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What is best prostate treatment for my BPH?
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- Опубліковано 22 жов 2022
- In 2023, patients have many options including Urolift, Rezum, iTIND, GreenLight, HoLEP, TURP, PAE, and others. The purpose of this video is to explain the current options and how a urologist can guide a patient into making the treatment decision that will serve them best.
@RRGonzalezUrology #menshealth #BPH #HoLEP #Rezum #Urolift #Aquablation #Urology #iTIND #precisionmedicine
As a retired physician, this is one of the best videos I have seen on choices for BPH. excellent!
Best video on the subject I have seen.
Excellent discussion. Thank you.
i’ve been doing so much research and this has been the most informative to the point video I’ve seen yet. thank you for this great presentation to help people like me suffering from enlarged prostate
What a great video. I’ve been researching options and this the first video that really describes all the options in a clear concise way. Thank you.
You are so welcome!
THANK YOU DOC!!!!! This IS the BEST BPH Video I've seen so far!
I have been so under educated on this problem that I didn't even recognize the symptoms and now I have urine retention and have to self catheter Every Time I need to void, while I research for my choices of treatment! CRAZY This has slammed into my life in a VERY serious way in a seemingly 6 week period of time! I'm a 22yr retired Navy Vet! I've heard of the way VETS get treated after serving, but now I'm experiencing the BOTTOM of the list Attitude in the MILITARY Medical insurance world! This VERY educational video is SO Helpful to me and I thank You Sir.
Brilliant presentation.I had Rezum procedure in June 2022,couldn’t be happier with results.
This presentation was incredibly informative. Thank you Dr. Gonzalez
Urolift completely and permanently destroyed my life !!!! Now I am faced with my new urologist wanting to do another surgery (greenlight) to correct to the botched UROLIFT procedure.
I am told I would have to self catheterize everyday possible for the rest of my life. My symptoms now are WORSE than before Urolift. Please be advised and don't say I didn't warn you if you get this procedure !!!!!
I agree many guys tell me STAY AWAY FROM UROLIFT👍👍👍👍👍
Look into PAE. Urologists don’t mention it because it’s performed by an Interventional Radiologist.
This is an excellent video. I only wish Dr. Gonzalez lived in Newport Beach California.
Im 34 years old I’m getting HOLEP March 5th for my enlarged prostate 55 cm…I can’t wait to get my sanity back! ❤
Very nice presentation sir
Thank you doctor. 68 and having Green light treatment in three weeks. Your video was very educational and confirmed I'm making the right choice.
How did it go?👍👍👍👍
@@lunacallie6858 I have much improved flow now. But still have urinary incontinence and frequent urination. So I'm having another procedure soon to implant a sacral nerve modulation device.
Thanks. I have to watch this again, and save it for future reference.
Thanks man! ❤
Thanks Dr. Gonzales. Great video presentation that helps me in making a right decision .
I am happy that you found it helpful. Best of luck.
Very informative and well explained video.
Glad it was helpful!
#Urolift completely and permanently destroyed my life !!!! Now I am faced with my new urologist wanting to do another surgery (greenlight) to correct to the botched UROLIFT procedure.
I am told I would have to self catheterize everyday possible for the rest of my life. My symptoms now are WORSE than before Urolift. Please be advised and don't say I didn't warn you if you get this procedure !!!!!
Aquablation is the one im looking into👍👍👍👍👍
I had that last week. Sweet!
@@yaneznayu9997 Results??😁😁😁😁🤞🤞🤞
Thanks for the excellent video!
thank you for the feedback
Very informative. Thanks
Glad you found it helpful!
Thanks the best present I have seen thanks from Philadelphia
Our pleasure! Glad you liked it
Excellent presentation and very educational! Thanks!
Glad it was helpful!
Thank you for a very informative video. Greatly appreciated.
Thank you for this excellent and thorough presentation. I'll be having procedures soon to evaluate my BPH condition, and this is extremely helpful to me in better understanding the options that will be available depending on my test results, along with my age and health conditions. My only concern is that the practice may be focused on using UroLift as the only solution they will offer - but I hope that won't be the case.
Thank you..doc.
the difficulty in the decision matrix is normalizing the effect for patients already taking multiple prostate/bladder related meds. If one would stop taking all those meds for a few weeks, what would the symptom risk/reward look like?
My questions primarily between laser and aquablation. With either of these, is the urethrae damaged in the process? What is the factor of what is removed or destroyed? I found the cystoscope procedure was fairly painful with burning though far better than going through a biopsy. My prostate was measured to be about 100 ml. Is either of these surgeries painful?
What about a Prostate Artery Embolization procedure? It cuts off blood supply, does not cause errectile dysfunction, quick recovery.
PAE is an excellent option and is categorized in the "MIST" treatments (effect between that of med and surgery). It is the MIST therapy that I prefer for patients with prostates >80 ml who are not in retention, renal failure, with stones or with recurrent infections.
Excellent presentation, but you did not mention Prostatic Artery Embolization. Why is that the case. Thank you.
The risk/benefit chart is very helpful. Where would Prostatic artery embolization (PAE) be placed on that chart?
It falls in the MIST category
@@RRGonzalezUrology How about the benefit rating?
@@tomc101 Both risks and benefits overlap in the "MIST" bubble between medications and surgery where benefits are less than that of surgery but likely more than medications alone, and risks are less than surgery. Certain PAE risks that are rare can be severe, like glans necrosis of the penis (most recover), rectal weeping (improves) and bladder necrosis/damage (extremely rare but described in literature). Best to discuss with PAE expert with a lot of experience; these are usually interventional radiologists.
I ruled out PAE coz it fails on too many men after a cpl yrs
Im opting for aquablation
Excellent informational video, Dr. Gonzalez! Today I was able to set up a new patient appointment with your office for May 2. I live in Port Isabel, Texas, which is about a 7 hour drive to your office. I’m eager to meet you and I look forward to you helping me restore my quality of life.😊
Regarding anticoagulants, do you consider prophylactic 81mg aspirin in the same space for laser treatment as a Plavix or Eliquis?
Thank you for all that you do!!
Happy to help, and look forward to meeting you. Aspirin does not limit your choices to laser, alone. Lasers do have the lowest risk of bleeding compared to other BPH procedures like TURP.
Thank you for the video. What is the risk of incontinence with the various procedures?
Great presentation. What are the newer ones being developed? Thanks
We will be posting videos on some clinical trials soon. One includes the Breeze study
Thank you Doctor. I have to ask. Which treatment modality would you elect if you were faced with the need for treatment. You may not be able to answer but it is difficult to navigate these various processes because various institutions have spent large amounts of money to establish a particular treatment that they are then vested in.
It really needs to be personalized to prostate size and symptoms. Large centers like ours offer the full array of options. This allows us to individualize to treatment to each man.
@@RRGonzalezUrology Thank you
Had two Urolift sessions over the years, now yet again must relieve the restrictions. Probably have at least 10 pins in my prostate. What kind of complications does this present during these laser procedures? Which of them would work around this problem? HoLep looks best to me, because it removes the entire prostate tissue, so there is apparently no chance of having to go thru it again.
have you considered aquablation?
@@sirus312 Yes, looks promising, but what to do with all those Urolift pins left behind? Saw a HoLep vid where the laser just melts away the steel pins and nylon strings. But then I wonder what they do with all those fragments of pins and string?
Correct. You can have Aquablation and/or laser enucleation (HoLEP, GreenLEP) to remove those.
There are short term risks of blood in the urine and urinary infection after laser, similar to risks after Urolift. The risk of erectile dysfunction
When someone is referred from out of town to your hospital, how many trips will they normally have to make to Houston from start to finish with surgery and what is the time frame?
For a surgical procedure, 5-7 days would be conservative. In these cases, most diagnostic procedures that would have been done at an outside institution would be reviewed (prostate volume study for anatomy; functional testing like Urocuff or flow/PVR, etc). We value diagnostic testing to help guide patients through the testing. Care for US patients (713)441-6455 [Naomi/Rita/Maribel]. For patients who come in from outside the US [Global services coordination line +1(713)441-2340 ]
Excellent informational video, Dr. Gonzalez! Today I was able to set up an appointment with your office for May 2. I live in Port Isabel, TX, about a 7 hour drive to your office. I’m eager to meet you and I look forward to you helping me regain my quality of life.😊
Hello Dr. Gonzalez - A few questions, if I may:
1. My urologist has not done a digital rectal exam, although he did feel my prostate and I've had an MRI. Is the digital rectal exam a necessary diagnostic tool at this point?
2. I have an enlarged prostate which MRI showed there are spots with a score of "3", so inconclusive for cancer. Can a biopsy be taken simultaneously with a resection, or should the biopsy be done first? I'd rather only go "under" once.
3. I've been looking at Aquablation very favorably, but there are ZERO urologists in my state who do it. If I traveled for the procedure, what tests would a doctor such as yourself want to see in advance in order to streamline the process?
I've tried 4 different medications. Three of them had intolerable side effects, and the 4th simply doesn't do anything for me.
Thanks.
Thank you for your questions. This is a channel for information on general urologic care. For personal health questions, we encourage you to seek care with a urologist. When prostate medications do not help the urination, it can be another issue such as overactive bladder or obstructive sleep apnea causing nocturnal polyuria. Aquablation is one of many good options for treating BPH, and you can discuss this further with your urologist.
Why wasn’t Prostate Artery Embolization (PAE) mentioned? Is that not considered a viable option?
It was added to the AUA guidelines as an option for select patients after the video was completed. It is a good option if no median lobe and prostate >60 ml, especially in men who are not good surgical candidates.
Great presentation. My only question is that you compared 5 year Rezum and Urolift efficacy data and then compared it to 2 & 3 year PVP, TURP, and aquablation data.
Would you agree that is not an "apples to apples" comparison?
Two points: these are not apples to apples as the point of the presentation is to highlight differences in therapies (apple to orange to lemon). Secondly, there are multiple case series but highlighted studies have a good comparison arm or RCT design.
Excellent presentation. I went to your Houston Methodist website but I could not find information on prostate treatments. I know it must be hidden there (somewhere?) but I couldn't find it. Please provide a direct link that points specifically to prostate treatments. Thank you.
www.houstonmethodist.org/urology/benign-prostate-hyperplasia/
It may also be:
www.houstonmethodist.org/urology/BPH/
Unfortunately, he didn't address the problem of urinary frequency. Whst if someone's flow is not the issue but they are urinating 30-40x per 24 hours. What's the best treatment in that case?
That may be overactive bladder that can be both independent of the prostate (two separate problems) or related. You can learn more by cutting and pasting the link below into your browser:
www.auanet.org/documents/about/OAB-Clinical-Care-Pathway.pdf
Wanting more sedation with rezum.
This should be communicated to your urology team. However, consider that if you opt to be "asleep" with general anesthesia, having one of the surgical options will result in a more rapid alleviation of urinary symptoms.
HUMANITY FIRST
always
What about PAE treatment
PAE is an option in the MIST category of treatments (not surgical) that can treat prostates >80 ml. It can also help those large prostates that repeatedly bleed.
What about PAE
PAE is an option in the MIST category of treatments (not surgical) that can treat prostates >80 ml. It can also help those large prostates that repeatedly bleed.
Informative but the distracting music is a big mistake.
I appreciate your opinion and feedback.
Who does the surgery the surgeon or the trainees? Do use ga or spinal?
I do, but there are always urologists who learn by watching. We have virtual reality simulators by Virta-Med for hands on training in a simulated environment.
Most patients prefer general with LMA (not intubated nor with paralytics)
Thank you for your reply but can you save the sperm ducts and work around the urethan tube?
@@serinodiaz4140 We have ejaculatory hood sparing procedures (laser) as well as Aquablation that also spares the ejaculatory hood [what I believe you are calling the sperm ducts]. The prostatic urethra is remodeled during the majority of the procedures. You should consult with your urologist to learn more about the options.
Remove the prostate
Doctor I have 54 years old and my prostate is bad, I don't have cancer but the PSA are high, is between 11.2, 12.4, 11.75, I have a fairly narrow urethra and the size of the prostate is 80 ml. I had 2 biopsies and two MRIs in three years. After 3 doctors now I have a new one and he has proposed surgery, in your experience which procedure would be a good option? Rezum or Urolift? THANK YOU DOCTOR!!!!
If you are not responding to medications, I recommend surgery (multiple options). We review this on the video. Rezum and Urolift are likely too little, too late. However, this is not meant to be medical advice but rather to direct you for urological evaluation and treatment.
Im 54 too. Its too young to have a bad prostate. Assess reasons. Lifestyle changes will also help
Hello from Vancouver Canada, im 62 general healthy i was in the Philippines when it hit me like a Freight Train had a few beers within 5 hrs i couldn't piss 1 drop went to Emergency 6 am they treated me very well my 1st Catheter, blood test, prostate exam, scan all in 2 hrs $ 150. Canadian 😮. 3 days before flying back to Vancouver i have now had 4 different Catheters 2 popped !! Made in China. Canada's Health Care is DISGUSTING !! 😡😡 NO HELP !! I've never been sick or need help my prostate is pretty big !! It's going 5 months now as of September 5th. There's only 2 places in Canada Aquablation Onterio & Montreal Medical doesn't cover 😡 prices from
$ 6,500 to $ 19,000. And a waiting list ☹️ I've been thinking going to the Philippines but if you can do it for a far price. Hope to hear back from you, thanks.
Interesting, had similar symptoms yrs. ago when in Laos/Thailand and eventually led to a 5 yr Active Surveillance program with a urologist in North Van, BC. Over this time span had to go to emergency perhaps 3-4 times due to acute urinary retention and get that taken care of. On both Flomax and Avodart until recently, as in consultation with my urologist decided to have the TURP procedure, that was six weeks ago. Now off the pills, and back to my normal activities completely, will see what the PSA reading is in Dec. as it was 14.5 pre-surgery. About 25 gms. of the prostate removed. Also have low grade prostate cancer (3+3), and a family member who died from prostate cancer, so watch this very closely.
May be better to have treatment in the Phillipines ... 👍
My urologist recommend the urolift for my bph. But says I need general anesthesia for the procedure due to it being very painful is this true?
It depends on patient (and urologist) comfort. We do it under local anesthesia. If you did not tolerate local cystoscopy under local (not general) anesthesia, they may recommend general or sedation. If you have not had cystoscopy and ultrasound, consider a full evaluation to make sure that Urolift is the correct treatment for your particular size/shape of prostate.
Many men Do Not recommend UROLIFT, Goodluck 👍👍👍
You lost all of your credibility by not mentioning EMBOLIZATION, which is also approved by the FDA. This tells me you are focused on your money making scheme and not the patient choices or health. Embolization is indeed the least evasive of all of the procedures. Why dont you talk about embolization?????
How about AEP??
Anatomic endoscopic enucleation of prostate (AEEP) is done with a variety of technologies, particularly laser. I address this at the end of the video as the safest surgical option (particularly for high risk men on blood thinners). I offer HoLEP, ThuFLEP, and GLEP in particular.