Gat Goren, PAE, LUTS, Part 6

Peter: Do you mean PAE??. ..To my knowledge GG is not done in the UK.

Martin: Interesting response from Dr. Goren. I never asked--I was afraid I wouldn't like it!

You had the GG done in Tel Aviv, right? BTW, did your Testosterone actually increase after the GG procedure, or did it merely continue being high afterwards?

Yeah, Peter must have meant "PAE," unless he found a doc in Britain willing to do what I call a "home-brewed" GG procedure. Martin, wasn't there another guy who had PAE in late 2013, but hasn't checked back with us in a while?

I no longer use the stinging nettles root you mention from time to time, but I think it worked when I needed it. (In case anyone's keeping track, cranberry extract is the other "natural" supplement that worked when I needed it.)

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Overview on Vitamin D and DNA damage:
https://www.vitamindcouncil.org/blog/vitamin-d-protecting-against-dna-damage/

(I'm a big believer in Vitamin D supplementation, but suggest that it be done under a physician's care to avoid the potential for overdosing.)

Post Edited (Chicago Dave) : 2/11/2015 2:12:20 PM (GMT-7)

Peter said...
Have had GG done yesterday in the UK. I wait to see if I have a good result.

Has GG opened a surgery in the UK??? Or was it performed by someone else.

Nosheds - http://proarcmedical.com/default.asp

Interesting. But. How does the bladder close itself off now when you have ... emptied???

That's sort of like an improved stent or series of stents.where the stent material is kept away from corrosive liquids - urine in this case.

http://proarcmedical.com/default.asp

This seems similar to Urolift. However, like Urolift, it probably cannot be removed without major surgery if it does not work or if something goes wrong after a while. Urolift probably has been used more widely. It is even approved by FDA. (I think, Urolift does not work if there is a median lobe or if the prostate is too large.)

www.medgadget.com/2013/09/minimally-invasive-urolift-system-gets-fda-approval.html

/uroliftforbph.com/

Post Edited (pamaf) : 2/13/2015 10:04:28 AM (GMT-7)

Any good Interventional radiologist can do GG. There are a number of other procedures which are very similar. Because it is not usually done in the UK I'm afraid I'm unable to recommend the person that carried it out. It was done privately of course (aprox £2k), took about an hour & a half & I went home by train 2 hrs. later. I had a cistocopy prior to just check things out first. As I said, I will wait to see if there is any benefit otherwise I will try PAE. I will post again in 3 months.

Hello chaps, I just don't know where the time has gone!!! I do look in from time to time and read the great posts which must of great assistance to those considering any procedure.

March this year I'll be reaching my third anniversary since undergoing the G/G procedure.

I have not been to see a urologist since, as I've felt no need too!

Progress:

Most nights, I can sleep through until the morning when I get up around 8 ish. Sometimes, If I've had a cup of green tea late - after 10pm, I may find myself having to get up once or twice. I put that down to the green tea diuretic effect.

I'm taking NO medications - haven't for a long time.

Daytime visits - just about normal.

Flow - very slow first pee of the day, after my morning jog, the stream is steady and usually continuous - although I still double void to ensure it's just about all out.

Still very very happy with the results and consider it worth the money spent.

Sounds like GG and PAE each have a fair amount of radiation exposure. Did I read equivalent of 200-400 chest X-rays? That might push me towards the Ho Lep laser surgery.

Vincentpz,

I am in a very similar position to you. Started with a Urolift which led to urethral swelling, urinary retention, kidney function damage (mild hydronephrosis), acute urinary retention and now a nonfunctioning bladder. I'm currently cathing 3x daily. Needless to say I'm devastated that I did the Urolift. Most positive thing I've found about returning bladder function was this on Holep at Mayo Clinic:

"Detrusor acontractility is viewed as a relative contraindication to surgical intervention for men with bladder outlet obstruction secondary to BPH. Mayo Clinic researchers are testing the use of HoLEP for men with hypocontractile or acontractile bladders.

In a prospective trial of men ages 53 to 85 years, Mayo urologists performed HoLEP on 15 participants with evidence of BPH and bladders that had very little function or contraction ability. Preoperatively, all participants had catheter-dependent urinary retention for a median of five months (range: three to 60 months). Postoperatively, all men were able to void spontaneously without need for intermittent catheterization, with 13 participants displaying a return of detrusor contractility, and two participants voiding exclusively by Valsalva efforts. At their six-month postoperative follow-up, all participants were still able to urinate. Although these findings are preliminary, they suggest that HoLEP may be a viable treatment option for men with BPH and hypocontractile or acontractile detrusor muscle.

My free testosterone level is normal and my testosterone level is on the high side but still normal. Is GG procedure more specific on the small veins or could another interventional radiologist who does variococele treatment able to perform the same GG procedure with similar outcomes? The waiting time for the pricey GG is long. I ll update what the clinic says abt my blockage and if they accept me or not.

Martin Victor said...
If you are concerned about radiation, take Iodoral...a combination of potassium iodide and iodine for 30 days prior and 30 days after. ...12.5 mg is sufficient to help counteract radiation....even 24 mg for better protection. This amount of iodine will not harm you...just start with smaller doses initially.

I thought this was recommended to protect the thyroid gland from medical radioactive material or in case of a nuclear accident. Are you sure that it will work also for medical x-rays. Besides, GG and PAE x-rays are applied near the prostate and not near the thyroid.

en.wikipedia.org/wiki/Potassium_iodide

"Thyroid iodine uptake blockade with potassium iodide is used in nuclear medicine scintigraphy and therapy with some radioiodinated compounds that are not targeted to the thyroid, such as iobenguane (MIBG), which is used to image or treat neural tissue tumors, or iodinated fibrinogen, which is used in fibrinogen scans to investigate clotting. ..."

"In 1982, the U.S. Food and Drug Administration approved potassium iodide to protect thyroid glands from radioactive iodine involving accidents or fission emergencies. In an accidental event or attack on a nuclear power plant, or in nuclear bomb fallout, volatile fission product radionuclides may be released. Of these products, 131I is one of the most common and is particularly dangerous to the thyroid gland because it may lead to thyroid cancer. By saturating the body with a source of stable iodide prior to exposure, inhaled or ingested 131I tends to be excreted, which prevents radioiodine uptake by the thyroid. The protective effect of KI lasts approximately 24 hours.[citation needed] For optimal prophylaxis, KI must be dosed daily until a risk of significant exposure to radioiodine by either inhalation or ingestion no longer exists..."

Just wanted to stick my 2 cents in re GG:

I am 55, have 118 gram prostate and have been on 4-6 mg of Cardura, and Uroxotral before that, for several years. My BPH is manageable, but not great. I have to go every hour or two although I can hold it in if I have to, like on the golf course or at a movie.

If I don't void for a while, it is sometimes difficult to go at all until I walk around for 15 or 20 minutes.

I can sometimes sleep through the night, but usually go 1-3 times per night.

I had the GG procedure 3 months ago in Cyprus. A radiologist from Israel (originally from South Africa) did the procedure and Dr. Gat supervised (I guess) in the operating room. It took about 2 hours if I recall correctly and was not uncomfortable at all.

I was supposed to take it easy for a few days after that, which I did, but there was no discomfort other than a little dull ache in the region where they inserted the catheters into the veins.

For a few weeks to a month after the procedure I had occasional mild pain in the testicles, which Dr. Gat said was normal in some patients.

Dr. Gat and the radiologist were very nice and the hospital in Cyprus was clean and modern. The city (the capital Nicosia) where the procedure took place was typically eastern Mediterranean/Middle Eastern - not a high standard of living, not very pretty, but it seemed safe. If you want to combine the procedure with a vacation, I suggest going during their high season, and going to the north or south coast. There are some very nice hotels and casinos on the north coast (there is Vegas style casino gambling in Northern Cyprus, but not Southern).

That is the good news. Now the bad news. The procedure did not help me at all. So far at least, although they claim that there should be lots of improvement after 3 months. I am not holding my breath. To be honest, although Dr. Gat was very nice, he seemed to be a little bit of a quack when talking to him about this procedure and some other things. I am not a doctor, so take that impression with a grain of salt.

Now, just because it has not worked for me, so far at least, does not mean that it is not a valid procedure. However, my impression is that it is not. I was also surprised that Dr. Gat is not a urologist. I just assumed that he was. He apparently "discovered" this procedure while working with men who were having fertility problems. There was another, older man, from Israel who was there having the GG procedure, but for prostate cancer. I am VERY skeptical of using GG to treat PC, but I know nothing of that.

MGL59: I am surprised Dr. Gat took you on as a patient. A 118 gram prostate is pretty large. In any case, had you done more research you would have found Dr. Gat's specialty as stated on his website is that of an
"andrologist." His training is as an obstetrician and gynecologist. I would take your impression of Dr. Gat "as a little bit of a quack", with exactly a grain of salt.. He is both a brilliant Doctor and Mathematical Engineer. You don't get to do research at the Weitszman Institute in Israel without having superior credentials. We are fortunate to have medical doctors such as Dr. Gat and Dr. Goren who think "out of the box" and who develop techniques that advance the cause of medical science.