GAT GOREN PROCEDURE FOR BPH

[MisterJa]

So the procedure is really expensive, and the clinic has asked for test results that I doubt I could get (I can get the results, but I am sure I cannot get some of the tests...).

For what it's worth, I have started taking horse chestnut extract. I know this isn't specifically a varicocele thread, but some research has shown that escin (the active ingredient in horse chestnut extract) can have positive impacts on varicoceles (or maybe at least their symptoms)

Escin Improves Sperm Quality in Male Patients with Varicocele-Associated Infertility

In the escin group, when severity of varicocele was classified to mild, moderate or severe degree according to the diameter of the spermatic vein, the improvement rates in disease severity were higher in the mild (41.7% vs. 20.0%, P<0.05) and moderate severity subgroups (64.4% vs. 20.0%, P<0.05) when compared to that in the severe subgroup (20.0%). The improvement rate in disease severity was also higher in the moderate subgroup when compared to that in the mild subgroup (64.4% vs. 41.7%, P<0.05).

I have only been taking it for a couple weeks; but I will let folks know how things develop.

[martell2005]

Hello Misterja,

I have a similar history as you (but I had embolization instead of microsurgery).

However, I wonder why do you think that your urinary issues are related to your varicocele. The only pathway we know would be through enlarged prostate, and that seems unlikely at your age. At any rates, you could easily check if you really have an enlarged prostate. I have similar symptoms as you (and I'm young too), but when I had a prostate physical examination (just palpation), Dr found it normal so I wouldn't be so sure that varicocele is the cause.

As for testosterone, why not take a test ? Like you, I thought my testosterone would be low but actually it was high. Facial hair is not a perfect correlate of testosterone, you may simply not have the genetic for facial hair. Anyway, I would think that the most obvious sign of varicocele damage is testicular size and sperm count, not testosterone level. Your body can compensate by increasing the stimulation of testicles (by having a high LH for instance, like in my case). From what I understand, spermatogenesis is a much more delicate and sensitive process than testosterone production.

Also, even if you kill all your incompetent veins, what is your guarantee that your remaining veins won't become incompetent in a few years? Do you have an explanation for the cause of your varicoceles? That's what worries me. This may be a lesser issue for older men, since they have less chance of developping new varicocele, especially since the etiology of varicocele seem to involve high blood flow to the testicles (when you are a teen).

This is a tough problem, I haven't managed to find a complete solution.

[MisterJa]

Thanks for the reply! I'll try to answer your questions one at-a-time:

However, I wonder why do you think that your urinary issues are related to your varicocele. The only pathway we know would be through enlarged prostate, and that seems unlikely at your age. At any rates, you could easily check if you really have an enlarged prostate. I have similar symptoms as you (and I'm young too), but when I had a prostate physical examination (just palpation), Dr found it normal so I wouldn't be so sure that varicocele is the cause.

I have further reasons for suspecting an enlarged prostate (I know it is 'common wisdom' that it couldn't be enlarged in a young person, but I have had a varicocele for a long time and had it when I went through puberty, so if I have a Gat/Goren malfunction, my prostate has been getting straight shots of T-rich blood for over a decade). I often get pain in my groin area (between my testicles and anus), back pain, malformed stool, etc. I have heard there are ways to do a self exam; as odd as it sounds, I may consider looking into that.

So far docs haven't been interested in checking into the issue; they have simply told me that if my urinary symptoms don't improve, they will stick a camera into bladder. Apparently they would rather traumatize my urethra than stick their finger up my butt; I can't at all follow the logic most doctors use, but I think too many operate under 'conventional wisdom' guidelines with little regard for current research and technique.

As for testosterone, why not take a test ? Like you, I thought my testosterone would be low but actually it was high.

This is interesting; like I have said, I am not a doctor. I saw the GG research and was surprised by how well it fit my symptoms and wanted to look into the matter.

Facial hair is not a perfect correlate of testosterone, you may simply not have the genetic for facial hair.

And body hair? And an Adam's apple? And hand size? I will be blunt and say I have the body of a 15 year old boy. This may not be from low testosterone, but it also very well could be, and that is why I saw the GG explanation as plausible.

Anyway, I would think that the most obvious sign of varicocele damage is testicular size and sperm count, not testosterone level. Your body can compensate by increasing the stimulation of testicles (by having a high LH for instance, like in my case). From what I understand, spermatogenesis is a much more delicate and sensitive process than testosterone production.

GG doesn't posit that the low T is from lack of production caused by varicocele-induced testicle damage. It says that the low T is from the rerouting of T directly into the prostate instead of the body.

In GG, the testicles produce normal levels of T; it just all goes straight to the prostate instead of the bloodstream.

Also, even if you kill all your incompetent veins, what is your guarantee that your remaining veins won't become incompetent in a few years? Do you have an explanation for the cause of your varicoceles? That's what worries me. This may be a lesser issue for older men, since they have less chance of developping new varicocele, especially since the etiology of varicocele seem to involve high blood flow to the testicles (when you are a teen).

I used to ride bicycle a lot when I was young and I have suffered severe constipation for almost my entire life. I just recently got the constipation under control, but when it flares up is when I get the worst varicocele pain. I was also kicked in the crotch when I was young; I am sure like most active boys I had my share of run-ins between my legs, but this incident has always stuck with me, so perhaps it hurt very bad and was thus quite severe.

This is a tough problem, I haven't managed to find a complete solution.

Have you managed to find any solution? Any direction you can offer me would be great!

Thanks,
MrJa

[martell2005]

Thanks for the reply! I'll try to answer your questions one at-a-time:

So far docs haven't been interested in checking into the issue; they have simply told me that if my urinary symptoms don't improve, they will stick a camera into bladder. Apparently they would rather traumatize my urethra than stick their finger up my butt; I can't at all follow the logic most doctors use, but I think too many operate under 'conventional wisdom' guidelines with little regard for current research and technique.

I have had similar experiences with General Practitioners. As you say, they operate under guidelines which are not updated regularly, and they don't have a deep understanding of these issues. I often feel like I know much more than them on this particular subject. Actually, this is even true for urologists; most of them are vaguely aware of the literature, but there are so many more acute and urgent diseases that these tricky long-term issues often get ignored.

Im with you on the urethral catheter test, I would need to be really desperate to accept such an invasive test.

About your symptoms, none of them are very specific and can probably be better explained by your constipation. Constipation can cause urinary problems through pressure on the bladder I think.

As for me, I do also have pelvic pain. Bizarrely, I don't wake up at night to urinate, but I stain my bed. I think prefer some staining than waking up every night honestly.

And body hair? And an Adam's apple? And hand size? I will be blunt and say I have the body of a 15 year old boy. This may not be from low testosterone, but it also very well could be, and that is why I saw the GG explanation as plausible.

Of course, the more such correlates you have the more likely it is that you have low testosterone. For me, some of my features suggest low testosterone, but others suggest normal/high testosterone (like my hair loss). I have a high voice, small hands and small testicles, but my testosterone is around 800 ng/ml. I was certain I had low T mainly because my testicles size was something like 2 standard deviations below the mean (mean is 18cc mine was 13cc). Just take a test in a private clinic its not very expensive.

GG doesn't posit that the low T is from lack of production caused by varicocele-induced testicle damage. It says that the low T is from the rerouting of T directly into the prostate instead of the body.

In GG, the testicles produce normal levels of T; it just all goes straight to the prostate instead of the bloodstream.

This is news to me, are you 100% certain that this is part of their theory? I know about testosterone going to the prostate, but I didn't assume this would result in significantly lower circulating serum TT, even if it makes complete sense. Still, the GG theory stipulates that varicocele causes poor blood circulation in the testicles, which could somewhat affect T production. This is reinforced by the fact that spermatogenesis IS affected by varicocele-induced damage and that testicles DO shrink: you have to think that varicocele can also impair testosterone production through testicles damage.

I used to ride bicycle a lot when I was young and I have suffered severe constipation for almost my entire life. I just recently got the constipation under control, but when it flares up is when I get the worst varicocele pain. I was also kicked in the crotch when I was young; I am sure like most active boys I had my share of run-ins between my legs, but this incident has always stuck with me, so perhaps it hurt very bad and was thus quite severe.

From what I understand, there seems to be two aspects to varicocele etiology: 1) the causes of valves malfunctions, and 2) the causes of varicocele-induced damage. 2) seems to be mainly attributed to erect posture: quadruped don't even need the veins valve, so varicocele should not be an issue for them . About 1), we don't know: evidences suggest sports, constipation, but maybe simply long term accumulation of damage again due to the erect posture. Never seen anything about groin injury but it makes sense.

I'm not sure entirely convinced about constipation: it may simply be that constipation causes pain and aggravation through reflux without being the cause of the valve dysfunction. Pain doesn't seem to be really relevant as far as varicoceles are concerned. Constipation could be causing the varicocele to go from subclinical to clinical, but that doesn't really mean more severe varicocele damage to the organs.

It may be more accurate to think of varicocele has a normal consequence of aging among biped and not something due to punctual events like a groin injury or straining during bowel movements. It may be that most men will develop varicocele in their life, clinical or sub-clinical. I really don't know, and it is a key question to address in order to choose the best option.

Have you managed to find any solution? Any direction you can offer me would be great!

My conclusion is that the GG treatment is the best treatment option we got right now. It is not entirely clear to me though if doing nothing is a better option considering the price, the risk (radiations for example), and the long term pronostic (reccurence).

Cheers, I really enjoy exchanging on this with someone else of a similar background

[MisterJa]

About your symptoms, none of them are very specific and can probably be better explained by your constipation. Constipation can cause urinary problems through pressure on the bladder I think.

I have been there, where I need to urinate frequently because I have a pending bowel movement. But my constipation involves the need to push very hard to get out the stool even though the stool isn't hard (it's often soft). And even when the stool is all out I still have the problems...

I had a colonoscopy and they found nothing abnormal and so diagnosed me with IBS-C (my father and brother also suffer from chronic constipation, so there is probably some familial history there).

The docs recommended daily doses of Miralax, which worked. But I got sick of taking medication all the time. I found a natural cure to my constipation: squatty-potty. Fixing the angle of voiding has solved almost all my problems with constipation.

As for me, I do also have pelvic pain. Bizarrely, I don't wake up at night to urinate, but I stain my bed. I think prefer some staining than waking up every night honestly.

Interesting. Are you saying you wet the bed? Is it a lot, or just leaking? The thing that gets me is that when I have to wake to urinate there is rarely much in me and it just trickles out.

I was certain I had low T mainly because my testicles size was something like 2 standard deviations below the mean (mean is 18cc mine was 13cc). Just take a test in a private clinic its not very expensive.

I will look into that. Thanks! My testicles are both normal and I had a semen analysis that was also 'normal' (the people who gave me my results said there were some abnormalities but my urologist dismissed them; bottom line, though, I am still very fertile).

This is news to me, are you 100% certain that this is part of their theory? I know about testosterone going to the prostate, but I didn't assume this would result in significantly lower circulating serum TT, even if it makes complete sense.

Yep. If you google Andrologia and Gat you will find his paper where he addresses the anomaly of BPH and low serum T.

Still, the GG theory stipulates that varicocele causes poor blood circulation in the testicles, which could somewhat affect T production. This is reinforced by the fact that spermatogenesis IS affected by varicocele-induced damage and that testicles DO shrink: you have to think that varicocele can also impair testosterone production through testicles damage.

When I first suspected low T, I considered the possibility that the testicle was underproducing. But after seeing the GG theory, I have started to reconsider since GG would (if my prostate is indeed enlarged) explain ALL of my symptoms.

I'm not sure entirely convinced about constipation: it may simply be that constipation causes pain and aggravation through reflux without being the cause of the valve dysfunction. Pain doesn't seem to be really relevant as far as varicoceles are concerned. Constipation could be causing the varicocele to go from subclinical to clinical, but that doesn't really mean more severe varicocele damage to the organs.

When you squeeze it increases the pressure in the blood vessels down there. The same thing causes hemorrhoids.

It may be more accurate to think of varicocele has a normal consequence of aging among biped and not something due to punctual events like a groin injury or straining during bowel movements. It may be that most men will develop varicocele in their life, clinical or sub-clinical. I really don't know, and it is a key question to address in order to choose the best option.

I've had mine for so long though...

Cheers, I really enjoy exchanging on this with someone else of a similar background

As do I! Not many people enjoy the same thick conversation on these things like I do.

MrJa

[martell2005]

Interesting. Are you saying you wet the bed? Is it a lot, or just leaking? The thing that gets me is that when I have to wake to urinate there is rarely much in me and it just trickles out.

No it is just leaking, I don't feel it but I see the stain in the morning. I also have leaking when I am awake sometimes. I have had trouble with my stream for some years, I cannot recall any trigger though. One Dr seemed to think it is due to some pelvic muscles malfunction, since I also have hip issues which can be due to that. I have never believed this explanation.I always thought my problem was the prostate, but then again physical examination was negative.

I will look into that. Thanks! My testicles are both normal and I had a semen analysis that was also 'normal' (the people who gave me my results said there were some abnormalities but my urologist dismissed them; bottom line, though, I am still very fertile).

Normal doesn't mean much. My testicles are also considered normal. Abnormal testicles are basically atrophied testicles, which is extreme. This is frequent in medicine; abnormal mean something really severe is going on, but you can be low-normal and have issues (example: testosterone levels).

The same is true for sperm count. 15 million/ml is considered normal, but the true mean sperm count is above 100 million/ml. The way they determine what is a normal sperm test is by taking the 5% worse test result of confirmed fathers. If you think about it for 2secs, it is a very poor way of assessing your testicles health and fertility, because some of these fathers had very very low probability of conception.

Yep. If you google Andrologia and Gat you will find his paper where he addresses the anomaly of BPH and low serum T.

I just skimmed through one of their paper, and the only thing about testosterone production is this:

"This pathologically elevated
hydrostatic pressure causes persistent hypoxia in the testicular
microcirculation, leading to deterioration in spermatogenesis followed
by a reduction in testosterone production."

Which is in line with what I have mentionned.

When you squeeze it increases the pressure in the blood vessels down there. The same thing causes hemorrhoids.

I am aware of that, but something that make varicose veins symptomatic or apparent is not necessarily the cause of valve malfunction. The same is true for hemorrhoids. But you are right, it is very likely that constipation is a cause of varicose vein.

[Althe1st]

What is the current status of the Gat Goren clinic and the BPH treatment? I read the publications and it makes so much sense.