Answers to frequently asked questions

A minimum of 4 days and 3 nights, starting with the day prior to the procedure (where Dr. Karamanian will want to see you in his office no later than 2 or 3 pm). If you want to stay longer, we are happy to take care of you throughout your stay.

You are provided with both Nurse Donnie’s and Dr. Karamanian’s cell phone numbers.

Dr. Karamanian has a good relationship with two outstanding urologists in Houston. If we need their help, Dr. Karamanian will not hesitate to call or text them.

For BPH treatment:
Private insurance will sometimes cover a significant portion of the procedure, minus copays and deductibles. You can try calling your insurance with these codes and asking:
The CPT code is 52647 and the ICD code is N40.1.
Medicare is complicated, but the answer is generally no.

For Cancer Treatment:
Private insurance will usually not cover a significant portion of the procedure. You can try calling your insurance with these codes and asking:
The CPT code is 55899 and the ICD code is C61.
Medicare is complicated, but the answer is generally no.

A nerve block has a small but real risk of injuring a nerve, and regarding the prostate, these nerves are responsible for erectile function.  Also, the combination of fentanyl (a narcotic) and versed (similar to valium) provide superb pain and anxiety relief.  Most patients rate their pain and discomfort during the procedure in the range of 2-4, 1 being minimal and 10 being horrible.  IV conscious sedation plus a local numbing shot inside of the prostate (which Dr. Karamanian does do) makes the procedure itself consistently more tolerable as compared with oral valium and/or a nerve block.

The “Blue Laser” is marketing term.  The laser system that is most commonly used is the Visualase laser system which has two available laser fiber optics: a smaller one with a blue plastic cover and a slightly larger one with an orange plastic cover.  In order to create wider ablation zones for better margins (for cancer) and larger tissue destruction (for BPH), we use the slightly larger fiber optic.

We exclusively use the Visualase laser.  Before proceeding with treatment elsewhere with the CLS laser, we suggest asking the physician if he or she is a paid CLS consultant to identify possible biases.

When the prostate grows so much that it is under a lot of pressure, it tries to expand in a direction with relatively less pressure.  Sometimes, this is the direction of the bladder, and a median lobe can grow into the bladder.  These can be difficult to treat with certain procedures, but with MRI guidance, a laser can be placed directly into the median lobe for treatment.

We take many steps to minimize the risk of infection, including a IM or IV shot of antibiotics the day before, the day of, and the day after the procedure.  In addition, we prescribe a course of oral antibiotics. We have patients perform a fleet enema the evening before and the morning of the procedure.  Finally, before starting the procedure, we wipe down the inside of the rectum with betadine to clear any residual debris and wipe down the wall of the rectum with an antiseptic.

Dr. Karamanian completed an ACGME certified interventional radiology fellowship, part of which is training in the safe use of IV conscious sedation.


The American College of Radiology–Society of Interventional Radiology Practice Parameter for Sedation/Analgesia disagrees with your statement saying, “Patients who are ASA class I or II qualify for sedation/analgesia outside the operating room; ie, by personnel other than anesthesiologists.” ASA class I or II patients are those who are healthy or with mild systemic disease.

  1. Performing procedures with moderate sedation without an anesthesiologist present is a safe and accepted practice in the correct circumstances when performed under the supervision of a physician who has completed an ACGME accredited interventional radiology fellowship.
  2. Dr. Karamanian has performed hundreds of procedures with patients under moderate sedation (without an anesthesiologist present), including during complex procedures such as uterine fibroid embolizations, transarterial chemoembolizations for liver cancer, ultrasound guided liver microwave ablations, transjugular intrahepatic portosystemic shunt (TIPS) placement, MRI guided laser ablation for prostate cancer, MRI guided prostate biopsies, and more basic procedures such as port catheter or tunneled dialysis catheter placements.
  3. Having a properly trained physician experienced in conscious sedation and a very high quality registered nurse with significant critical care experience, good judgement, and appropriate certifications (e.g., ACLS, CSRN, etc) is critical. Nurse Donnie has these qualifications.
  4. Having high quality monitoring equipment including capnography (not required but very helpful) allows moderate sedation to be given even more safely.
  5. Having the fast acting, IV reversal agents immediately available, along with all the medications required for advanced cardiac life support, intubation equipment, a defibrillator, suction, etc. is both prudent and necessary in the rare event that a situation should arise. 

Another source:


“A nurse, doctor, or dentist, will give you conscious sedation in the hospital or outpatient clinic. Most of the time, it will not be an anesthesiologist.”

Another source (from the American Society of Anesthesiologists):


“An anesthesiologist or a registered nurse or nurse anesthetist working with a qualified physician may administer the sedation.”