In your opinion why do you think you responded so quickly to the PAE procedure?
Hi Neil,
I don't think that I responded particularly quickly to the PAE. A couple of other people on this thread had a PAE and said that they had similar experiences. The research I have seen shows that those that respond well to a PAE (aprox. 80% or so from what I remember in the literature) see significant changes in a month. It seems 3 months is the time to wait forthe maximum changes to be seen.
One condition that research shows PAE does very well with is acute urinary retention. That is, the bladder stays pretty full after you urinate. The concern with that is that the urine could end up moving in a retrograde fashion back up the jets to the kidneys, and damage them. I had that, among other things. And operator experience, research shows, makes a difference for this procedure.
I had a patient come in about 5 weeks ago with symptoms and signs of portal hypertension and other issues, including low urinary flow.
The CT scan showed that his kidneys had been damaged by urinary backflow and the specialist that I referred him to told him he needs to be on dialysis. Last time I saw him, last week, he said he had a catheter and a bag under his pants to collect the urine. They had tried direct lines from the kidneys to the bag but he moved and dislodged them.
I shuddered to think that could have happened to me if I had not done an ultrasound in that area because I wante to check myself for a possible sports-induced inguinal hernia. The US person asked, incidentally, if I had used the bathroom before the procedure, because my bladder was full. I knew I had a problem then. I had urinated a couple of minutes before the procedure.
On the subject of acute urinary retention, which a lot of men with BPH have (if you urinate and little comes out, then, of course, a lot usually stays in the bladder). This isn't medical advice, and a good urologist would know this and more what to do, such as more complex and necessary urodynamic testing and CT scan with contrast, but one thing to consider is a simple and inexpensive test that can be easily paid out of pocket, if necessary. Not everyone has adequate insurance coverage, can tolerate the contrast agents, or the money to pay for more sophisticated testing.
There is another advantage to this: it can be an inexpensive way of getting a pretty good sense for the size of your prostate, all done at the same time.
An ultrasound of the bladder before and after urination usuall costs a little over a hundred dollars or so in most local private imaging centers. It shows pre and post functional urination bladder volume, or post void residual. Normally, the amount of mls,( millileters) of urine post urination should be close to zero.
Most young men, and the research on this varies, have around 350-400 or so mls of urine when they go to the bathroom. As we get older, that number drops to around 250 mls each time, but the total daily amount urinated stays the same, which is why older men go to the bathroom more.
If you buy a cheap transparent four-dollar plastic urinary container with the mls listed on the side, (ebay/amazon wth free shipping) you can get a sense for what your output is. That is what I do with mine, and at home, I get a rough sense for output. Hopefully with time mine with increase.
If you are under a 100 ml or so with your urinary output, as I was, you could be having significant urinary retention. I had it, and it likely created a diverticulum because of the pressure I was using to try to get the urine out.
Stones usually are created in a diverticulum over time which can make it harder for UTIs to get eliminated, since the organisms can nest there. I have them and now need to see about getting them out.
I mentioned another advantage to the ultrasound: performed pre-void, with a full bladder, it can be an inexpensive way of getting a pretty good sense for the size of your prostate, all done at the same time, same cost.
The digital rectal exam by your friendly urologist or general practitioner, (hopefully someone who can't palm a basketball), can only feel the central part of the prostate, although they can get a sense for the hardness/tone etc of what they do palpate.
The manual exam does not reveal the total volume of the prostate. There is a rectal probe that can be used as part of an ultrasound that can give a very good idea of the size of the prostate as well as give other info. There is good research on this, and getting an ultrasound for this would be inexpensive.
The problem is, when I spoke to the medical director of a large multi-location imaging center in my area about it, because I wanted to start ordering as an inexpensive screening test, he said that they were not doing them because urologists still preferred to use the digital exam. As a result, this imaging center had not wanted to invest in buying probes that would not be used.
Whatever procedure you end up going under, the urinary measuring bottle is a good way to track urinary outflow progress. Even if you haven't had a procedure, over time using it will give you a sense for whether your output is increasing or decreasing.
If it gets to be low enough, consider getting checked so that you help to avoid what happened to the patient I mentioned.
I hope this info is of help, Neil. Perhaps other people on this thread who had a PAE can chime in.
Hi Fouad,
My doc said post procedure that I could exercise a week after it, although he said some recommend 2 weeks of waiting. He said don't use a bicycle for 6 weeks because of the pressure it puts on the prostate. I don't know about the frequent sex thing, it was not mentioned as part of the usual post PAE routine.
Sorry to hear that, Neil, it must be a huge disappointment. please keep us informed. I wish you well.
Glenn, it's obviously your call on this, I just wonder why a physician denies moving forward when a procedure has not worked because of what seems an ego issue.
Neuromodulation has shown to be effective in severe incontinence. It's been half a year since your failed procedure. If it were me, I would want to work with a urologist, and soon, that would be looking forward to trying something else to help you. Best of luck, let us know
Thank you very kindly for this helpful response ( I wish you had a first name I could address as 333 sounds like an android!).
I did have all the US tests you mentioned back in April as well as a cytstoscopy in June. My bladder did shows signs of hypertrophy and trabeculation but there no stones (signs of calculus) or diverticula. Also there was no median lobe or signs of bladder floor elevation. All this was remarkable given that my prostate was measured by a TRUS 5 years ago at 150gm and in April by another TRUS at almost 300gms. All this data was why Dr. Isaacson thought I was an ideal candidate for PAE and indeed my procedure was an outstanding technical success but so far a clinical failure.
Here's my coda: Tomorrow I fly (from Toronto) back to UNC to have a 3T-MRI of my prostate to understand better what is/is not happening. I will report my findings here. Thanks again "unit 333" for all your good advice and time - I'm sure we all learn a lot from you and appreciate it greatly. Neil
maybe you should consider a second opinion and have your mp3TMRI done and read by someone alse, like top expert in prostate MRI, Dr.Busch
Thanks andrze - I agree with you and plan to do just as you suggest depending on the MRI results. While I am very claustrophobic I am greatly looking forward to this MRI so I can move forward one way or another. All the best to you. Neil
Neil,
don't forget to get CD from your MRI, as well as MRI report, you can easily transfer MRI images free using wetransfercom website(up to 2GB) I used it to send it to some MRI experts in europe, or just send your CD, to Dr.Busch, as I did, he charges $200 USD, for second opinion and has a habit to call you personally and discuss your images in detail, as was in my case and as others reported or whoever you think is the most qualified,
let us know how your visit turned out,
Andrew from Calgary
Thank you for making me aware of that option. I would think that among the 12 other urologists at my doctor's location, one of them will be aware of this. If not, there are three university teaching hospitals within an hour of where I live, and I know that one of them uses neuromodulation for pain control. Neuromodulation would, on the surface, seem a less invasive option than the AMS 800.
I wish I could find data from longitudinal studies for individuals who were significanlty incontintent two months post TURP, showing how many resolve at 4 months, 6 months, 8 months and so forth.
Hi - did you ever figure out the cause of your obstruction - like a median lobe? Good luck.
Thanks Andrew - that is important information and I appreciate it. Take care. Neil
Neil, I'm sorry to hear that your PAE doesn't seem to be successful...And, it's too soon to know whether my REZUM will be successful too...I'm just hoping and praying at this time....Likewise, I will pray that you find a successful treatment for your prostate problems....Take Care!...
Thanks Randy for the prayers and I will say a few for you too. I wish we all did not have to go through this - there is so much else to do. Take care. Neil
No, not sure. Typically, it is the transition zone where the hyperplasia occurs that leads to LUTS. It forms roughly the shape of an innermost circle around much of the urethra. Around it is the central zone, then the periphery. Histologically, there isn't much difference between the zones, or lobes.
Let us know what the doctor said, its a learning curve for all of us.
Didn't your cystoscopy give you an idnication of the cause of your obstruction? The urologist who did my transurethral U/S had told me I had large median lobe that was obstructing my bladder outlet but I found that curious as prednisone (taken for asthma a few times ) would totally clear up my BPH symptons for a week or so. So I had another uro do a cystoscopy (which I watched realtime) and in fact I had no indication of a median lobe at all - just a very long hyperplasia in the transitional zone clamping down on my urethra.
Do you have a theory for the cause of your obstruction? Did you have an MRI to get a better visualization of the pathophysiology of your prostate perhasp along with a TRUS for a true 3D dynamic scan? Did you ever self-cath?
I had to cancel my trip today due to illness overnite and have rescheduled the scan for 2 weeks from now. I had talked with Dr.Isaacson about embolizing down into the transitional zone where the BPH resides, as you describe but he said he prefers to stay clear of that region because of the dangers of embolizing the urethra. Perhaps with large prostates that could be why the PAE is less effective or takes longer? All the best. Neil
I curious. I see many here talking bad about TURP procedure. I assume you're referring to any procedure that is done through the urethra. I see no mention of HOLEP surgery with done through the urethra. I have read great things about this procedure. The only down side is retrograde ejaculation. I know that sucks but seems to me this procedure gives the most bang for the buck. It also seems to give lasting relief from BPH
Thd TURP is just "one procedure" for prostate problems while there are "many", ie. 20+. Their success depends on your doctor's experience performing them successfully, as well as, the specific type of treatment being appropriate for your "individual" prostate problems...I and many others on this forum have chosen not to do the TURP, because "too many patients" confirm "too many" complications and side effects, some of which are irreversible...My first URO DOC could only offer a TURP so I chose a URO DOC that was recommended to me that offered non-invasive alterative prostate treatments and had a long history of success. He ran a Lot of Tests and determined the REZUM was the Best Treatment for My Specific Condition which, even Dr. Isaacson agreed with (PAE Specialist)...Thus, I feel like the REZUM offered me the best chance of success.....We'll soon know when we try a TRIAL VOID next week and repeat it if necessary until the bladder-prostate perform as they should...At least I'm not experiencing Any Negative Complications nor Pain, at this time, due to the REZUM....I hope my TRIAL VOID is successful and I can "regain My Normal Life"...
Good info Randy, thanks for the post. Can you tell us what you clinically presented with that led to REZUM versus PAE as being chosen the best procedure for you? Good luck next week....may the flow be with you
What the urologist said was that I had the classic signs of obstructive urinary flow due to BPH. You have an anatomical variation that may explain your lack of success, I don't know, but it will be interesting to see what Dr. Isaacson tells you.
By the way, for those who want to know early on with more precision how they will fare after a PAE, there is a research article I ran across that said that an MRI taken 30 post-procedure of the prostate can give a good clue as to success in the future. It said the amount of necrotic tissue (more is better) seemed to be a good indicator of success.
Also, for those that are contemplating PAE, since it seems that tissue changes rather than size reduction account for almost all of the benefit, similar to taking an alpha inhibitor, I wonder if those that have had good success with them are more likely to do well with a PAE.
It would be a very good paper for some to write. A retrospective study, if that information is available. There is still a lot that is not know about why the PAE works. It's not about the size: I mentioned in another post that in 3 years time, the prostate is almost the same size as before, but the benefits don't change much, at least according to research so far.