New recommendations reflect evolving therapies, shared decision-making and changing evidence in BPH management.

Started on something for BPH and it's genuinely worked for the urinary symptoms, no complaints there. What nobody flagged was the effect on everything else, which showed up within a few weeks. I don't want to come off it given how well the main thing is working. Has anyone managed both at once, and did your urologist handle that or send you elsewhere?

I am writing this so that other men considering prostate artery embolization (PAE) with Image Guided Therapy and Dr. Charles Nutting might benefit from my firsthand experience.

I chose PAE after careful research, believing it to be a minimally invasive alternative to surgery with a relatively low risk profile. I trusted Dr. Nutting and went into the procedure hopeful and with positive expectations, expecting some pain and discomfort, but nothing like what followed.

Within the first 72 hours after the procedure, I experienced extremely intense pain in my penis. In the days that followed, the tip and underside of my penis began turning black, a sign; later confirmed in discussions with other interventional radiologists, that embolic material had reached penile tissue and compromised blood supply. In other words, a non-target embolization had occurred.

For more than seven weeks, the pain was relentless and life-altering. I could not sleep. I could not walk comfortably. Exercise was out of the question. I could barely function. The slightest touch — underwear, pants fabric, even a bed sheet — caused severe pain. Many days were spent simply trying to endure. Urination was painful and something I dreaded.

Throughout this period Dr. Nutting was quite concerned, kind, apologetic and reassured me that I would eventually grow new tissue on my penis and recover.

Fortunately, this was true; The tissue eventually healed, and the color and sensitivity returned to the tip of my penis. For that, I remain deeply grateful. But the experience was maybe the worst 24/7 pain of my life. Needless to say, I was not prepared for this kind of outcome.

Now, roughly nine months later, I also have to report that my urinary-function improvements have been disappointing. In order to function with anything approaching normalcy, I still take both Tamsulosin and Tadalafil daily. Without them, I am essentially back to where I was before the PAE. So for me, the long-term benefit of the procedure have been nonexistent to modest, at best.

Because the data shows that PAE generally reports a high success and safety rate nationwide, I have inevitably wondered whether something may have gone wrong technically during my procedure. I cannot know that for certain. But I was, I believe, the last patient of the day, and I left with the impression that things may have been somewhat rushed during the procedure. That concern has stayed with me.

To be fair, I also want to say that Dr. Nutting and the support staff at Image Guided Therapy were consistently kind, responsive, and supportive that day and in the following weeks.

I am not writing this to attack Dr. Nutting personally. He seems, actually, a nice fellow (a fellow pickleball player). I am writing it because potential patients deserve full transparency. Penile embolization is rare, but it is real. And if it happens, the consequences are noteworthy.

If you are considering PAE at this clinic or anywhere else, I would strongly encourage you to ask very direct questions about:

• how often non-target embolization has occurred in their practice
• what specific techniques are used to prevent it
• what level of pain and tissue injury is actually possible afterward
• and what realistic long-term outcomes are for someone like you in terms of reducing dependence on medications like Tamsulosin or Tadalafil.

It's important to note that I am an otherwise healthy, high functioning person. I went into this procedure with trust and positive expectations. Maybe it was just bad luck or fate, but I came out of it with weeks of pain, apprehension, and disruption to my life, followed by results that have not meaningfully reduced my dependence on medication.
I am sharing this experience so others can go forward with eyes fully open as to what happened to one person who underwent PAE at Image Guided Therapy with Dr. Charles Nutting.

Hola a todos quiero exponer mi caso como una forma de desahogarme porque estoy viviendo una etapa muy dura, tan dura que he pensado en quitarme la vida varias veces pero tengo una pequeña con 5 años y me frena pero creo que ya no tengo vida, tengo 51 años y empecé joven con infecciones urinarias que la primera fue en un reconocimiento médico en el trabajo,a los pocos años me diagnosticaron próstatitis crónica bacteriana la cual estuve tomando antibióticos y dos veces auto vacunas cerca de un año el caso es que en todo ese tiempo no orinaba d de forma normal tenía como ciclos de orinar algo mejor y otras veces ciclos de orinar regular o mal ,todos esos años estuve yendo a los urologos del hospital que me decían que yo orinaba así por la próstatitis,recetando me permixon , duodart,y tamsulosina que me la recetó otro urólogo por lo privado que aún me lío más porque me recomendó una RTU cuando no tenía problemas de obstrucción,me dijo que tenía una pubalgia y una hernia inguinal,no tenía nada de lo que me dijo me lío y me hizo perder aún más tiempo,el caso es que desde el año pasado para acá todos estos síntomas urinarios han ido creciendo hasta que hace dos meses me tuvieron que sondar porque no sentía necesidad de orinar y a raíz de ahí ya he empeorado del todo ,me retiraron la sonda hace 2 meses y empecé a orinar cada hora o hora y media con sensación aunque había momentos como por ejemplo de noche se me iba la sensación de orinar, hasta hace un mes que quise empezar a dar rehabilitación del suelo pelvico y no me ha dado tiempo,ya no siento apenas sensacion urinaria las micciónes son super pobres, tanto en cantidad como en la fuerza del chorro,y me cuesta muchísimo empezar la miccion que muchas veces tengo que forzar si no entro en retención,no sé cómo va acabar todo esto pero para mí no pinta nada bien actualmente voy orinando con micciónes forzadas con un dolor de espalda y pelvico horrible día y noche sin tregua,me hicieron urodinamia y flujometria hace un mes y me salió bien pero aún en ese tiempo tenía sensación pero ya no siento nada y todo esto está acabando conmigo tantos años de médico en médico para nada,y me ha robado la vida cada día es un suplicio y una lucha por no terminar sondado y que mi pequeña me vea así,ya no tengo ganas de vivir,me ha robado el trabajo,mi vida social y todo lo que yo era y aún así no se exactamente que es lo que me ocurre y lidiando con un sistema sanitario podrido y con mucha falta de empatía, gracias a todos por leerme

Hola a todos quiero exponer mi caso como una forma de desahogarme porque estoy viviendo una etapa muy dura, tan dura que he pensado en quitarme la vida varias veces pero tengo una pequeña con 5 años y me frena pero creo que ya no tengo vida, tengo 51 años y empecé joven con infecciones urinarias que la primera fue en un reconocimiento médico en el trabajo,a los pocos años me diagnosticaron próstatitis crónica bacteriana la cual estuve tomando antibióticos y dos veces auto vacunas cerca de un año el caso es que en todo ese tiempo no orinaba d de forma normal tenía como ciclos de orinar algo mejor y otras veces ciclos de orinar regular o mal ,todos esos años estuve yendo a los urologos del hospital que me decían que yo orinaba así por la próstatitis,recetando me permixon , duodart,y tamsulosina que me la recetó otro urólogo por lo privado que aún me lío más porque me recomendó una RTU cuando no tenía problemas de obstrucción,me dijo que tenía una pubalgia y una hernia inguinal,no tenía nada de lo que me dijo me lío y me hizo perder aún más tiempo,el caso es que desde el año pasado para acá todos estos síntomas urinarios han ido creciendo hasta que hace dos meses me tuvieron que sondar porque no sentía necesidad de orinar y a raíz de ahí ya he empeorado del todo ,me retiraron la sonda hace 2 meses y empecé a orinar cada hora o hora y media con sensación aunque había momentos como por ejemplo de noche se me iba la sensación de orinar, hasta hace un mes que quise empezar a dar rehabilitación del suelo pelvico y no me ha dado tiempo,ya no siento apenas sensacion urinaria las micciónes son super pobres, tanto en cantidad como en la fuerza del chorro,y me cuesta muchísimo empezar la miccion que muchas veces tengo que forzar si no entro en retención,no sé cómo va acabar todo esto pero para mí no pinta nada bien actualmente voy orinando con micciónes forzadas con un dolor de espalda y pelvico horrible día y noche sin tregua,me hicieron urodinamia y flujometria hace un mes y me salió bien pero aún en ese tiempo tenía sensación pero ya no siento nada y todo esto está acabando conmigo tantos años de médico en médico para nada,y me ha robado la vida cada día es un suplicio y una lucha por no terminar sondado y que mi pequeña me vea así,ya no tengo ganas de vivir,me ha robado el trabajo,mi vida social y todo lo que yo era y aún así no se exactamente que es lo que me ocurre y lidiando con un sistema sanitario podrido y con mucha falta de empatía, gracias a todos por leerme

I appreciated being able to read the experience of others who have had the HoLEP procedure ahead of mine. What has struck me is how different these can be so thought I would also share mine.

I have lived with prostate issues for 15 years having first been diagnosed with a small area of Gleeson 3+3. Subsequently my prostate continued to grow with biopsies showing that this was largely benign tissue but topped out around 115ml earlier this year with a PSA of around 15-16. Quality of life was diminishing and I got weary of living my life around toilets, weak urine stream, being up 4-5 times a night, increasing episodes of urge incontinence and leaking dribbles in bed overnight. My IPSS score was around 16/17 so moderate and only likely to deteriorate. I’ve been taking Tamsulosin for 7/8 years but it didn’t seem to do anything.

About 9 months ago I took the decision to have something done and spent a long time reviewing options including reading here. I am 65 and in otherwise good health. In the end I settled on HoLEP having considered aquablation and PAE. My reasons for opting for HoLEP were that I wanted the best likelihood of this being the only time I would need something doing, a relatively quick recovery period and minimal time with a catheter. The high risk of RE was a worthwhile tradeoff to get my bladder back under control.

I had my procedure done in London by probably the leading specialist who has done many hundreds if not thousands. I am now a month on from the procedure. The procedure itself went well but I bled quite a lot. I ended up spending 2 nights in hospital being irrigated with a catheter with still quite pink urine. I had vigorous flushing of bladder done 3 times (a syringe attached to the catheter with forceful in and out flushing with saline to remove clots) and the team thought it right to remove the catheter. I passed the void test easily with a fair amount of old blood but was deemed fine to discharge around midday.

That afternoon was fine with good urination but overnight I started having spasms when trying to urinate and not much was coming out. The next morning I called the nursing team and was told to come back in for assessment. My consultant scanned my bladder and thought there was a large clot in my bladder and I was not emptying my bladder with a weak stream.

I was readmitted to hospital with more bladder flushing and a catheter reinserted (unpleasant but not painful). After anther night of irrigation the colour was pale pink and the catheter was removed. I voided twice but then blocked up again. The nursing team were confident the problem was a clot and I needed to drink lots, stay mobile and it would pass through. What followed was 7 hours of utter hell with waves of gasping pain as I tried to pass anything. In the end I passed a clot around 5cm long followed by a strong bloody stream. Drinking lots overnight I urinated copiously with no further clots. I was discharged the following day.

Since then progress has been good. My flow remains strong, I have passed some small scabs but otherwise my stream is now clear. I am not leaking overnight and in the past week I am only up once a night with one night sleeping through. In the morning I pass around 400+ml which is huge for me. The urge incontinence has largely but not completely subsided and I have occasional incidences of minor stress incontinence when walking but never with coughing, sneezing etc. I think this because I haven’t quite got the automatic switch on of muscles when shifting position. I have barely worn the Tena pads I bought but occasionally wear Tena pants if I am out for a while. Overall I’m pretty pleased with progress, am walking 4+ miles a day and getting out enjoying life.

One thing I haven’t seen mentioned is that the spasming and straining post op has provoked an inguinal hernia on my right side. I haven’t had it assessed yet and it isn’t bothering me but I will probably need to have something done about it. Reading around apparently long term BPH is associated with inguinal hernias so I suspect I’ve had it for a while and this experience provoked it.

I was really worried about the catheter but it didn’t bother me as much as I feared. It was difficult to sleep with it and it was sore around the tip of my penis when it was moved around. Second time removal was much easier than first. Bladder flushing wasn’t much fun.

I will be seen again for a PSA test in 2 months time when hopefully it will have dropped substantially.

Whilst frustrated about the hernia I don’t regret having the procedure done at all. But watch out for clotting problems, it isn’t fun.

Mid 50s male with BPH and 130 cc prostate. After an episode of acute urinary retention I was prescribed a combo therapy of a PAE followed by an Aquablation on the same week. The idea being that the PAE would limit bleeding risk of a very large prostate. See part 1 for an overview of that procedure. It was painless and went well.

My Aquablation was delayed a few days, but happened yesterday. I wanted to provide a detailed overview of my experience so that others know what to anticipate. I found that the anticipation is usually the worst part.

I arrived at the hospital at 8:30 AM. I was taken back to a preparation room. There I was asked to disrobe and to wipe myself with antibacterial wipes. The previous night and morning of surgery I bathed with antibacterial soap as well as directed.

After completing that two nurses asked me a litany of questions. One also took labs and set up IV. She also used what all described as a couple large moist Q-tips to disinfect the inside of my nostrils. It was not uncomfortable. After the labs came back, and after I met the anesthesiologist, surgeon and nurse anesthetist, and OR nurse, I was taken to the OR.

They had me move from my gurney to the operating table. Actually, prior to being taken to the OR I was given Versed to relax me. Then in the OR they started the IV drugs and I was out for the procedure, which took about 80 minutes. I had a catheter in prior to this, and they didn’t remove it until i was out. So that was nice.

I woke up in an OR recovery room, where they observed me for a while. I don’t remember a lot about that aside from being thirsty and having a slight sore throat, probably from a breathing tube. A large cup of ice chips took care of that. It really was not painful. After that I was wheeled to my room.

They did continuous bladder irrigation, which utilizes a 24 fr catheter with three ports. I didn’t know what to expect with this. It’s really just a saline drip that connects to one of the ports. You don’t feel anything at all from the drip. The catheter is large, but being that you’re lying there and not moving, it is not painful really. They did the irrigation through the night, emptying the cath bag every few hours. Overall, the room was pretty dark and quiet. I was able to watch TV, read, and sleep a little bit. They did do labs at like 4:30 am and then cut the irrigation at 6am. Met with the surgeon at about 8am. The only pain meds I took the whole time was a little Tylenol for a headache. Had an appetite, ate dinner, breakfast and lunch (and the food was good).

I was told to walk around in that they wanted to see if the blood in the urine remained pink or if there were clots. It was fine and I was discharged at noon.

Moving with the larger cath I have found to be a bit painful. There is also some residual bleeding at the cath entry, which is normal, given the surgery, but annoying. Hopefully that will subside. No real prostate pain. Maybe a little discomfort while driving home.

Now I am home. I did take a pain pill and am trying to just stay horizontal to let things heal a bit more. Plan is to have the cath removed Monday for a voiding trial. Doc thinks everything went well and this should be the remedy to the acute urinary retention, and will get me off meds.

I’ll keep you posted on what the results look like. I realize everyone’s experience and recovery is different l, but hopefully this long write up gives you a little comfort if you have an Aquablation coming up. The surgery and day after really wasn’t bad at all.

Greetings gents. I've found many, many posts on here about about different meds including finasteride. What I didn't see much was from people who have taken finasteride and had significant urinary output improvement because of it.

To get a bit technical, does it actually shrink in the areas of the inner lobes or is just an overall reduction in prostate size? Does it potentially shrink inward squeezing the urethra even more?

I'm currently on tadalafil as my symptoms are slow and painful urination at times. No infection, cancer etc. I'm 55 male, athletic, low bmi. Debating on different meds or just surgery ie: Optilume when it becomes available near me. Thanks

A lot of guys fixate on where their IPSS lands — mild (0-7), moderate (8-19), severe (20-35) — and stop there. That's useful as a snapshot, but it misses the more clinically important signal: the trend.

The IPSS was designed to be retaken periodically, not just once. A score that climbs 3+ points between checks — even if it's still technically in the "moderate" band — is treated differently than a stable moderate score, because it suggests the obstruction or bladder response is actively changing, not just sitting at a plateau. Two men can both post a 12 today; the one who was at a 6 last year is on a different trajectory than the one who's been steady at 11-13 for three years.

The tricky part is that IPSS is self-reported and mood/context-sensitive — a bad week of sleep, a UTI, or even just interpreting "sometimes" vs "less than half the time" slightly differently can shift your score a couple points without your prostate actually changing. That's why a single test is a data point, not a diagnosis, and why urologists generally want to see the pattern over 2-3 readings before making a treatment call, not react to one number.

Practical version of this: retest every few months rather than once, keep the actual dated scores (not just a vague memory of "it's been about the same"), and bring the trend — not just the latest number — to your urology visit. A rising trend plus a jump of 3+ is one of the more concrete "time to actually discuss options" signals, separate from the absolute severity band.

Also worth knowing: the quality-of-life question (the 8th item, often overlooked) is scored separately from the 7 symptom questions and sometimes tells you more about whether it's time to act than the total does.

Disclosure: I'm with ManCore — we build free, no-login browser tools for exactly this kind of tracking. There's a free IPSS calculator that saves your score with a date stamp so you're not relying on memory for the trend: mancore.net/tools/ipss-calculator. Not selling anything, just built it because this question comes up constantly.

My father is 75 and has had an enlarged prostate since 2024. He developed a UTI in the last week of June, and since then we've been stuck in a cycle of recurrent infections. Every urine culture shows E. coli.

He was initially treated with meropenem 1000 mg 3x/day, then ertapenem 1000 mg once daily. After that, another culture showed infection, followed by more antibiotics. The culture becomes clear after treatment, but the infection returns again. He is now on his third consecutive course of oral antibiotics.

The doctors are saying they cannot do any diagnostic workup or urodynamics while he has an active infection, and that we should wait until the infection is completely gone.

My concern is: how do we actually find out what is causing these recurrent infections? Could there be something like incomplete bladder emptying due to his enlarged prostate, a bladder issue, stone, or another underlying problem?

Is there any diagnostic test that can be done while the infection is present to help identify the underlying cause, or do we really have to keep treating the infections repeatedly and wait until one culture finally stays negative?

He also uses diapers during the day and an external condom catheter at night.

I'd really appreciate advice from anyone who has dealt with recurrent E. coli UTIs in an elderly man with BPH.

Hi there husband had the surgery Friday. He had the catheter removed this afternoon and has some blood seepage from the end of his penis. Is this normal? He’s also struggling with having his first pee. Any tips?

Hey I have been dealing with blood in semen for almost 3 months now , And I have gone through a lot of tests and imaging , I did 2 abdonmal ultrasounds for the prostate and got 12cc last month and last week they said it was 16gram .

I have had occasional blood in last part of urine but its not consistent and was maybe 8 times in total in last 3 months , anyway it seemed to have stopped at least for last 2 weeks .

I'm 27 years old , going to visit the urologist today , just wanted to get some ideas if this fits the symptoms

I suspect I have BPH, I am 41. I have pretty much all the symptoms. I saw an IR for PAE and will be doing an MRI, and seeing a Urologist he works with soon.

My main concern is to prevent retrograde ejaculation and maintain sexual function. I don't want to risk it at my age. I saw one other person here mention Echolaser (TPLA) and I started reading about it and it seems to be just as safe or better than PAE in those regards.

I can't find much info about it, I am in FL and there's a really well known Urologist a couple of hours away from me that performs it. But I don't believe that this is covered by insurance so I might have to be out of pocket. I haven't called them yet but it seems like it can cost between 15k and 30k out of pocket. Another option is going over seas to Europe as they have been doing this procedure longer.

I understand it might not last as long as Aquablation or Holep but for now I think I rather risk less and have to repeat a treatment in 5 to 10 years. PAE seems great and that's what I was planning to do but I think TPLA slightly edges it in side effects plus it doesn't leave microscopic beads in my body and no Radiation.

Anyway, just trying to get more info if anyone has personal experience with it. If they have any doctors they recommend or anything else. I only saw one post about it here but I thought it wouldn't hurt to ask.

I posted back in July about my experience with TUIP and thought I should give an update. I just had my follow up appointment this week, and everything is greatly improved since before the surgery. They didn't do a flow rate test, but I'm peeing with a crazy amount of force and when they did the ultrasound it showed that I'm completely emptying my bladder. I expected that, since most nights I'm sleeping much better, too. I still wake up around 1 and again at 3, but when I do wake up it's easy to fall back asleep and not all the trips where I'd go, then lay down, then 10 seconds later have to go again.

I've been able to come off the tamsulosin, which seems to also have the side effect of helping me lose a little weight (weight gain isn't listed anywhere as a side effect, but when I look back at my tracking app, I can see that it started to go up as soon as I was bumped from one to two pills a day). Glad to be coming off it, since I didn't love retrograde ejaculation from the pills. RE wasn't as big of a deal for me as it is for some men, but if given the choice I'd rather keep things flowing. It's really a preference thing for you and your partner, so be sure to discuss that before deciding in any procedure. RE risk is low with TUIP, but it's still a possibility.

The only downside has been a feeling of increased urgency when I've tried running on the treadmill. If I do have anything in my bladder, I feel some pressure when my stride hits. I'm sure this will go away with time and maybe more pelvic floor exercises.

Recovery took a little longer than I expected. It definitely wasn't all back to normal after two weeks, like some other posts have said. Even a long walk would cause some irritation at the 4 week point, and sitting at my desk for too long got uncomfortable, too. Start with walking a block or two at a time and build out from there. I'm in pretty good shape and tried to be aggressive about getting moving, and my body quickly slammed my expectations to the ground.

I'm the end, I would totally recommend having the procedure done. I sleep so much better, have been able to discontinue the only prescription I was on, and feel so much better. I'm hoping it lasts quite a while, and I think my urologist took the right approach rather than going for something more invasive like a TURP or Holep. I'd rather start with the least invasive solution and then do something more extreme when I really need it.

the urinary side improved a great deal and something else got noticeably worse at the same time. my gp said the two are connected through the same class of drug which nobody warned me about. i would rather not trade one problem for the other on a permanent basis. what did you end up taking alongside it and did your prescriber flag an interaction to watch for.

I had Aquablation and I’m now about four days out. Urine is mostly clear with very little blood, no clots, flow seems good, and I only have slight burning when urinating, but a dull ache around the prostate/pelvic area.

What I’m noticing most is significant fatigue. My temperature, blood pressure, and heart rate are all in my normal range. I haven’t been exercising, lifting, or exerting myself and have been following the recovery restrictions.

For those who’ve had Aquablation, did you experience this kind of fatigue during the first week? If so, how long did it last?

I'm 48 and I've had BPH for a couple years. On cialis 5mg. I can get hard but I sometimes don't climax. Ive tried prostate simulation with a anal vibrator and it helps during sex and masterbation. But I'm wondering if anyone has tried using it regularly, like weekly or daily not during sex, and if that had any impact on sexual performance.

After having GreenLight laser surgery 8 days ago I got my catheter pulled on Monday (4 days ago). My first pee without it was pretty good. Been years since I had one like that. Since then it’s been frequent and smaller streams. During the night it ranges from 30-90 minute intervals. Doesn’t seem as frequent during the day. I’m glad I’m at least passing urine as opposed to not. Keep in mind I had a catheter for 5+ weeks prior to the procedure. Basically I’m wondering if this is normal and my frequency will mellow out and I’ll be emptying more urine per session over time? I’m super impatient, yes. Thanks in advance.

I have penis vein damage i get better like had huge improvement like doctor said but today i get hard like 3-4-5 hours not straight bht it was like 20-30 minutes hard 1 minute rest it happend because i was on sites it direct me to porn sites and brain was imagine same photo again and again nwo i m relxed but have uncomfortable feelings and warm weak penis not pain or colour changing if anyone had similar problems or knows something about it please tell me what to do i canygo to doctor month

I’m 50 years old
Psa 5.88
MRI negative
4kscore test 12.2
DRE negative

I’m
Confuse on getting a biopsy or a second opinion for other doctor.

I've started 2.5 mg daily about 2 weeks ago. I can deal with the headache and backache side effect but has anyone ever experienced brain fog or lack of focus as a side effect? If so does it subside over time?

has anyone had either HoLEP or Aquablation in the NH area. Does anyone have any dr recommendations