I would appreciate hearing from anybody who has had a successful PAE, from anybody who has had an unsuccessful one or from anyone who is knowledgeable of it. I'm starting to focus on PAE and I know their is a wealth of knowedge on this forum. I've heard good things about it. I've heard that it is covered by insurance, but not sure about medicare. I'm 67 years of age and other than BPH I'm heathy. I recently had a clear prostate MRI (negative for tumors suspicious lesions), my prostate is about 79 cc's with meidan lobe hypertrophy projecting into the bladder. My PSA's fluctuate between high 2's and low 3's. I'm slowly learning to CIC, (scares the sh-t out of me). Done it twice and it ain't fun. The way my BPH is progressing I may have to start doing it on a regular basis soon. Anyways I would like to get all the info I can about PAE so I can rule it in or out and start looking for provider if I determine it's the right procedure for me. Thank you.
Gary,
Based on responses from men on this forum who have had a PAE (myself included) it was less than successful where a median lobe was present. IRs are getting better at dealing with this, so you should speak with your IR and find out if he has been able to do an effective PAE with median lobe issues.
Mine was fully covered by insurance (Kaiser).
Tom
Hi Gary,
I have had very similar diagnosis as you . Prostate just 55ml with extremally big median lobe IPP - protruding to bladder - acting like pressure valve.PAE in Lisbon Portugal May 2017, Fully NO effect
just waste time and money. After more study and investigation I learnt in case of mydiagnosisPAE is failed in 80-90 % . MRI showed the real anatomy and after consultation I realised the reason of failure. Anyway I provided CIC from 2016 to April 2018 just to buy time . ( But it was hard time - several infection, bleeding ,etc. April 2018 is milestone of my life after FLA procedure in Houston with Dr. K.If you need more details, pls PM me . Stan
Gary,
My last reply is waiting to be moderated.
I will write it again avoiding any links or email addresses.
I had a PAE done in 2013 which did not help probably due to my enlrged median lobe.
Anecdotal evidence suggests that PAE is not as successful for enlarged median lobe.
I had an email conversation with:
Sandeep Bagla, MD
Vascular & Interventional Radiology
Vascular Institute of Virginia
Woodbridge, VA
1 Do you have a procedure to treat enlarged median lobe ? I presume you would block arteries supplying the median lobe.
Dr Bagla: Yes we target these arteries
- How many median lobe procedures have you done and what is the success rate ?
Dr Bagla: Many but don’t know exact number
Technical success near 100% and clinical success near 90%
- Is there a danger with the median lobe procedure of weakening the bladder neck sphincter, and possible ischema to the bladder, since you would be getting close to those areas ?
Dr Bagla: Never seen this
Hope this helps,
Thomas
I had a PAE at St. Louis University in St. Louis, MO on July 2, 2015. My prostate was about the same as yours at 80cc. They were not very good at doing it. They could only get to one side, and I think they missed the prostate artery on the side they reached. I had some small improvements for about six months, but then I suddenly reverted to pre-procedure problems. Since, I’ve had ultrasound analysis which showed that some shrinkage occurred in the outer zone of the one side, but not in the core of the prostate where it would have helped. My prostate looks like the Apple logo. I have now had a Urolift, and I’m having problems with that. The PAE cost me $7000, my insurance $37,000. The UROLIFT cost me $1400, my insurance $6400.
I see both procedures as having great potential and preferable to TURP. Success for the PAE depends, more than anything, on getting an Interventional Radiologist who has done numerous procedures and is dedicated to keeping himself current on updates from the medical community.
Gary,
I had an unsuccessful PAE and was told that the odds of success are much less when there is an enlarged median lobe.
The CIC gets much easier. I said no way at first but am accustomed to it and, while, not ideal, I think it is the best option while waiting for a better procedure to come along.I’ve tried 4 different caths and find the coloplast speedicath male compact by far the best.
Best of luck!
Arlington,
Where and when did you have PAE done ? Did you have an enlarged median lobe when your PAE was done ? Did they do the new procedure for enlarged median lobe, blocking median lobe arteries ?
Thomas
Gary, I am in a very similar situation as you (BPH for well over 18 months). Haven’t had an MRI, but they did digital check, ultra-sound, and cystoscopy. They haven’t measured my prostate, but say it’s “fairly small” and is “probably” swelling/growing inside and causing a severe restriction of my urethra. They recommended the Urolift procedure; I think because that is one of the things they specialize in. I too am very interested in PAE and have heard mostly positive results. Where are you located ? I live near San Luis Obispo, California and am currently trying to find a good Medical Provider / Urologist that is experienced with PAE in my area. And as far as CIC… I too have done it and fear it (3 times, thus far), each time with smaller french size cathaters, because the first time it made me bleed. I found that 8 fr and using lube helps Tremendously; so as not to damage my urethra. Any suggestions and recommendations from others, would be greatly appreciated.
Chuck,
You didn’t mention your insurance coverage. If you’re with Kaiser you can get a PAE from Dr. Hastings at the Kaiser Medical Center in Oakland - a GREAT IR doctor. The PAE is covered by Kaiser insurance. All you have to pay is the copay.
Tom
Chuck,
There have been some posts on this web site about good results with a PAE doctor in San Diego, I don’t know the name. You should try to determine if you have an enlarged median lobe. In the past large median lobe patients did not do well with either Urolift or PAE. however there are new techniques with both procedures for the enlarged median lobe.
Everyone has problems with bleeding when first starting CIC, it is normal. You have to watch carefully for UTI when there is bleeding, Be sure to keep every thing clean. I wash the opening with a providone iodine wash. Use a measuring cup and if the urine gets cloudy or smells bad suspect UTI and get a head start by seeing a doctor for testing and possible antibiotic. If there is bleeding the body will heal it and after a week or two it will not happen again, and you will not feel any pain going in.
Thomas
Chuck,
PAE’s are not performed by urologists, they are performed by interventional radiologists (IRs). That’s one reason that most urologists probably would not recommend a PAE. If you decide on a PAE, be sure to go with a doc who is very experienced. I had a PAE done by Dr Sandeep Bagla in VA, probably the most experienced PAE doc in the US.
Rich
Don’t know why the formatting gets messed up on this site. Here’s another attempt:
PAE’s are not performed by urologists, they are performed by interventional radiologists (IRs). That’s one reason that most urologists probably would not recommend a PAE. If you decide on a PAE, be sure to go with a doc who is very experienced. I had a PAE done by Dr Sandeep Bagla in VA, probably the most experienced PAE doc in the US.
Thanks Tom. Wish I had Kaiser, I have Anthem Blue Cross. PPO
Bless you for the encouragement Brother.
Rich, if I was rich (all pun intended) I would fly out to Dr. Sandeep Bagla in VA in a heart beat. I’ve read numerous Positive comments and conversations for/with him on this site and elsewhere. Alas, I will need to stay on the Left Coast (Calif.) and seek out the best IR, as you recommend.
I will also request an MRI, to ascertain if I have a median lobe obstruction or other contra-indicative issue before having a PAE.
You Guys are all AWESOME. Knowledgeable, Supportive, Reassuring, etc… and above all else… Entertaining ! LOL
Chuck
Good luck. Let us know how this all unfolds for you.
Rich
Rich,So far I have found that my “local area” IR’s (San Luis Obispo Radiologists) do not perform PAE and could not or would not refer me to any IR who does. Thanks to this group, I have contacted both Kaiser Med. Center in Oakland, CA as well as UC San Diego Med. Center.
The former charges big $$$ because I’m not part of their HMO or PPO or whatever health care system, and the later is currently in Clinical Studies until 2022; of which I “may” qualify to participate in. Simply put, if they accept me, I would have to drive about 6 hours down and 6 hours back approximately 5 or 6 times (initial procedure, 1 month follow-up, 3 month, 6 month, 1 year and 2 year follow-ups). Hence at this point, I’m laying all my eggs in one basket (so to speak 
I will of course, keep this group updated; hopefully with positive news. As others have stated, I sincerely appreciate all of my Brothers (and Sisters too) posting their experienced based knowledge. And I believe sharing our experiences will help other people make better informed/intelligent choices for themselves inre these related conditions (*ala Ken, Kenneth, Thomas, Tom, Gary, Ramblin, Rich, Arlington, Stan, the other Chuck, and everyone else I am forgetting…).
Chuck,
You should find out if you have an enlarged median lobe (EML) first, either by MRI (preferably 3T MRI), Cystoscopy, or TRUS, ask your Urologist. If you have an enlarged median lobe ask the clinical trial if they do a procedure for the median lobe. If they don’t you may be wasting your time even though it’s free. If you have EML you may be better off finding a doctor who can do the EML procedure like Dr Bagla in Virginia.
Thomas
I had a PAE in June 2018 in a clinic in Katowice Poland. Total cost inc hospital stay 2 days (1 before and 1 after) PLN 12500 (about GBP 2500) plus my travel costs. I paid that. Dr Ludyga, the intervationist radiologist) has done lots of these. I have just come back from a 9 month check which cost GBP 175. He has pronounced it clinically a success and, as patient, a success with night time trips to toilet reduced from 3 or 4 to just one. I stopped taking tamulosin as it interfered with my sexual function. My prostate was 130 gms before op. I am 76 and weigh 71 kgs. The big advantage for me was that it was non invasive, with tube poked in through my thigh while I was sedated for 2 hours
Thanks Thomas. I did have a cystoscopy and the Uro said “there’s no problems”. At the time I thought he was referring to kidney stones or infections. In retrospect, now I’m not sure exactly what he was referencing. So I will request an MRI (3T MRI if available) to check for EML, before I undergo any “procedure”.