Gat Goren, PAE, LUTS, Part 6

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PeterDisAbelard.
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Date Joined Jul 2012
Total Posts : 5640
   Posted 12/13/2014 10:13 AM (GMT -7)   
NOTICE: This thread is once again approaching the point where the software has been known to choke. Please use the new (Part 7) thread to continue this discussion. I will be locking this thread in a few minutes.

The new thread is here:


www.healingwell.com/community/default.aspx?f=35&m=3404502

-- PeterDisAbelard.

---

I am starting a new thread for the Gat Goren discussion since there is a limit of 9 continuation pages on the forum before a thread becomes corrupted and lost. Please continue that discussion here.

If you want to read the previous (Part 5) thread it is here:

www.healingwell.com/community/default.aspx?f=35&m=3079381
62 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

Post Edited (PeterDisAbelard.) : 5/11/2015 9:16:56 PM (GMT-6)


Chicago Dave
Regular Member


Date Joined Apr 2013
Total Posts : 223
   Posted 12/13/2014 12:43 PM (GMT -7)   
#### Interim Update #####

Last month I had an aggravation of symptoms, as I previously mentioned. I thought it would never get better, but after three weeks the symptoms began to fade and eventually recede. Thank goodness. Finally!

The reasons for the aggravation remains obscure. It might have been a change in my vitamin regimen, or my lack of exercise. Maybe it was one of the periodic healing crises I'm familiar with. I don't know.

Nettle Root extract helped. Thanks for the suggestion, Martin. (I used an inexpensive store brand I bought at Whole Foods, though I'm sure the brands Martin suggested were of much higher quality. I was in a hurry and didn't want to wait for an online order to be delivered.) After using it for about a week, I was able to discontinue it. I'm back now to something like "normal." Things feel a little different now than two months ago--but not in a bad way.

I will post again in a couple of months when things have stabilized and I can better see what's happening.

####

Bob: I always look forward to your posts on this board or the others you post on. You are very balanced and diplomatic, and you always give a lot of interesting facts.

It seems only simple justice that the various microwave-type treatments are falling out of favor now. In late 2010, I spent a lot of time looking into these. It seemed a reasonable first step, and the promotional materials were universally glowing. I began to get suspicious when I couldn't get my hands on the original peer-reviewed studies. The last straw was a conversation I had with a nurse at my old urologist in Louisiana, who is a really top-notch guy. She said that they no longer used these treatments because the improvements didn't last long. (The office switched to either regular TURP or laser.) I guess this is now public knowledge, but it was still a popular treatment option back in 2010.

Medical science advances!

5/30/2011 GG procedure. Before GG: Prostate: 51 g by transdermal ultrasound
5/2012: Prostate: 22.3 g by TRU/S. Symptoms still very annoying.
5/2013: Better control of symptoms. Look Ma, no more Rapaflo!!!

[Edit: Hundreds of typos]

Post Edited (Chicago Dave) : 12/13/2014 9:27:30 PM (GMT-7)


1rphguy
Regular Member


Date Joined Jun 2013
Total Posts : 61
   Posted 12/15/2014 5:26 AM (GMT -7)   
Dave, almost every time I drink coffee I have issues flare-up again. So, I rarely drink coffee anymore.

interestingly, I love Dr. Pepper. One a day doesn't bother me, so I don't think it is just the caffeine doing it to me and there must be something else in coffee doing it.

I had the PAE.
I see the questions and criticisms of the GG on here, but I'm not sure that the PAE performers are much different in giving their data.
I was enrolled in the "study" and it was not going to be no charge, but if my insurance were to cover it, they would not make me pay anything extra.
At the 3 month period I was not seeing good results. I received a notice that I was not being accepted for the trial study......... after I had already been accepted, had it performed, and not seeing good results yet.
Plus, they ended up making me pay after the insurance paid them even though they said I wouldn't have to.

Now, did it work? Certainly, just took longer. My prostate went from over 50 to less than 35. I have median lobe, but experienced good results anyway. just took longer. Plus, I had to have a bladder diverticulum repair before my results got significantly better.

the only reason I did not go get the GG was that they shut down operations for a good while in May, 2013 and was VERY poor in responding to me or updating me concerning when they would resume.

Something didn't just fee right and, also, I needed to get something done soon. I am glad I had the PAE instead of some other GL or similar procedure.

Bob_NJ
Regular Member


Date Joined Jan 2009
Total Posts : 190
   Posted Yesterday 8:26 PM (GMT -7)   
Skateman,
Amazing news about Nymox failing its trials for bph after 7 years of nothing but glowing reports. Perhaps they broadened the scope to low grade PC because they knew the bph trial was going to fail. The interesting thing for me was reading a post on another forum by someone who claimed he had been in the trial and gotten excellent results that had lasted several years at that point. Perhaps they cherry pick the trial participants and exclude those who look they are not getting the best outcomes as happened to rphguy in his PAE trial.

Rphguy,
Thanks for the update and story about your trial experience.

Dave,
Hope your symptoms get better. Was it just frequency and discomfort or were their changes in your stream, burning, etc? I once ate potato chips with dirty hands and wound up with a UTI. The prostate is a mystery wrapped in an enigma. Even during my worst symptoms I had a few hours when everything was fine. I could never figure out what mechanics were in play. Did my prostate swell up and then loosen up for no reason? Nothing made sense a lot of the time.

My own update--
I went to the urologist last night, to try to get some help and information on why I urinate more than 2 liters every third or fourth night, and urinate a third to a half liter on most other nights, and probably a liter most days. My uro was detained and I saw the PA instead, who wouldn't prescribe the desmopressin without a series of pituitary blood tests, and also wants me to submit a detailed diary of fluid inputs and urine outputs, which I am now compiling. It's probably the correct procedure, but an RX for the desmopressin would have either worked or not. They have been giving desmopressin to children for about 50 years to try to control bedwetting. It works for some and not others. I wonder if it could pose a danger to an older man when children get it routinely?
On a lighter note I mentioned to the PA than I had read that millions of men and women in the US suffer from LUTS with no medical cause ever found. The PA agreed and said they encounter that often. It seems like getting complete relief from this condition is like hitting the jackpot.

Post Edited (Bob_NJ) : 12/17/2014 8:30:06 PM (GMT-7)


Skateman
Regular Member


Date Joined Jul 2013
Total Posts : 70
   Posted Today 12:23 PM (GMT -7)   
See,


https://www.cornellurology.com/clinical-conditions/male-infertility/surgical-procedures/microsurgical-varicocelectomy/

Chicago Dave
Regular Member


Date Joined Apr 2013
Total Posts : 223
   Posted Today 6:15 PM (GMT -7)   
RPH:

Thanks for updating us. The important thing is that your PAE has helped you; that's great.

As for how they handled your "enrollment" in the study, it seems suspicious to say the least. Most clinical trials are on an "intent to treat" basis: Once enrolled, always enrolled. Legitimate clinical trials are not supposed to "cherry pick" subjects or selectively report outcomes! I can't explain this type of conduct.

I love coffee but gave it up 12 years ago because I couldn't limit myself. Now a single cup sends my blood pressure through the roof and keeping me up all night. (Years without coffee have deprived my liver of the "inducible enzymes" it needs to process caffeine.)

Bob and RPH:

My current symptoms for the last two years are typically some frequency/urgency and some very light LUTS. I've never had the burning stream symptoms. Presently, I'm doing pretty well, about where I was a couple of months ago, before the bad episode I posted about. The light LUTS causes me to shift in my chair. It's a pale reflection of what it felt like before and even after my GG procedure. Fortunately, it's better now, without drugs, than it was when I was on Rapaflo for two years following the procedure.

Bob and Skateman:

Skateman alerted us to the situation with Nymox and its failed trial. (Thanks, Ira.) Nymox common stock was at $5/share before the bad results came out. It's now at 50-cents/share, a cool 90% drop almost overnight.

Now consider what happened earlier this week to another company with a BPH drug. Sophiris stock dropped 80% Monday following disappointing results from a trial of its BPH drug. (The Sophiris news were only "interim" results, so it's possible the market overreacted. Then again, maybe the reason the stock price plunged "only" 80% rather than 90% was because of that fact. The actual treatment effect was not disclosed, only the fact that the drug did not reach some predefined level wanted for planning purposes. The final results won't be known until late 2015.)

I wonder how many more companies are out there with drugs or devices for treating BPH?

ClapTheHammer
Regular Member


Date Joined Jun 2012
Total Posts : 104
   Posted 12/20/2014 4:04 AM (GMT -7)   
Chicago Dave Now consider what happened earlier this week to another company with a BPH drug. Sophiris stock dropped 80% Monday following disappointing results from a trial of its BPH drug. (The Sophiris news were only "interim" results, so it's possible the market overreacted. Then again, maybe the reason the stock price plunged "only" 80% rather than 90% was because of that fact. The actual treatment effect was not disclosed, only the fact that the drug did not reach some predefined level wanted for planning purposes. The final results won't be known until late 2015.)

It seems that as prostate problems suffers, 'we' are all subject to a lot of hyped up and downright misinformation or absence of information by all kinds of entities whose purpose is profit rather than alleviating our symptoms or solving once and for all, our prostate problems.

On the other hand, making a profit is an integral part of capitalism.

ClapTheHammer
Regular Member


Date Joined Jun 2012
Total Posts : 104
   Posted 12/20/2014 4:08 AM (GMT -7)   
Skatemen. Thanks for the link. (I think). I was a bit squeamish going through that article though. Especially the pictures.

And my scrotum was .... shivering.

Skateman
Regular Member


Date Joined Jul 2013
Total Posts : 70
   Posted 12/20/2014 11:00 AM (GMT -7)   
ClapTheHammer said...
And my scrotum was .... shivering.
Yes. D a m n graphic!

The patient has to be completely under anesthesia for that procedure, otherwise his blood pressure would zoom on every less than affirmative comment during the surgery.

The doctors who authored the article claim greater permanent "procedural success" than that achieved by radiography procedures (though I do not know if they've had access to GG statistics). I put "procedural success" in quotes because I'm referring to the immediate objective of the procedure, namely occlusion (or removal) of veins.

From what I can tell, the authors occlude (or remove) the same veins as the GG procedure. For Americans, this microsurgical procedure may be less expensive and easier to access than the GG procedure, and should have the same longer term results, whatever they may be.

I just sent the following email message to the authors of the article:


Skateman said...
Dear Drs. Schlegel, Goldstein and Paduch,

There is discussion among BPH sufferers who also have varicocele about whether or not removal of the varicocele will tend to cause the size of the prostate to shrink, with consequent diminishment of BPH symptoms. One discussion of the subject can be seen here:

http://www.healingwell.com/community/default.aspx?f=35&m=3079381&p=6

Doctors Ygal Gat and Menachem Goren (a/k/a Michael Gornish), who currently practice in Israel and Cyprus, contend that it does.

Their webpage on the subject can be seen here:
http://www.pirion.co.il/index.php?option=com_content&view=article&id=6&Itemid=69&lang=en

If I understand correctly the information in your article (found here < https://www.cornellurology.com/clinical-conditions/male-infertility/surgical-procedures/microsurgical-varicocelectomy/> you have performed 1000s of varicocelectomy procedures. I suspect that most of your patients tend to be younger, and not yet suffering from BPH.

However, at least some of your patients likely were suffering from BPH symptoms.

One question is this: Did any of these patients indicate to you a reduction in those symptoms?

Another question: Do you remove the same, less, more veins than do Drs. Gat and Goren (as described in their application for patent)?

Thank you in advance for your response.

Post Edited (Skateman) : 12/20/2014 11:24:28 AM (GMT-7)


Skateman
Regular Member


Date Joined Jul 2013
Total Posts : 70
   Posted 12/20/2014 11:06 PM (GMT -7)   
I did receive a response from one of the doctors to whom my most recent email was sent.

It is a real pleasure to deal with a medical practitioner that sees the important academic value of his or her experience.

The gist of his comments:

1. Regarding varicocele repair, he believes that the microsurgical procedure is the most effective in preventing reflux to the testes.

2. He is familiar with Dr. Gat's position that varicocele and BPH are related.

3. Nevertheless, he does not believe it is clear that varicocele repair changes the natural course of BPH, and he indicated that there is some data suggesting that increased testosterone from varicocele repair could increase prostate growth.

I have requested further information about the data that he referred to. I hope that he will not feel imposed upon by my request.

ClapTheHammer
Regular Member


Date Joined Jun 2012
Total Posts : 104
   Posted 12/21/2014 9:41 AM (GMT -7)   
skateman - It is a real pleasure to deal with a medical practitioner that sees the important academic value of his or her experience.

How very true.

Heard a discussion on television about patients coming to their GPs (General Practitioners), with internet articles and (internet) conclusions from the known symptoms that the patient felt. A senior neurologist in Israel says that one patient supplied him with a conclusion about a neurological problem that he would never have considered considering the known symptoms. That internet conclusion, using further test results prompted by the internet conclusion, turned out to be spot on.

Good for him admitting it in public. The internet is changing our lives in so many ways. And some doctors are becoming less 'superior'.

martin victor
Regular Member


Date Joined Oct 2012
Total Posts : 216
   Posted 12/24/2014 7:26 PM (GMT -7)   
Dave: I am glad you are feeling better. Yes, all brands of nettle root are not the same. Here is some information from Medi Herb on BPH. Interestingly, as many of us know, increasing bladder function is a major component for decreasing BPH symptoms. Medi Herb discusses crataeva stem bark.

"Crataeva is one of the most important Ayurvedic herbs with influence in the urinary tract. The herb possesses bladder tonic and anti-inflammatory activity.34 It is now widely accepted that not all BPH symptoms are due to enlargement of the prostate, particularly in older men, where an atonic bladder can contribute significantly to symptoms.

Clinical data supports such a use. Thirty patients with hypotonic bladder due to BPH were given a decoction of Crataeva. There was a marked improvement in frequency, incontinence, pain and retention of urine. Urine flow improved as well as an increase in bladder tone after therapy."

http://www.mediherb.com/pdf/5015.pdf

thunder2004
Regular Member


Date Joined May 2013
Total Posts : 81
   Posted 12/26/2014 1:24 PM (GMT -7)   
Skateman,

The paper that show increased prostate volume to the prescense of varicocele is here:
http://www.ncbi.nlm.nih.gov/pubmed/25056570

Dr. Gat's theory is incomplete, and after a ton of research, I think I might have a theory as to why some of your prostates are shrinking while others have not from the procedure.

I believe the microsurgical approach has a high likelihood of INCRAESING prostate volume as opposed to the intervention radiology approach.

I will sort it all out in a long blog post that I will create - along with associated papers.

Golfosca
New Member


Date Joined Oct 2014
Total Posts : 14
   Posted 12/26/2014 5:51 PM (GMT -7)   
Hello. There has been a good deal of talking since I last looked in; I'm concerned that the discussion is at least properly informed.
Briefly, my experience has been uncannily like Liam's. I am awaiting the six month point, when I will be doing a final round of tests including measurement of the size of my prostate. I will of course report the outcome.
But the discussions which compare the GG procedure to microsurgical varicocelectomy are misinformed. There is no surgery in the GG procedure, and in plumbing terms, they deal with different pipes.
GG have identified the deterioration of the non return valves of the Internal Spermatic Veins as being the underlying driver of BHP. The ISVs carry venous return blood from the testes, containing a high concentration of free testosterone.
There are two ISVs, one on each side of the body, running from the groin to the heart. They elevate the blood returning from the testes up a ladder of non return valves, back to the heart. Failure of the non return valves (which happens as we age), means that the steps of the ladder are removed and the hydrostatic pressure of blood at the base of the ISV is now up to eight times normal.
GG's break through was to identify (usually) three very small transverse veins which provide a pathway from the base of the ISVs to the prostate. Driven by the abnormally high static pressure at the base of the ISVs, there is an increased flow of the venous blood carrying high levels of free testosterone, and this subjects the prostate to concentrations of testosterone some 130 times normal. GG addresses this anomaly and returns the concentration to normal.
GG's technique is to use a catheter to locate and then to block these veins using the same scleroticising chemical as is used in treating traditional varicose veins. NO SURGERY.
So simple, so gentle, so free of side effects, that it was a no-brainer to me in assessing which treatment to undergo. I am by nature a coward. My cowardice has been rewarded.
As an aside, the veterinarian world accepts unequivocally that the canine version of BPH is driven by testosterone. It occurs in 80% of "whole" dogs aged 5 or more, and it never occurs in dogs that have been castrated.
Take a look: http://vetsci.co.uk/2011/11/11/canine-benign-prostatic-hyperplasia/
Are we on to something here? Who wants to go first?

Chicago Dave
Regular Member


Date Joined Apr 2013
Total Posts : 223
   Posted 12/26/2014 6:46 PM (GMT -7)   
Golfosca:

Thanks for reviewing the theory behind GG for our newbies.

There was a lot of discussion on this back in the Fall 2013 for folks who want to revisit it. Every time, it's discussed, it becomes a little more understandable. Unfortunately, it's not covered in Urology 101, so I don't think it will convince people who have been brought up to think that there is no relationship between ISV valves and prostate conditions.

The role of those "three very small transverse veins" was mentioned back then, but not in detail. It's not clear to me whether GG needs to sclerotize them, too, or if it's sufficient to close the ISVs and collaterals. This point would be salient for guys seeking "home grown" GG procedures with local interventional radiologists. Since I chose the "authentic" GG procedure, none of these little details was that important to me. (Though they might be of interest to IRs who are asked to perform a GG-like procedure.)

idea I myself brought up the "treatment" for canine BPH back then. I was hoping that some intrepid forum reader would give it a shot, but no one ever volunteered. I mean, what could possibly go wrong? Castration is such a simple and elegant treatment....inexpensive even. Surely hard-pressed insurance companies would start pushing this on their insureds, but they somehow managed to drop the ball. I have not yet given up hope. There are 10,000 treatments for prostate problems in men, and it's only a matter of time before castration gets its own 15 minutes of BPH-curing fame. Can't wait.

Golfosca, Thunder is a great original researcher. He does not post lightly. If he is willing to take a deep dive into the relationship between microsurgery, GG and prostate conditions, then I, for one, look forward to seeing what he learns. And so should others IMHO.

Golfosca
New Member


Date Joined Oct 2014
Total Posts : 14
   Posted 12/26/2014 9:28 PM (GMT -7)   
Hello ac72. Subjunctive? You're right, of course. Man, it's so long since I gave any thought to grammar, any time I do I get labelled "pedantic" by my kids. This forum has a life of its own!

More seriously, ChicagoDave posts
"The role of those "three very small transverse veins" was mentioned back then, but not in detail. It's not clear to me whether GG needs to sclerotize them, too, or if it's sufficient to close the ISVs and collaterals. This point would be salient for guys seeking "home grown" GG procedures with local interventional radiologists. Since I chose the "authentic" GG procedure, none of these little details was that important to me. (Though they might be of interest to IRs who are asked to perform a GG-like procedure.)"

You've got it slightly wrong, Dave. GG does scleroticize the transverse veins. It does nothing to the ISVs. It just uses them as pathways for the catheter during the procedure.
But thanks for the good spirited comments.

ac72
New Member


Date Joined Oct 2013
Total Posts : 11
   Posted 12/26/2014 9:36 PM (GMT -7)   
Golfosca

if there are only the (few) transverse veins to be dealt with why pray does the operation take so long (to help us all get a clearer picture of what happens during the op, if you would be so kind, and can be so profligate with your time).

(Thank you for your gracious response to my pedantry. But if so, and it is not too late, may I trouble you to actually amend the offending verb – it’s such a masterful account otherwise – worthy of preservation in the annals of time - not even the good doctors manage such a clear explanation (though perhaps that is why one employs a barrister (attorney?) – it being difficult acting for oneself).)

In fact pursuing Chicago Dave’s thought might you not wisely consider storing up treasure in Heaven by devoting time - even a year - to providing a faithful account of what a home grown IR needs to have clear - and so at one blow lay the ground work for an exponential safe growth in availability of GG’s relief worldwide.

Post Edited (ac72) : 12/26/2014 11:00:42 PM (GMT-7)


Chicago Dave
Regular Member


Date Joined Apr 2013
Total Posts : 223
   Posted 12/26/2014 10:54 PM (GMT -7)   
Golf,

Hmmmm. We had a really long drawn-out discussion about this on this forum in late 2013, and I had numerous discussions with Dr. G himself in late 2010. I came away with the distinct impression that it was important to sclerotize both intra-spermatic veins (ISV's) and any parallel collaterals. I remember several conversations with various folks about collaterals, which are a bugaboo in this procedure as they represent alternative paths of unwanted venous return to the prostate area. Many of the details about the theories have faded in the four years since I was avidly researching this, but the necessity of sealing off ISV's remains.

[Cue dramatic music. Flashback! Fade to hospital. Dave is lying on the bed of the fluoroscope.]

I remember watching the TV screen as Dr. Goren threaded the catheter through my leg and abdominal veins to gain access to the top of the ISVs. You're wide awake, and Dr. Goren will gladly give you a play-by-play if you're interested. He had to tap several times to get access to each ISV. Apparently it is often the case that the topmost valve in the ISV is often functional and does a good job blocking the "backflow" represented by the descending catheter tip. But eventually he succeeded. Then he eased the catheter down the ISV, and I believe he sclerotized its whole length. He did one ISV and then the other the same way as I watched the live-action on the monitor. But I really wasn't trying to learn exactly what he was doing, and could be mistaken. (AC: It takes a lot of time to thread the catheter so far through the veins. That's why the procedure takes an hour and half or so.)

A digression: Dr. Goren had to make several attempts to access one of my ISVs--that top valve!--and was very perseverant in his quest. Normally, this would be totally forgettable except for the fact that his standard procedure calls for repositioning the catheter tip by kneading my abdomen and trying to poke it into place along its winding route. For most guys this is nothing, but I have a sensitive (and well-padded!) midsection that strongly resents digital probing! I was making all kinds of faces and grunting noises, and he asked me if I wanted to stop. I told him No: that I had come this far and I wanted the full treatment, regardless. He obliged and soon worked the catheter tip past the recalcitrant ISV valve. At this point, it takes almost nothing to push it all the way down the ISV, then slowly withdraw it, squeezing out the sclerotizing fluid along its length. Well, I thought that's what he was doing anyway, Golf.

I never heard anyone else report this discomfort, so I think I'm a small minority. There was only one other mildly uncomfortable moment about my experience. After the procedure was completed, I felt pretty good, just hungry as I hadn't eaten much that day. So on the way back to my hotel, I stopped off for a burger and fries. Not a good decision. They went down fine, but came right up in 20 minutes. This surprised me as I didn't feel particularly stressed by the experience (except for the tummy kneading, which always annoys me). But I did sleep the entire next day and much of the day after. The sleep was uneventful, and there were no further interesting experiences to report.

Probably TMI for most readers.

Auld Ange Syne! It's right in season.

Golfosca
New Member


Date Joined Oct 2014
Total Posts : 14
   Posted 12/27/2014 1:03 AM (GMT -7)   
AC... first, let's clear up a major misapprehension; the procedure takes typically 45 minutes including preparation. It took almost exactly that time for me. It is indeed simple. As to going back and amending the offending verb, forgive me if I don't. I don't know how, I generally don't "go back", and I suspect that only thee and me care about it.
As to exponential growth in the GG process resulting from spreading the word, just look at how it gets bogged down on this forum!!! LiamIreland and I both left Nycosia full of missionary fervour to spread the word, and I can only say that here in Sydney my good intentions have run aground on the sands of vested interest. But I will keep up a progress report.
Dave, I'm sorry that your experience was not as peaceful as mine and Liam's. Your cue of dramatic music brought it all back, and I can admit that lying there under the TV screen I was petrified. But Dr Goren was reassuring and supremely competent, and within minutes I was fascinated and watching intently. I am sure that you got a slighty wrong picture while you were in there, unless the procedure has changed, and I can see no reason for that to have been the case. I'm prepared to say categorically that the only veins that were sealed/scleroticised in my case, confirmed by the literature, were the transverse veins joining the ISVs to the prostate; the ISVs were the pathway to the site but were not treated in any way. And yes, there was a degree of pelvic prodding to steer the catheter at times, though not much and not uncomfortable. In fact, after the little sting of the local anaesthetic needle I didn't feel a thing. But then I'm a mere 72, in the prime of life...
And I could have done with a burger and chips but had to settle for Park Hilton snacks. No after effects whatsoever.
And as you say, 'tis the season. Best wishes all round.

thunder2004
Regular Member


Date Joined May 2013
Total Posts : 81
   Posted 12/27/2014 8:13 AM (GMT -7)   
Golfosca said...
Hello ac72. Subjunctive? You're right, of course. Man, it's so long since I gave any thought to grammar, any time I do I get labelled "pedantic" by my kids. This forum has a life of its own!

More seriously, ChicagoDave posts
"The role of those "three very small transverse veins" was mentioned back then, but not in detail. It's not clear to me whether GG needs to sclerotize them, too, or if it's sufficient to close the ISVs and collaterals. This point would be salient for guys seeking "home grown" GG procedures with local interventional radiologists. Since I chose the "authentic" GG procedure, none of these little details was that important to me. (Though they might be of interest to IRs who are asked to perform a GG-like procedure.)"

You've got it slightly wrong, Dave. GG does scleroticize the transverse veins. It does nothing to the ISVs. It just uses them as pathways for the catheter during the procedure.
But thanks for the good spirited comments.


Golfosca, GG procedure absolutely closes the ISV's, which run from the renal vein to the scrotum. It closes the ISV and associated collaterals. If ISV is not closed, varicocele is not repaired.

martin victor
Regular Member


Date Joined Oct 2012
Total Posts : 216
   Posted 12/27/2014 8:55 AM (GMT -7)   
Golfosca: Per your statement:

" I'm prepared to say categorically that the only veins that were sealed/scleroticised in my case, confirmed by the literature, were the transverse veins joining the ISVs to the prostate; the ISVs were the pathway to the site but were not treated in any way."

Your experience must have differed from mine as I watched the ISV's sealed by Dr. Perlow, an associate of Dr. Gat/Goren. I question which transverse veins you refer to. According to Dr. Gat's Patent Application:

(0135) In exemplary embodiments of the invention, the reflux is prevented or impeded by occlusion (e.g. embolization or sclerosis) of the left internal spermatic vein and or the right internal spermatic vein that has effected the excessive hydrostatic pressure EP. Optionally and additionally, some or all veins through which the reflux flows, such as the deferential vein and the pampiniform plexus are occluded. Optionally or additionally, bypass veins that might have developed are occluded too.

The patent application also goes on to state that the deferential vein and pampiniform plexus are occluded when a metastases or suspicion for metastasis is present to reduce the risk of metastases proliferation.

The tranverse veins leading from the pampiniform complex include the cremasteric vein, the scrotal vein, and the differential vein. Prior to my procedure I was most concerned about the flow of testosterone from the testis should the ISV's be blocked. In my conversation with Dr. Gat, I reviewed an anatomic chart showing the new pathways of testosterone and was re-assured that these 3 veins were sufficient in doing the work of the ISV's by transporting testosterone to the inferior vena cava.

thunder2004
Regular Member


Date Joined May 2013
Total Posts : 81
   Posted 12/27/2014 12:07 PM (GMT -7)   
Golfosca - what part of the literature are you referring to that describes closing off the "transverse veins" from the ISV to the prostate?

martin victor
Regular Member


Date Joined Oct 2012
Total Posts : 216
   Posted 12/27/2014 1:42 PM (GMT -7)   
hmmm! The mystery gets deeper

Golfosca..Thanks for bringing to my attention that non human primates get bhp ( http://vetsci.co.uk/2011/11/11/canine-benign-prostatic-hyperplasia/)

I was under the distinct impression that only humans had vertical ISV's. That the valves on ISM's fail due to gravity incurred on the 35- 40 cm climb up from the testis to the renal vein. It was imparted to me during my conversation with Dr. Gat et al that non human primates have horizontal ISM's and thus animals such as canines do not incur BPH. So the question comes to mind, ...if both humans with vertical ISM's and canines with horizontal ISM's both get BPH, is gravity and the resultant backward pressure of testosterone the real cause of this problem. Is the Gat procedure a temporary fix just like TURPS?

Perhaps the real cause of BPH is from hormones that are not balanced due to improper lifestyle, nutrition, or excess chemicals in the environment and not from vertical ISM's and gravitational pressure as proclaimed by Dr. Gat. Failed ISM's are thus a symptom rather than the cause. Estrogen dominance is a primary suspect from exposure to petrochemical toxins (called xenoestrogens) such as pesticides, emulsifiers, and toxic chemicals that out gas from certain plastics, adhesives (such as carpeting) etc. There are so many reasons for estrogen dominance that it is no wonder that by the time a man becomes the age of 60,...60% of the male population are afflicted. Other causes of estrogen dominance include excess cortisol from chronic stress, smoking, trans fatty acids, obesity, sleep deprivation polluted air etc etc.

Chicago Dave
Regular Member


Date Joined Apr 2013
Total Posts : 223
   Posted 12/28/2014 10:21 PM (GMT -7)   
Muchisimos apologies in advance for this super-long post.
###

To Fence-Sitters and Associated Lurkers:

My advice is to get the GG procedure...providing that you can easily afford it. The downside is limited: Nothing as far as I've heard. If worst comes to worst, you would be out $25K or whatever, but otherwise be whole and undamaged.

Here's my take on the GG-decision calculus:

If you have some type of varicose-vein situation going on in your abdomen, then the GG procedure may totally fail. There might be collateral bypasses that cannot be sealed, foiling the procedure. Or, another bypass could arise later on, causing failure down the road. Either way, there will be pressure and backflow to the veins that drain the prostate and other organs, and there will be no benefits from the procedure.
What are the odds? I know that this has already happened to one member of this board, so the odds have to be greater than zero. I suppose that there's a 10 or 20 percent of either initial failure or subsequent failure. That's just my guess; I have no data to support that.

Say the chance of outright failure is 20%. That still leaves 80% who will benefit from the procedure to one degree or another. Naturally, that includes benefits to the prostate and LUTS-type symptoms. But it also includes possible benefits to other organs which share the same venous drainage, including the bladder and testes. I believe that I personally have seen helpful benefits in both these areas from my May 2011 GG procedure.
There is also a theoretical benefit of lowered risk of prostate cancer (PCa). I myself viewed this as a "fail-safe benefit" when deciding to get the procedure. Having already experienced benefits to my LUTS syndromes and an objective shrinkage in my prostate, I also hope to be at lower risk of PCa as I age. A trifecta of prostate-related benefits. Guys might also enjoy increased fertility from GG, but I doubt this would be an issue to many guys reading this board.

If 80 out of 100 GG patients eventually reap a benefit, it's still a fact that not all 80 will have a great resolution of prostate issues. Thanks to Martin's posts, forum readers now know that an enlarged median lobe is one condition that might foretell a less-than-satisfactory outcome. I suspect that guys with really humongous prostates or who had symptoms for decades may also not have fully satisfactory results. (I have no data to support that last statement; I'm merely doing armchair speculating. And bear in mind that I'm a patient not a doctor.) So out of those 80 guys who might theoretically benefit from GG, perhaps 30 to 70 might have really good symptom resolution. So is it closer to 30 or closer to 70? Beats me.

As Bob so sagely observed (I'm liberally paraphrasing): If a particular treatment happens to work for you, then you think that particular treatment has a 100% success rate. And should it fail, then the treatment has a 100% failure rate. (Subjunctive aficionados: We call your attention to the use of "should fail" above.)

Even if the GG procedure fails, you have still kept all your options open. And if GG has halted the slow, annual growth of your prostate, isn't that a good thing? It means that your follow-up laser or TURP or Urolift or whatever procedure will last that much longer without needing to be repeated or replaced.

"You pays your money and takes your chances." It's your body, your money and ultimately your decision. In health as in life.

I've said it before and I'll say it again: I most regret not having this procedure done 20 or 30 years earlier. In the future, I think that GG might come into its own as an early-intervention, quasi-preventative procedure to be undertaken soon after symptoms first emerge. But that's the future, it's not where we're at now. Instead, the current treatment paradigm is to wait until the prostate/BPH/etc problems become so unbearable that guys have no choice but to do *something*. And then they start looking at their "alternatives": the lasers, TURPS, etc, etc, etc. To me this is positively medieval. I hope and I trust that in 50 years medicine will have a completely different mindset in treating male "age-related" "prostate" "problems".

In the meantime, I recommend GG for guys who can afford to place a calculated bet on an experimental procedure.

###

Now, my take on the how GG works to restore circulation to the prostate, bladder and testes. This was hashed out at length in the Fall of 2013. (Those posts are still available for the reader's edification and/or amusement.) I'm fairly burnt out on this discussion, and I'd wager that Thunder and Martin are similarly disinclined to revisit this territory. But here's my recollection of our conclusions, amended and simplified by my rapidly deteriorating senior-citizen (age: 57) memory.

The Intra-Spermatic Veins (ISVs) span from near the scrotum to the renal vein (as Thunder reminds us). There are two of them, one on the right and one on the left. Their job is to drain the prostate circulation by returning the oxygen-depleted blood back to the heart and lungs.

Unfortunately, there is insufficient blood pressure there to optimally force the venous blood through the ISVs simply from the action of the heart. To lift the venous blood from the prostate-level to the kidney level, nature has devised a series of one-way valves. These are the notorious "valves" we've been talking about. The ISV valves have a dual-function: (1) When mechanically sound, they help return venous blood to the heart. (2) When busted, they help support the lifestyles of various medical specialists. Let's look at (1) in more detail.

When you bend your torso while moving, the ISVs are squeezed. Now consider what would happen without any valves: This squeezing would force the venous blood in the each ISV down and up at the same time. When you unbend your torso, the blood would rush back in, leaving things much as they were before. No net movement of blood would occur. Now imagine the same system with working one-way valves, which permit flow going up (toward the heart), but block flow going down (toward the prostate). The squeezing of each ISV still forces the same amount of blood out of the ISV, but the working valves channel all this blood up and out of the ISV on its way to the heart. When the squeezing stops, the ejected blood is blocked from re-entering the ISV by the topmost valve, which also impeded Dr. Goren in my procedure. The partial vacuum allows new blood to enter the ISV from below, and the cycle repeats the next time you move. This the normal function of the ISV when the valves are working to block backflow ("reflux").

Under Dr. Gat's hypotheses, these valves eventually fail in many/most men, and the ISVs no longer drain the prostate. The action of the ISVs with failed valves will be like ISVs with no valves above, as described above. Here's a visual image that came out of last year's discussions. Imagine two pencil-thick tubes filled with blood sitting atop the prostate. These represent the ISVs with failed valves. The blood there just bounces up and down, but doesn't actually flow, blocking the drainage of the prostate area.

The GG procedure seals up ("sclerotizes", from the latin word for "harden") the ISVs. Often there will be collateral bypasses that run in parallel to the ISVs along some of their length. Naturally, these collaterals lack any one-way valves. They represent some type of "varicose" process going on. As I'm not a doctor, I don't understand exactly how they arise. Some men have them, and some men don't. I did not have them; the difficulty in my procedure arose only from the difficulty in guiding the catheter tip and in obtaining access to the ISVs which were blocked by the topmost valve, which happened to be working. Dr. Goren said that it's not uncommon for the topmost valve to work even after the lower valves have already failed. The other thing I know about collaterals is that they might grow in some men *after* the GG procedure, but no one really knows exactly how often this might happen or when. In either case, untreated collaterals are bad news and will block the benefits of the GG procedure.

(It's very possible that the GG procedure sclerotizes other minor veins, too, as Golfosca has reported. I am content to leave the mastery of its subtleties to Dr. Goren and his colleagues. It would not surprise me--in fact, I would expect it--that the procedure is done slightly differently for different cases. After all, most medical procedures need to be customized to the patient for best effect.)

Now for the $64,000 question: How does sealing up the ISVs help restore the normal circulation of the lower abdomen? After all, the ISV is the main return path of venous return to the heart. So it's counterintuitive, to say the least, that by blocking the main return path, the flow can be improved. It's sort of like saying that North-South traffic in the Los Angeles area could be improved by permanently closing the 5, 100 and 405 freeways. This is where things get squirrelly and complicated. At one time, while deciding whether or not to go forward with the procedure, I was very interested in this question. Not only did I read all of Dr. Gat's paper where he tried to explain it, but I also read the emails from Dr. Gat which explained how it all worked with a lot of math equations. Alas! Though I may have known at one time, now I don't.

As I recall through the dim mists of memory, there is indeed an alternate return path for venous blood from the prostate to return to the heart (as Martin confirmed). This alternate route has different diameters of veins and according to some strange laws of hydrodynamics--which govern the movement of the blood through the circulation--the particular combination of the small diameter veins with the larger diameter veins they connect with, allow the miracle of increased circulation. (I said above that the pressure in the ISVs was not enough to optimally return venous blood to the heart. Maybe I misremembered: Maybe it was enough, but that the normal ISVs acted as a turbo-charged system for venous return. It's complicated, guys, so be warned.)

Go back to the image: Imagine the pencil-thick ISVs bouncing up and down as the body twists, sucking up venous blood from the prostate area and splashing it back and forth, interfering with the flow in the alternate return path. Now imagine those ISVs totally sealed off, and the venous blood placidly flowing through the alternate path back to the heart. Now imagine that the improved drainage brings a lot more fresh blood to the prostate/bladder/testes region and that this new fresh blood improves the function of those organs. Better function=fewer problems.

Granted, this is an exercise in visualization rather than a scientific demonstration of how GG improves the circulation. But at least it helps one keep in mind what the issues are.

As I said, before my procedure, these theoretical issues were a major concern for me. Now, three years later with good results, I don't care. Maybe Dr. Goren told me the truth about blocking the ISVs as I watched the monitor in the hospital. Or maybe the monitor was merely a clever Potemkin-style ruse to hide the fact that he was injecting smart nanobots into my groin to rebuild the prostate and bladder. Or possibly elves or medical fairies were somehow involved. I used to care about all these details, now I'm pretty blase.

So that's my fuzzily remembered take on the GG procedure. Before I let you go I want to call your attention Dr. Gat's findings about increased testosterone (T) concentrations in the prostate circulation. This has been discussed previously on this forum, most recently by Golfosca. Dr. Gat measured the T concentration at a point in the circulation in hydrostatic connection with the prostate circulation. I think this measurement was done on just one patient, but it's probably a very tricky measurement. The T concentration was like 130 times (more than 10,000 percent!) higher than elsewhere in the patient. Back to the imagination exercises: Imagine bathing your prostate and bladder in a T concentration 100 times larger than usual, and with oxygen-depleted blood to boot. Do you think your prostate and bladder would appreciate this? Now imagine asking your personal physician for a prescription of T to raise your overall T level 100 times. Do you think he'd give you such a script, given that MDs agonize over prescribing doses of T to raise the T concentration to 2 or 3 times pre-treatment levels? Granted, this measurement was performed on just a single patient, but it's pretty disturbing if it's representative of the situation in guys with busted ISV valves, which is many guys eventually.

###
Guys: If you want to edit or modify one of your earlier posts, just click one of the icons at the upper-right of the post in question. If you don't see the icons, then you probably have to sign-in again to the forum.

###
Martin: I agree that the etiology of BPH is probably multifactorial (where "multifactorial" is construed in its technical sense of "heck if I know").

###

Seasons Greetings To One and All!

ClapTheHammer
Regular Member


Date Joined Jun 2012
Total Posts : 104
   Posted 12/29/2014 8:02 AM (GMT -7)   
ChicagoDave - Say the chance of outright failure is 20%. That still leaves 80% who will benefit

Come now Dave. Let the good doctors publish their statistics on success and failure. I wouldn't expect 100% success but, if it was really 80% effective, then they should submit to proper medical trials.

Something that they have failed to do.
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