Optilume balloon therapy for BPH

Posted by keithmr @keithmr, Feb 16, 2024

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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I had the Optilume BPH procedure exactly one month ago today and so far not happy and worried. Still bleeding with almost every urination but most concerning I am leaking all the time. I never had a problem with any form of incontinence and now I’m leaking when I stand up or go walking and when I really have to go I feel some urine leaking out. Also have had a few major leaks while sleeping. No one one ever mentioned this as a possible risk. I am 62 and in very good shape. I’m really worried this is going to be permanent.

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Profile picture for jj195 @jj195

I had the Optilume BPH procedure exactly one month ago today and so far not happy and worried. Still bleeding with almost every urination but most concerning I am leaking all the time. I never had a problem with any form of incontinence and now I’m leaking when I stand up or go walking and when I really have to go I feel some urine leaking out. Also have had a few major leaks while sleeping. No one one ever mentioned this as a possible risk. I am 62 and in very good shape. I’m really worried this is going to be permanent.

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@jj195, I can imagine that you are not happy about the side effect of incontinence. Have you talked to are care team about it?

Have you considered getting a referral to a specialized PT who works on Kegel exercises and other strategies for incontinence?

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Profile picture for Colleen Young, Connect Director @colleenyoung

@jj195, I can imagine that you are not happy about the side effect of incontinence. Have you talked to are care team about it?

Have you considered getting a referral to a specialized PT who works on Kegel exercises and other strategies for incontinence?

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@colleenyoung
Colleen, thanks for the note. I have not tried PT yet as so far every time I try levels it starts bleeding again and the pain soreness comes back. I’m now six weeks and still have stress incontinence so at some point I’m going to have to try PT.

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@dvsilcox222 I had the Optilume BPH early March the recovery clearly takes lingering than two weeks, that is just BS marketing. Expect way more blood than advertised. Have pads to put under you while the catheter is in as blood leaks out. After the catheter is out you will leak blood so have pads for your underwear. Also do not be surprised if you wind up with stress incontinence

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Yikes. Not familiar with this procedure for BPH. I’m contemplating PAE or URO – CUFF.

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Profile picture for jj195 @jj195

@dvsilcox222 I had the Optilume BPH early March the recovery clearly takes lingering than two weeks, that is just BS marketing. Expect way more blood than advertised. Have pads to put under you while the catheter is in as blood leaks out. After the catheter is out you will leak blood so have pads for your underwear. Also do not be surprised if you wind up with stress incontinence

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Thanks @jj195, a new procedure.
I heard that it should be bloody, - but how is the result? And are you still bleeding. Are you still hurting? Are you doing better?
Any incontinense, - or other side effects?

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Thanks for asking, the blood stopped leaking stopped at around 4 weeks, with some still in urine till 6weeks. Pain really stopped around 2 weeks after surgery with just a dull ache remaining for a couple more weeks after that, no big deal. Flow is up and down some days same as before surgery and other times I feel like okay that is better.
Unfortunately I am still dealing with some minor stress incontinence more annoying than anything. It does really irritate me that my doctor and frankly nothing in the language from the manufacturer mention this as a possible side effect.

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I am very healthy and fit 72 year old. I had the Optilume bph proceedure 10 weeks ago in mid May. It has been hell for me from the start. First problem was that the catheter blocked the evening of the proceedure. They sent me off with a bottle of sterile water and a large syringe and told me to flush it if it blocked. I was able to clear it buy pushing that syinge as mightily as possible. The next three days with the catheter were highlighted by spasms of pain every 30 minutes or so. After catheter removal things did not get better. Urgency and frequency were much worse than before, stream was weak at best and drbbling most of the time, mostly bloody and clots. When I contacted the doctor's ofice they told me recovery could take up to three months. That was new information not revealed prior to the proceedure. Ten days ago I had a late night trip to Emergency to be catheterized again for acute urinary retention. The brownish mess they draind was revolting and I was put on Ceflex. The urine capured in th bag was a combination of urind blood and clots and the next day the tube blocked with clots and back to Emergency to pull and replace the catheter. Next day, urinary retention back to emergency this time a raging infection. Urination is now 30 times a night exremely painful and yields 10 to 25 ml.
If it's not obvious, no, I am not happy that I chose to undergo Optilume BPH procedure. By every metric I am much worse off than before including the fact that I have needed to wear pads since the procedure.

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Profile picture for snowycreek @snowycreek

I am very healthy and fit 72 year old. I had the Optilume bph proceedure 10 weeks ago in mid May. It has been hell for me from the start. First problem was that the catheter blocked the evening of the proceedure. They sent me off with a bottle of sterile water and a large syringe and told me to flush it if it blocked. I was able to clear it buy pushing that syinge as mightily as possible. The next three days with the catheter were highlighted by spasms of pain every 30 minutes or so. After catheter removal things did not get better. Urgency and frequency were much worse than before, stream was weak at best and drbbling most of the time, mostly bloody and clots. When I contacted the doctor's ofice they told me recovery could take up to three months. That was new information not revealed prior to the proceedure. Ten days ago I had a late night trip to Emergency to be catheterized again for acute urinary retention. The brownish mess they draind was revolting and I was put on Ceflex. The urine capured in th bag was a combination of urind blood and clots and the next day the tube blocked with clots and back to Emergency to pull and replace the catheter. Next day, urinary retention back to emergency this time a raging infection. Urination is now 30 times a night exremely painful and yields 10 to 25 ml.
If it's not obvious, no, I am not happy that I chose to undergo Optilume BPH procedure. By every metric I am much worse off than before including the fact that I have needed to wear pads since the procedure.

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@snowycreek That's awful and I'm sorry. I've made my share of mistakes such as Rezum which did not work for me. Did you get any imaging done such as a MRI w/contrast? Did you compare the procedure to the others out there? It's not easy because all situations are different, as are the outcomes.

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Profile picture for jojo99 @jojo99

I am a 76 year old male. I've had 3 PAES. One in 2014 another one in 2017 and another one in 2023. That is how long they lasted. My prostate I went from 160 to 138 On the last PAE. It was done by Dr Bagula in northern Virginia. He is the one that's done the most in the country. The last one didn't Reduce it enough . And I still have problems urinating. He said he would do it again but there was about a 20% chance it may work. He suggested an aquablation,
I had them done then because there was nothing else At that time to have but a turp which I didn't want. So it gave me 10 years to the next best thing came out being the aqua. So I can talk as a person who's been through the trenches From three paees to the aquabilation. The after effects for the PAE were just burning urination for three days and that was it. I had my aqua ablation 10 weeks ago. I'm able to urinate with no problem but I have frequency urgency and burning every time I pee.
Up 4 and five times a night. Two weeks after my Paes I was getting up between one and 2x a night I've had For weak ejaculations Out of 25 orgasms.
My dr keeps telling me it can take up to 6 months for this to go away hopefully it will. I was on Flomax and proscar for two months before the aqua surgery because of difficulty in urination.
That gave me reverse ejaculations. The orgasms were just as strong. I felt like I was ejaculating but I didn't. The drugs had horrible side effects and I was taken off them immediately after the aqua surgery. So I'm glad I did the PAES I wish the last one didn't fail. I hope the aqua problems will cure themselves in the next few months as my doctor said. But the PAE was only a week at the most of burning. So I would take a pae any day Before an aqua. So anyone who has any questions about Paes just let me know

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@jojo99 Thanks for a very informative description of your treatment. Can I ask how your post-aquablation course is going?

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