From scheduling the procedure to following up after you’ve been discharged, we’ve got you covered.

Logistics & Setting the Date (Several months prior to the FLA)

• Schedule the FLA procedure: Typically, we set up the procedure for a Saturday or Sunday. This allows you to have your pre-op visit on Friday and then a post-op visit on the Monday. Based on feedback from our patients, they like this approach as it affords them minimal interruption in their work schedule.
• Determine payment type: Are you paying out-of-pocket or through insurance? Out-of-pocket patients must submit payment 7 days prior to the procedure.
• Book lodging and transportation: If you are traveling into Galveston for this procedure, we will provide you with a list of hotels and transportation options. Plan to stay locally for two nights and three days: work up, procedure and recovery days. This allows for quick and efficient work up and follow up care. Please be sure to book these accommodations early.

Before the Procedure “Pre-Op” (One week prior to the FLA)

• 5 Days Before:
  • Do not take blood thinners (Coumadin, Plavix, aspirin, ibuprofen, etc.)
  • Use Tylenol for minor aches or pains
  • If under the care of a cardiologist, consult with them for clearance to stop blood thinners
• 1 Day Before (Pre-Procedure Appointment):
  • Confirm driver to take you home/ hotel. *You must have a driver for 24 hours post procedure to assist you*
  • Review the procedure, obtain consents, labs, and assessments
  • Confirm the pharmacy for post-op medications
  • Ensure all necessary financial documents and transactions take place
  • Ask any remaining questions
  • Expect to be at the facility for about 4-5 hours
• The Night Before:
  • Administer Fleet’s adult saline enema (may be purchased over-the-counter at any drug store) to reduce the bacteria in the rectum reducing risk of infection
  • Nothing by mouth after midnight the day of procedure. You may only take sips of water with medications
• The Morning Of:
  • Administer Fleet’s adult saline enema (may be purchased over-the-counter at any drug store) to reduce the bacteria in the rectum reducing risk of infection
  • Nothing by mouth after midnight the day of procedure. You may only take sips of water with medications

The Procedure (The day of the FLA)

• Get Registered: You will arrive at the registration desk to sign in. An escort will direct you to the Interventional Radiology patient care area.
• Check Vitals: Once in the patient care area, you’ll remove your clothes and personal items; they will be safely locked during the procedure. You’ll be able to spend time with family while members of our team check vitals, confirm your procedure, and place an intravenous line (typically in your hand) to deliver fluids and medication.
• Initial Sedation: Next, we deliver Ativan (for anxiety) so that we can place a catheter. After your family is escorted to a waiting room, we place the catheter.
• FLA Procedure: A team member helps move you from the patient care area to the MRI suite. A registered nurse administers moderate sedation* you with Fentanyl (for the discomfort) and Versed (the sedative). Dr. Walser spends 1-3 hours performing the FLA procedure while using ultrasound or MRI guidance, with transrectal (probe in the rectum) or transperineal (the skin between the scrotum and anus) needle placement. Final images are taken with contrast to identify any suspicious areas in the prostate.
• Recovery: After the procedure, you return to the patient care area and recover for 30-45 minutes. As the sedation wears off, you will feel drowsy. You will review and sign the After Visit Summary which includes your discharge instructions. The pre-determined driver will take you to the hotel or to your home.

*Many people ask us why we don’t choose sedation through general anesthesia. We believe that general anesthesia doesn’t provide sufficient benefit to the patient. Not to mention, general anesthesia is accompanied by procedural risks, as well as longer recovery time, more personnel, and greater expense. Moderate sedation works for our patients – if you have questions or concerns, please reach out to our team.

After the Procedure “Post-Op” and Post-Discharge (During the 2 weeks after the FLA)

• One Day Post-op: You will start taking your prescription medication. Specifically:
  • Flomax (generic = doxazosin) decreases inflammation and improve the flow of urine
  • Aleve (generic = naproxen sodium) or Motrin (generic = ibuprofen) for pain
  • Uribel (generic = Methenamine + sodium phosphate monobasic + phenyl salicylate + methylene blue + hyoscyamine sulfate) every 6 hours to control bladder spasms.
  • We will call you at your hotel to check in on you and see how you’re feeling.

• Two Days Post-op: You will come in for an in-person appointment with Dr. Walser. We will also schedule your 2-week follow up visit.
  • A urinary catheter is placed during the procedure to prevent burning of the urethra during the ablation and will remain for 1-2 days. This allows swelling to subside and prevents blocking of the urethra leading to urinary retention.
• Two Weeks Post-op: You may experience some very short term post-op side effects. The most frequently cited by patients include:
  • For 10-14 days post-op, you may have hematuria (blood in the urine). We suspected that as the prostate heals, it begins to slough, and blood is eliminated through your urine.
  • For 8 weeks post-op, you may experience a sudden urge to urinate at night and a lack of appetite. This is generally due to Benign Prostatic Hypertrophy (BPH) and the symptoms will subside if you continue to take Flomax (doxazosin) as prescribed.
  • In very rare cases, you may experience epididymitis (testicular swelling and pain). In this case, we will call in prescriptions for 5 days of 500mg Ciprofloxacin @ 2x per day or 10 days of 160/800mg Bactrim DS @ 1x per day, and 10 days of 440mg Naproxen Sodium (Aleve).