Current Controversies in Prostatic Artery Embolization w/ Dr. Sam Mouli | BackTable Podcast Ep. 280

[@wsteele5864]

My option right now is Holep (urologist only option offered) and PAE, discovered first by my own research and this podcast. It is a no brainer which path I am about to embark on. I took notes on what I want 300-500 micron particles, coils for sources outside the main artery, no coil on the main supply to preserve the option of re-treatment. If a second treatment failed, THEN and only THEN would I take one of the more invasive options. Thank you so much to Dr Barraza and Dr. Mouli for such an illuminating discussion.

[@mstack1949]

How do I vet or what questions should I be asking a doctor that does PAE? I fear a poor or new "provider" who is not experienced enough. At what point or how many procedures should the doctor perform before they are considered experienced? Excellent information - thanks!

[@hawaiiangunner]

Depends what Clinic you're in. But most clinics do not let a doctor perform this until they have had at least 50 to 100 procedures under their belt. It just depends on the hospital and what their standards are. But no less than 50

[@DougCragoe]

A doctor has to start somewhere. So somebody is going to be patient #1 and so on till he does it 50 times. Then after the 50 procedures he has some experience. But he can't do 50 procedures on a practice dummy. @@hawaiiangunner

[@jacquesbeliveau8531]

Do you mind cutting out on the BS and promotion... Get on with the title of your podcast....wake up.

[@Retiredtraveler1961]

I just had a PAE 40 days ago. The procedure was uneventful except that laying on my back for >2 hours was excruciating. I had a urolift but experienced a recurrence of LUTS 8 months later. Both sides of prostate were embolized. The post treatment meds were antibiotics, steroid pack & Pyridium. Other than feeling like I had a goose egg up my bum the first afternoon, I had zero issues after that. I never used Perydium for urinary symptoms. No blood, retrograde ejaculation or anything concerning. I was back in the gym one week later. However is riding a bike an issue??? I ride stationary bike 20 mins 4x week. Of note, my insurance was billed >$24,700, ouch! Outpatient 2 hr procedure.

[@kenneth-o9l]

it cost me $3,000 in New Delhi. Just had it done 3 days ago.

[@daveyvane]

You liked the goose egg bit.

[@redeemed7260]

@@kenneth-o9l I can guess that would not be the cost for a foreigner

[@LeoCruz-v5b]

I am planning to have PAE. Could you please give us an update since it's been a year. Thanks

[@Retiredtraveler1961]

@ good morning. It’s been over a year & my symptoms remain resolved HOWEVER….i have unrelated occasional urinary frequency due to irritants (coffee, citrus, & soda). The urologist advised cut those bladder irritants out of your fluid intake. Best of luck.

[@andrewfrench8100]

Can the procedure be done if there is prolonged infection in the prostrate?

[@billbender-c8n]

Had PAE yesterday 12/19.No pain at all and no sidafects. As someone else posted was 2 hours on your back.

[@TheJoncic]

How are you now?

[@LeoCruz-v5b]

Could you please give us an update since it's been a year. Thanks

[@tsabo8227]

Very informative. Thank you. Had a urolift about 4 years ago. Simple. After 4 years just ok. Did tons of research. Decided to go w/aquablation. 7 days out? Happy to report am peeing like a 20 year old again... So far so good. I am looking down the line ten years, and most likely would Pae, if there are unified standards... Just a an additional note... Stayed one night in hospital after aquablation, and they run about 20 to 30 bags saline solution thru ones catheder, which wasnt real fun, but overall would definitely do it again. Imp. No heat generated using aquablation, and perameters setup beforehand by doctor, than button pushed and the robotic portion does the rest...

[@BobSmith-ye5gw]

Had a "Butterfly Device" implanted as a participant in a double blind investigational study 2 months ago....have experienced a slow and slight reducton in LUTS (frequency, urgency), but chronic discomfort on urination which was quite miserable and has just recently abated somewhat. About 2 weeks ago, experienced acute perineal pain during a bike ride, followed shortly thereaafter by severe hematuria, which began to abate by my third voiding. Problem is, the Device has become displaced or migrated and is extending into the neck of the bladder (and may be responsible for my continued symptoms), which necessitates removal or repositioning of the Device. Urologist who's the participating clinician has suggested to that I consider a TUIP or TURP (which could be accomplished concurrent with the Device's removal) unless I want to have him replace or re-position the Butterfly Device. I'm of the mind "get it out of there" and I'll consider the alternatives going forward rather than jumping to a TUIP or TURP. I live in So. California. Curious what thoughts and advice you might have on this scenario.

[@user-eg1sw7kd6g]

If not a urologist, what specialty doctor does this procedure? i'm located in north FL, near Panama City. I had a EURO lift about 1.5 years ago. Results are frustrating. Occasional full flow on the 2nd or 3rd void only when I wake to Urinate at night, never during the day. Starting a flow is extremely difficult. Typically, its go to the urinal and wait for 3 - 10 min for the flow to start. Bladder function, kidneys all check good. Scoped a couple of times following the EURO Lift procedure, but nothing found. I'm starting to wounder if I have some variation of detrusor -- spincter dyssynergia, I don't fit the bill in regards to a spinal injury, I'm physically in good health, but the occasional full flow and the fact that starting is so difficult, makes me wonder if the prostate is the real issue.

[@garlandetheridge9902]

Interventionalist Radiologist

[@sailwinds69]

Try PAE.

[@sailwinds69]

I found CIc in Reno that did it. They also have offices in

[@daveyvane]

You don’t need a medical degree, just a sound proof room.

[@searover83]

my issue is mostly in the medial lobe.. This was not mentioned in your lecture.. Can you please comment?

[@silaslongshot941]

Since the object of the procedure is to block blood flow to the prostate, what happens to all that necrotic (dead) tissue?

[@nicasietenicasiete7358]

I saw another video say the body absorbs it. Whatever that means.

[@andrewthomson6851]

Had PAE done October 2021, yes body absorbs. Shrink my prostate and like a young man again.

[@nicasietenicasiete7358]

@@andrewthomson6851 After researching this procedure. Its slowly becoming my first choice. I haven't found much statistics on it but it seems like the best. If you have a website or dr name for the procedure it would be very much appreciated.

[@andrewthomson6851]

@@nicasietenicasiete7358 Hello, I’m in Sydney Australia. Are you in the States? We can have it done on our Medicare. I can only say it changed my life and would recommend it highly. I had it done in Sydney at the Northern Beaches Hospital by a Dr. Shawn Quigley. Hope you get it sorted like me. Good luck

[@scubarojo]

@@andrewthomson6851 When you say "like a young man"...how "young" are you now. I'm 74.

[@GregBikofsky]

The portion about collaterals was interesting. I had a failed aquablation last year. So that was very interesting for me.

[@steves916]

Great information helps me understand the risk profile of the procedure before my initial consultation, note i'm another self referral post urological assessment

[@user-eg1sw7kd6g]

Can PAE successfully target large median lobes? History: UroLift 2 years ago (intact and working) . No improvement with UroLift. New Doc. discovered high bladder neck and large median lobe. prostate size 55g. Lobe is where all my issues are stemming from. Want to preserve current Sexual level. On daily coumadin ( heart valve). I've not had much luck finding out if a median lobe can be treated successfully with PAE. Closest IR who does PAE is Jacksonville FL, about 5 hours one way.

[@garlandetheridge9902]

Excellent presentation!!

[@patrickrwhite8354]

I had this PAE DONE twice and can't get off of the medication and I still have urgency doing the day. I take a water pill for HBP. ANY ADVICE THE FIRST TIME I HAD THE BEADS THEN MONTHS LATER I HAD THE GLUE NOTHING WORKED AND I WOULD LOVE SOME ANSWERS AND ADVICE I AM FROM CANADA

[@louisekidy937]

Hi Patrick - may I ask where you had this done ?

[@billsrelectric]

Who does the Glue PAE? It seems to be less available.

[@patrickrwhite8354]

@@louisekidy937 Yes in Alberta!

[@maheshdadlani9239]

Is cancer screening necessary prior to this procedure? If yes, what needs to be done? Blood work or MRI of the prostate? Kindly advise. Thanks.

[@eugenebdotson7363]

It's to late for the patience when they find out that they can't ejaculate after the procedure, THE doctor expects the tissue to be passed when you pee, you need to have suction to remove the discarded tissue, I had the Rezume procedure and followed all the recommend instructions, now I have to rethink my direction !

[@FlaThunderstorm]

Just to clear up any questioning. Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm. Retrograde ejaculation isn't harmful, but it can cause male infertility. I had the same after I had Green Light Laser a few years ago. Never reduced my sexual activity in any way.

[@beboboymann3823]

AwesOme report! Why would insurance companies not pay for this treatment? Looking at the possibilities of serious issues with invasive treatments this procedure makes sense.

[@jjsmnow]

Wrong! They do pay for it. Govt usa regular medicare (not the dam disadvantages plans) payed for it twice in 10 years in my case. Look up Dr Bagla in Virginia or on other videos.

[@sailwinds69]

@@jjsmnow Yes I have a Medicare disadvantage program I'm fighting right now for not paying for my PAE which work for me Great after two months of doing it I highly recommend PAE to any guy with a large prostate insurance companies are totally f*****

[@sailwinds69]

My insurance prominence Medicare disadvantage did not pay for it I had to pay for it and I'm fighting them now about it most insurance companies pay for it there's just a few they're holding out sayings experimental saying it doesn't work saying you're risking your life doing it Total lies Medicare approve this over 5 years ago and they're not following the Medicare rules

[@umakantgairola9422]

Appears to be better therapy. What type of neno particles are used for embolization ...??

[@hootowl6354]

There was six and a half minutes of commercials before the episode even started. What the hell is going on with KZbin?

[@roberts.1400]

Get KZbin Premium, not very expensive and you'll never see a commercial or ad again ... Plus, you can share the Premium membership with family or friends at no extra charge. So, if you're watching your pennies maybe get a kickback from someone to help defray the cost would help out ...

[@monroetinker9844]

Great lecture. I am a provider and I think a lot more education needs to be done for the patients on all the various treatments pros and cons so that they can make a better informed decision. I like the idea of having some place to go in the future if this minimally invasive procedure is done early on. A lot of time treatments are bridge to nowhere.

[@jimzimmerman5288]

Kaiser said my 30 gram(#might wrong)prostate was really to small for a good out come? Is that true?

[@atomicbrothers8600]

might want to research TUIP Transurethral incision of the prostate (contrasted to TURP transuretheral rescetion)

[@jaypeters2518]

I am puzzled by the fact that nowhere in the podcast is it mentioned how much the prostate was reduced I was told it was going to be 50% , ended up being 15%

[@hankhalbert6542]

18% here

[@avillar39]

The larger the prostate the more it’s reduced.

[@jaypeters2518]

I was at 153 cc before the PAE. 125 after the PAE

[@hankhalbert6542]

Mine, went down 18%.

[@jonathanbryant9855]

It's so crazy that an organ with no room to grow starts growing. Im glad the brain doesn't do this.

[@michaelwesner5753]

I had 2. They don't work.😢

[@Thom3748]

Not one bit of improvement?

[@jaypeters2518]

I had one with minimal results. I'd like to see a distribution of reduction in prostate size.

[@Thom3748]

@@jaypeters2518 I asked my urologist about this procedure and he wasn’t at all thrilled. He said the data is inconclusive. Here is southern California. The procedure is done by radiologist not by urologist. I think that says a lot about where the professionals stand on the efficacy side for the procedure.

[@jaypeters2518]

@@Thom3748 it is a mixed bag. My urologist was all for it like it was a panacea. He was expecting a 50% reduction in prostate size. As as I mentioned earlier, mye reduction in prostate size was only about 15% from 150 g to 125. I did experience severe PAE syndrome, which landed me in the ER for a couple of days. It may have been just my stomach's reaction to Tylenol and an antibiotic. After listenin* to the podcast it was clear that all IRs are not equal. if I had Dr Sam Mouli the results could have been different?

[@DnBarPoet77]

Very informative discussion! I'm considering a PAE based on recommendation from urologist.

[@MrJOHNMICHAELVEGA]

Why didn’t it work ? The radiologist told me he didn’t know!

[@danielriccardi6408]

only reason it wouldnt work is if they do not get the beads into the right artery

[@MrJOHNMICHAELVEGA]

Could you explain this because that would mean Fraud!

[@alanbrown1563]

I had a tumour removed form my small intestine 2 months a go and ever since I have very loose bowl movements, I all so have a large prostate which I cant pea sat down as my bowls seem to squeeze my prostate stopping me form weeing but since my operation i have lost control of my bowls so when i stand to wee I mess myself this happens about 2 to 2 times a week mostly getting up 5 to 6 time a night half a sleep and forgetting. I end up getting a shower cleaning up the mess while my family sleep then going down stairs crying my eyes out I've been to see my doc about my Prostate problem but he only says take these meds because the hospital wont see you if you don't I've been on them 2 months already but the same reply's I cant take this any more and feel like taking my own life I haven't been able to make love to my wife for about 5 months I'm at the ned of my tether as I've tried virtually every snake oil product there is and had to leave my job because of me messing myself I feel useless .

[@scubarojo]

Well lets see what my Doc says about PAE. He's never mentioned it...and he's not a very old doc.

[@user-eg1sw7kd6g]

My urologist didn't mention it either. Coming up on 2 years post op UroLift, with no improvements in my bph. i am going to mention it at my next appt. I found a radiologist locally but i have to have a reference to see him. Not sure why, unless there are some additional tests which need to performed by the Urologist? I've done all the test, meds, natural meds, diet and exercise without any improvements in the last 3.5 years. I hope I don't run into resistance to the point of switching Urologist and starting over again.

[@danielriccardi6408]

yea but they never mention the massive dose of radiation you get with this procedure!

[@Scott-cu4ol]

how long after the procedure before you can resume sexual intimacy?

[@sailwinds69]

Cost 12028 paid Jan 2023 and it worked 2 months after procedure I had prostate that blocked me from urination... now Mar 14 back to normal pee. Thanks PAE

[@glenwoodriverresidentsgrou136]

How dos PAE work on MLE? On a percentage basis, how much does the prostate shrink after treatment?

[@Scott-cu4ol]

@@glenwoodriverresidentsgrou136 i’m not sure but i had my done a little over a month ago and the improvement is remarkable! I would strongly recommend it.

[@robertmahler8894]

@@glenwoodriverresidentsgrou136 30-40%

[@robertmahler8894]

@@sailwinds69, Are you saying the blockage is back? How are you doing NOW!

[@MrJOHNMICHAELVEGA]

I had Prostate Artery Embolization done but it didn’t work. 0 outcome total failure!

[@DeathSentryCoH]

Any info on why it didn't work? was your prostate size within the size specs they indicate? did veins grow back too quickly?

[@danielriccardi6408]

how big was your prostate?

[@dmcarden]

​@@DeathSentryCoHI wonder what keeps the veins from growing back..if anything

[@glgl1472]

I call this whole podcast but the sin of omission not one word about the amount of radiation that a person is exposed to how that is may be standardized or not standardized and what you guys are doing to reduce it that's a huge controversy that's what's keeping me from actually having it and the fact that you didn't even mention it tells me that you're hiding something

[@paulnotdownunder3172]

There is no radiation involved.

[@Hippokrates9]

For what's worth, your body won't take more radiation than you usually have during a CT scan, MRI or X-ray.

[@ignaciosarmina2654]

Fluoroscopy or live X-ray”, which radiation energy, is used throughout the procedure. That’s how the catheter is guided into the prostatic artery.

[@danielriccardi6408]

I wonder how much radiation are you exposing yourself to?

[@NetoperekMordulec]

All those procedures are barbaric and stink with the dark ages! The issue is that elderly, non contributing to the wealth $$$$$$$$of the society are the sufferers. More than 90% of men above age of 75 are suffering enlarge prostates but who gives a rat's ass. If it was a problem of young people, in a production age when a enlarged prostate would take them out of the tax paying duties, I bet my balls that a solution to this so medically benign situation was found years ago! A permanent and a good solution.

[@darrellcriswell9919]

You have no idea what you are talking about!

[@altalena123]

@@darrellcriswell9919 I could not agree more

[@SunnyG007]

@@darrellcriswell9919 care to elaborate? It isn't a normal practice to do culture on biopsy. they only look for abnormal cells, meaning cancer cells. Why don't they do a bacteria culture. Why does antibiotics help reduce symptoms?

[@garlandetheridge9902]

Although this is the desired procedure, I've heard not all insurances companies pay for this. I hear that the cost is unaffordable to the average man. Not sure of the cost, somewhere between $50.000 and $60.000.

[@sailwinds69]

Cost 12028 just paid and it worked

[@garlandetheridge9902]

@@sailwinds69 Thanks Steve for your reply. Is that 12,028.00?

[@sailwinds69]

Stupid insurance didn't cover avoid prominence medicare advantage. Liars calling procedure experimental

[@sailwinds69]

@@garlandetheridge9902 yes

[@garlandetheridge9902]

Not prohibitive but a lot