PAE (Prostate Arterial Embolization) last year did not work for me, so I am looking at the next "least invasive" option, which I have concluded is iTind. My urologist does not perform this procedure, but a colleague in his practice does, so I met with him a couple of days ago for a consult. He requires another cystoscopy first. He says that the most important factor for success is choosing the right patient, and the main criteria is size and position of the median lobe. The cystoscopy is scheduled for late July, 2022. Hopefully I will be OK'd and the procedure can be scheduled within the month after that. In discussion, he admitted that he had only performed the procedure 4 times, but then claimed that was more than any other urologist in Arizona. He insisted that the procedure is very simple for a urologist to perform. The most important part is making sure the device is fully retracted before pulling it out. I would hope so! Anyway, he said he has more procedures scheduled and will have had more experience before it is my turn. As a side note, he said he was not surprised that PAE did not work for me, as a 40 cc prostate is too small. I knew it was marginal going in. If iTind does not work, or I am not a candidate, then I guess Urolift is the next "least invasive" option. I just like the idea of reshaping the prostate rather than cutting or blasting it away.
Daryl - in similar boat... 20 gram prostate, refused by PAE doc, went to 3T MRI with Dr. Karamanian in Houston was the best diagnostic thing I ever did. It was $250 consult, the MRI was paid by medicare, and I have the data now for the right procedure. I had considered the ITIND, but like your doc, he had only done his first handful. I have had two failed surgeries, an ablation and the Rezum. Therefore, I am looking at Healthgrades comments and the comments on these threads and slowly making diagnostic decisions, waiting for ITIND operators to get more of a handle on outcome before putting that at the head of the list. I have also learned that my prostate / bladder OAB is highly affected by consuming optimal diet. Highly recommend Dr. Karamanian in Houston (like so many on these threads to get the definitive prostate archetecture and to reassure no cancer before doing any procedure if you have not had the 3T MRI yet. Check him out on Healthgrades. Best wishes to you sir.
Isn't the criteria for an ITind procedure that one cannot have have a big median lobe protrusion? What did the urologist stay that made you a good candidate for an ITind procedure?
I am the original poster here. Here's a brief update.
I saw my urologist a couple of days ago. He performed a cystoscopy and said I was an excellent candidate for iTind.
The main feature is that none of my prostate protrudes at all into the bladder. I think the relatively small size (40 cc) is also a plus.
During the cysto he showed me on the screen from within the bladder looking back at the urethra. The bladder wall was flat and the urethra just a narrow oval opening.
I have already arranged for clearance from my PCP (required because it will be done under general anaesthesia) so now just waiting to hear from his scheduler.
An urologist who had done a handful of I Tind said that I might be a candidate for I Tind if on cysto I looked like I would. Too much of a hammer looking for a nail comment for me to trust. Am going to a 5 star 350 recommendations urologist next.
I am scheduled for the iTind procedure September 29, 2022. I'll follow up here with my experience.
Best of luck for great results and a speedy recovery
The urologist told me that I was an excellent candidate because my prostate is relatively small (40 cc) and though I have a median lobe, it does not protrude into the bladder at all.
I had the iTind inserted today. I was totally out for the procedure, so it was very easy,
It's now 7 hours later. My main complaints are frequent urgency and a little stinging during urination. I am not even aware of the device, so far. No sensation in the perineum area, where I was told I might feel it.
It seems like I'm 10 minutes relaxing in a recliner, then 5 minutes on the toilet, over and over.
Lots of blood and some blood clots still, which I was told is normal.
Pain during urination is maybe 2 or 3, though I confess to taking some left-over opioids along with the pyridium the doctor prescribed. They said the frequency and urgency and pain should decrease after a day or two.
I go back in 7 days to get it removed.
I'll update here if anything changes.
Day 2 after insertion. I slept better last night than I expected, but not great. The longest I went without having to get up to urinate was about an hour. More typically 20 - 30 minutes.
Today is a little better than yesterday. Still having to go every half hour or so, and still stings a little during urination, but tolerable. There is still blood each time, but less and definitely fewer clots. I'm still taking the pyridium.
I realized that the constant feeling of incipient constipation was actually the iTind device doing it's thing. The prostate is quite close to the rectum. I don't notice it unless I think about it. Definitely not uncomfortable.
The Depends pads are essential. I've gone through about 10 since yesterday. They never got soaked through or leaked, but once they get bloody I like to change them.
Day 3: Definitely longer periods between urgency, but it's just as "urgent": Don't get between me and the toilet!
I had several hour-long "naps" during the night between trips to the toilet.
It still stings during urination, but I think less. Tolerable anyway. I'm still taking pyridium.
Definitely less blood, and I don't see any clots anymore.
The sensation in the perineum is about the same. It's there if I think about it, but quite mild.
Day 4: While lying down in bed or in a recliner, I can wait 2 - 3 hours. As soon as I stand up, though, I have to move quickly to the toilet. But that means that I slept well last night, and I can make it through half of a football game, as long as I don't get up.
Stinging is almost gone, just hanging on a little. I suspect that the string might be irritating the opening of the urethra, causing some of the irritation. I read somewhere that a little Vaseline there can help, so I've been trying that.
Very small amount of blood and rarely a small clot.
Anyway, I feel good. The following 4 days should be pretty easy.
Day 5: About the same as yesterday.
I note that the procedure is always described as "5 - 7 days". I can't find any studies comparing 5 days and 7 days.
My urologist uses 7 days, which I suspect is so that he can schedule all procedures for Thursdays. If 5 days works as well, I would just as soon be done...
But if 7 days works better, then fine. Would 8 days be even better? How about a month? :(
Day 6:
I'm getting tired of having this thing inside me. Doesn't hurt, just feels like something down there is not quite right... Someone described it like a popcorn kernel stuck between your teeth, or pebble in your shoe.
Irritating, I will be glad to get rid of it, but I can wait another day and a half.
Day 7: Tomorrow it comes out.
I've had a new symptom the past couple of days. During urination there is no pain at all, barely any sensation. But just as I finish I am hit with a sharp cramping feeling, from the general area of my prostate. Maybe a 4 or 5, pretty unpleasant.
I Googled "pain after urination", and it typically indicates a problem with the prostate or bladder, while a UTI generally causes pain at the beginning of urination.
So yes, there is a "problem" with my prostate right now; there's a wire gadget cutting into it! I anticipate that this will resolve as soon as the devilish device is removed.
One more day!
Extraction!
The iTind device was removed today, under Nitrous Oxide (they gave me the option, which I gladly accepted).
"Breathe deep!" and the world gradually receded until I was only aware of some tugging going on down there. No pain.
And then it was done. A few minutes to fully wake up, and I was out the door.
Since coming home I have only urinated one time. It seemed like mostly blood, which I was told to expect. I was afraid it would sting a lot after all the recent trauma to my urinary tract, but it was not bad at all. Flow rate seemed about the same as before I started the treatment last week; I was also told that should steadily improve over the next 2-3 months as swelling goes down and clots are cleared.
And that constant, constipated pressure feeling in my perineum is gone. That's a relief! And I can already tell that urgency is reduced.
I'll update when anything changes.
Hi Daryl, thanks for posting your experience with the itind procedure and post recovery. I am scheduled for the same procedure in about a month so any other progress reports would be highly valued or tips that you could recommend. Thanks Timmy
5 Days after removal:
I still don't notice any improvement in flow, compared to before the device was inserted. Kind of disappointing, but they do say that it should continue to improve for 2 - 3 months.
I ejected lots of blood and clots, some small and some large, the first couple of days; seemed like more blood than urine at first. All clear now.
An unexpected effect for the first 2-3 days after removal was pain during erection. Quite sharp, near the base of the glans. I think there were some tears or scratches in the urethra from the insertion and extraction processes that had healed in a flaccid state, and the stretching was tearing them again. The problem has faded now, and no longer prevents me from exercising the option.
I see the urologist for the last time in 2 days (one week after removal), and I think he is planning to take a look inside, so I'll see what he says about all this.
Week after removal -- Condition: Still about the same as before the procedure began. The pain-on-erection problem is gone. No blood, clots or other symptoms.
I saw the urologist's PA yesterday. He was encouraging, said that I should give it more time to allow swelling and inflammation to continue decreasing. He did not do a cysto -- there was no need at this time, and "Let's not irritate things any more than they already are."
I go back in 4 weeks.
I'll report back here if there are any changes.
25 days after removal: I don't notice any significant improvement.
There was one interesting event, though: About a week ago I went for a 4 mile hike in the desert. When I came back, the first time I urinated the stream was almost pure black, like dried blood, and fairly strong. It startled and scared me at first, but the next stream a couple of hours later was totally normal and I concluded that the exertion of the hike had broken loose some dried blood. I was hopeful that this would be a big turning point and that flow would be better, but it didn't really seem to make any difference.
I go back to see the urologist next week for a one month follow-up.
I was told that improvement would continue for about 2 months, but at this point I am not optimistic.