Greenlight versus Acquablation

Wow. How much did it cost you?

See below. Bobcats would like more infor.

It wasn't me it was Ken. I haven't gone "under the knife" yet.

I had two surgeries at once and I still only spent one night in the hospital. Don't worry about the foley catheter. Most patients have it for one day, some a little longer depending on your bleeding. My bag was relatively clear after one night. I had a much more serious bladder diverticulum surgery which resulted in having a sewn up bladder that required a catheter for 9 days to avoid stressing the bladder. The aquablation is actually a minimally invasive painless procedure. Just google Aquablation and you will see how its done. Its like a CNC machine making an exact cut without heat which is the key element. Don't hesitate; go see Dr Desai. Because it is not always covered by insurance, he will not try to "sell" you but he will inform you. I went from one extreme to the other. I was in full retention; now I urinate at full stream within 1 or 2 seconds of starting and I always fully void. Every other procedure out there has serious potential side effects. That is why I paid out of pocket. I couldn't imagine living my golden years with any of them.

You paid out of pocket for Aquablation? How much was it? My doctor wouldn't even tell me after my insurance refused it. I had a Rezum instead. Less invasive.

Motto,

.

And as an outpatient procedure, Rezum costs a lot less too. My Rezum was $2500 out of pocket. The consultation and cystoscopy before my Rezum cost me another $600 so the total cost was about $3100.

.

I have a high annual deductible, low monthly premium insurance plan. Doing a Rezum out-of-plan and out-of-pocket cost me several thousand less then doing a TURP in-plan without the complications.

.

And as you mentioned, it is less invasive. I have no RE, no ED, and after total retention, I can pee again!

.

Steve

If you go up to the bay area in Calif, there is a doctor and hospital where the total cost is around $10,000. Call the people at Aquablation and they will forward the information in regard to estimated prices around the country.

I did a lot of research too (I am a retired research scientist) with the help of a family member who was an MD for over 40 years. We chose Rezum after looking at the various options available today. I had a large median (not medial) lobe and was in complete retention for over 10 months. I had no resulting complications. My Rezum cost me $2500. That is 1/4 the price of Aquablation.

.

The family-member-MD says that Rezum is a game change in BPH treatment because all the men who have been doing nothing other than meds and self-cathing when they do not want to do a TURP, can now try the less invasive Rezum 1st and see if it works. Also Boston Scientific bought NxThera who developed Rezum which indicates that a very big player in the medical devices industry has confidence in it.

.

How widespread is Aquablation and other than the company that developed it, does it have any major backing?

.

Steve

I had three urologist including one that offered it tell me that REZUM typically was not a long term solution. The urologist that offered it told me that the results are mixed and that I should have a turp for optimum results. After further research , I chose Dr Desai at USC to perform AQUABLATION. I saw my prostate on the screen during a follow up scoping. There was a perfect tunnel going through it. I have talked to three other patients and they had the same success. One patient had a massive prostate and he is thrilled with the results. The clinical trials are public for all to view. My doctor was on that team. I paid extra for a procedure that I felt gave me the best long term odds for successful results without the dreaded side effects. I wanted the best procedure to preserve my repaired bladder that was damaged from going too long with BPH. For the budget conscious patient; Rezum is certainly worth a try. You still have the option to try something else if the results are not what you hoped for.

Ken,

.

With all the new procedures, including Rezum, there is not long-term data, simply because the procedure has not been around that long so the period of record (POR) is short. Rezum has 4 years of published data. There is most likely over 5 years of data by now, but the last year is not published yet as it can take about a year from submission to publication.

.

There is long term data for TURP and GLEP which have been around for a while so urologist say to have a TURP for long-term results. We know that the prostate keeps growing and that TURPs have been redone. Personally, I am staying on Finasteride to limit my prostate regrowth and because I did not have side effects, other than my bald spot has filled back in.

.

What is the POR on data for Aquablation and what does it say? Also as the family-member-MD told me, most doctors will push for the procedures that they do because that is what they make their money on. Given the higher cost of Aquablation, it may be a real money maker. I saw 3 different urologists until I chose the one who did my Rezum.

.

Steve

In the UK with our 'Free' NHS they like Rezum because it is the cheapest procedure and no hospital stay required.

Derek,

Yes, as an outpatient procedure Rezum will be the least expensive as you are not paying for operating room expenses. Also, as an outpatient procedure, no hospital stay is required. Personally, given how many men have or will get BPH, I think that Rezum is a game changer in BPH treatment. Because it is a new procedure, it is important to find a urologist who has done enough of them though to be sufficiently experience with the procedure.

.

Steve

The way I understand Rezum is that tissue is not removed as with GL, HoLep or TURP but damaged for want of a better word and gradually breaks off and is passed in your urine stream hopefully without being too big to cause a blockage. My Uro said that GL lasers away the selected tissue as it does not save any as HoLep does and as with TURP it is irrigated away . It them smooths the remaining surface area. That area comes off as part of the healing process. In my case it was not really noticeable with only a couple of biggish pieces and one big clot that momentarily stopped my flow.

From a report:

TURP and PVP and vaporization

TURP and PVP are performed with surgical instruments that allow for

continuous irrigation of the prostatic urethra and bladder. When tissue

is vaporized with a greenlight laser, or cut with a TURP resectoscope,

there are many tissue particles that float in this irrigation fluid and

are taken out of the patient through the scope. They just do not

condensate. TURP and PVP destroy the urethral lining (the correct word

should be endothelial - rather than epithelial, endo means inside, and

epi outside, so the epithelium applies to the skin, and the endothelium

to all "internal skins", it is used for any lining of internal

organs),

but this epithelium grows again and when you look inside after some

time, you see it has regenerated completely. In some areas there is

some scar tissue, specially after TURP, but as it happens with wounds

in the skin, the regenerative process manages to cover the wound

surface completely.

Derek,

.

With Rezum, the steam kills the tissue and then over time, the body gets rid of the dead prostate tissue. Some of it is absorbed and some of it is peed out. I definitely had periods when I was passing pieces of tissue.

.

With Rezum, the urethra is penetrated by a series of puncture wounds. I was not aware that the urethra regenerates after a TURP or GLEP. Could you PM me with a link to this as the forums don't allow links.

.

Steve

It was a post in 2006 by an internationally known Urologist Fernando Gómez Sancha who used to reply to posts on a prostate news group and also had a blog. If you look on Youtube a lot of his lectures are on it and demos of his procedures

The full post:

Too many complex and metaphysical questions for

a relatively simple

subject. This urethral lining problem mesmerizes a lot of patients. I

will try to help.

1. prostatic urethral lining.

If you think of the prostatic urethra as the throat of a boy, and of

the prostatic hyperplasia as the tonsils in a boy's throat, you will

quickly understand that removing the hyperplastic tissue works exactly

as removing the tonsils. You have to cut through the epithelial lining

of the prostatic urethra to reach the hyperplastic tissue. When you

finish there is a wound in both cases, there is a surface that needs to

undergo repairs, and the borders of the wound start to grow new

epithelial cells that will eventually cover the wound surface. if you

look inside the boy's throat just after the operation you will see two

wound surfaces, if you look inside the prostatic urethra after TURP or

PVP, there is a 360º wound surface. After tonsillectomy, it is

impossible for those surfaces to stick together, because they are never

in contact. After TURP or PVP it is theoretically possible that two

surfaces in contact could develop adherences, but this is extremely

rare. TURP and PVP cavities usually have a diameter of 2-3 cm, so

surfaces do not stick together, and the urine gets between these

surfaces, making it difficult to develop adherences.

2. Prostatic ducts obstruction

Prostatic ducts can become obstructed, the glands keep secreting and

then you have a retention cyst. They are very common and easy to see

with ultrasound of the prostate. You can also see retention cysts after

TURP. So some of these ducts get obstructed with the surgery as you

sugggest, but this does not derive into major clinical problems.

A TURP could cut the ejaculatory ducts if it is very aggressive and

penetrates the so called central zone of the prostate, but usually TURP

and PVP are restricted to the hyperplastic tissue, that derives from

the transitional zone of the prostate. So it is relatively rare to

obstruct the ejaculatory ducts with prostatic surgery. It is not a

cause of much concern for patients or urologists. Some young people

suffer obstruction of the ejaculatory ducts after infections, or for

unknown causes and they notice they ejaculate less volume of semen, and

they have fertility problems, but this obstruction rarely causes pain

or other symptoms.

3. prostatic urethra as a tube or duct:

I have not seen two prostatic urethras looking exactly the same. They

tend to be different, as prostatic shapes vary from person to person.

You never see two mouths that are exactly the same, do you? Some

prostatic urethras look from the inside like an open tube, other

prostatic urethras are not an open tube, but an obstructed tube,

because there are two masses of tissue that grow from the sides and

coapt in the midline. Some urethras look like a tube with a full

bladder (there is pressure inside the prostatic urethral lumen and it

opens up) and as a colapsed tube when the bladder is empty. In the

embryo, the urethra is a tube that is only lined with epithelial cells.

Then some buds start to develop from the urethra and these buds invade

the surrounding mesenchyma (this is the name of embryonal tissue that

has not yet differenciated into a mature tissue). These buds are hollow

bags of epithelial cells that will later differenciate into the

prostatic glands (the parenchyma - the glandular tissue) - these cells

will secrete the prostatic secretion, and will produce the famous PSA.

The surrounding tissue will differenciate into the prostatic stroma

(collagen, smooth muscle fibers, elastin, and other components) - a

scaffold that will support the prostatic glands.

4. TURP and PVP and vaporization

TURP and PVP are performed with surgical instruments that allow for

continuous irrigation of the prostatic urethra and bladder. When tissue

is vaporized with a greenlight laser, or cut with a TURP resectoscope,

there are many tissue particles that float in this irrigation fluid and

are taken out of the patient through the scope. They just do not

condensate. TURP and PVP destroy the urethral lining (the correct word

should be endothelial - rather than epithelial, endo means inside, and

epi outside, so the epithelium applies to the skin, and the endothelium

to all "internal skins", it is used for any lining of internal

organs),

but this epithelium grows again and when you look inside after some

time, you see it has regenerated completely. In some areas there is

some scar tissue, specially after TURP, but as it happens with wounds

in the skin, the regenerative process manages to cover the wound

surface completely.

5. Prostatic capsule.

The prostate does not have a proper capsule. It is surrounded by

fascial sheaths that are almost only visible under the microscope.

In a 20 year old prostate, there is an area near the bladder neck,

surrounding the urethral endothelium, the transitional zone, that will

be the origin of the benign hyperplastic tissue. It will start to grow

and it will progressively push the original prostatic tissue outwards.

In an old man with a big prostate, this growth of tissue from the area

surrounding the urethra will have pushed the original prostatic tissue

outwards, and between these two parts of the prostate, the central

hyperplastic tissue and the external original prostatic tissue there is

a very clear cleavage plane. When an open prostatectomy is performed,

the surgeon incises the prostate until he reaches this cleavage plane,

and then uses his finger to enucleate the hyperplastic tissue, he

breaks the urethra and extracts the BPH tissue with a hole in the

middle (like a donut) - the urethra. Then the incission is closed with

a suture. This gives the impression of a "surgical capsule", that is

tipically 5-10 mm thick, and this is really the original prostate.

We surgeons talk about the capsule knowing that we refer to the

original prostatic tissue. When we perform TURP (well, I do not perform

TURP any longer) or PVP, we want to reach the "capsule" (the surgical

capsule), to make sure we remove all the hyperplastic tissue.

Apparently, some prostates are more distensible than others, and that

explains in part that some men with relatively small prostates are very

obstructed (the growth is not able to push the prostate outwards, so it

obstructs the urethral lumen) and some men with much bigger prostates

can urinate very well (a more distensible original prostate allows this

tissue to enlarge the prostate, and the urethra is not so compressed).

This also happens with e.g. kidney tumors. A tumor inside the kidney

can push the renal tissue and compress it and when you look at the

kidney it appears to be encapsulated, but what you see is renal tissue

that has been compressed and seems to form a capsule around the tumor.

Open prostatectomies on very big prostates are like opening the skin of

an orange (the surgical capsule or the original prostatic tissue) and

extracting the flesh (the hyperplastic tissue)...

6.- liposuction of the prostate...

Prostatic tissue is quite elastic, but it is also quite rubery or

tough... there is no way of performing what you suggest...The

hiperplastic tissue is a benign tumor of the prostate, it has stroma

(collagen, muscle fibres, etc..) and parenchyma (glandular tissue).

Ellen Shapiro from new york has been studying the proportion of stroma

and parenchyma in BPH, a difficult question to investigate.... but

there are two components also in BPH. The smooth muscle in the stroma

responds with relaxation to alpha blockers. The glandular tissue

responds to finasteride with atrophy. Both mechanisms derive in

symptoms improvement in patients through different mechanisms.

It is a pity these google groups do not allow for drawing. It would be

very nice to use some drawings to explain these things.

My best wishes to all, I hope this was helpful.

Fernando Gómez Sancha

It seems to me that Rezum cannot be selective in the tissue that it kills unlike TURP or the laser ones. Some early GL patients who had hurried procedures were later told that instead of having the expected smooth prostate capsule it looked like ragged hanging curtains.

It and Urolift I would run a mile from if ever offered. With Urolift I cannot see how the banded tissue does not continue to grow. Ones who have had later problems have mentioned the bands are now embedded in the prostate.

Kenneth1955 had Urolift and used to have knowledgeable posts on it and had contacted prostate experts around the world in his search for information.

Sadly he has not posted for some time I hope that he is all right.

It is surprising how many people are needed in the operating theatre.

A couple of years ago I had an Amplatzer amulet fitted in my atrium to prevent any blood clots getting to my heart.

I counted ten in the cardiac lab. No wonder it cost me so much.

They can be very specific about where they spray with Rezum - which is why it can deal with enlarged median loves and be relatively safe regarding RE

Are there any online videos of the procedure ?

Derek,

.

Google "vimeo rezum". Look at the "Rezum Procedure 49g Prostate on Vimeo" and "Rezum Procedure 75g Prostate on Vimeo" links. There is also a "Rezum Procedure 36g Prostate" video which did not come up in my Google search.

.

As oldbuzzard said "They can be very specific about where they spray with Rezum - which is why it can deal with enlarged median loves and be relatively safe regarding RE".

.

From the urologist's notes on my Rezum: "The median lobe was treated in 2 locations" and "The verumontanum, sphincter complex were spared." This means that they can specifically target the median lobe and they can avoid the area that causes RE.

.

Steve

Thank you, I''ll look at that.

Hi Derek,

.

Thanks for the rather lengthy reply. Could you PM me with a link to Fernando Gómez Sancha article as I would really like to read it and these forums have problems with posting links so PM's are usually how we do links.

.

As I have mentioned, but maybe not to you, when I researched the various BPH procedures and chose Rezum, I worked with a family member who I have known for over 60 years who was an MD for over 40 years. He was an otorhinolaryngologist so he did thousands of tonsillectomies in his career.

.

We talked tonight and I read some of what you included in your post. He said that it was partially correct but an apple and oranges comparison because the prostate/urethra and throat/tonsils are 2 different tissue systems. When he practiced, he was good friends with a urologist and they had lunch together.

.

The family-member-MD encouraged me to find an alternative to TURP, which was at the bottom of his list because of its known morbidity and complications. Urolift was 2nd from the bottom for several reasons, including stress failures, permanent implants and continued prostate growth.

.

PAE was also eliminated because I had a median lobe obstruction which PAE does not treat. In the end Rezum was at the top followed by GLEP and plasma/button TURP which vaporizes tissue and seals the wound like GLEP. We did not consider some of the more "exotic" procedures like FLA and HoLEP.

.

My Rezum worked out well for me and I went from complete retention and 10 months of catheters to peeing again. Over time, I will see if my prostate grows back or not. In the meantime, I am staying on Finasteride to hopefully prevent this as I have seen no side effects other than my bald spot filling back in 👍

.

Steve

Steven,

Happy to hear your Rezum worked out for you. About one of the comments later in your post: you mentioned plasma/button TURP. It has been said by me and others over and over and over again that there are three types of TURP: the older style monopolar TURP, and the newer style bipolar and plasma button TURP. The older monopolar did have a higher rate of complications and issues than the newer style. You said that "In the end Rezum was at the top followed by GLEP and plasma/button TURP...." This confusion or misunderstanding about the three types of TURP seems to be never ending. Just trying to get the record straight here after many posts. I had a bipolar TURP in April - very easy, home in 4.5 hours, no issues, no pain. All went well.

Tom

It was not an article but a reply by him to questions on an old prostate news group that I kept as I said years ago. If you do a search on his name he has a lot of published articles and his blog.

Tom,

.

The 1st urologist that I saw did the old monopolar TURP. There are still doctors doing the old school TURP. GLEP and the new plasma button TURP are similar. One uses the heat of a laser to vaporize the prostate tissue and the other uses the heat from a plasma stream applied to the button to vaporize the prostate tissue. A urologist could better qualify the pluses and minuses of these 2 similar techniques.

.

Steve