Undergoing preliminary consults at Inova for PAE procedure. Was told I would be on Prednisone following surgery. Problem - I can not and will not take the prednisone regime of building up dosage and tapering down. I did this about 5 years ago for another problem and had EXTREME anxiety for over three weeks. I did not think I was ever gong to be normal again. It is NOT an uncommon problem. What did the rest of you take post procedure?? Surely there must be something other than prednisone. If I just have to take the prednisone, I will not go through with the procedure.
I took Prednisone (along with other meds) post-PAE. Is the dosage they are recommending the same as what you took 5 years ago? Did you ask them if there is an alternative?
Hate that stuff. Makes me feel nasty.
I would reconsider PAE, it works sometimes for some people but there is a high rate of failure and some risks. The first time I did it they did not give me prednisone, it hurt like hell and burnt for about a week but it IS possible. I had a second PAE and they gave me prednisone because I requested it, that time it was easier but PAE did absolutely nothing for me - I read some medical journal online that says there is an 18% failure rate - you can google it for yourself. Had I known what I know now about PAE I would have stayed away from it.
The way I understand it is that if it does not work then the other procedures can be tried. On the 2nd of this month, I had a procedure at VA where they went up into my urinary bladder and laser busted up TEN bladder stones that were as big as 2 cm. They were causing me to have hematuria. It is not fun peeing blood at least once a week. From what I read, this is probably the result of my BPH and incomplete voiding of the bladder and hence the formation of stones from the concentrated urine. The VA does not do PAE but the "other gold standard" sounds not too great either and that is what they offer.
I did do another procedure, FLA and I believe the delay having a good procedure and extra stress to my bladder from PAE (because the first week or so it's almost impossible to pee) made the procedure not as effective as it would have been. If you are getting it for free I suppose it's not a big risk, though like I wrote before there have been reports of damage when the material they inject does not go to the target. I don't understand why they don't recommend wearing a Foley catheter the first week after PAE, apart from maybe they are not Urologists and don't know how to help with that. If you can afford it FLA is the way to go I believe, or maybe Rezum which is more affordable and has less sexual side effects than TURP.
Hey buddy I would have to agree with Mike. If you can not tolerate Prednisone, DO NOT have the PAE .
If I had not had the prednisone, for several weeks after my PAE procedure, there is no way I would have been able to empty at all.
Not to mention my procedure was a complete failure. My prostate is exactly the same size as it was before the procedure after 6 months. Total wate of money for me. But seriously you need the prdnisone, and antibiotics.
Considering FLA here, just wish insurance would cover it.
Good luck
My experience with and understanding about PAE is very different from Mike's. There are risks with every procedure, and depending on your condition, there are risks with doing nothing. I was able to pee right after my PAE, though it did burn when I peed for about two days. Re: the microbeads ending up where you wouldn't want them, be sure (as with any procedure) to choose an IR or urodoc who has done many, many of the procedures that you will be having. Be sure to research all options, as they all have pros and cons. If you are considering PAE, I believe the most experienced IR's in the US are Dr Bagla in VA and Dr Issacson in NC.
Joe, in regard to insurance on FLA. I do not know the particulars, but I understand that some of the private insurance companies like blue cross blue shield are paying a percentage of the cost now. I believe it may have been Jim that possible got it approved but Dr. Karamanian should be able to tell you. I am recieving a percentage back from Medicare on my FLA procedure. As I understand it is all in the codes used during the filing. Your doctor can give ou those. I know that the clinical trial is still going on but if you had PAE previously that would eliminate you from the trial.
But I Did pay full for mine and it has been a total success for me. Well worth the debt I incurred. But I am pleased I will get some of that money back.
As someone else said, it is truly a product of picking the right practitioner as that is the key to success because this procedure is an art as much as a science. FLA is very accurate and very controlled in the tissue removal where PAE is totally random in tissue removal. It has worked well for a lot of the men on this site. I know currently of no failures.
vigneron,
i would say that if you cannot use the Prednisone then you will have to have an extended foley cath in the PAE procedure. Another possible and helpful anti inflammatory is Aleve 220 mg twice a day. I did use this.
I did not do PAE even though I did go visit the two most experience doctors in that field. I instead chose FLA and that choice was a blessing for me. I did not do the prednisone dose as the later men did when they should have and I think it would have helped me but I don't like what steroids can to to an immune system so I was fine in the FLA as you wear a foley cath for at least a week anyway. With FLA you will have the foley cath for at least 7 days anyway and it was not that bad for me.
Good luck In your choice and if you need any more detail information, feel free to personal message me by using the "envelope icon" above and next to my name in this message and we can then communicate. I will tell you what I know about both PAE and FLA.
john
Hello again J, I think we talked before, under another topic. I have talked a couple times with DR K and his staff, and needless to say they are amazing people to deal with. I sent them all of my insurance information, which is BCBS for the state of TN. Unfortunately Dr K says they do not have a billing office, so therefore will not seek a prior authorization from my insurance. Ravina did send me all of the CPT codes, and I have checked with the insurance, and all are approved and covered. However they will not give a prior approval, without a request from the provider. I am going to try and speak with a supervisor tomorrow and see if there may be someway to by pass that requirement. I will pay for it out of pocket if I have to but dang it would be nice to get them to start covering it.
Its funny I was the first patient ever that got approved for PAE thru BCBS at UNC. Perhaps I can get luck again lol.
Thanks again for the info.
Joe
Talk to the Dr about taking ibruprophen ( Motrin). They are giving you the prednisone to decrease the inflammation in your prostate. The Motrin will do much the same thing without any anxiety .
Neal
I just had a PAE on Monday morning. Urine flow is just fine - possibly slightly better than before, but I have been taking 1 Tamsulosin (Flomax) every other day, and now increased to every day. Post Op information I got from the hospital said to expect some side effects for a couple of weeks, then max PAE effect at one month out. After that there would be some continued improvement for 6 months.
So, if you don't want the Pred ask for the Tamsulosin or other similar meds.
I decided to go with the PAE because the side effects are far less severe than TURP or Laser. Just read what some guys go through after these cutting/burning procedures. I'm talking about hospitalization, Foley catheters for days or weeks, blood in urine, retrograde ejaculation etc. These procedures require that the instruments go up through your urethra and that can really irritate that tissue.
PAE stats are almost as effective as TURP or Laser based on very latest studies just presented, so in a recent report "Dr. Pisco reported that the cumulative success rate within 6 months of the procedure was 89%, which declined to 82% for the 807 patients in the 1-3 year follow-up subcohort. Patients in the “long term” post-three year category had a 78% cumulative success rate."
I have been discussing the various BPH treatments here for several years, and have been reading all available studies - decided to go ahead with the PAE because it has the highest success rate relative to side effects. So far, and I am now 2 1/2 days home from the surgery, the side effects have diminished and I am feeling about as good as I did the day before I went in.
The only issue I had on the day of the procedure was that the last opportunity I had to urinate was as at 7am, with the surgery starting just after 8am. They give you IV fluids, which is basically diluted salt water. I was supine in a recovery room from about 10:30am and instructed to lie on my back for the next four hours. I had a condom type catheter attached, but was completely unable to urinate lying down. So, I requested a Foley, and at about 12:30pm that drained off 600cc of urine!
When I got home, yes, there was some burning sensation when I went to urinate, and my rectum was also a bit inflamed - I believe from the drug they give to constipate you so you won't have an "accident" during the procedure.
I seem to be fine now. All tissue irritation has calmed down.
I am going to do a separate PAE post here about my experience. If the PAE works for me, then I will be happy that I did the procedure. It if doesn't, I will consider something else next year.
Tom
Tom that is a great report I want to point out that FLA is not through the urethra. It is done rectal and saves the urethra from the trauma that is done by urologist in the procedures you mentioned. It is also never done by the urologist. Only by Interventional Radiologist the same as PAE. I did not have a lot of blood in my procedure and none at all from the rectum.
Yes I did and all the men who do FLA have a Cath for about a week but mine was not bad. I did my procedure in December of 2016. I went back to work the second week as I was on vacation for the procedure. No retro grade in fact no sexual side effects at all with the procedure. This was my main concern and why I decided I was only going with one of these two procedures. We went to lunch when I left the hospital and toured NASA for almost 4 hours the day after the procedure which I do not recommend to other. Strangely enough, I as a lot of FLA patients, had a erection the second day after the procedure was done even with a catheter in me. No pain but very unexpected!! Yes, it was gone before I went to NASA thank goodness.
Thanks for given us you information on your success. We need to remember where we were in this process before the procedure and help all the men we can in an effort for them to fine the best choice for their situation. There is a lot to consider and I believe getting a good urine flow analysis and a 3 TMRI so you can actually see what is causing the blockage is the first and most important step in deciding what to do. These two procedures are not fully covered by insurance yet so it can be expensive. We need these procedures to work for us.
Good luck
It is wonderful
Hi, Vigneron, What can I say. "One man's meat can be another man's poison". Fortunately I did not suffer the side effects you describe.
I was treated for asthma despite my protests that I had no history of respiratory problems. My highest dosage of prednizone was 80 mg x 4 per day! Then about 30 years ago I discovered that Singulair potentiated the prednizone and I was able to cut the latter down to 5 mg daily, which is barely therapeutic.
Yesterday (August 16th, 2017) I walked out of my respiratory specialist's office with the official assertion that I was, from the respiratory perspective, a perfectly healthy man. So much for the "incurable asthma", but I am not a doctor. Who knows, you might get lucky and find a beneficial drug interaction.
I wish you the best of luck! Alan.
Yes, some if perhaps almost most people do not have a problem. but --- there are others, like myself, who have a BIG problem. I can not even use nasal inhalers with steroids such as Nasocort. When I had my problem, doctors said it could not possibly be from Prednisone because the anxiety lasted too long. I was referred to mental health and given some downers which did not help. VA thought I was just having PTSD symptoms for which I was diagnosed (Vietnam Vet). It was only when I looked up side effects that I found that yes, indeed, it can be a major problem for some people. Doctors should AT LEAST inform people of the possible side effects and severe side effects. I was not. I am wondering if perhaps some of the side effects from PAE procedure are in some small part related to Prednisone. In case there are doubters, here is a link on what others have experienced:
http://www.medhelp.org/posts/Anxiety/Anxiety-and-Prednisone--Anyone-PLEASE/show/579342
Rich, I know PAE works for some, I spoke to someone in person who had it done by the same Docs who did me, he was only the 6th patient and had perfect astounding results. That was the reason I took the chance on something new.
Here is some info I gleaned from a medical abstract which had I read before my PAE(s) would have pushed me away. Basically it's pointing out besides the risks that after 3 years it is 64% less effective, if I am reading it correctly. This makes sense as the body has the ability to re-route blood supply. I suppose with any of the traditional surgeries the prostate can grow back, but probably not as fast as blood supply.
See below - if you search on internet for 'Minimally invasive surgical therapies for benign prostatic hypertrophy' you will find the whole article which is quite interesting reviewing some other procedures.
****
Contemporary literature highlights considerable failure rates as high as 19% with 15% of patients requiring TURP within the 1st year after treatment. Uptake may have been limited due to these factors and availability of specialist interventional radiologists required to perform the procedure. However, increasing experience with PAE has led to improved procedural success rates. PAE has gained interest recently with further studies showing acceptable outcomes in IPSS scores at 24-months' postintervention. Despite this, TURP results in significantly better (P = 0.029) outcomes in IPSS scores and quality of life scores at 1-months' and 3-months' postprocedure.38 Another large prospective series by Pisco et al reported a 63% reduction in IPSS at 36-months' follow-up with PAE.Complications of PAE are not insignificant and include failure of the procedure, dysuria, hematuria, hematospermia, rectal bleeding, and urinary retention. Although rare, risks of inadvertent embolization and untargeted ischemia of the bladder, corpus cavernosum, or anus do exist and pose a significant compromise to patient outcomes. A recent meta-analysis identified six cases of bladder ischemia. More long-term data is necessary to define the safety and feasibility of PAE.
I was prescribed prednisone and ibuprofen.
I learned about FLA (Focal Laser Ablation) last year and it seemed like a great way to go, but could only find one doctor who performed the procedure and he was all the way across the country. Also, it's not covered by my insurance (Kaiser). My PAE was done at Kaiser and only cost me a copay of $250.
Since you had yours in Houston it appears as if more IRs are doing FLA now.
Tom
Yes, I am surprised you did not find the providers last year. Though I agree, there are not many IR's who have dedicated to this FLA procedure in the prostate. Prostate cancer with FLA has been done for a long time and there are many cases. There are many of these PAc IR's. I know of three (3) doctors at the time I did my procedure in December focused on FLA in the Prostate both for PCa and BPH. The key is absolutely in picking the correct person to do the job. As I said before, this is an Art as much as a Science and I think that procedural idiosyncrasy is a blessing if you pick the right Doctor. I did not care about the geography of the Doctor but I did not want to leave the country. I am so sorry I did not know of your searching last year or I would have gladly given you all the information I had to help you at that time.
I sincerely hope your PAE has given you the relief you need and I am glad it did not cost you much. FLA was expensive but as I have said many times if I would have known then what the results would be now, I would have paid much more for this great results. I put it on my credit cards and it was the happiest payments I ever made to a credit card company! I am very blessed and thankful I found the right solution and provider for me.
There are guys in this web site that did FLA after their PAE did not work or stopped working over time. They are also available to give their story and information to anyone it would help. Don't get me wrong PAE works for some men in some cases. But the blood flow will grow back and replace the restricted arteries over a period of time. The human body is made to do that.
I feel with BPH, one needs to know what the situation details are before you pull the trigger on a procedure decision. What is really causing the bad flow and urges? I wanted to see it with my own eyes. Your bladder condition is also a big consideration. The 3 TMRI read by the person who actually knows what they are look at gives you many answers to the questions of what needs to be done. Looking at the blockage on screen and then seeing the whole prostate and the components of the prostate not only allow for the outline of a successful removal of the symptoms but it provides the way to save the sexual value of the gland. No retrograde ejaculation or ED issues are caused when FLA is done by the IR that can map out and see exactly what and where things need to be done and then watch it in real time while doing the FLA. I also did not want a procedure that was intrusive to the urethra by being done up and through the urethra into the prostate. That was what started me down the PAE path, then later the FLA path as FLA comes from the other direction and not up the urethra.
Good luck and if you need anything in the future just ask and I will help with what I can. I believe with all my heart that we should never forget what we went through with BPH. And we should continue to pay it forward with helping other men who are scared and trying to research a remedy. Those who have questions should be able to get answers from other men who have gone through this. Doctors just think they understand. Unless they have actually been the patient they do not relate the same. Clinical success to a doctor is not always symptomatic success to a patient. There is a lot in the way of treatments out there to chose from now days. I believe that knowing as much as possible about your condition and not just believing what some doctor says, provides the best possible outcome. At times, men with BPH seem to be and they feel alone in there issues. I was there once. I know. There is no wrong decision, if it works. The mistake can be made in waiting too long for a treatment and causing other bad issues. I almost did that.
John