Don’t surprised if your uro doc does not recommend PAE. PAE’s are performed by interventional radiologists (IRs), My excellent uro doc (life saver when i had a kidney stone) was woefully uniformed about PAEs … he mentioned potential problems that may have been true 10 yrs ago, but not a concern these days.
Rich
Not sure if PAE would be a suitable option due to the PCa.
Yeah, Ken, it is great when studies are done primarily in men who dont have sex, when you want RE info.
They’re out there though. Check out the Barber study mentioned earlier. Also, the NICE study from september 2018.
On page 13 of 38 of the 2018 NICE study comparing TURP vs Aquablation, it says 42% of TURP patients (with beginning prostate sizes 50ml or larger) developed anejaculation, whereas only 2% of the Aquablation patients developed the same problem. I quote from NICE:
“In sexually active men, mean erectile function scores (IIEF-15) were stable after water jet ablation and decreased slightly after TURP except for overall sexual satisfaction where water jet ablation was statistically significantly better (p=0.0492).
Ejaculatory function scores (MSHQ-EjD) were stable after water jet ablation but worsened significantly after TURP (p=0.0254).”
Neither of us wants to pick another man’s BPH procedure, like you said. AND STATISTICS VARY! I would expect st least 10% RE regardless of what a study says, just because Ive heard different numbers. Thank you for your open mindedness.
Marty
Thanks, Marty. It’s great to hear how well things are turning out for you. And ditto for the other guys you mention. I will indeed be researching further!
d
Thank you for chiming in, rich. My impression - although I’ve only been seeing my current uro for a little while - is that he’s likely up on all the newest gadgets, etc. He’s fairly young and did a fellowship at City of Hope, a top research hospital here in southern California. He also seems very open to passing me on to other docs if the situation warrants, and will tell me straight up whatever my PCa sitch might preclude.
Regardless, I’m figuring that the hospital system I’m enrolled in likely doesn’t have the very latest stuff. And then there’s the thing I read on the Aquaetc’s website about the non-US sale.
I’ll post an update after I speak to him in another 10 days and appreciate your input!
Just to make sure you are looking at the right website, the mfr of the Aquabeam robot is Procept - Robotics. Google Procept. It is for sale throughout the world.
Ive never seen this procedure mentioned with PCa. Let us know what you find out.
Marty
When we were talking about this in 2018. A lot of the guys could not believe the numbers. You know if you talk with a doctor and he want you to have a Turp he tells you to be ready for RE 100% and 2% is not right. I talk with Mr Barber he told me that it is more they 2% I think the trail was with 181 men.
I think where you read that was in the Phase 3 trail. That was the only one that said anything about retro. But think about.
The Aquablation get rid of the whole prostate. The connections are cut from the seminal vesicle to the ejaculatory duct. Where is the ejaculation coming from. Maybe the cowper glands But that is where per cum comes from. It does take time to clean out the tubes. Maybe that is why men go dry.
Your volume is cut down way low because nothing is connected.
All I want is for all men to do there research before they pick a procedure. They did to be aware of all the side effects.
There was a guy on here he did not know what he was going to do. His name was Mike.I have been talking to him and he picked to have a Holep done. His prostate was 130g the doctor took out the central zone and the median lobe. That was 55g He is doing great. He said that he pees like a 40 year old. No problems
Also here is some information about Frank 90 year old He was doing CIC for 3 years and was doing well His prostate started to bleed. The doctor try to get him to do a Turp but they also told him that he will never have a natural flow. So way have it in the first place
Thy put him in the hospital and cauterize the prostate 2 time. Still bleeding. They sent him to another hospital and they did a PAE on him and the bleeding stopped. He is doing very well now.
Be safe everyone…Ken
Thanks, Marty. And yes, it was the Procept-Biorobotics site I visited. When you go to the FAQs and expand “How does Aquablation therapy work?”, there’s a video. At the very beginning a graphic comes on at the bottom “Not available for sale in United States”. Maybe that was on there before the FDA approved it and they simply haven’t removed it.
More questions to ask!
Ken
I’m not sure what you mean when you say, “Aquablation gets rid of the whole prostate.”
They remove as much or as little as they deem necessary to improve flow. The doc can be as conservative as you want him to be. It’s a very precise process done on a multidimensional real time ultrasound with a cystoscope also involved. The doctor draws on the screen the region he wants removed, avoiding the seminal ducts and sets the robot loose (with a kill switch under his foot) and 4 minutes later the procedure, which he watches real time, is completed.
i ejaculate as much, if not more, than prior to my Aquablation. I’m sure not having a full bladder all the time, post void, certainly doesn’t hurt.
Anyways, both of us are happy with our results, which further goes to demonstrate your point that different procedures work for different needs.
Marty
Marty I’m very happy for you that it works
I have not looks it to it much after my talk with Mr Barber when he wrote and told me that the procedure can not be a justed.
I still have his e-mail. What I asked him was can it be started a little farther away from the bladder neck to avoid the seminal vessels. That is when he told me that the procedure cannot be a justed. That was also the email that he told me that if I wanted a procedure that was 100 % no side effects to have a Urolift because it does have a good outcome and no side effects.
We can go back and forth. Men can pick what they want and for me it not a go
Be safe and I hope all stays well for you…Ken
Ken, I just have to jump in here and push back on some of the comments you are making as they are inaccurate, misleading and potentially harmful to others reading the forum.
Aquablation does not remove the whole prostate (“it’s the whole prostate or nothing”). That is a preposterous statement. I just returned from an appointment with one of the two urologists you mentioned at Ga Urology. I explained my situation to him, that I’ve needed to have something more aggressive than a Urolift done for over a year but have been on a quest to find a doctor and a technique that will minimize the risk of the side effects you’re referring to. First words out of his mouth - it all depends on what the patient needs. He said he had an elderly (70+) aquablation patient told him he didn’t care about RE and just wanted to get rid of the BPH symptoms. So he programmed the ablation contours to remove the maximum amount of adenoma, including the area around the ejaculatory ducts. The patient is happy. He said in my case he would design the contours so that the bladder neck would be left intact and the veru, its surrounding tissue and the path of the ducts to the veru would be undisturbed. He did say he cautions all of his patients regardless of the BPH procedure to assume you will get RE because there is always that chance with the exception of Urolift. That is just a doctor counseling his patient to understand the risks.
Moreover, what would be the point in a company developing a new approach to a problem (damage caused by heat, lack of precision and long operating times) and then have it set up so the only thing a surgeon could program the machine to do would be to ablate the entire prostate? That’s just nonsensical on its face.
It is similarly inaccurate to say that all TURPs are alike and 100% result in RE. There was just a guy posting here recently who had a bladder neck sparing TURP done at Stanford. I consulted with a Uro after at least two of his patients posted here described him saying he doesn’t hear about RE from his TURP patients and thinks the % who get it is a few %. He told me the exact same thing and explained why. He resects to create a void with a different shape and less volume than most surgeons do with TURPs. Those two guys told me they had no RE after he did a plasma button TURP. The term TURP stands for Transurethral Resection of the Prostate. It doesn’t specify how much is resected, what the shape of the void is, whether the instrument is monopolar or bipolar, what functioning parts of the prostate are removed or not, etc…and most importantly, it doesn’t specify who does it. You’re painting with way too broad of a brush with your bashing of TURPs instead of thoughtfully examining each aspect of a large number of variables that when performed as a given procedure becomes a unique event with varying outcomes.
Aquablation is attractive for many reasons. The surgeon doesn’t have to continually make decisions on what and how to resect as he goes, in real time. He has the luxury of less time pressure because he can design the contours using live TRUS imagery before single fiber of tissue is ablated. Only when he is satisfied with the plan does he begin cutting, and that lasts only a few minutes. He monitors the ablation as it occurs both on the ultrasound imagery and video from a camera on the instrument. He doesn’t have to deal with a bad visual field that can happen with bleeders or disorientation. If he doesn’t like what he sees, he just lifts his foot off the pedal and makes whatever adjustments he feels are needed. The most obvious benefit is it generates no heat in the tissue that could damage parts of the prostate or nerves that need to be spared. The uro I just met with compared traditional hand-held techniques to the old-fashioned kind of milling machine that was operated manually. They are both subject to human error in performing the process. Aquablation is analogous to a CNC machine that mills a block of aluminum exactly and precisely as it was programmed to do in software. In my humble opinion it represents the future of surgical intervention for BPH.
So I for one would appreciate it if you would stop being so cynical and negative towards any BPH procedure other than UroLift. Resecting, abating, vaporizing, cauterizing, etc., tissue have been surgical methods used for decades and centuries. If you don’t like them, fine, but please try to be more accurate in your criticisms. Likewise with your fear of having any tissue removed. This ain’t rocket science, if a pipe is stopped up, you have to remove what is causing it to be stopped up. UroLift is a unique way of dealing with the problem but is not without its own risks and shortcomings. In my case the benefits were noticeable and only lasted for a couple of years, but now I have foreign objects in my body that are serving little to no purpose. I hope it continues to hold up for you for many years. We should all be so fortunate.
“The steam is giving in a injection at 70 Celsius which is 158 Fahrenheit. The doctor that was talking about this said that it cooks the prostate tissue. Did you also know that at 131 Fahrenheit causes second degree burns and at 162 Fahrenheit the human tissue is destroyed so they are just under that.”
Steam, by definition, has a temperature > 100 degrees Celsius at any pressure > 14.7 PSIG. The tissue is heated to 70* C from the heat released when the steam changes state back to liquid water, not by the temperature of the steam. I think you’re being overly dramatic and misleading by saying tissue is cooked and comparing to 2nd degree burns. That is the point – to kill the tissue. If it’s very painful it’s because the patient opted to do it without anesthesia or opted to remain awake but was not given a prostate nerve block injection on each side of his prostate prior to the injections.
Hello Russ
I’m sorry that you feel that I am being over dramatic but I am just telling you what the video that I watch said.
The video was on Med Tube. The Doctors name was Ulrich Witzsch It was a SMIT 2019 The video was on Rezum and they did talk about 70 C when I look it up it did tell me that it was 158 F and the doctor did say that the prostate tissue is cooked.
This is all I have to say on this subject. Have a great day…Ken
Russ I’m sorry that you don’t like what I’m saying but I am only telling you what I read. I have not looked into Aguablation since August of 2018. It was nothing I would do. If they have work out some of the bugs that great. If you feel it is right for you go for it.
But 2 years ago they were not adjusting anything per Mr Barber. If they can do what you are saying that is great.
I do know there are many Turps and The newer ones are much better then the old stand by. With the button Turp the doctor has more control of what he is cutting. But these take more time so you must find a doctor that care about your concerns.
Over time any procedure can fail. You said that your Urolift only lasted 2 years Did the doctor check if there is another problem. Could be you sphincter or your bladder The prostate can’t always be the trouble maker
As of 3 years ago when I had a Ridge Scope done my prostate was still wide open but my pressure was not good. I had no problem peeing I found out I had a very tight external sphincter. That was slowing everything down I take Vesicare 10 mg It is a muscles relaxer. And I can tell the difference.
Like I said you can’t always blame the prostate you have other parts that can go wrong.
If the doctor can do what he said then that would be great but you never know if you are going to get retro. That I will not live without. God gave me that function and I am going out with it.
Also the last thing I’m going to say is When you talk to the doctor in Georgia. Did they fix the bleeding problem. I know 2 years ago after the procedure that had to put a balloon in where the prostate was and leave it there for at least 2 hour to stop the bleeding. I hope they fix that problem
This was because the water jet did not stop the bleeding like the other procedure.
Ken
Ken, how could the aquablation contour mapping software not be adjustable? By saying that you’re implying every single prostate it is used on is identical. Of course it’s adjustable. The entire concept of the Probeam system is based on that. Maybe you mean something different from what I’m interpreting from what you’ve written.
2 years after my UroLift my uro ordered a urodynamics study. It showed conclusively that my issue is obstruction, not detrusor weakness. That was visually confirmed by cystos last December and this past August. From the operative report on the cysto done in August: “None of the Urolift surgical clips were visible.” I had 5 implants. My lateral lobes were/are obstructing the channel and median lobe is pushing up into the bladder neck.
In the WATER I and WATER II studies done both electrocautery and a “tamponade balloon” were used at different points. By the time they got to WATER II I believe they were using a custom designed tamponade balloon exclusively. The uro I met with said he uses both for different purposes, though he only cauterizes one small area where the rotational motion of the shaft can cause bleeders. But the balloon Foley needs to be in place 2-5 hours post op to achieve haemostasis. That’s the main reason aquablation patients need to stay overnight. As with almost everything else in life, that drawback with aquablation is a tradeoff. The benefit gained is no collateral thermal damage to tissue, nerves, etc. that need to be protected.
I understand you’re repeating what you heard or saw. Sometimes context is needed. The theory of operation of Rezum is that the heat released by the steam changing state to water is what causes cellular necrosis. Perhaps it’s a technical point, but goes to understanding of the process. You are correct that the tissue does get heated to a temp of 70 C, just not how it happens.
I’m happy that they fix that problem with the bleeding.
But one last time I am going to say this. I was told 2 years ago from Mr Barber that it could not be adjested that is what I am going on. If they fixed the problem good for them.
Also 2 years ago when Mr. Barber brought the procedure to New York they were still using the old balloon way. Glad they fix that to.
If you want that procedure go for it. That is your choice.
Ken
Russ,
Balloon Foley is what was used on me. I didn’t realize that was its purpose. Thanks for info.
Marty
No problem Russ
I just wish more doctor would take the time to explain the procedure to the patients. Not 5 minutes and you out. I know not all are like that but they are in the symptom
Have a great day…Ken
This is about Aquablation
This was a question that I sent to Neil Barber August of 2018.
I ask him if the area around the seminal canals can be avoided to help with the ejaculation. Less of a chance of retro
This is what he wrote me. I’m afraid the planning is in real time when you are asleep You can’t identify the prostatic or common ejaculatory ducts. But you could plan to be conservative at the bladder neck and where the ducts emerge in the hope of higher rates. If you want a procedure that 100 % preserves all sexual function. Then the Urolift is the only option with good data behind it.
I did make a mistake. When I watch the video. It does look like they remove the hole prostate. That is not true it only removes half of the prostate. Sorry.
After reading his reply on the second email. This is what he said .Aquablation like all procedure remove roughly half of the prostate to make a wide tunnel. The bladder neck is important in maintaining normal ejaculation should semen be delivered in the prostatic urethra ( There is always a chance that will be cut )
So having a good doctor to do any procedure is the key.
God Bless to all…Ken