Optilume balloon therapy for BPH

Posted by keithmr @keithmr, Feb 16 12:10am

Hi. I'm 67 with BPH and a rather small (30ml) prostate.
I've researched the new Optilume procedure for BPH but not finding others that have had the procedure or have also been looking into it. For myself I had a Cystoscopy and the urologist said ideal for aquablation I agreed to it but have since changed my mind and here's why. Unlike other surgical procedures Optilume for BPH is performed in the Drs office with only local and usually spinal block anesthesia. Optilume for BPH does remove any Prostatic tissue. What it does is a dual balloon catheter is inserted thru the urethral, it small and is inserted thru a 19fr rigid cystoscope along with the camera . The catheter passes into the bladder then is backed out so the smaller of the two balloons is in bladder and will hold the specially sized for each patient second balloon in the prostate. The balloon is then inflated causing a commisoratomy or tear between the two anterior lobes of the prostate then a drug called paclitaxel is placed for about ten minutes on the tear. Paclitaxel prevents the lobes from growing back together again. You will leave the Drs office unassisted with a catheter placed that will be removed usually in 24 hours. It shows durability in 5 year studies. Mostly for me, I have no reason to have my prostate obliterated and even partially removed. I expect to continue to have unaffected sexual function other than being relieved of the side effects of tamsulosin which have hit me hard. Orgasm quality is extremely important and seldom discussed in research. Don't confuse orgasm with ejaculation. It's the orgasm that feels good and why would any patient not preserve that for themselves. Optilume for BPH was approved approximately July of 2023 so hopefully clinics and surgeons will jump on the opportunity to provide a very effective alternative to tissue removal.

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ndclayt41 | @ndclayt41 | Feb 17 10:24am

I had my prostate removed in 11/22/2023 the ejaculation is gone but the organism is still there and highly enjoyable

cgriffin3 | @cgriffin3 | Feb 19 5:27am

Excellent breakdown. Thank you. I am 74 years of age and just recently had a penile implant (AMS 700). I do have BPH (102cc). However, I must be missing something cause the urination regiment is tolerable. There is no pain. And only once a month I get trickle like symptoms. The implant allows me erections. I cannot tolerate Fanastiside. Took me only two tablets to figure that out.

cgriffin3 | @cgriffin3 | Feb 19 5:33am

In reply to @ndclayt41 "I had my prostate removed in 11/22/2023 the ejaculation is gone but the organism is still..." + (show)

My point: even though you have been diagnosed BPH. Don't be so quick to poke around down there. What my wife fears is one day I might not be able to urinate at all. I simply reply: that will be a clear indication that I need to poke around down there
😜.

Colleen Young, Connect Director | @colleenyoung | Feb 19 9:50am

@keithmr, given that the The Optilume® drug-coated balloon (DCB) is a relatively new procedure, it is helpful to hear from others who have had it done. You and other may also appreciate the experiences shared by @rjw4usmc and @davyde in this related discussion:

- Optilume Balloon Treatment for Prostatic Strictures
https://connect.mayoclinic.org/discussion/optilume-balloon-treatment-for-prostatic-strictures/
@dstephens20 and @scurry were also looking into Optilume.

Keith, what is the one tip you would offer to other men considering this treatment for benign prostatic hyperplasia (BPH)? What do you wish you had known?

keithmr | @keithmr | Feb 19 9:59am

I haven't had a procedure yet. I just don't think MIST should really include removal of tissue. There must be many men that don't need the longer healing process and in hospital stay and that goes along when there is a simple procedure truly minimally invasive and performed with local anesthics. Why obliterate just separate.

usc94 | @usc94 | Feb 20 11:55am

Everyone has their own situation to assess, and I am definitely in favor of starting with least invasive option(s). In my case, however, I have had two laser PVP procedures, one Rezum procedure, and tissue has grown back after each one. I am now getting ready to have my fourth BPH surgery. I recognize my case is probably rather unusual, and for this reason I am seeking my further care/surgery at Mayo. The good news is that there is an increasing array of less invasive options available now for BPH treatment. This can make it challenging in selecting the best one for any given person. I feel the key here is to have a skilled urologist who is able to help evaluate the full range of options (including pros/cons, risks/benefits) to select the one that best fits the individual's condition. If I had not been through what I already have I would definitely consider the MIST procedure.

keithmr | @keithmr | Apr 24 11:53am

I now have a date set for the Optilume BPH. Because it's a new procedure to the Dr. It will be performed in a hospital operating room. My pre surgery exam went well except for one thing that I wish the doctors and assistants would hear. That is 10ml is not enough lidocaine to instill and expect it to numb thru the urethra and the prostate. The volume of gel for my own urethra andbprostate is more like 20ml and still. Have to milk it down thru the prostate. I know this because I place foley catheters in myself up size 30fr with 24 being typical. So what happened because the 10ml the assistant instilled was not sufficient to numb. I told her that and asked her to put more and she dismissed my request outright with the following statement " we don't do it that way here" then tried to assure me it would be fine. Well it wasn't fine. The construction of flexible cystoscope has ridges spiraling it's length and do not feel good as the Dr shoves it in thinking it's numbed. I was livid and about jumped off the table. As I settled back down the lidocaine that the scope pushed thru did eventually numb. By then the procedure was neatly complete. I'm not here to gripe but I can't help but think that we need to be heard. I won't let that happen to me again. As far as anyone looking into help with your BPH I'd advise to make it known you want the full length of your urethra and prostate numbed. Then it's nothing at all to be anxious about. Dr's should knould know all men aren't created the same and I'd ask them to rethink the volume of lidocaine used and adjust the volume to help your patient really be comfortable. I'm sure this going on nationwide. It's time to rethink and make cystoscopy a simple and painless procedure as it's purported to be.
Be gentle to us, gentlemen. You'll see more us of willing to come in with lower anxiety and higher trust in you the Dr.
More later

heisenberg34 | @heisenberg34 | Apr 25 9:13am

In reply to @keithmr "I now have a date set for the Optilume BPH. Because it's a new procedure to..." + (show)

When I was in the ER two weeks ago for blood in the urine, I sat for nine hours waiting for some kind of help. Finally it was decided that I should receive a catheter. I heard the nurse and EMT talking about how they were out of lidocaine. Well, they shoved that thing into me anyway. To say the least, it was an excruciating experience. They sent me home with the catheter and a bag. After five days I couldn't stand the pain any more. Urologist could not get me in for two weeks. Finally went to PCP who removed it. What a relief. That was a week and a half ago. Still have some pain in my urethra from having the catheter jammed into me. Never again!. Hope you have a better expereince than I did.

keithmr | @keithmr | Apr 25 12:48pm

In reply to @heisenberg34 "When I was in the ER two weeks ago for blood in the urine, I sat..." + (show)

Watch for urethral stricture. Could form injury to your urethra from insertion of a foley catheter or other. Surely they lubricated?

keithmr | @keithmr | May 14 10:50am

Tomorrow may 15. I'm scheduled for the new Optilume for BPH procedure. I've had questions and concerns answered over the last month and anticipate a simple procedure with minimal very low pain level after, 1 to 2 on VAS, two days with a catheter and two weeks or less to heal. I let you know more details tomorrow when I return home. Everyone on meds or serving surgical intervention for BPH should be informed of this new procedure as a first option.