My Rezum Journey for 16 Weeks

Sharing my BPH & Rezum journey and hope it is helpful:

Age 54, have had BPH for more than 10 years that had progressively gotten worse. Was on 2.5 mg of Cialis for over 8 years and minimal relief. In November 2018 was having a lot of problems with urgency, burning, frequent urination, dribbling and getting up two to four times a night. Would often have to urinate repeatedly as I never completely voided my bladder. Very weak stream and would have to really push and never felt complete relief or felt like I completely voided. Went to see a urologist in October 2018. PSA = 1.7, 35ml PVR, Urologist ordered Retroperitoneal and Transrectal sonogram which showed prostate was moderately enlarged with volume of 35.2ml and measuring 4.6 x 3.3 x 4.4 and prominence of the central zone.

Put on tamsulosin in November 2018, did get improvement of some symptoms and somewhat improved flow but this diminished over time and symptoms continued to worsen throughout 2019. Also tried finasteride but discontinued it due to decreased libido and low energy. tamsulosin has caused RE, some sexual dysfunction, and orthostatic hypotension which I did not like but tolerated due to the improvement in my urinary symptoms.

My urologist had discussed Rezum with me early on but never tried to push me towards it. He just explained it as an available option and when he first mentioned I was not interested. Over a few months I did my own research and watched YouTube videos of the procedure and patient testimonials.Due to the side effects of the tamsulosin and with my symptoms worsening I finally decided in July 2019 that I wanted to talk to my urologist about Rezum. He never tried to push it and in fact he pointed out several times that there was only three-year data and longer-term data was not available. He also pointed out that my BPH could and would likely come back at some point in the future. He was very fair balanced. He never tried to push TURP or other procedures. He did say that he had very good results with Rezum and most of his patients were satisfied with the results and some but not all had gotten off medication. We did not discuss any treatment failures that he had experienced. I didn’t find this forum until after my procedure so I would have had a lot more questions if I had.

He does the procedure in the OR under general anesthesia and after reading many of comments in this forum I am glad he did. He also places a foley catheter for a minimum of seven days post procedure.

My procedure was performed on 7-29-2019. I had an easy time with the anesthesia, when I woke up the catheter was a bit uncomfortable and the nurse taught me how to manage the leg bag and the larger bag for night time use. It took a little bit to get used the tube and there was some discomfort at the end of my penis but I adapted to it. It was nice to have the larger bag at night as I was able to sleep all night for the first time in many years. I did take urelle periodically during the first week which did help with the burning. I did not experience any bladder spasms. I adjusted to the cath fairly quickly and other than discomfort & occasionally and some bleeding I did fine. I did experience leakage a couple times and was told there might be a clot blocking the cath and to make sure that urine was still flowing into the bag and if not then to come in to. It didn’t turn out to be a problem. During the first week I found the leg bag to be easy to use, I wasn’t out running marathons with it but I went to the store and ran errands with it. I didn’t have much blood passing but would see an occasional small clot pass into the bag.

Week 2: Had the cath out seven days after the procedure. No pain at all with taking it out. They did a bladder challenge by injecting some saline into my bladder via the cath and then making sure I could urinate with the cath out which I was able to (very weak stream but did fully void the fluid they injected). If I had not been able to then they would have reinserted the foley for another three days and try again. My urologist said that based on his experience he really believes in using the foley for seven days and has had better results by doing this. He and the PA indicated that they had had a fair number of patients and who have to have the foley put back in for a few more days, glad I didn’t need that.

Drank a lot each day, and urinated every 15 to 30 minutes the first two or three days. I did pass some small clots and had some burning but took a half tablet of Urelle two or three times and was fine after that. Definitely good to have some Urelle on hand even post-cath as I found it helpful. My stream was weak with a very long weak tail but I didn’t need to push, just be patient and let it slowly drain. From the start, it didn’t burn as much as it was prior to the surgery. One thing I noticed right away is that I already had no dribbling at the end of voiding and it felt like my bladder was completely empty once I was done peeing, although I have to be very patient when urinating as the last third of my stream is very slow and drawn out, but once done I am done and no longer end up with wet underwear. A few times I would have a stronger stream but most of the time it is fairly weak but I don’t have to push at all and it is really nice to feel like my bladder is empty and not still retaining urine. It is also nice not to be dribbling and getting my shorts wet. On days 12, 13, and 14 only got up once or twice a night to urinate.

Overall on day 14 things are improving, stream seems like it is getting slightly better but still pretty weak. Hoping I will be able to get off tamsulosin by month three.

Week 3:

Feeling fine. Can drink a 24oz coffee in the morning and not have to pee 5-6X post coffee, now can go much longer before needing to pee, urgency is not as great, and may only have to go 2 or 3 times.This is one area I see a difference as I love coffee and had refused to give it up even though I was having so many issues and coffee made it worse. Post Rezum I definitely see a difference in how I feel and experience voiding post my morning coffee. It feels more normal.

Stream is a little stronger but not much, it’s pretty variable, it is still pretty weak and the last third really slows down and I have to be patient to wait to finish. If I just relax and let it flow it is better than if I get impatient and try to push. Still good thing continues to be that once done I am done and it feels like I have completely voided my bladder. I can definitely go longer in-between needing to urinate. I can wait longer and urgency is no longer as strong and I don’t feel like I am in a crisis and it doesn’t hit me quickly like it did before, again it’s more normal now in terms of what I feel when starting to need to urinate. I am still getting up 2-3X per night because I am drinking a lot and if I would restrict my fluids earlier in the evening, I might only have to get up 1-2X per night. Hoping this gets better over time.

Bottom line Week 3: Positives, many of my symptoms are much better, urgency, burning, very frequent urination, needing to push, never feeling like my bladder fully voided, needing to go shortly after I just went, and dribbling/leakage post urination, all better. Sexual function has actually improved.

What’s not quite as good as I hoped is that my stream is only slightly stronger and still weak, and varies quite a bit, the last third of the stream really weakens and I have to be patient to just let it finish but at least when I am done, I am really done and don’t leak all over. I am guessing this is a bladder muscle issue but will discuss with my urologist at my next appointment. Still taking tamsulosin and don’t think I can come off it yet but hoping that I am just at the beginning and as the next few months go by things will open up and I will be able to get off of it.

Week 4:

Went backwards, stream is weaker, a couple days really weak even at the beginning and takes a lot of patience to wait on.I did drink more alcohol this week as I was at a business meeting, and missed tamsulosin one day and really noticed a difference.I certainly can’t stop it right now. This week was worse than weeks two or three. Still have RE. Was up one to three times a night.

Positives, still no burning, bladder empties more completely, can go much longer before needing to urinate and even when my bladder is really full I can wait and don’t feel like it is crisis so that is all better but wow is my stream weaker and it takes a long time to completely urinate. Definite step backwards and hope things starting trending back in the right direction. Just need to be patient at this point and see what happens in the coming weeks.

Week 5:

Started out the week really discouraged as I felt like I was going backwards. On Tuesday passed what look like a small piece of tissue. On Tuesday and Wednesday my stream seemed weaker, had to push a little, dribbled a little, and a couple times felt like I had to go again shortly after voiding. So really discouraged when I wrote in my symptom journal on Wednesday. Then Thursday things improved, my stream was stronger and the tail-end of the stream seemed maybe a little shorter. No dribbling, bladder felt empty and normal post void. Friday and Saturday things were a little better too so relieved that finishing the week trending back in the right direction. Still up a minimum of 2X per night. Still taking tamsulosin and don’t think it’s time to stop it yet. See my urologist this week for follow-up.

Week 6:

Very positive week. Much longer time between voids, on Tuesday night I slept through the night without getting up which was a first!! Ending up sleeping all night for three nights this week and only getting up once on the other nights. Still had some smaller voids with a weak stream but overall definitely see a difference.

Had my follow-up appointment with my urologist and learned to my surprise that I only had one injection on each side! I guess because my prostate was smaller and not nearly as large as what I see many are in the other stories I have read here, perhaps he is more conservative, not really sure. I think that less is probably better. From what I have read here it seems like the more injections the more likely you might be to experience unwanted effects like RE etc.

Overall very positive and feel better about things this week. I hope to stop my tamsulosin in the next month. Leaving for a two-week vacation so will wait until after that before I try stopping it.

Week 7 & 8:

Went on two-week vacation different time zone, went backwards in terms of strength of stream. If I really have a full bladder stream is okay but most of the time it is weak and slow especially the last 1/3 of the stream. Was getting up 1-2 times per night on our trip. Other symptoms burning, urgency, dribbling still much better.

Week 9:

Decided to go ahead and stop tamsulosin. May be a little early but wanted to give it a try. Second day post last dose could definitely tell as my stream was weaker.

Weeks 10 & 11:

First few days off tamsulosin were not as good and I was just about ready to go back on it when things got better, so glad I was patient with it as things started trending positive 5 or 6 days post last dose.When my bladder is full my stream is stronger and probably 70% like a normal stream.If I void without much of a full bladder then the stream is not nearly as strong. The tail end of the stream is still weak but seems shorter. The big improvement is that the last week I slept all night 5 nights and only got up once on the other 2 nights. That is significant progress. The other thing I am pleased with is that urination seems more normal. Even if I drink a lot, I don’t have to go to the bathroom nearly as much and much longer between voids. Very positive two weeks and hope there are more gains to come.

Week 16:

Over all I am pleased and happy I had the procedure. Happy to be off the tamsulosin. No longer have any burning, severe urgency, or dribbling . My stream hasn’t changed much and still not we strong as I would like it to be but more normal. It still tails off and takes a long time to complete and that has not improved as much as I hoped it would, but not a problem just have to be patient. If I am careful about how much I drink in the evening then I sleep through the night most nights which is an amazing improvement from the 2-4 times per night where I started. I will post again at 24 weeks but until then I hope that my experience / journey will help others who are considering the procedure. Good luck to all.

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