I have been offered a TURP by my urologist, I am on alfuzosin, which isn't working and makes me tired all the time. I can't have a proper pee, and I am getting really fed up with it all. I ready about PAE today and don't know what to do next, is there anywhere in the UK, I think Southampton offer it, but not sure if it is on the NHS or you have to pay. It is the other end of the country, I am in Leicester. Any help apprecited. Does PAE work for BPH?
PAE is administered by a Radiologist. A TURP is the standard operation for BPH.
The TURP is more likely to be effective first time, is likely to cause retrograde ejaculation but is very safe.
PAE can cause life threatening strokes but the incident is about 1 in 300. It also less likely to be successful as they have to find the artery and be successful in blocking it. People often need more than one for for it to work.
It is pretty hard to find objective stats comparing both. TURP has been around for many many years and so is the standard operation but there are something like 60 different treatment methods for BPH.
Thanks Grant, that is really helpful. I didn't know about the possible risk of stroke, that is a worry.
I got some more information.
The procedure can be several hours long and costs about four times as much as a TURP.
It also results in substantial amounts of radiation getting into the patient...
The PAE procedure required interventional fluoroscopy which involves a radiation beam directed over a small surface area of skin for a considerable amount of time. PAE is a complicated procedure involving complex anatomical structures of the prostatic arteries. This complexity leads to an increased radiation dose to patients and health care providers. Older males are less sensitive to the stochastic effects of radiation, however, fluoroscopy time also influences the radiation dose. 40 Lengthy fluoroscopy times during PAE can occur regularly.41 The mean fluoroscopy time across the four studies ranged from 18 to 86 minutes which is longer than uterine artery embolisation, a relatively similar vascular embolisation procedure. 42 It is possible the longer fluoroscopy time for PAE may be due to the complex nature of the prostatic arteries. Alternatively, PAE is a novel procedure and the fluoroscopy time may reduce as interventional radiologists gain more experience performing the technique. The highest radiation dose is targeted on the patient’s skin.
Well, my Urologist told me that. The real picture of any of these procedures is complicated and PAE is quite new.
It requires several people involved in the operation and it is quite a long procedure, over several hours.
I'd say it is highly unlikely that the NHS is going to go for PAE until it is totally proven and it seems to me that there is a lot of downside in costs and some extra risks.
Thanks Grant. I was hoping to find a treatment that wasn't as invasive as the TURP procedure. I went for consultation for Urolift and the surgeon told me it would only last 18 months, and the cost was about £5000.00, so I carried on with the drugs and herbal options, we are now starting to have little affect. I will keep looking. I really don't want a TURP.
I would go for the TURP if it gets bad which it sounds like it is.
The PAE is an option for you if you don't mind paying through the nose to get it done privately in England. It would easily cost 5000 pounds I would guess.
I read some stats on it, it looked encouraging but the short term results were worse than TURP, the medium term results similar and long term results unknown as it is quite new.
It is really bad.
I don't have 5000.00 spare, so I am looking for something on the NHS or that I can afford.
I am looking at the Holep laser, but need a referrel from my GP to see a specialist.
To be honest, I think the cost is going to be the barrier for me and the only place I can find to do it is in Southampton, which is other end of the country to me. Thank again Grant. Much appreciated.
I would avoid a TURP if at all possible. Its last century's tech and can cause more problems than any of the other options. I think the info you have gotten on PAE is overblown. It has had very successful results and for most men, does enough to get them peeing normally. Radiologists will dis it because they don't do them.
Urolift has worked for much longer than 18 months for most men and can easily be repeated if it doesn't while any damage done by TURP is permanent. HoLep is a good option if you don't mind retro ejaculation which is a likely side effect. There is also another low risk option - Rezum - which does pretty much the same thing as PAE, but by spraying steam on the the prostate and killing the tissue that way. No radiation, etc.
Again - TURP is a last resort and I would go to considerable lengths to avoid it.
Thanks so much. You have given me a lot to think about. I hadn't heard about Rezum. My urologist, just suggested TURP and I felt I didn't have any other options, he was almost booking me in. This forum is great, I feel I will get a lot of ideas. I will avoid TURP.
Actually its £9000 at southampton!
Philip, I don't know how old are you and if you plan more children or not?
i just had my TURP on June 1st and from first hand experience I can tell you is not bad at all. I already completely recovered and I am totally satisfied. Urination is great with very strong stream with very little blood either at beginning or at the end of urination. No pain at all. Did not take single pain pill after I was discharged from the hospital. Even, I don't mind if I have RE. No more urinating problems, catheterisation and all what comes with BPH.
ONLY BAD THING WAS TURP FOUND CANCER so I am waiting to have prostate biopsy in about 3-4 months.
NO REGRETS ABOUT TURP.
Forgot to mention, I am 51 year old.
I agree with oldbuzzard, I had PAE done in Australia, maybe i's different in the UK, but in Australia they use a Magellan Robotic System if I am not mistaken, the surgeon sits down right next to you. I actually asked him about that, he said he does PAE's all the time and if there were worries about radiation would he sit there for that long ?
I think this board is great for finding out about new procedures, costs etc. but you have to speak to professionals and ask them the relevant questions. Most Urologists are either ignorant or not interested in PAE for obvious reasons.
As far as strokes, I don't believe that for a moment, though I WAS told by my surgeon that if they were to insert catheters into your arm it potentially could cause a stroke. I doubt it's ever happened or we probably would have heard about it by now.
I had the PAE about 4 months ago, it helped but not as much as I'd hoped, could be my anatomy was more complicated they told me my procedure was longer than normal due to difficulties finding the exact place to insert the spheres. I'd still take that any day over any kind of invasive surgery especially since they are coming up with new stuff all the time.
Hi, I am 57, I am not planning any children. Thanks for the info about TURP, so sorry to hear about the results, I really hope you are okay and the biopsy is okay. Philip.
No chance - can't afford that. Thanks Grant.
Mike, I think they do use a robot in some hospitals, there is a centre in Oxford and I think they use advanced techology.
The forum, which I joined today, has opended my eyes to other options, I am seeing my GP tomorrow, as I haven't been able to pee without lots of alfuzosin, which make me tired all the time. My symptoms go up and down, some days my flow is fine and then some days, I have to have a hot bath to be able to pee. It is really getting me down. I like the idea of PAE because of the RE with TURP. But in realilty I just want to be able to pee again.
Phil maybe you can add Cialis to your regimen and drop the alfuzosin. Generic Tadalafil from India is cheaper.
As for PAE maybe you can do a payment plan. Or pretend you are an illegal immigrant then they'll do it for nothing and give you a nice house to live in as well and a generous allowance?
Philip, Like you Iwas on medication to help me urinate but whilst taking Tamsulosin, It only marginally improved my flow. In Feb I took my urologists advice and had a turp. Flow immediately improved. Some bleeding on starting to pee for about 5 weeks but no more than expected. Yes I have re but to me a small price to pay for getting my life back. 4 months on I now go through the night most nights without getting up, visit the toilet less frequently and spend a lot less time in there taking around 30 seconds to empty. For me I wish I had not let these forums put me off, and had had the op sooner.