Gat Goren, PAE, LUTS, Part 8

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neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/20/2017 1:33 PM (GMT -7)   
Thanks Frank - that was really good of you to do that for us. I hope Dr. Julien avails himself of the opportunity you presented to him.
I will post here following my consult next week.
Take care.

tgt111
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Date Joined Mar 2017
Total Posts : 6
   Posted 3/20/2017 5:42 PM (GMT -7)   
Yes, Thanks Frank. Thanks Neil. Keep us posted. It's surprising how difficult it is to get through... I assume the Doctors who do this in the US use some kind of clips or beads to embolize the veins, why doesn't the company who makes those products sponsor a study? Like the company that sponsors the PAE study..

Chicago Dave
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Date Joined Apr 2013
Total Posts : 223
   Posted 3/21/2017 1:45 PM (GMT -7)   
Interesting stuff, guys! I didn't realize that another researcher had published a paper supporting GG.

tgt111 said...
I assume the Doctors who do this in the US use some kind of clips or beads to embolize the veins, why doesn't the company who makes those products sponsor a study?

I believe that the veins in GG are closed with a standard sclerotizing agent. Nothing new to patent or to support a research program.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/22/2017 9:38 AM (GMT -7)   
- it is just a microfoam agent with the consistency of toothpaste that is used for treating varicose veins. The veins collapse and are dissolved but as has been mentioned here many times the VIR must be careful to also seal any collaterals that immediately open up and bilaterally.
I sent the Struck study to Dr. Vartanian who I will see next week and I must say he is quite keen on it so I'll keep my fingers crossed and hope I have clinical varicoceles.

tgt111
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   Posted 3/23/2017 5:43 AM (GMT -7)   
Good luck Neil. I hope it all works out and Dr.Vartanian is interested in the procedure. Is it possible to have BPH without clinical varicoceles? It seems to be cause and effect.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/25/2017 12:53 PM (GMT -7)   
Hello Dave,
I've been meaning to ask you and others here if you ever looked into a microsurgical varicocelectomy where the ISVs are just cut at the base and tied off?
I wrote Dr. Marc Goldstein in New York a while ago about this and here is his response:

"I don’t use Gat-Goren’s radiographic technique. I do microsurgical varicocelectomy for BPH which has a much higher success rate than his radiographic occlusion. ".

I had forgotten about this response and wonder if anyone has ever had it for BPH that you know of?
Take care.
Neil

ClapTheHammer
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Date Joined Jun 2012
Total Posts : 104
   Posted 3/25/2017 10:59 PM (GMT -7)   
Frank in Florida and neil123. It is interesting how 'these doctors' are pretty uncommunicative. It's not as if they are doing the procedure for free. One would think that well funded medical universities in the US would do some study, even competing medical trials, to assess the success or otherwise of various treatments not involving opening the patient up, to solve such common urinating problems in men.

I have not heard anything in Israel for the past year at least. Our (sainted) prime minister had the Gat Goren procedure less than a year ago. But, we have not been updated as to the success or not of the operation. I suppose that if he has further surgery on his prostate, 'we' will be informed by out diligent press.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/26/2017 6:53 AM (GMT -7)   
Hi Clap,
Did you have the GG procedure done and if so how are you doing now? I went through all my notes on this long thread but I did not have your name on the list of 17 men here who had GG. I wish they would all post an update here on their conditions!

One thing that came to mind recently is just getting the ISVs cut off and tied at the base - the so-called microsurgical varicolelectomy - as an alternative to GG. I didn't see much discussion of that here as I went back through my notes. Do you have any thoughts on this?

I looked at the Cedar Sinai web site last night on prostate and all things urinary related to men. They offer all procedures there - it is like a crash course on the current state of the art for BPH and infertility problems. For example, they have iTIND, REZUM, cryo, urolift etc. etc. for BPH. But then under infertility they list both the sclerotization (bilateral!) occlusion procedure as well as the microsurgical varicolelectomy which is also done robotically there. But they don't offer the last two for BPH. I sent them a note asking if it would be approved for BPH along the lines of GG.

Anyway, I am tired of doing CIC 4 times a day including one at 3 am and would like to get started on GG. Maybe my consult this week in Detroit will offer some hope.

BPHinCa
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Date Joined Apr 2017
Total Posts : 2
   Posted 4/5/2017 3:40 AM (GMT -7)   
Been following this for a few years. I'm 44 and was Diagnosed with vericocele about 14 years ago and BPH about 2years ago as the urologist was trying to figure out the source of my pain while sitting (still not resolved). Anyway going to start looking for vericocele embolization doctors on the west coast (USA).

After reading over every page of this thread it makes the most logical sense to me. Is least invasive and downside seems fairly minimal. I've sat on the sidelines long enough with urgency symptoms slowly progressing, and testicular tenderness more present... it's time. Will keep you all posted. Keep fighting the good fight and sharing information!

BPHinCa
New Member


Date Joined Apr 2017
Total Posts : 2
   Posted 4/5/2017 3:52 AM (GMT -7)   
Oh and wanted to share this interesting article if it hadn't been posted. calmerme.com/importance-of-vitamin-k2-for-prostate-health-and-varicose-veins/

neil123
Regular Member


Date Joined May 2016
Total Posts : 35
   Posted 4/7/2017 12:51 PM (GMT -7)   
I am now scheduled May 2 for a bilateral embolization of my ISVs at Beaumont Hospital in Detroit. My ultrasound showed both left and right prominent varicoceles so the VIR (Dr. Vartanian) agreed to embolize them for me. He generally treats varicoceles in young men for fertility but as mine are very uncomfortable requiring cushions etc he has agreed to it.
He is aware of the Gat procedure and my BPH of course. He said he will try to embolize any collaterals that open during the procedure. I will have conscious sedation.

Is there anything else I should mention to him before the procedure? He is very kind and open to new ideas.

I am proud to join this very long pioneering thread and hope I can add my own positive experience in confirming the Gat Goren theory.
Thanks.

tgt111
New Member


Date Joined Mar 2017
Total Posts : 6
   Posted 4/10/2017 5:23 PM (GMT -7)   
That's fantastic Neil. I really appreciate the work you're doing. I guess you finally found an IR Dr with an open mind. I haven't done anything myself yet. I was scheduled for a PAE with Dr. Bagala but I canceled it. I'd rather do what you're doing. So I guess if I was to look into this I have to contact Dr. Vartanian's office. Then have them send me the scripts for ultrsound tests to look for varicocele's? Then take it from there. I assume it's covered by insurance also...

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 4/16/2017 11:37 AM (GMT -7)   
Chicago Dave and Frank in Florida:

Did you have any inflammation problems after your procedures that interfered with your ability to pee?
I am concerned that inflammation might interfere with my ability to self-cath or natural void after my upcoming bilateral ISV embolization. The doctor said I could just take Motrin but I only respond to prednisone when it comes to my BPH being aggravated.

Thanks.

Neil

Chicago Dave
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Date Joined Apr 2013
Total Posts : 223
   Posted 4/20/2017 3:14 PM (GMT -7)   
Neil123 said...
Chicago Dave and Frank in Florida:

Did you have any inflammation problems after your procedures that interfered with your ability to pee?

No. I didn't notice any inflammation following the procedure.

neil123
Regular Member


Date Joined May 2016
Total Posts : 35
   Posted 5/21/2017 4:44 PM (GMT -7)   
Dave
I've been trying to reach all of 18 the guys on this thread who had GG to see how they are doing but you are the only one that responded. Do you keep in touch with them?
Thanks.

tgt111
New Member


Date Joined Mar 2017
Total Posts : 6
   Posted 5/24/2017 5:30 AM (GMT -7)   
How's it going Neil? Did you have the procedure with the Doctor in the Detroit area, Dr. Vartanian?

Chicago Dave
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Date Joined Apr 2013
Total Posts : 223
   Posted 5/24/2017 8:00 AM (GMT -7)   
Neil, No--I'm not in regular contact with other guys. I tried to email one of the old regulars months ago, but he never responded.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 5/24/2017 8:16 AM (GMT -7)   
Hello tgt,

I had to cancel my varicocele embolization with Dr. Vartanian the day before because I got another UTI.
Following that I learned more about how Dr. Gat performs his embolization without the use of coils. Instead he uses a balloon-catheter he invented to target specific regions to inject a liquid embolic agent. He warns against coils for several reasons.
So I sent this info to Dr. Vartanian and asked him about it. He never responded to me! I wrote 3 times and left 2 phone messages and never heard back.
So I guess he didn't like my questioning his procedure but I wasn't and just wanted to discuss Dr. Gat's procedure.
So I've written him off and am now setting up a phone consultation with Dr. David Sperling at Columbia hospital in New York who is also a VIR and performs these procedures. He is no relation to DR. Sperling of FLA fame.
I'll keep you posted. I sure wish the guys on this thread would chime in about their own Gat Goren procedure.
Take care. Neil

martin victor
Regular Member


Date Joined Oct 2012
Total Posts : 216
   Posted 6/22/2017 8:35 AM (GMT -7)   
I was one of the original people who had the Gat Goren procedure maybe 5 years or so ago. The bad news was my prostate of 50 grams did not shrink. The good news is that after this long period of time it has not gotten bigger. I have median lobe protrusion into the bladder for which I am told by my urologist does not work for the Gat Goren technique. Yet, I am very satisfied I saw the doctors in Israel. Nothing has changed..I still get up once or twice a night with a slow stream at night. Overall, I am happy with the results and definitely recommend the procedure.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 6/25/2017 6:42 PM (GMT -7)   
Thank you Martin for responding. I am trying to find a doctor stateside who performs the varicocele embolization procedure similar to Dr. Gat without using coils and goes after all the secondary veins. I have a few leads.
I am glad you continue to do well. I read all your posts here. Do you hear from any of the other men who had the procedure>
All the best.

andyaction
Regular Member


Date Joined May 2012
Total Posts : 60
   Posted 9/6/2017 3:15 PM (GMT -7)   
All - and Neil especially:

As long term contributors to this discussion will know. I had the GG procedure back in 2012.
Then I was 60.

At that time, it took me half an hour to pee and then ten minutes later, I need to go again, I was getting up at least five times every night, going out led me to developing a portable disposable super absorbent bag in case of emergencies and my life was in effect, ruined.

Today, over 5 years since the procedure. I sleep almost every night without needing to go to the loo. I have a steady, medium flow, continuous stream and go just about normally with regards frequency. Whereas it's not 100% - like when I was a teenager, I now live life without worrying. Here's my concern: PSA is 7.5 - last tested 2 months ago. This is down from 9.5 six months previously. I have been taking POMI - T supplement and guys, this appears to be working well. I will psa test again in a few months and keep you all posted.

Neil, if you consider an embolization make sure that it's not just the spermatic veins that are closed off. Ensure the capilliaries that open up are also sealed. Check this with your specialist

andyaction
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Date Joined May 2012
Total Posts : 60
   Posted 9/6/2017 3:24 PM (GMT -7)   
PS .. neil , the procedure is totally painless and 15 mins after being "released" I walked back to the hotel some 15 mins away from the hospital.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 9/7/2017 2:49 PM (GMT -7)   
Hi Andy,
Thanks so much for responding to me. A few years ago I was on another forum (inspire) with a few other guys trying to figure out the Gat Goren stuff and you were kind enough to come over there and tell us to look at this thread. I spent a few weeks going through every post making notes about GG and all the other great ideas being explored by the guys. I learned first about PAE here and had it done last summer at UNC but it had no effect on my BPH symptoms.
I do wish all 17 men here who had GG would post an update like your and Martin Victor and Chicago Dave. I had hoped you formed a "GG Club"!
Anyway, I live near Toronto and it is not practical for me to travel to Cyprus/Israel. So I have studied all the papers and read the GG patents and then started searching for an IR in the US/Canada who would do their procedure on my bilateral varicoceles.
While most IRs ( and ALL uros ) trash the GG theory they were still happy to seal my gonadal veins. Unfortunately they all insist on using coils along with a sclerosant agent. Now GG never used coils in their procedures for good reasons and I learned from various studies that in Europe now it is the new standard of practice to not use coils, even for the so-called sandwich method.
Coils work ok for awhile but later on many men develop problems from the coils. It seems the IRs in N. America don't worry about that because they can then blame these later issues on unrelated causes. But they do not want to risk possible sclerosant going into the scrotal area and causing phlebitis for which they could be liable - get the picture??
So after a year of studying, interviewing and meeting with many IRs I finally found one right here in my own backyard in Toronto who says he can do the procedure w/o coils and who understands the need to seal all collaterals and secondary veins that open during the procedure. He will just hand pressure on the inguinal ring region to keep sclerosant from entering the scrotum.
He also commented to me that while he treats mostly young men for fertility, he has heard back from older men (I am 68) that their BPH symptoms resolved after their varicocele bilateral sealing. So that was good news. Right now I am scheduled for Oct. 27.
I do hope this works and then it could be available to other men locally instead of having to travel so far ( and the expense of course). I should mention that because of my large prostate (220gm) I self-cath daily although I do have good natural voids in between. It is just to keep the pressure off my bladder/kidneys. I am fortunate to not have any median lobe or other physical obstruction - just 2 large side lobes.
I am sorry to hear you have an elevated PSA. Do you know the size of your prostate now? It is more the PSA density that is important and its changes over times. I can discuss this with you more if you wish.

Thanks again for being there for all of us and leading the way!
Neil

andyaction
Regular Member


Date Joined May 2012
Total Posts : 60
   Posted 9/7/2017 3:12 PM (GMT -7)   
Neil,

I remember! I haven't been in the Inspire discussion for some time so will take a look.

I hope your procedure goes well, it's really good that you too have taken the trouble and the effort to help drive the the potential for the procedure. Many men could benefit. Good on you!

I didn't know about the sclerosing agent and coils, But do remember Dr G asking me to press on a point he indicated.

I'm not sure how serious the 7.5 psa is. I feel ok! and it's dropping! I keep meaning to go and get a volume test done but keep putting it off. I spoke with Dr G a few months ago and he told me to go and get such a test. Soon!

Neil, Any advice is always welcome. The density thing sounds interesting.

neil123
Regular Member


Date Joined May 2016
Total Posts : 35
   Posted 9/7/2017 6:33 PM (GMT -7)   
Hi Andy,
That's neat that you still communicate with Dr. G. Is he still performing the procedure in Cyprus or has he moved back to Israel? I write his son Jonathan once a year about when their study will be published, but he always writes back that it is coming out in a few months!

The European IRs also have the patient participate in the procedure by pressing on specific veins as well as performing the Valsalva maneuver. They also provide the patient with a monitor at his head so he can watch everything happen. Did you have that too? I asked for one but the doc here just laughed.

As you know there are many factors that contribute to an elevated PSA. It is really important to determine your prostate size since PSA numbers for large prostates tend not to reflect cancer activity. That is because PSA is generated by prostate glandular tissue so the bigger the prostate the higher the PSA. For example, my PSA fluctuates between 8 and 20 but the nominal PSA number for a normal prostate my size is 35 so if you take the PSA number and divide it by the prostate volume ( PSA density) it is a very small number.

BUT if you prostate is normal, say 35 to 50gm, and you have PSA numbers like these, and there is an established upward trend over a year or so, then that could be a problem. So you need to get the volume checked which is easy to do with an ultrasound. And you might as well get your bladder and kidneys checked at the same scan. Depending on the results you might then want a multi parametric 3T MRI but hopefully not. Also there are other diagnostic tests I can tell you about. BUT you definitely want to avoid any needle biopsies at all costs unless a well-defined lesion shows up. But that is way down the line and hopefully offline.

Thanks for your kind wishes. I would have preferred to go to Dr. Gat but I also hope that I can provide an alternative for men closer to home that achieves a similar result.
All the best.
Neil
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