does having an implant complicate prostate surgery?

[Waynetho]

That video was made in 2016. The procedure was approved a year or so later.

Ah, clarity now!

[ccrider]

Unfortunately, Urolift wasn't an option for me. My medial lobe had grown so much that it extended a good way into the bladder which created a ball flap of sorts. Urolift can't fix that. I needed some form of prostate enucleation. TRUP, HoLEP, Green light, etc. I went with TURP.

Have you had a cytoscopy yet to verify that you're a candidate for Urolift?

I read somewhere that enlarged medial lobe is no longer a big contraindication for the Uro-Lift procedure. I can't recall what medical paper I read it in but I'd be willing to bet that many doctors still ascribe to the original letter of the rules laid down stating that the medial lobe must be less than a certain size.

It might be worth looking up that detail again but unfortunately even if it's true, the information wouldn't help you now, mike123.

I received an implant by Dr. Kramer back in December 2016...excellent result...I later started suffering from BPH-frequent urination/urgency/waking for multi trips to the bathroom...got a MRI & found out my prostate was like 110 cc...way too large for the Urolift. Did some research & decided on the high power Greenlight procedure last year. Had it done at the end of April 2019...easy outpatient procedure w/ propofol. Catheter was removed the following day...no discomfort whatsoever. By September, my BPH symptoms were virtually gone...frequency of urination/urgency dramatically reduced, maybe wake up once a night at most to urinate. Also suffered no retrograde ejaculation (experienced that w/a trial of tamulosin), although the amount of ejaculate has been somewhat reduced. Urinary flow is now at absolute maximum as well. Bottom line: if you have a big prostate, I'd recommend that you look into the high power Greenlight as a possibility...far less invasive than the TURP & considered by most to be as effective.

[sweaterfan]

Just an update: Two weeks after getting the aquablation I felt great. Two weeks after that my symptoms returned, even worse than before. Thinking that I had an overactive bladder in addition to a large prostate (which, it was assumed, was addressed) I was put on medication and finally had comprehensive bladder tests. It turns out that my prostate size only decreased from 79 grams to 65 grams, so the aquablation failed to remove enough tissue. Very disheartening especially since I paid $9500 out of pocket and I was hoping to get my urinary problems fixed before the beginning of the year so I could schedule implant surgery. To add insult to injury, I'm the only patient my urologist treated for whom aquablation did not produce fantastic results. Yay me. I hope this does not portend a future implant catastrophe. My urologist is suggesting TUVP, but it has significant risks (85% of TUVP/TURP patients end up with retrograde ejaculation).

I recently had a video conference with my future implant surgeon in another city to discuss not only the implant process but also options for my urinary problem. I looked into PAE but the $12K procedure is not covered by BCBS either and the chances of it working are less than some other options. He strongly discouraged PAE. He's a Rezum Center of Excellence award winner so he favors Rezum as the next step. I had already done some research on Rezum and there is a local Center of Excellence urologist in the same practice as my regular urologist. I went to see him and he's starting over at square one to ensure I have a prostate problem, not a bladder problem. More tests, more delay. Yay.

Late last year I called BCBS and they told me than an implant was covered by my company's plan, subject to pre-determination for medical necessity. My idea was to get my urinary condition addressed then go for the implant. When I mentioned BCBS to my future implant surgeon a few weeks ago he said right away that BCBS would not cover it. His staff confirmed what he said, and I also called BCBS only to find out there's an exclusion for the procedure. Had they told me that last year I would have enrolled in Medicare instead of re-enrolling in my company's plan. Now the implant will be postponed to next year, assuming my prostate/bladder problem can be identified and resolved.

It's the second time BCBS has given me or one of my providers the wrong answer. I can live with "no" as an answer, but for heaven's sake give me the right answer the first time. I already stopped HSA contributions as required by Medicare and have an advisor who will help me with choosing Medicare Advantage/Medigap when we get closer to the end of the year. By the time I get an implant I'll be too worn out to use it.

Thanks to all of the kind folks on FT I was able to do a lot of research and create a list of questions for the surgeon regarding the implant. He was impressed with the knowledge I accumulated and consultation went very well. Looking forward to 2022.

Keep pumping, boys!

[Waynetho]

That's odd. My company funded BCBS insurance covered my implant on the first go-around without a second look. My reason codes included damage/curvature/hourglass due to Peyronie's Disease. I was floored that I didn't have to fight a denial on the first attempt.

That's really a bummer that they said that after previously saying it was approved. Hope you get things sorted though.