Is rezum a good alternative to other BPH procedures?

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Have had 2 unsuccessful PAE procedures in the last year. Don’t have enlarged median lobe. Still having clinical problems. Is rezum a good next step?

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  • Posted

    Not in my opinion but I had a 3T MRI to show exactly what the issue was and then had a very successful focal laser ablation 9 months ago it has been very successful with no side effects at all and if you have any interest in this let me know I will p.m. you and give you the details good luck I know it's a struggle trying to figure out what to do next. I did go and take the time to meet Doctor bagla and dr. Isaacson and I did consider pae before I made the decision to go with FLA. I wish you the best of luck. There are several of us that have gone this Direction with fla and have been very successful. several of us would welcome having a discussion with you if that would help

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    • Posted

      Ok, this is easy but a little difficult to explain so bear with me on this. You should see on a message from me to anyone on the site, a small envelope between my tag name (j12080) and your tag name (mike03369). This is at the top of the message just above the time stamp of when the message was sent and is located on the left side at the top. If my tag name is first, the envelope is what you select and it will take you to the sign in screen for the personal message file. So, select that envelope next to my tag name and then sing in with your standard sign in user name and password. It will take you to the personal message. and you can write what you wish. be sure to put a subject or topic in the message and then send it . 

      I am now going to send you one and you can answer it as this may be easier for you. Just look at the top of this message between our two tag names and you will see the envelope I am speaking of. 

      I hope this explains it. It is not real apparent on the site for some reason. 

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    • Posted

      ok Mike I sent you a couple of personal messages. did you get them and are you now understanding how to send a PM? 

      Step 1 Hit the reply to j12080 legend on the bottom right of this message. That takes you into Your Reply to j12080. 

      Step 2: Then you go up to the left top of this actual message and click on the envelope between your tag name and mine. This will put you in the personal message session and you will have to sign in with your user name and password. Then you can send the message in that screen. 

      OR you can read the personal messages I have previously sent and you can reply to one of those. 

      I hope this helps you. Ross is back in county Thursday and he said he would be happy to tell you his PAE and FLA story. 

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    • Posted

      saw your post about Rezum and was was curious about the procedure you did? Can you explain a little more on your situation and about the procedure you had done?

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  • Posted

    , I also forgot to tell you that a few of the men that have had the FLA had previously had one or two Pas before trying the FLA I am sure they would be willing to tell you their story if you have interest
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    • Posted

      Thanks for the info. Feeling somewhat adrift. Current Urologist suggested Urolift. Doesn’t interest me.  My PSA has dropped from 5.5 to 2.2 with the 2 PAE’s but clinically, the results have been anemic. I know that my prostate has been damaged, but not in the areas that affect flow. After having 2 procedures that take up to 6 months to see if they work, I’d like to get something that will fix the problem definitively.  Seems like surgical procedures will do that but have such high negatives potentially. I will research FLA, but would very much like your thoughts as to how you came to pick it as your initial procedure. Thanks. 
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  • Posted

    Hey Mike, I have to agree with John. Please do some research on FLA before trying anything else.

    I also had a completely failed PAE in Jan 2016.

    i just had the FLA done last Thursday the 19th . While it is still to soon to tell what the results will finally be, so far I am very pleased with the results. While my stream is still very weak, all of my sexual functions are intact.

    Just do not get in arush

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    • Posted

      Thanks Joe for the sage advice. I feel like time is running out because I’m a wimp about self cath. I know that buys time, but right now I’m putting a lot of stress on my wife trying to run our 2 stores while I am running on 50%, and not pulling my weight because of this condition. FLA. after having a PAE. Your smarter than me. I did 2 PAE’s thinking Dr would get it the second time. I’m just burned out thinking about another procedure that will take months to find out if it will work. Hope you will share with me your improvement. Thanks for responding 
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    • Posted

      Joe, I am really pleased to hear you are doing well. It will take 4 to 5 weeks for the inflammation to subside and then you should really be pleased. I was so admiring or my stream when that time happened I kept wanting my wife to come and watch. She just was not that interest and said she would take my word for it. That was a long time ago and since then I am now ten months out on the procedure, it has become the new norm for me and I seem to forget sometimes just how bad it was with the BPH symptoms I had for nine years.

      You hang in there and it will get much better. My inflammation seem to subside for more than six months. It just continued to get better. You are in the "two step forward then one step back" recovery stage. It seems like it really improves on one day then the next day it is not quite as good as the previous day. Then the next day it is good again. No rhyme and no reason except inflammation reduces over time and in waves. But it does continue to improve daily but slowly. You have great support with Dr. K and Donnie. 

      As I said I could not be happier at this point. Ross also had PAE unsuccessfully and he is now very happy. He is about 4 months out now I think. He lives in New York and we speak a lot. Great guy to talk with. 

      Again, happy to hear your progress. 

      John

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  • Posted

    Before considering Rezum (or any other procedure) a good next step is to further investigate why the PAE's didn't work. One of the usual suspects is the bladder which may have lost its elasticity. You could be wasting your time going from one procedure to the next if that is the problem. If you haven't already, consider urodynamic testing which will measure bladder function. You will not get this functional information from imaging, including a 3T MRI. You also might want to get a cystoscopy for a first hand look. I assume you have already had a bladder scan and a bladder/kidney ultrasound study? If  not, you will want those as well. 

    Jim

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    • Posted

      Great advise Jim. I agree but I also know that with an MRI, a proper trained Dr. would be able to show him exactly where the prostate atrophied in the PAE and where the pinching on the urethra is located at this time. The PAE reduction and the exact location of that atrophy is obvious and can be seen in the MRI.

      I know Dr. Karamanian showed this to Ross prior to the FLA and it was very apparent before with this MRI. Dr. K would look at this and tell Mike or even show it to him. With that MRI he can also tell him is the exact removal of certain tissue would help his symptoms. He does not charge for this consultation or analysis. It would tell Mike the current physical dynamic of the prostate and what the PAE actually did and did not atrophied for Mike. I would want to know that if I had the PAE and it did not result in the success I hoped for. I would feel like "ok, exactly what did the PAE procedure do in the prostate with the blood being cut off?" 

      You are correct that the bladder situations needs a different and further study analysis and is important to know. Then with all this information and evidence Mike could make a choice of what to do going forward. 

      I saw the bladder Tribeculation that was in my bladder walls before FLA in the MRI I did. I am fairly sure that it is improved over the last year. I will check it again when I do the next MRI and compare the films. I did an ultrasound of the bladder 3 months ago and i was no longer retaining urine in my bladder according to this. That pleased me. 

       

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    • Posted

      @John: I also know that with an MRI, a proper trained Dr. would be able to show him exactly where the prostate atrophied in the PAE and where the pinching on the urethra is located at this time.

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      Hi John, 

      A lot of us having enlarged prostates that impinge/pinch on the urethra. While useful for surgical guidance in the case of FLA, the 3T MRI cannot measure bladder function. Urodynamic testing is a functional test. Not saying that a 3T MRI isn't useful, but it doesn't replace urodynamic testing and used without urodynamic testing, there's just a lot less data available in terms of predicting surgical outcomes. 

      @John: With that MRI he can also tell him is the exact removal of certain tissue would help his symptoms. 

      -----------------------

      Removal of "certain tissue" might help patient "A" significantly, patient "B" somewhat, and patient "C" not at all.  Again, it all depends on how the rest of the system functions, and most usually that's the bladder. 

      Jim

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    • Posted

      Jim, as I said earlier, I fully agree with you and is not dispute them by my comments. but also the bladder function is in some cases, i.e. mine, Ross's who had full blockage along with Victor, Mike, Steve and others, the bladder retention was removed with the opening of the pinched location in the urethra. I unlike several of these men did not have full retention at the time of the FLA but I did urinate poorly every 30 minutes and sometimes on myself. Yes I was retaining which caused the tribeculation shown in the MRI and explained to me by Dr. Busche and Dr. Iaascson.  I should have done exactly the test you outlined prior to my treatment to be even more informed in making a decision. I did get lucky as I was in group A. I do not know of anyone  in the C group you speak of and I have spoken with Jim and Michael who both wish their results were better but both say is was good enough to do the procedure. Michael is a special case with the very bad kidney condition he had prior to the FLA procedure. He is better and doing a lot of Soccer and bike riding. And I am happy for him but I really hope he can get better with the self cath regimen you have helped hm with. 

      Again, you need to hear me that I agree with your analysis and recommendation. But this analysis should be done before ANY of the treatments that the Urologist provide. We do also agree on that. The difference being with urologist, these Uro's will try to sell a man their solution of the month when you try to get the Urodynamic testing. It becomes their stage for the sales pitch. A necessary evil a man must endure. All treatments should be evaluated. Pressure should not be placed on a man who is suffering through this condition but with urologist , it is most of the time. 

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    • Posted

      @John: I do not know of anyone  in the C group you speak of and I have spoken with Jim and Michael who both wish their results were better but both say is was good enough to do the procedure. Michael is a special case with the very bad kidney condition he had prior to the FLA procedure.

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      First, it's good to know we're in agreement in that proper pre-operative testing and evaluation is the right first step, and that is why I recommended such to the OP before going into any particular procedure. 

      "Group C" was not a reference specific to FLA, but simply a reference to the fact that one could have radically different surgical outcomes from the same MRI with different bladder conditions. However, since you brought it up, we have had at least one FLA failure (I'm not referring to Michael here) as of his last posting which I pointed out to you the last exchange we had a month or so ago prior to your going fishing I believe. As to Michael, I know he feels he made the right decision but he still has issues. And while Michael did have some issues going into FLA, so do many men looking for relief. I also had kidney issues (hydronephrosis) prior to self catheterization. It's not that uncommon with BPH/LUTS.

      Jim

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    • Posted

      Speaking of the Kidney issues you have had, I have wondered, do you know what cause the kidney issues? I know you have said that self catching has really help your kidneys and you hope to fully recover from the bladder retention. Is this bladder retention caused because of the kidney or is the kidney issue caused from the bladder retention? Where did the hydronephrosis come from? What caused your condition? This is what the doctors warned me about and scared me into moving forward with something. As they said back then "do anything just stop waiting".This was last October and I chose FLA in December. Neither of those two doctors did FLA they were PAE guys but their advice was well taken. All four Uro's had Trup for me and at least one more flavor of the month to chose from.

      I have a question also that if the self cath process opens you up, is there a blockage in the urethra that is pinching off the bladder to some degree and the cath opens it up? Just curious.

      My wife is yelling at me that if I am not in bed by 12 she says I will turn into a pumpkin and that is not a safe thing to be this close to Halloween. So I am going to bed and will speak again with you tomorrow. 

      Good night my friend. 

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    • Posted

      Obstruction causes retention and higher bladder pressures which can sometimes cause urine to back up (reflux) into the kidneys. That dynamic is called hydronephrosis (water in the kidneys). 

      If you catch it in time it generally resolves very quickly as soon as the bladder is able to empty completely. This could be a result of a successful surgery or procedure or simply from self catheterization. In my case, my hydronephrosis resolved within a couple of weeks of self catheterization. If that's what Michael had, I'm sure his also resolved fairly quickly once his bladder started to empty more completely. 

      The best way to monitor the kidneys are through periodic simple blood tests and bladder/kidney ultrasounds. I had a kidney bladder ultrasound a few months ago just to make sure everything is still OK, and it is. I recommend anyone this non invasive test to anyone with BPH/LUTS. 

      @John: I have a question also that if the self cath process opens you up, is there a blockage in the urethra that is pinching off the bladder to some degree and the cath opens it up? Just curious.

      -------------------------------------------------

      The primary function of self cathing is to empty the bladder completely to both protect kidneys as well as the bladder itself. In addition emptying and protecting the bladder from further stretching, it can also rehabilitate the bladder to some extent by restoring elasticity by keeping bladder volumes low. 

      Unfortunately, self cathing doesn't help much with the obstruction itself as it pinches the urethra. The exception might be in the case of urethral strictures where self cathing is often used to open the urethra up. But with a prostatic obstruction, you would need something that permanently kept it open like a stent, but stent technology isn't quite there yet. 

      So basically self cathing doesn't help with the obstruction, but rather is a mechanism to void in spite of an obstruction. 

      Jim

       

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    • Posted

      To add a little...

      In my case for example, my prostatic obstruction hasn't improved during the three plus years I've been self cathing. What has improved is the elasticity of my bladder and my detrusor muscles. They have improved to the extent that most of the time I can void naturally, without retention, and even without self catheterization. This compared to three years ago when my bladder function was so poor that I could hardly void on my own and they ended up draining 1.5 liters out of me with a catheter. 

      Jim

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