Prostatic Artery Embolization procedure

Men's health
21

Caringbah your point is very valid. While there are many good, knowledgeable and caring urologists, this procedure takes part of their proverbial bread away from their table, as well as primacy of treatment. and we are all human.

For example, a govt study showed that doctors who have a financial interest in imaging centers tend to order imaging studies between 30 and 50% more often for a number of conditions than doctors who don't, everything else being equal.

Yesterday I had a new patient who presented with symptomatic right testicular varicose veins, the pain is getting worse since he does manual labor, but said he had refused the surgeon's recommendation for surgery. I told him that he should consider having an embolization procedure instead, and to see an interventional radiologist for a consult.

22

Yes some of the urologist say the same thing and try to force you into The Gold Standard.  I like the one about when they tell you about the turp they kind of surgar coat the reply and say you may get retro but everything else will be the same.  How do they know.  All men are diffrent.    I ask my urologist alot of things and he is very good He told me that is a text book answer because that is what they learned being all men are made the same way  My urologist also told me about the turp procedure He will not do one unless there is nothing else.  He all ways trys other things first.  My prostate was stuck together He did a uro-lift on me in 2015  works greats.  I trust him but he knows how I feel about my prostate It is staying right were it is.  Life is to short to give up one thing for another.  Take care  Ken  PS  I also told him that sometime a urologist forget that they are men and what they are doing to another mans body.  My urologist smiled and did not say a word    

23

I bet the first thing the doctor wanted to do is cut it out and put a prostheses in.  And told him it will look and feel the same...Ken

24

Hi 333health

Hi Gary,

Just want to know if your cystoscope showed any enlargement in the median lobe. Do you think exercise after PAE would delay improvement. Do you think frequent sex would delay improvement. I noticed that you have both the profound knowledge and the experience of going through PAE procedure and your contribution is so invaluable

Fouad

25

Dear 333health.

I could have written your text, every word of it.

I am also a MD, my urologist was also against PAE and exactly 23 days after my PAE I feel exactly like you.

If my prostate grows again in 3 years I will embolize again, as simple as that.

The sad side is that urologists all over the world just don`t tell patients about PAE.

26

Thanks so much for your report. So helpful.

27

Congratulations on picking the winning procedure.

I had a TURP 10 years ago. I had been getting up 4 to 7 times a night. I did then get some retrograde action, but not always. 

In the ensuing years, my BPH continued. I'm now 68. I was back to being up 4 times a night. I was considering another TURP, and was not happy that it was the only option. Then I heard about the PAE in a podcast of the Radio National's Health Report in November 2015. (I'm in Melbourne, Australia). I asked my urologist about the procedure, and he didn't think it was a good idea to be leaving dead tissue in the body. He was at least aware of the procedure.

I persisted. The procedure did not appear to be available in my city. My doctor found a local interventional radiologist - Dr Dinesh Ranatunga. He does the procedure under the guidance of Dr Glen Schlaphoff who is based in Sydney. You can read elsewhere that Dr Schlaphoff is the guru for this procedure!

These two gentlemen did my bilateral PAE on 29-Aug-16 through the radial artery. Dr Schlaphoff came down from Sydney. I had a general anaesthetic and was under for 5h15m. And now after such a short time,  just 13 days later, I couldn't be happier. There was no pain. Just a feeling that something had happened behind the bladder.  I didn't sleep much on the night the PAE was done, and was peeing every 20 minutes or so with the intervals increasing as morning arrived. Since then, matters have improved dramatically. I've been up just once a night, every night since. And that is totally acceptable. I hear it just gets better and better. 

I appreciate that for me it is early days yet, and am not scheduled to see Dr Ranatunga for another two weeks. But so far, I'm delighted. 

Once the PAE procedure becomes well known, more and more men will be demanding it. The procedure is a huge leap forward compared to the TURP. The side effects are miniscule compared to an almost certain guarantee of having your sexual equipment or functioning damaged with a TURP.  Sex seems to be important to us men! Who knew?

So I'm telling everyone I can about PAE. I haven't yet got to the stage of wearing a button that says "Ask me about my PAE", but I think the cause warrants that level of support.

Thanks for publishing your story. Anyone in Australia who needs more details is welcome to contact me.

Les

28

Congratulations!....I hope your PAE becomes a long term cure for you...Thanks for sharing your experience...

29

Hi 333health - thanks for answering all my questions and again all the best to you.

I ask all these questions because I also had the PAE performed a week before yours at UNC. In my case my BPH was a 300gm prostate with no median lobe - just 2 very large lobes in the transitional zone clamping down on my urethra. I have been on Avodart and Xatral for 10 years. My psa is about 11 so the density is very low. I have also been extensively screened for PCa.

Dr. Isaacson went throught my radial artery. He said I was the ideal candidate for PAE and easily performed a bilateral embolization with great success. But sadly I have not seen any improvement in 5 weeks. I had to restart self cath in the evening a few weeks ago and take out 350ml so I can sleep a few hours.

Also I had absolutely no pain or discomfort at any time after the procedure which seems contrary to dynamic necorsis. I will be travelling again to Chapel Hill this Monday for a 3T MRI ( at my request) to see why the procedure has not worked for me. I fear I will be facing a robotic SP by December as my voiding continues to worsen. I am very discouraged by the outcome though Dr, Issacson and his staff were very kind. Thanks again for your repsonse and I all the best. Neil

30

Great post, Les, and its wonderful to see your results.

About your urologist's comment that it was "wasn't a good idea to leave dead tissue in the body": it is striking to hear this type of response.

Embolization for different tissues has been taking place for many years, and safely. It has been for many years for a number of conditions, including but not limited to uterine fibroids, for tumors of the extremities, for testicular varicosities, for severe prostatic and bladder hemorraghing   (how could a urologist not know that?) Arteriovenous malformations, hepatocellular carcinoma, etc.

If your urologist is really interested in the histology of prostatic tissue post-PAE, you may want to look up and send him the following research article, found in the Brazilian journal of urology:

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia.

The authors include some of the pioneers in PAE, such as Carnevale.

George Camara-Lopes, Romulo Mattedi, Alberto A. Antunes, Francisco C. Carnevale, Giovanni G. Cerri, Miguel Srougi1  , Venancio A. Alves1  , Katia R. M. Leite

 

31

Sorry that you havent improved.

Whats a 'robotic sp'?

Thanks

32

I had a REZUM procedure ~ 2 weeks ago...I am on a direct catheter for a month so it's hard to tell if the procedure will help at this time...I have experienced a large amount of blood in my urine two different times since the procedure. My urologist states that's normal and to not be concerned. Nevertheless, I am concerned....Should I be?..l.

33

Thanks jjjj - robotic sp is the da vinci robotic simple prostatectomy which basically reams out the inside of the prostate while leaving the capsule and nerve bundles and sphincters intact. Neil

34

Hey JJJJ  Please think before you do anything.  My friend was talked or force into haveing a Robotic prostatecteomy for prostate cancer.  He had a 21 needle biopsy 10 out of the 21 can back with cancer cells.  He doctor told him that his only chance was having this done.  He also told him that he would do a nerve bundle sparing so he can still have sex with no problem.  Now was 50 at the time.  Not getting any other information he said ok.  He just moved back to florida.  He is so depressed that he wants to die.  He can have sex unless he gives himself a shot in his penis and for a orgasm.  If he can get it it take him 1 1/2 hours to have a very mild orgasm.  My friend told me it not worth.  He get to tired and gives up.  He said he wish he would have waited.  He broke down the last time I saw him because he does not have a normal life anymore and just want to die.  A man at any age should not have to go through life.  He ask the doctor about it and all the doctor said was well you don't have cancer.   Makre sure you ghet all the information and don't have anything done before you way all the side effects of any procedure......Ken   

35

Sadly, I had  a similar encounter.  I mentioned PAE and my urologist claimed to have never heard of it.  I briefly described what I knew of it, and a young female urologist who was with him to observe spoke up, and said she knew of it as it was being done in Boston where she was previously.

Unfortunately, I went ahead with Green Laser TURP and six months later, I have extreme/total incontinence still. ( After the GL procedure, he had to do a Gyrus TURP to clean up after the first.)   I do kegels, core exercises, and use a stimulation device (via an anal prob) and nothing seems to make a difference.

My urologist refuses to discuss the AMS 800 artificial sphincter, say that it would mean that "we've failed."   Every day I go through 6 to 8 heavy duty pads and Depends pull ups doesn't speak of success to me. The practice is apparently wanting me to wait at least a year before considering the AMS-800.   A reference I found in a urology journal article in 1989 says that 99.5 percent of patients have partially or fully become incontinent.  I wonder if data exist for the unhappy 0.5% as to what happens after two months?   Is there a longitudinal study  for this cohort?

36

EDIT: Sentence in last paragraph should read: A reference I found in a urology journal article from1989 says that 99.5 percent of patients have partially or fully recovered continence after two months.

 

37

Dear 18r, 

I totally agree with you. I would call this conduct unprofessional. Urologists have a duty of care to educate themselves about the best methods of treating BPH. 

In my own experience with BPH I consulted three urologists...one wanted to do TURP, the other Holep, and the third wanted to do open surgery on me. Each called their proceedure the "gold standard" . 

I then found about PAE and had it done 18 months ago. 

The overall impression I had of urologists was that they are a greedy, arrogant bunch more concerned about their own bottom line rather than the best interests of their patients. 

38

Hi Neil,

I've been seeing my uro guy for about 4 years. My treatment was Finesteride and Tamsulosin. My prostate size was 200 and my psa was very low, like .75. The Uro guy wanted nothing to do with the PAE, not even discussing it. He wanted me to have the Supre-prostalectomy, which I believe is the same as a TURP. Anyway, when he talked about a week in the hospital with a catheter, bleeding, incontinence, etc., I told him forget.

My peeing 6 to 8 times a night was history almost overnight with the PAE. My interventional radiologists went in via the femoral artery without anesthesia. After the 5 & 1/2 hour proceudre, I laid on my back for another 5 hours. They then took out the catheter and I was released. I had no bleeding, no contraindications from the procedure, and have experienced continuous recovery from the BPH symptoms. a week after the procedure I was off both Finesteride and Tamsulosin.

Men with B.P.H. need to get out of the stone age of T.U.R.P. and enter the new age of P.A.E. being done at a Medical Centre near you. If not, then go find one. Your on your own cause your Urologists ain't helpin' you at all!!!.

Hope this helps.

39

Thanks Gary for your response. It is good to know about another success story. Hope you continue to improve every day. Neil

40

Glenn  I am so sorry that you are going through this problem.  Maybe you should not have let your urologist talk you into the turp and went and talk with athe people that do PAE  Maybe you wou have has better out come  Ken