Is rezum a good alternative to other BPH procedures?

Mike,

As long as you're not retaining a lot, I wouldn't worry much about kidney back pressure, but of course, periodic bladder/kidney ultrasounds are a good reality check. I had one myself a couple of months ago to make sure I wasn't damaging my kidneys as I had been off the catheters completely for five months at the time of the ultrasound. I have no doubt that my voiding pressures were high during those five months due to my prostatic obstruction, but I wasn't retaining and therefore no kidney issues. 

Makes sense that Flomax can take the place of CIC, as you're sort of borderline right now. Either one, or a combination, shoud work (pick your favorite poison) but again, I don't see kidney issues as a problem as long as you're not retaining. But definitely get that bladder/kidney ultraound sooner than later. It's totally non-invasive, there is no radiation, so really no downsides. You also want to have your blood checked (kidney function tests) every six months or so. 

Jim

Hello Mike, and thanks for the info. It sounds like I am following in your footsteps, except I stopped after the first PAE, even tho a second was offered.

I just had my FLA done on Oct 19th, so just a few days ago.

But my primary care Doc has been monitoring my kidney function since my PAE and it has steadily declined for some reason. I am NOT saying there is any connection but it does seem odd. I am a very active, healthy 54 year old otherwise.

I am scheduled for an ultrasound of my kidneys, and bladder this afternoon at 4 p.m.

Good luck Joe - if it IS related it's because you put stress on your bladder probably from PAE first few weeks, at least that is logical the bladder might be affected, not voiding properly etc. But don't expect any improvements yet as a result of FLA. If you had a Foley in for a week or so that might have helped the kidney situation.

Thanks Mike, I never thought about the Foley helping with thst, but it makes sense

I'm due for an annual checkup soon so that will cover kidney function blood test. I found that if I miss Flomax PVRs will go up to like 160 - 200. With Flomax down to 100 but it takes a few days for it to get there. At least I don't think I've had a serious UTI for a couple of months thanks to using pre-lubricated catheters.

If I remember correctly, I had normal kidney function blood tests at the same time my bladder/kidney ultrasound showed that I had hydronephrosis (water in the kidneys). Of course, you will want the kidney function blood tests, but given your history, the prudent thing is to get a bladder/kidney ultrasound.

Jim

Hi Jim,

I DID have an ultrasound on Bladder about 3 months ago and it showed I was just about over any hydronephrosis, maybe one kidney had a trace. I sent the images to Dr K and he said I was OK and safe. I don't remember if they did it specifically on the bladder but I remember the radiologist showing me how the jets were operating to send the urine into the bladder.

Anyway I still want to do the urodynamic test, just right now I feel like a break from any kind of tests and am traveling next month for a month, maybe early next year.

Thanks

Michael

I plan on having a bladder/kidney ultrasound every year and I have zero trace of hydronephrosis. If you still have a "trace" in one kidney then I would repeat in another three months. BTW was it done in a hospital or clinic with one of the big machines and read by a radiologist? I wouldn't trust the typical office ultrasound machine for a kidney scan. As to the bladder/kidney ultrasound study itself, they scan the bladder as well as both kidneys and that is why you were able to see the "jets" using the doppler ultrasound aspect. In addition they also do a PVR but it's not really a real world PVR since they usually overload you with fluid to better examine the bladder walls. So take their PVR with a grain of salt. Your real world PVR is what comes out of your catheter at home under normal conditions. 

Urodynamic testing is another animal altogether. For the most information, you will want video urodynamics, but not every urologist offers it. The other thing about video urodynamics is that the doctors that do offer it tend to take urodynamics more seriously, as opposed to the quick read one tends to get from the average urologist.  

Jim 

Jim

Thanks Jim,

I'll discuss these matters when I next see the Urologist - I'm probably going to ask for another Cystoscopy as much as I hate the idea just to get an idea if the Urologist sees the prostate is still obstructing as much or if there is another cause like scarring, what bladder looks like and so on.

If I remember Dr K said I had no hydrophrenosis at all on the latest scan, I trust his reading more than others since he's a lot more familiar with my history and anatomy.

Regards,

Michael

Jim,

     I really appreciate the help that you've given me and others on this forum. I've been self-cathing now for a couple of months. I have an appointment early in December in Springfield IL at SIU Urology. I'm hoping that I'm a candidate for the Rezum procedure, but as you recommended, I'll be getting the full testing done first to make sure that it's appropriate treatment for my BPH symptoms. 

    I plan to provide updates as I progress on this journey.

Ken

Hi Jim,

As someone who also had 2 PAEs I had no idea why it did not work until Dr K showed me on MRI images that a small section of the prostate had been embolized, but it was nowhere near the section causing the obstruction. My guess is if that's the case even a cystosocopy would not spot it.

 

But the 3T MRI will not show bladder function and urodynamics will. Bladder function can be just as important a factor as obstruction in terms of voiding. I'm not against getting a 3T MRI but it doesn't replace urodynamics plus a first hand look (cystoscopy) always makes sense before such a major decision. 

Jim

I agree of course, just saying if PAE doesn't work it's probably because the obstruction was not removed and the reason is they weren't able to target the correct section of the prostate. Seems like the PAE docs don't really know why it works sometimes and sometimes not. I was told after an initial MRI that they mapped out my arteries etc, and were very confident they knew what they were doing.

Jim, once again, you are correct. Nothing in life is 100% except Death, and Taxes. You are also correct on your testing advice to men. It is a shame they have to do that testing with a Urologist. 

The reasons I chose FLA was not because of working the percentages from the various touts about the procedures available.  And for FLA, I could not get any of the percentage on success of the treatment at that time. I feel I was the first person that had done this treatment without having cancer. Though I did realize that thousands of men had used FLA for prostate cancer. And a lot of them had great success with that of both the cancer and the BPH they had. I chose it because it made the most common sense for a variety of reasons.

I have stated all of this in the past. The fact that a trained Doctor was ablating in the prostate with realtime eyes on the gland as he was doing the procedure was a very compelling motive. As compared to the Urological treatments that were blind and or guessing at the tissue removal. Also, the device treatment all seemed like a gimmick to me when I looked at Urolift and iTend. I also put confidence in the procedure because it was not invading me through the route of the Urethra. So many of the other URO treatments go up the urethra and then punch a hole back into the gland to remove random tissue. 

PAE also seemed to me to be a hope and a pray as to what tissue in the prostate would actually  lose the blood flow through the clogging of the feeding artery. I knew atrophy was not constant across the gland nor was it be controllable during the treatment and I understood that before I decided what I would do. 

This is not my effort to discount those other procedures. You are correct, they work. In several cases. The final  deciding factor for me was the confidence in the Doctor. That happened because of the tremendous communication that was provide on any and all questions asked by me or my wife. I could not get that from any of the other many doctors we traveled to meet with or the ones we spoke with. 

Also I understand a lot of people make a financial decision about their treatment. I did not because nothing was more important to me than great symptom results without sexual side effects. Not only was I told the reasons that could happen with FLA but I was shown that in my specific case.  I could see all the logical reasons for the success I have gotten. This was evidence enough for me that I borrowed the money and went in debt to have the procedure that I felt I had the most confidence in. But, unlike today, I did not have several men who had already had FLA and could share their specific situation and results with me. And this is now available to men considering doing something.

We all know how you feel about the bladder side of this condition and you are the wise one about this. You have instructed and helped a lot of men. But I did not have full retention during my 9 years of the symptoms . I wanted to see it with my own eyes before I chose a procedure and the MRI's  helped me the most.

So, after I saw the situation that i actually had I felt I knew what I needed to do. I needed the blockage in my urethra removed that I was shown in my MRI before FLA. Also my prostate was protruding up into the bladder and causing a valley area in the bladder that was holding urine and causing partial retention which did cause the bladder tribeculation I was also shown in the MRI. After the procedure the next MRI showed no more pinch in the urethra and the valley in the bladder had gone down as the protrusion up into the bladder by the prostate was gone. The precise game plan was laid out for me and shown to me and it made complete sense. Much more than the PAE strategy I got from both Bagla or Iaascson when I met with each of them. They had nothing to show me except their concept of shrinking the prostate enough to clear the blockage and the median lobe. 

My point is that the MRI helped my case a lot at the time enough to make a clear logical decision. Urologist do not use MRI's and regardless of what they say, they really don't know enough about what they are looking at in an MRI. Wouldn't it be wonderful if they would work with one of the few radiologist that could help their analysis? I did not feel  at the time of the procedure decision that a URO with a scope would have told me anything different. But, I do wish I would have had the dynamic test. 

Hi John,

You took the risks that pioneers take, you should be commended for that, and fortunately it worked out for you. Also, from what you have told us about your prior symptons, etc, I'm sure you would have passed urodynamic testing with flying colors.

But not everyone will pass urodynamics, such as those with compromised bladder function, and these are the ones that may not do as well with FLA, or any procedure for that matter. It's an important point as it talks to the limitation of making decisions based on anecdotal accounts such as we have in this forum.  

I like FLA for all the reasons you like it. But personally I'd like to see a little more data, and preferably in a controlled trial setting. Do you know when Dr. K. plans to publish his trial data?

Jim

Jim,

No, I have not spoken with him in a while. So I cannot tell you. I do have some question though that you can inform me about. 

First let me say it makes sense to me that most older men and especially all men with BPH have a compromised and somewhat weaker bladder function anyway simply as a result of both of those things. As I was told by the Urologist, the longer you let BPH change the flow patterns of urine, the longer you compromise the bladder functions. And, as we all know very well the older we get the weaker all muscles of our body become regardless of the BPH.

In regard to your blockage:

(JIM JAMES) 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.

I must inquire, what made your compromised bladder situation? The obstruction? I take it that you as the rest of us have a blocked urethra somewhere in the gland or neck?

Were did the retention come from? What actually caused it? Was it a kidney or was it the pinched off Urethra you have spoke about several times? Would it not be a  good practice to have a 3TMRI and then have Dr. K tell you what and where he sees your closure? He would not charge you to do that. I am sure the cystoscopy shows an angle and directional approach to the tissue but I would think the 3TMRI would give a perspective of the urethra closure without the pressure of the inserted scope in the urethra that could provide meaningful information. In other words is the tissue pressing closed because of pressure from the swollen gland coming from inside or is in fact the tissue maybe in fact some damage to the tissue inside the urethra and not the result of pressure? 

Maybe you have already had this done? it would by the way be covered by both Medicare or insurance. Not that this 3TMRI would fix anything but in fact as you tell us, knowledge is power. A picture from another angle read by a persons who is versus in looking at this many times in the prostate might give valuable information. 

And last, you are correct I was never totally blocked but I did get up every night from 8 to 12 times to urinate. I would feel empty and I was up again inside 30 minutes as I was not truly empty. I did not have trouble starting but I could not finish so I kept coming back. I don't know is that is called retention or not but it had to stop. And it did. I still get up two sometimes three times a night now but I empty between 300 and 400 ml each and every time. and I don't get up for several more hours. Dr. K says anyone would go urinate if that is the amount they have to void. I could lay there and hold it and not go but I want to go back to sleep and I do as soon as I release another 350 ml and I feel empty. 

No but the 3T MRI will show you WHY the PAE did not work. It will also show you the remaining blockage and it will show you that the tissue is pushing inward into the urethra.

it show the actual atrophy tissue that died from the lack of blood and when that dead tissue it not the tissue that is pushing in and causing the obstruction as was the case for both Mike and Ross, you still have the obstruction. Again you can actually see the spots that is the a the atrophy locations in the gland. Likewise you can see the places that are not atrophy. This show what caused the lack of results from the PAE procedure. Not consistent or controlled tissue reduction across the entire gland. 

Sorry that last one was in response to your comment to Mike. 

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You didn't reply to my first post, but I'll try again  [smile]  

There is no magic bullet/surgery when it comes to BPH/LUTS. If you go through the forums you will see people very happy (and not so happy) with ALL the procedures, and sometimes even with the same doctor! So, often it's not the type of procedure that makes the difference, but what is the underlying condition of both your prostate and bladder.

So before you try and decide which procedure is the best, you really want to find out why your two PAE's didn't work. That would include a bladder/kidney ultrasound, cystoscopy,

and especially urodynamics -- video urodynamics if possible. 

Jim

Hi Mike, from the MRI, where is your prostate obstruction on the urethra ? Hank

@John: No but the 3T MRI will show you WHY the PAE did not work.

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The 3T MRI will show you why the pae MIGHT not have worked. The other reason could be bladder dysfunction, which cannot be diagnosed by imaging such as an MRI, but only by functional testing and evaluation such as urodynamics. For example, two people can have identical obstructions but one can void pretty well and the other cannot. The difference is not the obstruction but the power of the pump (bladder).

Jim

John,

I had what I consider a very normal progression of LUTS (lower urinary tract symptons) starting in my late 20's. I intentionally used the term LUTS as opposed to BPH or even BPH/LUTS, because urinary tract symptons are not always caused by an enlarged prostate. (You mentioned "kidneys" in your post but kidney function does not cause LUTS, it's the opposite -- LUTS can sometimes cause a loss of kidney function)

In my case, like many others, my two causes of LUTS were both an enlarged prostate which caused a degree of obstruction, but probably even prior to that, and perhaps just as important, were many years of what I would term "holding it in" Be it that I was busy elsewhere, in a rush, doing a sporting event, whatever, "holding it in" can cause the bladder to stretch, and many men do this, and even brag about it when young. Unfortunately the ability to "hold it in" while young, can results in a stretched bladder as one grows older. 

So, between my growing prostate and "holding it in" my bladder gradually weakened to the point where my symptons of LUTS increased to where three years ago I couldn't hardly void at all. That's when I started to self cath (CIC). CIC didn't do anything with the obstruction, but it rehabbed my bladder to the point where the obstruction stopped causing LUTS to any significant degree. 

Like yourself, I also have 350 and 400ml natural voids these days, and my bladder empties completely. I have no sense of urgency, incontinence, or any of the other symptons that plagued me during my 30's, 40's, and 50's. My IPSS score is "mild" where three years ago before I started self cathing it was "severe". Because of the obstruction, there are still times when I need to cath, but it's infrequent and not a big deal for me.

There is no reason for me to have a 3T MRI at this point because whatever obstruction I have isn't symptomatic enough for me to address it surgically. It's risk versus reward again. Again, given my relative lack of symptons, there would be minimal reward for me and every surgery has it's risks, not to mention the down time, recovery, and in the case of FLA, the travel and expense. 

So for me, at this point in time, CIC makes more sense to me than any of the surgical alternatives. We all have to make our own decisions and what's right for me may not be right for someone else. 

Jim

Jim