder?

3

I thought it takes 3 months for the prostate to shrink? Does insurance cover this procedure, in regards to most companies and Medicare specifically.

4

Dr. Bagla advised me that while some guys get very quick results (like 5 days afterwards), that is the exception - not the norm.  Most guys get a slow but steady improvement over about a month, and then continue to get some additional improvement up to about three months.

It's only been two weeks for me but I can say that yes, I definitely have seen improvement already.  

5

I didn't have MRI imaging before my procedure so I can't really say if I had a large median lobe or not.  I remember him commenting to the other doctor and his nurses as they were finishing up that my prostate wasn't huge (I guess they can tell the size of the prostate from the fluroscope).  

In my case, I had been on prostate medicines for 10+ years.  They worked very well at first but decreased in effectiveness over the years.  I was up to two Flomax every day and still had to go quite often.  

Even after just two weeks I feel better about my symptoms.  I'm going less during the day and at night.  If I continue to get improvement for several more weeks like Dr. Bagla says I should, then I will consider it a huge success.

6

Thanks very much for this detailed descripion of your experience with PAE. Your uro is unusual--in my experience, most uros either don't know about PAE or actively discourage the procedure.

I'm curious about one thing. I've heard that Dr, Bagla is quite selective in choosing patients he thinks will benefit from PAE. Was that the case with you? And what were the criteria for selection? 

Thanks again for this very useful information, and keep us posted. Best of luck.

Don

7

Don, my urologist is Dr. Geib in Winchester VA.  Really nice guy.  He was at least familiar with the procedure - though he hadn't had any of his patients actually get one yet.  I was the first, and he was very supportive.  He wanted me to follow up in a month to see how I was doing.  

Regarding patient selection - Dr. Bagla has a questionaire that you fill out and send in to his nursing staff.  It's fairly detailed and it gives him a good idea if you would be a good candidate or not.  They get back in touch with you - in my case it was the next day - to let you know if Dr. Bagla thinks you would benefit from the procedure.  Since I'm not too far away from Woodbridge, I elected to drive down to their office and meet with him for a consult, but I imagine that a lot of guys would elect to talk to him via phone and/or email.

My PSA's had always been low.  As far as selection criteria goes, it was based on my history, how well the medicines had worked for me (but were no longer working very well), and perhaps the fact that my urologist was supportive of me having the procedure.  Dr. Bagla mentioned that prostate size alone is not the only thing they look at - it's a combination of factors, which I guess is what the long, detailed questionaire is designed to tell them.

 

8

bcb1, I always wanted to do PAE but my insurance company (Aetna) wasen't familiar with it. So I opted for Urolift which my insurance did cover. Its been one year now and I'm finding my pee stream is slowing down. I really do not want to put more pins inside of me so I'm undecided as to what to do. Just biding my time at the moment. You mentioned your insurer did eventually pay for your procedure. Was your insurer Medicare or private insurance if you don't mind me asking. Just trying to line up my options for the future. Thanks, Pete.

9

I also flew up and met with him and he was very informative and good to speak with. My wife and I enjoyed the meeting. In fact, my wife awarded Bagla the best looking doctor in America Award as we traveled and met with 9 doctors around the country regarding Prostate treatments for BPH. Four were Urologist. Only two were in my city. She said Bagla could be a movie star with his looks. We left there and drove to meet Dr Isaacson in Chapel Hill NC. They are friends and spoke highly of each other. Both are PAE IR doctors. I then started visiting the IR doctors who preformed FLA. None where near us so we had much more travel. Except none my wife was wearing a full leg brace as she had fallen and broken her new kneecap in half the night that we met with Isaacson in North Carolina. She said we could not stop researching as she knew I had to get something done very soon.

10

So pleased for you bcb1. I had my PAE 19 months ago and everything is going great. I had a dramatic improvement in my symptoms straight away and gradual improvement since then....still improving now. 

Im like you....I chose the least invasive method with the least side effects first. Like you, I figured if it didn't work I could always have laser later. 

It beats me why men would choose TURP as a first option. 

Guys, choose the least invasive method first...if it doesn't work you've always got TURP and laser. 

11

Americans still do not know if Dr. Bagla accepts payment under Medicare and if not what does the procedure cost out of pocket.

12

That is great to hear.  As the weeks go by you should get better in time Take it easy  Ken

13

Mark I can tell you what I was told by Dr bagla in my visit to see him. He told me Medicare would pay for the procedure if it was coded and turned in as another procedure other than BPH treatment. I think it has to do with blood loss and if he is treating a patient for blood loss it is a different code than the true BPH insurance code which Medicare would pay for. I was also told by him the procedure would be $12,500 if it was not paid for by Medicare. I'm sure the pricing could be flexible as I have heard a variety of price quotes on this website and he may have done it for a different price point than what I was quoted.

I then went to see Isaacson and he quoted me $ 7,500. The price did not and does not matter to me. Alll that matters is results. The procedure I had was more expensive than either of these and I would pay many times more than that for the results I got if I would have known that I was going to get this good of results. I went with focal laser ablation. I believe both procedures work. I did not realize at the time I selected FLA that it could possibly be this good or this quick.

14

Yes payment is the way the codes are put in.  If 1 number is off they they don't pay.  Take it easy...   Ken

15

Interesting. I hope things continue to improve. Keep us posted. --Don

16

Absolutely that was my thought.  PAE sounded like such an easy procedure, so much easier than TURP, Greenlight, or Holep.  As you say, start with the least invasive, easiest procedure first and you can always choose to have the more invasive procedures later if necessary.

I'm happy to say that just two weeks in, I'm happy with the results so far and I'm confident they will continue to get better.  Glad to hear that your PAE went well too!

17

My company was Blue Cross.  They were aware of the procedure and initially denied it, but Dr. Bagla followed up with them and they ended up approving it.

In my case I had several UTI's over the past several years, some fairly painful and nasty with dark brown urine - which indicates blood - and that might have helped swing the decision.  I do remember Dr. Bagla asking me about infections and any bleeding in the past when I did my consult with him.

18

I was greenlighted already, but it is best to try the PAE or the focal ablation to save the prostate.

19

That is a good way to go.  Why have a surgery if something less invasive would work.  Good luck to you and I know it will do the job  Take care  Ken

20

Yes I was also with BCBS and Dr B try to get it aproved but I really did not have a blood issue so I think they called him on it. It was fine as I choose the Focal Laser Ablation on December 19th 2016. I stayed home from work and just hung out during the holiday then back to work on 1-3-17.  I had little to no blood at all with this procedure and they give you conscious sedation and I felt nor remeber nothing except signing the paper and leaving two hours later to go eat a great lunch. with this procedure I was  was totally BPH symptom FREE as of the 6th of January 2017. After 8 years of suffering: For a while, I did not know how to act. I know longer have to plan my day around a restroom. I no longer carry extra under wear and a urin botttle in my truck.

NO more nocturia and I had been getting up usually 7 to 8 times each nigth, I now get up only once if I awake, day time urges that caused daily incontinence are Gone as I now have full bladder control!!  I would not dare try to hole it to the next stop two months ago. And the volumes of urin per occurance went much higher and  up to between 350 and 500cc. And as I told you the only side effect I have had is the huge increase in sexual functions. I was so worried about the possibe decrease in ejaculation fulid and I was completely wrong it went the other way as Dr. Karamanian said it would.

I can not tell you how great this is and I hope you continue to improve to this point as many PAE patients have. All the Interventional Radiologist are wonderful and really deliver in PAE and in FLA. Both are minimally invasive procedrue. We are lucky that these procedures have broken out.