Gat Goren Method part 2

Martin,

I looked at the paper on PAE you referred to. It was interesting. The authors reported the results of PAE on two subjects with acute urinary retention, and reported their prostate sizes as measured by both MRI and trans-rectal ultrasound. In both subjects, the prostate shrunk rapidly in the first month following the procedure, and then leveled off over the next five months. Interestingly, the ultimate prostate sizes closely matched the formula developed by Dr. Gat for his GG patients. I discussed this formula in my previous post.

Here are the ultrasound measurements of prostate size (in grams) for both patients:
PATIENT NO. -- BASELINE ---- MONTH 1 ---- MONTH 3 ----- MONTH 6 ---- DR. GAT'S FORMULA
---1 --------------- 63 g--------- 42 ----------- 38 ----------- 38 -------- 63-(60% of (63-20))=37.2
---2 --------------- 51 g--------- 41 ----------- 38 ----------- 38 -------- 51-(60% of (51-20))=32.4

It would be rash to draw inferences from a sample size of just two cases, but I can't resist. First, the prostate shrinkage took place very rapidly, within the first month following procedure. I think that this is much faster than GG patients have reported it. (And you didn't see any shrinkage in the first six months at all, Martin.) Second, the ultimate prostate size of these two PAE patients seems to be close to the averages reported by Dr. Gat in his GG patients. It was merely achieved much sooner. I find that interesting.

COMMENTS:
1. I chose to report the paper's ultrasound measurements rather than its MRI measurements--which were a little more dramatic for Subject 1--because Dr. Gat based his formula on his patients' ultrasound measurements.
2. It's possible that the patients will show further improvement over the next several months, but from the data, it doesn't look like it. It seems that their prostates ceased shrinking after 3 months.
3. The authors reported that they were able to embolize both arteries in Subject 1, but only one artery in Subject 2: This might explain why Subject 2's prostate didn't shrink more.
4. Both patients had acute urinary retention, a serious complication of BPH. I would have liked to see results of urinary improvement reported too, but the main idea was that the PAE procedure cured the acute retention and allowed the removal of urinary catheters in a couple of weeks.
5. For the record, my prostate size decreased from 51 g at baseline to 22.3 g at 12 months following GG, which is even better than the 32.4 g as predicted by Dr. Gat's formula. It's possible that this good outcome was exaggerated because of measurement error: the baseline measurement was a trans-abdominal ultrasound and the 12-month measurement was a trans-rectal ultrasound.

-dave

Post Edited (Chicago Dave) : 6/9/2013 12:09:40 PM (GMT-6)

Martin,
the PAE that Dr.Bagla is doing is less general, more specific, and supposedly more accurate in the placement. He's doing the smaller arteries along the urethra.

They (Dr. Bagla) have had absolutely no complications in their procedures.
Also, the only patient they had with poor results was a heavy smoker that they told him he must quit smoking or the procedure wouldn't help. He didn't quit and it didn't help much at all. The rest report amazing improvement.

Dr.Pisco's procedure in Portugal has had some of these complications, albeit very few and he has done many of them. Ischemia was reported. Also some pretty intense bruising due to the embolisms not being placed quite as accurately. Nothing serious in all reported complications and all resolved on their on, or in the case of the ischemia, a minor procedure fixed the problem with no further issues.

My understanding is that Dr.Pisco, of course, uses angiogram to guide his placement, but Dr. Bagla also uses extra diagnostic machine (mri I think) that gives him a much more precise placement of the embolism than is possible in Portugal.

Now, I'm not saying that either the GG or PAE is better or worse. they are different with different results.
It seems The results are much faster with PAE and also a higher % of success, but the GG is also supposedly fixing some other problems at the same time.
And insurance will likely cover the PAE with Dr. Bagla.

Who knows, though, I might do the GG down the road if my results aren't as good as I hope for.

This is what Dr. Gat said to one of our members (Michael) on 9/30/12 regarding PAE.

"coming back to the prostate arteries embolization, I asked Dr Gat about this via email earlier this year, and encouraged him to attend an embolization symposium where prostate artery embolization was being presented in the US. His response:

"Unfortunately we are now late for presenting our knowledge. It is possible that we will attend the meeting.
In any case this meeting nay give a push towards positive direction namely, "from knife to catheterization" even though their attitude is completely non-optimal and again targeted to the symptom by strangling the enlarged prostate without a knife."

"It is not the same logic and hence completely different mechanism of treatment. It treats the symptoms and we hope they succeed. ."

It is encouraging that it is a non surgical (embolization) approach."
--------------------------------------------

Optimally, I would guess that getting to the core of the disease (BPH) is the main aim of Dr. Gat's research. And the cause according to Dr. Gat is the mechanical failure of the spermatic valves. So, if this is the case, PAE is certainly a better substitute for TURP or Greenlight surgery, but again, it is a bandaid that treats the symptom and not the cause. By "strangulating" the prostate as Dr. Gat says, less blood goes to the affected area, bringing less nutrition and oxygen. How this affects complimentary organs after a long period of time is anyone's guess. But, given rph guy's limited choices and dire situation, I believe he has made the right decision. So far, PAE seems to have had excellent success.

Hi all, I am suffering from a large Varicocele (grade 3) as well as an enlarged prostate for my age. I have a couple of questions regarding the Gat and Goren procedure:

1) Does anyone know if the Gat and Goren method for treating varicoceles is the same procedure for treating prostate enlargement? If I get the varicocele treatment from Dr Gat and Goren that automatically takes care of the prostate problem too? If you tell them that you have just a varicocele/infertility problem, do they not take care of the faulty veins that affects the prostate?

2) What exactly does the Gat and Goren method do to seal off the faulty veins? Do they burn them? or do they inject gels that harden to become plastics, or do they put springs in those veins? I ask because I am young (only 31) and if this procedure puts something inside of me (like regular varicocele embolization), I am quite concerned with the long term consequences.

I tried calling their office but I keep getting an answering machine and it wasn't in English so I couldn't understand what they were saying. I heard that Dr Gat and Goren are away on a long research and I suppose their office is closed for now until this research finishes. Anyone tried contacting Dr Gat and Goren lately? Any of you have asked similar questions before to Dr Gat and Goren?

Thanks,
Thunder

Post Edited (thunder2004) : 6/11/2013 2:11:04 PM (GMT-6)

hi everyone......

Still here and am just about to post my pee video to you tube.. hope it gets accepted......

Well, it seems that a lot is happening...... those with bph have some decisions to make!

I'm always happy to talk to anyone about my experiences with Gat Goren and would even post my personal email if that helped.

I'm just about to go to my urologist who poo hoo'd the procedure.. so I'll take a camera and try to get a picture of his face when he sees the results...... tee hee... i'll post my latest results in due course.

Well for now. I don't think there is any more mileage in telling everyone how well things are going.. There are several on this post who will confirm improvement after the G/G procedure. Main thing to report is that in the last three weeks, I can't remember any nights i've had to get up.. . one or two at most!!!!

Anyone considering G/G... don't mess around, get in quick, put your name down for August...... When I had the treatment I think it was around $9000 ... I believe it more than doubled in the next year.... In August this year....

DON'T MISS THE BOAT....

Hi all,

I did some more research and it seems that the Sclerotherapy for varicoceles is actually a very old procedure that eventually got replaced by microsurgery. However, the traditional Antegrade Sclerotherapy for a varicocele is only a 30 minute operation while the Gat and Goren method is a 1.5 hour one.

The closest operation I found to the Gat and Goren procedure is called
transcatheter foam sclerotherapy for testicular varicocele with a fluoroscopic tracing technique
http://www.ncbi.nlm.nih.gov/pubmed/20434363

It seems to be done by radiologist at a hospital in China.

However, if Dr. Gat and Goren targets more specific veins, then it would seem more advanced than any other procedure in the world.

Thunder

Well today is the 3 week day post-procedure (PAE).
I was told in the beginning not to really expect anything until the 3rd week.

I've had a tough time, but not because of the PAE, but because of the reason I needed the PAE in the 1st place.
My prostate had very suddenly shut down my urethra practically completely in early May causing me to have to start self-cathing.
No matter how clean you try to be, you're going to introduce bacteria, etc into your bladder.
I acquired an infection prior to going to Virginia that was treated, but never felt like it had completely gone away.
but I had no bacteria in urine.
\
After returning home, obviously I was still self-cathing and on maintenance antibiotics. Kidneys flared up again. Started back on higher doses of antibiotics.
Actually, though, I had already seen wide urine streams better than the past many years. They just didn't last long enough to empty the bladder completely.
But, the infection got really bad. Intense pain on right side (between pubic bone and hipbone) when I'd urinate. The pain would quickly radiate up to my right kidney and down to my right testicle. This happened a few times and was sudden and intense enough to feel like fainting. Then started with fever, chills, etc.
Admitted to hospital last Tuesday night and stayed until Saturday.
Turns out, had pyelonephritis that was mixed between bacteria and Candida. The previous weeks of antibiotics had wiped out my good flora and the yeasts overgrew and took over. They were more concerned about the candida than the bacteria.
Will be taking another week of Levaquin and Diflucan 400mg daily for 1 month.

So, where am I in my progress?
1. I am urinating on my own again. about half the time my stream is stronger and wider than it's been likely in decades. half the time it is a skinny, weak stream. Occasionally, though, I get this attempt at a wide stream that just kinda splatters everywhere as it leaves the urethra. weird.
2. I am emptying my bladder not nearly completely which didn't surprise Dr.Bagla.

It's hard for me to really judge how things are going because of this infection situation that was totally separate from the procedure.

Dr.Bagla has told me that my bladder has been this way a long time and will need to be re-trained to empty completely. They don't want me to start this for another couple weeks, though. I, though, wonder if my diverticulum is part of the problem. My thinking is that as the bladder squeezes to expel the urine, it pushes it out the urethra and also some into the diverticulum which comes off the bladder really low. Wonder if I'll ever empty completely.

I return to my urologist on July 2 and will discuss with him the issues of the diverticulum and the bladder retraining.

I am just now at the point where I am actually supposed to start seeing results. We will see.

Had my follow up today with my uro and infectious disease doctor.
Bacterial part of the infection gone. the fungal part will take time. I'll be on Diflucan for another 4 weeks (6 total weeks).
My uro said my prostate is still inflamed from the infection and will take some weeks to settle down.
While there, he did a sonogram of my kidneys, bladder, and prostate.
Kidneys fine. Bladder with still fairly large residual volume.
BUT..... He said my prostate looks really small. You cannot really get an "accurate" measurement from sonogram, but said his estimate is that my prostate is likely about 30cc....... Prior to the PAE procedure it was over 50.
Next week, I go back to him for a cystoscope mostly to check my diverticulum.
At that time, he will get an accurate measure of my prostate.
Hopefully, this inflammation will start going away to where I will flow strong again, but more fully.

I'll update after my July 11 appointment.

But, if his estimate is accurate, my prostate shrunk 40% in just 1 month.

Ira,

The all-in cost is about $19,000 to $20,000, but could be higher. I'm sorry that I can't give you a more precise figure. It's been two years since I did this, and there might have been changes in the meantime. Let's flesh out the numbers (in US dollars):

Physicians fees (including tax, 2011 data): $15,000
Hospital fees: [Included]
Airfare: $2100 [Today's fare from the East coast: It varies.]
Hotel fees: $900 [$150/night x 6 nights]
Taxis: $200
Food: $280 [$40/day x 7 days]
Sub-Total: $18,480
Incidentals: ? (Passport, Airport parking, Gifts, Gratuities, Insurance Co-Pays, etc., etc.)
Pre-op tests (see below): $0-$1500(?)
Post-op tests: ?

The medical fees are from 2011, when I had the procedure. I don't know whether he's changed them since, up or down. Dr. Gat wants you to stay at least four days after the procedure to ensure that your circulation is restored. (He palpates the testes for clotted blood, confirming the varicocele was repaired, an indication that the circulation will be/has been restored.)

Airfare: The price quoted above is what I found on Orbitz tonight from Dulles Airport in Washington, D.C. Yours might be a little higher. Or a little lower. In 2011, I arrived on a Sunday, had my consultation and procedure on Tuesday, my post-op visit with him on Friday, and left very late Saturday (like 11:00 p.m.). This worked fine; other schedules would have worked just as well. Dr. Gat often works part-day Sundays. Saturday is the Holy Day; everything is closed.

Tel Aviv is an expensive city. The hotel price above is for the Ami Hotel ($150), near the beach. I liked this hotel, but I transferred to the Crown Plaza-City Center ($300/night) because I wanted it cool. I visited in the Summer and I have idiosyncrasies in that regard. Most folks would be happy at a hotel like this. [NOTE: I checked their website (http://www.atlas.co.il/) today and the Ami wasn't listed for the dates I put in. Other similar hotels were listed at $180-$190 rather than the $150 I paid two years ago. It would be worthwhile to look for less-expensive accommodations. I admit that I'm not a super-shopper.] I don't know what time of year is the "off season" in Israel.

You get around by taxi: It's about $40 to and from the airport, and similar to get to Dr. Gat's clinic and the hospital (where Dr. Goren performs the procedure). Food is higher than in the US, but $40 should easily cover it.

Pre-op tests: Dr. Gat will provide you a list of the tests he wants for your case. These will probably be different than the ones I took two years ago, because your complaint(s) are probably different from mine. Remember that this self-same G-G procedure treats several completely different conditions, so your tests will address your issues whether they includes BPH, low Testosterone, male infertility or whatever. So check with Dr. Gat before getting tests--that's all I'm trying to say.

I did several blood tests, including Total Testosterone, Free Testosterone, LH, FSH, and three clotting tests (to make sure the sclerotization procedure will work). I also did a urine flow test at my urologist's. Varicocele can be diagnosed with a "testicular ultrasound -- color flow doppler for detection of bilateral varicocele." This painless test is performed by a diagnostic radiologist, who can also estimate the size of the prostate and look for kidney abnormalities at the same time. It's helpful to have a baseline prostate size if you're using G-G to treat enlarged prostate, however prostate sizes can be estimated by other ways (e.g., TRUS by your urologist). It would have been tricky for me to get this done under my so-so insurance, so I was lucky to have an alternative.

Some of my bloodwork was covered by my insurance, and I had the rest of it, along with the ultrasound, done while I was out of country. It cost me maybe $700 in all. If you're lucky enough to get everything covered by insurance, then it might cost you much less...but you'll have to work that out with Dr. Gat, your local physician(s) and your insurance carrier.

Post-tests: Basically repeats of the pre-tests to check for progress. (The clotting tests do *not* need to be repeated. I did not have to repeat the doppler ultrasound either, but still needed a TRUS test to estimate prostate size.) If testosterone levels aren't an issue, than maybe Dr. Gat will let you skip the pre- and post-testosterone levels. But it *is* kind of interesting to see if they change after the procedure, so I'd certainly recommend them anyway. I've had a couple rounds of the post-tests already, mostly covered by insurance.

Ira, I think this answers your question as best I can. I like this board, but it doesn't offer a private messaging feature that hides the email address. And I don't want to start another email account. So I've left my email in my first post.

HTH.

-dave

Edit 7/2/13: Details on 2011 scheduling, upped airfare and daily meal allowance, increased subtotal cost, added "Incidentals" expense line--important, revised Dr. Gat's required post-op stay to *four* days based on an email from the clinic.

Post Edited (Chicago Dave) : 7/2/2013 8:56:18 PM (GMT-6)

Rphguy: Thanks for updating us. I'm glad your prostate has shrunk so much so quickly, but I'm sorry that your inflammation symptoms haven't been completely resolved yet. Please keep us updated.

Ira: I'm glad you found my post helpful. I had been wanting to do a big "itinerary" post for some time, and your question prompted me to just do it.

It's true what you said: This procedure involves a considerable investment in terms of dollars, time and effort. But for some guys, it is worth it--it can be an investment in health for the rest of your life.

The path of least resistance in all things is always to follow the herd. No thinking or research is required to do so. And the US medical system makes it so easy for you! Your doctor--with all the confidence in the world--will tell you exactly what you need to do! And there are hospitals located just minutes away from you right now waiting to carry out your doctor's orders!!! And to top it off, your insurance company will pick up most of the charges! It's all so orderly, so easy!!! What more could you possibly want?

Of course, if a guy follows the standard protocol, he should expect the standard results. It might be worthwhile for him to determine exactly what these standard results are. But few guys will make the effort. We trust the medical system implicitly.

One of the nice things about this board is the opportunity I've had to chat, by email and phone, with guys who are independent thinking, path-breaking types. There are so few of them! But it's been a pleasure e-meeting a couple of them, and I hope to meet others in the future.

Ira, everyone's situation is different, and all we can do is to handle it as best we can through all the fog of confusion and contradiction that always surround us.

-dave

Ross, great news. I had a couple days around day 8 that were getting great before the infection nailed me.

Did you have a history of large residual bladder volumes? if so, do you know if your residual volumes have lessened?

I longingly await the day I can quit flomax. My residual volumes are still large, because of the infection. My local doc says it will subside, though, it will take time.

Hi Guys, I'm new to healing well. I have a question about Gat -Goren in Israel. I sent them an email last month and was told that the prostate team is engaged in long research and is not accepting new patients. Has anyone else confirmed this?

NyGene: Welcome to the forum! We're glad to have you. It is true that Dr. Gat's office isn't accepting new patients while Dr. Gat concentrates on his big prostate-treatment paper. This was covered in earlier posts, of course.

Folks: Dr. Gat is still quite active and still quite enthusiastic about pursuing his namesake procedure. I would give you odds that he will return--as he predicted--to seeing new patients in late August or soon thereafter. (If he runs a couple weeks late, it wouldn't surprise me.) I believe his prostate-treatment paper could be a seminal paper in our understanding of prostate disease, its etiology and treatment. It seems unlikely that it will break new theoretical ground, since Dr. Gat's prior papers already did a good job in laying out his theories. But he should have a few more patients and a few more years of follow-up on existing patients, so this should be good. I just checked his website, and the papers about Enlarged Prostate have been taken off. I'm sure he didn't do this happily. [Edit: "Skateman" found three of Dr. Gat's best papers hidden away on the website--the links are in Skateman's post below.]

Ira: Dr. Gat would heartily approve of your conclusion because that's the way his theory points. [Dr. Gat believes that varicocele is present in most (or almost all) cases of any type of prostate disease. But the varicocele is often of the types that doctors can't detect unless they have a fancy color-doppler ultrasound machine in their office. And, most crucially, it's not the distended veins in the scrotum per se that cause the prostate disease, but the underlying circulation problems of which they are but an indicator. These circulation problems are caused by the failure of the one-way valves in the Intra-Spermatic Veins.] But in the real world there can be a wide gap between theory and reality. I'm really happy that our PAErs are with us on the board to help us discover how the G-G and PAE procedures really work over time.

-dave

Post Edited (Chicago Dave) : 7/5/2013 5:35:52 PM (GMT-6)