NEW! Gat Goren, Part 4. Now with PAE and LUTS!

Mayoclinic.org has a brief article, from September 2012, on Kegel exercises for men. See,

http://www.mayoclinic.org/kegel-exercises-for-men/art-20045074

Post Edited (Skateman) : 2/18/2014 7:37:00 PM (GMT-7)

Bob_NJ said...
Chumley,

The urolift may be a good solution for you. Bear in mind it won't stop the prostate from growing, it's basically pulling your lateral lobes away from your urethra. And if your problems are caused by bladder neck or bladder or an enlarged median lobe, it might not help at all. If it were me I'd want to know if enlarged lateral lobes were causing my problems, and were likely the sole cause, because that is all the urolift will address.

Bearing in mind the prostate grows at about 5% per year I'd also want to know how large my prostate was at present. The urolift apparently can't work for prostates over 100cc because too many clips would be required. Once you get to 6 clips (3 on a side) I read that they tend to interfere with each other's effect. Depending on your age and prostate size this may be a short or a long term solution. Of course that's also the case with turp and other less invasive procedures as well. Good luck and let us know how things progress.

A few years ago a urethral stent device was introduced for bph. It sounded good in theory but turned out to be a disaster as the stent became encased in tissue and required surgery to remove it when it failed.

I read an analysis from a recent urology conference where one of the panel members stated he believed the future solution to bph will be an injectible liquid that kills prostate tissue. That would be a great solution if it worked. For some reason they have been testing injectibles like Nymox 1207, alcohol, freezing agents, and botox for more than a decade but don't seem to be able to get these products accepted for anything other than use in trials.

Bob

Hi Bob , I like injectible liquid idea but will probably be too late for most of us Guys!

Anyway was very surprised to hear so soon back from my Urological Surgeon. He has been in touch with the Professor who I believe is currently the only one who does the Urolift procedure in the UK and he would be happy to come down to my NHS Hospital to do the procedure! My surgeon advised before we can go ahead he will need to obtain some funding and will be in touch with me and will review me in the clinic to discuss the procedure further and then decide whether to go ahead with it.

I couldn't ask for more than that and if he does obtain the funding and if viable after discussion, I assume I would be getting the op on the NHS! If it went ahead, I presume I would then be one of the ones trialing this procedure to see if better and cheaper for the NHS in the long run than Turps!

Whatever the outcome at least my Urologist doesn't have blinkers on and is and has been prepared to look at other alternatives, for which I am very grateful and am so glad I mentioned the various alternatives obtained from this thread, to him at our last appointment. Will keep you updated.

Hi Martin,

I thought Dr. Gat said the seal is for every vertical vein (basically vertical = pressure). But what do you mean it is only sealed up to a certain point?
Your question seems valid - which is where would the testosterone go if the internal spermatic veins were entirely glued? I remember Dr. Gat mentioned something about the new alternative route (with no excess vertical pressure) would not cause reflux back into the prostate. But what do you mean when you say "only up to the point where they bypass the common iliac" when the ISV and the Common Iliac are not connected?
Thanks,

martin victor said...
>>> Frank - I can offer a guess: G and G seal each and every vein draining the prostate. leaving even one open defeats the entire deal.<<<

I don't believe this is the case. To my knowledge the seal is only the ISV veins up to the point where they bypass the Common iliac and not into the pampiniform plexus. Testosterone now flows from three areas eventually making its way into the inferior vena cava. These three areas are the deferential vein, the scrotal vein and the cremasteric vein. So to answer your question the deferential vein remains intact. I had the procedure and was concerned what pathways testosterone would take if the internal spermatics were glued. And by the way, my libido is super high, along with my testosterone levels given my age of 71. I wish I could say that my urgency, and frequency has also improved after 18 months. I believe the Gat procedure along with PAE has its place as a better alternative to TURP or the other crude surgical interventions. But I am not convinced that Dr. GAT has the answer. Perhaps failure of the ISV values are more of an indication and symptom of inflammation than the cause of BPH. The cause can be multi-focal including diet, excess **********, prostatitis, hormone imbalance etc.

Thunder,

A long-standing treatment for BPH in dogs has been surgical castration (ouch!), as a Google search will show. It's fascinating that merely reducing the T levels shrinks the canine prostate. I imagine this treatment would be equally effective in shrinking human prostates, though some guys might wince at the side effects.

I wonder if any one has detected effects of hot spicy food on frequency and difficulty. I believe I had twice seen clear correlation (making the situation worse, of course). it would be interesting to find out whether or not this is happening to others.

Nosheds: I am a retired physician and I self-diagnosed myself with interstitial cystitis 12 y ago. Myy symptoms responded to dietary measures including avoiding spicy foods and preservatives. Over the last year I have developed BPH symptoms and then during the fall I developed a worsening of my symptoms. Duh... I had started adding jalapeno peppers to my food. When I eliminated those my symptoms improved greatly. A recent cystoscopy verified that I indeed do have interstitial cystitis. So, IC is one thing that you need to keep in the back of your mind as a cause of your symptoms.

Regarding my prostate problems, Flomax was very effective but I developed chronic low back pain and was just given a prescription for daily Cialis. Based on online comments I have high hopes for it to help.

I cannot afford the GG procedure but I just made an appointment with South Florida Vascular for evaluation. A scrotal ultrasound did show that I have bilateral varicoceles though they are small. I am keeping my fingers crossed that Medicare will cover the procedure. I will keep everyone updated with the results if I have it done.

Frank and nosheds. This topic is right up my alley. Several years ago when I first started experiencing burning pain and a much reduced flow while urinating I wasn't sure if I had IC (Interstitial Cystitis), Non-Bacterial Prostatitis, or BPH. I joined the interstitial cystitis forum and found that many people (mostly women) got LUTS symptoms from IC. They had the same symptoms of urgency and frequency and burning urine, and the restricted stream that I did, so I thought I might have IC. Also, although most men don't get IC, my mother had IC for many years so I thought I might have inherited it. She was on the IC diet so I decided to try it.

Over the course of a year I lost 20 lbs, but I also became afraid to eat many foods. But over time I realized that there was no consistent correlation between what I ate and my LUTS symptoms, and my symptoms never did improve. As a result I concluded I did not actually have IC, so the diet didn't help or hurt my symptoms.

When I had my TUMT procedure, followed a year later (about 21 months ago) by a Greenlight laser turp for BPH, my urologist said he had found lots of pus (abscesses) inside the prostate tissue he had ablated with the GL. So that meant I had non-bacterial prostatitis as well as BPH.

As I have recounted in prior posts, the GL benefits only lasted about 6 months, and then my symptoms returned at about 50% of what they were prior to the GL. Almost three months ago I had a resection of the bladder neck and removal of bladder stones, that so far, along with a daily flomax pill, seems to be working.

So I think the bottom line is that if your LUTS is caused by IC, then diet should help, but if it's not, it won't have much effect. Very spicy foods may make my urine burn a slight bit, and drinking whiskey and soda water acts as a quick diuretic (I don't buy whiskey, I just rent it) but I think those are normal reactions, not symptoms of disease.

I've been taking the flomax generic tamsulosin since my recent surgery and just got a prescription for daily 5mg cialis. I'm also hoping the cialis will let me cut down on the flomax.

Oops! I meant malic acid, not folic acid. Sorry. Folic acid is OK.

Since one member of the forum is using daily cialis for LUTS and another member had an interest in it I thought I'd post some preliminary results. Five days ago I switched from my 0.4mg tamsulosin (generic flomax) pill to the daily 5mg. cialis. My uro had given me a prescription for the cialis so I thought I'd give it a try. Here's what I learned so far.
1. Cialis is not covered by medicare or my supplemental insurance.
2. Cilis is expensive. A bottle of 30 is about equivalent to filling my Camry with gas three times.
3. On the Cialis website there is a voucher for a free 30 day supply of the daily cialis, which I used.
4.The first four days I had a pretty constant low grade headache. Today is the first day I didn't notice it.
5.In terms of stuffy nose, the Cialis is a little better than the tamsulosin was. With the tamsulosin I'd often wake up in the early hours totally blocked in both nostrils. With the Cialis I still get blocked up but not totally and not as bad.
6. In terms of strength of stream, Cialis is not as good as the tamsulosin. It's still decent, but not the gusher I was often getting with the tamsulosin. With the Cialis I am emptying out but it takes longer to urinate with a weaker stream.
7. The worst side effect I am experiencing is a feeling of being wired when I go to bed at night and interrupted sleep. The Tamsulosin used to knock me out and I slept quite soundly. With the cialis I am waking up several times a night and not getting right back to sleep. I'm hoping this insomnia will stop like the headache did.
8. It's too early to tell if the sexual benefits will be there, they say it takes a few weeks for that, but I should know by the time my first 30 day supply is finished.
9. Muscle aches and fatigue is about the same for both drugs.

Chumley,

I was happy that my local pharmacy accepted the voucher I printed from the Cialis website for a free 30 day trial supply. I guess they are pretty confident to give the first bottle of 30 for free. The 11 online reviews I read for daily cialis were all positive. I'll post again when I make a decision on whether to pay for the next bottle or not.
I actually slept quite soundly last night, only got up once to void and went right back to sleep. The only negative I can see so far, other than the cost, is that it does not give me quite as good a stream as I got with the tamsulosin.

before my isv embolization I had 5 yrs of symptoms,with frequency at the extreme of 14x per night. since I was up all night Anyway I did alot off reading which is how I stumbled on the G G paper in Andrologia which made alot of sense to my Harvard trained mind. I have been taking alpha blockers and cialis together since cialis was approved and that cut my frequency to 6 or 7 times per night. my veins were embolized 9 months ago ( total charges of about $7000, paid by my health insurance as treatment for painful varicocele ) I had trus measurement prior showing a 54 cc prostate. 8 weeks later it had reduced to 46cc and frequency abated to 4-5. At nine months it was measured as 37cc and frequency is typically 3-4 or less. recently I slept 7 hours uninterrupted, something unheard of in many years. still I seem to require the medication, only now it actually is working. What I find perplexing is that I see no evidence of academic research to confirm or refute the GG explanation, which if proven is really quite important.

the procedure used in my case has much in common with GG. my left and right internal spermatic veins and a duplicate on the left side were embolized with titanium coils. I believe this addresses the conceptual basics of Dr Gat's hypothesis, at least in my case. this is a standard procedure, performed all the time by interventional radiologists in the us for the treatment of symptomatic varicocele. my varicoceles were palpable during valsalvar and painful especially at the end of a long day on my feet. thus my excellent health insurance paid for this procedure, which cured my varicocele, removed a chronic pain condition, and coincidentally, my prostate has reduced from 54 to 46 and most recently to 37 cc. My psa went from 2.86 to 2.46 and today to 2.19. this seems remarkable to me for a change in 9 months when this condition had progressed in a miserable direction over 5 years previously. I am hopeful that perhaps a year from now I could be off the medications. Thus, while you must consider everything I have reported as anecdotal, it seems to me this is real.

Clap... I know another person who I communicated with in Israel who also had the GG procedure several months prior to me. The size of his prostate went from around 80 grams to 40. Apparently for some it does work. For me however, I am disappointed with my progress. After the first 6 months of the procedure, my prostate of 45-50 grams did not decrease. Now 18 months after the procedure, I still urinate once sometimes twice at night. I go 3-4 hours at night before needing a visit to the bathroom. Night urination stream is slow. More disconcerting is the fact that my bladder prior to the procedure held 8 oz of water...now the most I can release on a bathroom visit is 6 oz. I have hesitated doing another ultra sound. I would rather not see the smirk of a urologist telling me he was right.

Of course, there are many factors aside from the size of the prostate involving nocturia including bladder function and prostate enlargement location. In my case, mid lobe protrusion into the bladder may take a longer time to heal.

On the positive side. There are some really great results that Dr. Gat had indicated would be forthcoming but with patience. My Free testosterone has improved to levels unheard of in years. At the age of 71 1/2, according to my blood test last week, my free T is 11.2...incredibly high for someone my age. My PSA which has never been high is 0.6.

Following are the levels of Free and Serum testosterone before and after the procedure which was done on Aug 5, 2012. What is also noteworthy is how my levels fell immediately after the procedure and how they then rose. Apparently it took a while for the innate intelligence of my body to seek new pathways for the removal of testosterone other than the internal spermatics.

Date Free T level Serum T level

4/24/12 8.3 728 (Prior to Gat Procedure)

10/24/12 7.4 458

12/26/12 5.9 479

06/03/13 8.4 653

10/30/13 9.0 769

03/08/14 11.2 739

My DHT prior to the procedure was 54. Today it is 52. Best levels should be 30-50 as DHT promotes the growth of the prostate. My estradiol has consistently been in a good range of 20-30. I take a number of supplements including Prost-P10x, and PollenAid (Graminex). I recently started green tea extract to see if this would lower my DHT.