Hi Ganzman,
It's easier to talk than to write personalized posts, so if you email me (my email address in my first post), we can set up a time to talk. It's difficult to write something quick in a post without misstating something or offending folks unintentionally.
(1) This procedure is done only in Israel by Dr. Gat and his associates. Dr. Gat has trained someone else to act as back-up "andrologist", and Dr. Goren (the interventional radiologist) also has a back-up. Even if Dr. Gat and Dr. Goren retired soon (unlikely), there would still be folks trained to perform the procedure. It's true that there's a new procedure from a Portuguese fellow, but it's totally different. As I remember, the Portuguese procedure targets the prostate itself, but G-G affects the entire circulation of the prostate, bladder and testes. Very different.
(2) The procedure itself is rather technical and requires the services of two physicians co-operating closely together. The catheter has to be threaded through some troublesome veins. Interventional radiologists make their bread-and-butter doing this, but even they have to be trained for the G-G procedure. Dr. Gat acts as "andrologist" by diagnosing the symptoms and following up on the results. He was also in the operating room when Dr. Goren was performing the procedure on me. Apparently, two heads are better than one in finding and closing down all the varicocele bypasses. Dr. Goren spent about
2.5 hours with me (it took a little longer than usual), plus his travel time to the hospital, and Dr. Gat spent close to 4 hours of his time (which doesn't include time spent answering my copious emails: I'm a high-maintenance patient). Compare this to a TURP or laser prostate procedure, which can be performed by one physician in one or two hours.
(3) The heart of the dispute between Dr. Gat and the urological establishment is the role of varicocele in prostate disease/male infertility/low testosterone. There are many questions, with few really authoritative answers yet: How many men have varicocele? What is the best way to diagnose it? How often does it lead to problems? Gansman, you ran into the "party line" on varicocele that all urologists are trained to believe. I ran into this in 2010. The urologists that I spoke with then were overflowing with self-confidence--even if they turned out to be wrong in my case. It's difficult for us mere patients to see our way clear through this thicket, trained as we are to defer to medical specialists.
If Dr. Gat's theories are correct, then varicocele is extremely common in older men. (Here's the reasoning: It is known that prostate disease (BPH, PC) is very common among seniors, and if Dr. Gat is right that most prostate diseases are caused by circulation problems from varicocele, it follows that most men with prostate issues must have developed varicocele some years or decades earlier.)
Dr. Gat says that the failure of the one-way valves eventually leads to the usual prostate symptoms, though it could take years or decades. I've read some sources that define "varicocele" as the failure of the valves themselves. However, it seems that urologists define "varicocele" to be just the visible veins in the scrotum (technically, "Type 3 varicocele"). A diagnostic radiologist can diagnosis varicocele with a machine that bounces high-frequency sound off the flowing blood in the veins. This catches all the types of varicocele associated with the failure of the valves. Unless your urologist has ultrasonic transducers and detecters built into his fingertips, I'm not sure how he would be able to detect varicoceles of types other than Type 3. (Supposedly, he should be able to detect Type 2 varicocele by palpation, but in my experience, this is a lot to ask.)
Ganzman, if you can get an diagnostic radiologist to perform a "testicular ultrasound - color flow doppler for detection of bilateral varicocele" you can have a definitive answer to your question. The radiologist can also easily image the prostate and estimate its volume; this information is useful. I had this procedure done when I was visiting Costa Rica. I don't know how easy it would be to get it done under most insurance systems in the U.S.
Incidentally, Dr. Gat himself diagnoses varicocele in his clinic by applying thermal paper to the scrotum for a few seconds and looking for change in the paper's color. This is a quick procedure, but I think it's very tricky and other physicians don't have the knack.
(4) Ganzman, you imply a link between vein problems and varicocele. This is a good question for Dr. Gat. I always assumed that it really didn't matter: The base problem with varicocele is not the thick veins you see (with Type 3), but rather the pattern of venous drainage caused by the failure of the one-way valves. I heard that tall men and athletes (especially weight-lifters) are at greater risk for one-way valve failure (hence, varicocele). It seems that the greater pressure in the abdomen tend to wear out the one-way valves.
(5) I'm just a patient, not a doctor, but I think you've been handling your situation well, Ganzman. Urologists love their little procedures. Fortunately, your symptoms aren't very bad yet! My BPH symptoms were terrible. It's seems to be early in the development of the usual prostate problems for you, and that's good.
-dave
Edited 5/22/13 to correct name of ultrasound test.
Post Edited (Chicago Dave) : 5/22/2013 2:49:32 PM (GMT-6)