I've suffered from BPH for 30+ years. Had a TURP twenty years ago. BPH keeps coming back. Bad LUTS for years. Medication for a long time that no longer helps. Recently diagnosed with minor prostate cancer on which no one will operate. Fully familiar with catheterization. Question now is: Urolift or something else? My uro is backing urolift. I know there are people here who are for it and against it. I know there are (as with everything) potential bad effects, side effects and unhappy sequelae.
Of course, I do NOT want to wind up with a catheter for life, or any of the other myriad miseries that can result from prostate surgery/treatment of any kind. But I'm sad to say those things can happen with every single procedure about which I've read for twenty years and more. What say you, brethren? If I want relief from LUTS, if medication no longer works, what are the options with the largest upsides and the smallest downsides?
Different forum but there is Rezum procedure
FIrst, be glad no one will operate on your minor prostate cancer. Those surgeries are completely unnecessary 95% of the time and rarely end without impotence, incontinence or both.
What procedure is best will depend on the size of your prostate, where its growing and whether your prostate is the only problem you have. To diagnose all of that, you'll need to be scoped (to gauge the size and shape of your prostate) and a urodynamics test to determine if you have bladder issues as well. Long term BPH often impacts bladder function and no prostate procedure can help that.
If you don't have a median lobe, urolift could be a good option for you - if you do, then its a no go (literally). Rezum will work on pretty much any size prostate and while there is a size limit, many docs are performing it off label with good results, although the big ones take longer to shrink down so the benefits take longer to present themselves. There are plenty of threads on Rezum on this forum that you can use to educate yourself.
Also, FLA (Focused Laser Ablation) is a prostate cancer procedure that they are now testing (with excellent results so far) for BPH because many of the prostate cancer patients who also had BPH reported that their symptoms were gone after the procedure. There are threads on that one here too. One downside of FLA is that it isn't FDA approved for BPH so often you have to foot the bill yourself. But because you have a small cancer, you might be able to kill two birds with one procedure and have the whole thing covered. I would look into FLA and see if you qualify for coverage because of your cancer.
How large is your prostate?
There are several options; you definitely should have ultrasound sizing of your prostate, as well as a cystoscopy to rule out things like urethral strictures. Urodynamics may be beneficial, as well.
I think if I was in your mode and asking this question I would contact this man by sending him a personal Message on this site and I am sure he will contact you. He has first hand experience and he would share this with you.
https://patient.info/forums/discuss/urolift-walsh-urology-615827?utm_source=forum&utm_campaign=discussion-notification&utm_medium=email
Good luck. I chose FLA for BPH a year ago after nine years and it has been very good for me ever since. And, most important is NO Sexual Side Effect. But if you are interested in Urolift, here is a recent post regarding a patient.
Urolift has helped a lot of men, but it is certainly not for everyone. Factors including size and prostatic anatomy are factors. You should also have a diagnostic cystoscopy (at the very least) to rule out urethral strictures.
There are multiple procedures that your insurance will cover, but we cannot tell you if Urolift is right for you based on what you wrote. The fact that you had a TURP already leads me to believe that either your TURP was substandard, you have a very fast growing prostate, or that the prostate may not be the cause of your issues.
There are problems with all procedures. If your problem is your prostate the Urolift will open you up that may be all you need. 2 1/2 years for me Have a great day Ken
I did focal Laser Ablation a year ago and it was very successful for me. No sexual side effects and great symptomatic improvement. I am very pleased with the choice and the results. Many options out there.
Glad that your doing so good. I think a lot of men would pick FLA if it was covered by insurance. Let hope it will be soon. 2017 men need more from there surgery then side effects. Have a great day Ken
Thanks, oldbuzzard, I will check out both Rezum and FLA. I hadn't heard of either of them.
I believe FLA is covered for prostate cancer, and will also solve BPH if done properly. It has been done for cancer for years by interventional radiologists, not urologists. Urologists don't like It because they make no money on it. It is also usually covered by insurance when done for cancer. There are other threads on this forum that cover it in detail. Most men seem to get great results with it. Check out the doc in Houston. Details are on the other threads.
Neal
I wouldn't say that it isn't "liked", just that there is limited data.
Most urologists (and, actually, most interventionalists) never heard of it.
Once there is (hopefully) a lot of data and insurance covers it (and it becomes considered standard of care) , I will learn it and offer it to patients, much like any other procedure that can benefit patients.
Cost is often a large issue as well. Most of my patients can't afford their $100 copays for procedures. I would imagine that $20,000 or so would be their life savings.
Good morning Robert. You need to take control of your body. Don't let your symptoms rule. What OLD is telling you is true don't be rushed into any surgery. You said that your prostate is 70 grams so UROLIFT may work for you. it would open you up like any of the other surgery. There would be no cutting and you will heal faster. Your problem may not be the prostate it could be your bladder or even your kidneys. Find out first Take care Ken
Good morning Robert. You need to take control of your body. Don't let your symptoms rule. What OLD is telling you is true don't be rushed into any surgery. You said that your prostate is 70 grams so UROLIFT may work for you. it would open you up like any of the other surgery. There would be no cutting and you will heal faster. Your problem may not be the prostate it could be your bladder or even your kidneys. Find out first Take care Ken
I agree with everything that the Oldbuzzard has said, except to clarify the fact that Focal Laser Ablation (FLA) is approved by the FDA for BPH. The issue is not FDA approval. The issue is the payment of the cost by insurance. This is for both PCa and for BPH with regard to FLA.
This is changing. I personally received $4,700 reimbursement from Medicare. Other men have reported partial payments from private insurance companies. The fact of partial payment or not is all in the number coding of the procedure when filling for reimbursement. Again, this is not an FDA issue. It is solely an insurance issue. I boils down to the fact that if this was a Urological procedure it would have the power of the Association's lobby behind it. It does not. Interventional Radiologist are not of the numbers to have a powerful lobby representing them to the insurance providers.
I know that Urology tries to say that this and PAE are not FDA approved but this is just not true. The question needs to be why do they continue to say this? Do they really not know? Or, maybe they want you to believe that FLA is inferior to the laser procedures they do preform? Facts are the facts. If you do not believe me, pick up phone and call Dr. Karamanian in Houston TX. and he will explain it to you if needed.
Once again, Focal Laser Ablation is approved by the FDA for the prostate procedures preformed by Interventional Radiology.
"Medication for a long time that no longer helps. "
What medications did you try, and for how long? Hank
This is my opinion, and I'm not a medical expert. This site seems to attract guys who have had problems with various therapeutic procedures for BPH. I've read a recurrent theme regarding the Urolift procedure; that it's great ... for a while. Then the problems come back. It's my best guess that so many of our brothers-in-suffering are told they can give up their prostate medications, and so they do. The procedure doesn't change the architecture of the prostate by biochemical means. It remodels the prostate by mechanical means. The prostate may continue to grow. That said, some experts argue that even if the prostate does continue to grow, the ability to urinate remains unencumbered. Hope this helps.
Doc, I'm scheduled for either a Rezum or a Urolift at the beginning of 2018. I am 66 years old, and the prostate is approximately 45 g. It is controlled with dutasteride. I've heard from guys who had a Urolift procedure. Some of them raved about - for two or three months. We're told that we can give up prostate medications. Though I could be wrong, my assumption is that, once a man gives up a 5-AR inhibitor, the prostate may resume its growth, thereby negating the beneficial effects of a Urolift. If that is the case, I'd rather have the Rezum procedure. My question is this: In your experiences, how many men - give or take - were indeed able to give up their prostate medications, once and for all, with minimal issues? Final note: We're grateful for your opinions on this site. You've cleared up a lot of issues for us.
An advantage of FLA is that one can avoid RE, a major negative side effect of TURP. But this is irrelevant if your previous TURP has caused RE.
Hi Dr. Jersey,
Perhaps I am unfairly hard on urologists. I'm sure there are some reputable, patient centered ones. I'm sure you are one of them, or you wouldn't be taking the time to deal with us.
That said, I'm also sure that there are some who are not. Medicine is a profession, and I agree with you that there are many urologists who have no idea what a Urolift, PAE, or FLA are. If they are real professionals, they should be keeping up with what is new related to their profession. My urologist had not heard of any of these procedures until I told him about them. And, there IS research on PAE, and, I believe, Urolift. The ones who don't keep up, and the ones who are only in it for the money should be drummed out, but I have never heard of that happening, or even of a mechanism to do that. Have you?
Neal