Procedure Information

Vernon,

Thanks for sharing your experience with Rezum. Curious if it was covered by Medicare or your insurance?

Patrick

Patrick: The REZUM billing code was added to Medicare's list this year and I have a CIGNA supplement so the REZUM didn't cost me anything out of pocket. I'm glad because it didn't do much for me anyway. I am afraid of the Urolift because I heard stories about the bladder being punctured with the stents and I'm not okay with that. I'm beginning to think my issue is with my bladder and not my prostate at all, although my Uro did say the median lobe is my issue. I don't know. I need to get over the trauma of the REZUM before I think about having any other procedures performed.

Vernon,

Thanks for your reply and I feel your pain. I KNOW my problem is my bladder after 5 liters were drained from my "massively distended bladder" during my visit to the ER after my bike spill 3 months ago. Although my uro says my BPH caused the urinary retention, he says no use in expanding the pipe until my pump is working as I am not able to void at all without a catheter. My urodynamics test showed my muscles are not squeezing the urine out as they should and I likely have nerve damage from the overstretched bladder.

I will be patient with the CIC in hopes of rehabbing my bladder so I can reduce or eliminate the need for CIC one day. Meanwhile, I'll keep reading posts like yours to keep up with the latest treatments and learn from the experience of others. I'm in no hurry to rush into a surgical procedure with little chance of success as it sounds like all have risks of not only failure but living with irreversible negative side effects.

Thanks again for sharing your experience and best to you going forward!

Patrick

Hey Guy

It's no problem. Men need to know everything about the procedure that they are looking at.The few that I found out I have never heard before when any of the men have talked about it.

We can talk also about the Urolift also and the new procedure that the company came up with is the Med Lift which they came up with to take care of the median lobe.

Like any procedure you will not know if it works for you until it is done but then it's do late. I had my Urolift done almost 5 years ago and I am still wide open

Life goes on and so do we....Ken

Hey Marty

Aquablation is just another way of doing a Turp.

About 2 years ago I talked with the doctor that did the trial in the UK a Mr. Barber. He was the one that brought it to New York.We had a talk about it because I did not like the fact that they do the mapping of the prostate while you are asleep and it can't be adjusted. It's the whole prostate or nothing.

It carries the same side effect as the Turp. I have also talk with a few of the men that were in the trails. They were told that side effects rarely happens. After the procedure both men were able to have sex and they did not get retro at the time but about 6 months they went dry. They were not happy.

Talking with Mr Barber he said no procedure is guaranteed to save your sexual function. He said that if you want to have 100% guaranteed have a Urolift. So I told him that is what I had. It's going on 5 years and I am still wide open.

I would place them at Urolift, Medlift, PAE . Rezum for me would be a last resort because I'm not having any tissue cooked in my body. The others I will not even bother with because they will not be cutting any prostate tissue out of me

It not up to me what men have that is there choice. I don't have to live with there side effect they do.

All the best to everyone. Ken

Ken,

I suggest you google Neil Barber regarding Aquablation. There are YouTubes of him and studies he has authored regarding this procedure. He is a big fan of Aquablation as is NICE in their study of Aquablation last year.

For example, you may wish to read one study Barber co-authored in June, 2019 entitled "Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained." The title sums up the findings.

Furthermore, the study states “Aquablation’s symptom score improvements appeared to be larger than those reported for non-resective techniques, such as the convective water vapor energy (rezum®, 3.3 points higher) [16] and UroLift® procedure (3.7 points higher) [17].”

The final sentence of the above mentioned Barber co-authored study states “The lower rate of anejaculation after Aquablation is consistent with the procedure’s overall design, which avoids damage to tissues involved in ejaculation through precise, image-based targeting and robotic execution.”

Your understanding about how the mapping is done is not accurate. It is very flexible and can remove as much or as little of the prostate as the surgeon wants, with unparalleled precision.

With all due respect, the conclusions you stated about this procedure are just not consistent with the information currently available, although they may have been correct when the procedure first came out, that I don’t know. They are certainly not reflective of what Neil Barber is saying today.

When experts say Aquablation is a “TURP like” procedure today, they are saying it provides all the benefits of TURP without most of the TURP side effects.

in short, this is a procedure that men with BPH need to take a serious look at. It’s a game changer. I fear many men reading this forum are not getting enough accurate information about this very exciting option that is increasingly available throughout the world. HOPEFULLY, it will soon be paid for by your NHS, if it isnt already.

Be well and Merry Christmas,

Marty

Ken,

Regarding Urolift. This is an option that, as you state, confers the lowest risk of RE. However, no procedure is without downsides. And, when compared to Aquablation or Turp, flow improvements have a more consistent and better outcome.

Urolift does not remove any tissue, so the prostate is more inclined to grow back. We will see in coming years what follow up procedures are viable and not viable with the hardware that is left behind in the prostate tissue. I’m just not a big fan of leaving anything up there.

Because it does remove tissue, a “TURP like” procedure like Aquablation is expected to have a lower likelihood of recurrence of BPH symptoms for about ten years.

None of the available BPH procedures work every time. Also, none are without significant possible downsides, perhaps with the exception of PAE. That’s why it’s my first choice. It apparently has the least side effects.

Marty

Clarification:: According to studies (such as the study I quoted above) flow improvements with TURP and Aquablation tend to be more consistent and better than Urolift. My wording was a little off.

Good morning Marty

What you say may be true to a point but I have all of my email from Mr Neil Barber and what he told me about Aquablation in August of 2018. I'm sorry but it still has the side effects of a Turp. The data that they said on the trails really do not make cents. They said 7 % for Aquablation you will get retro and the Turp is at 35 % that right there is a lie because the first thing for a Turp is that you will loose your ejaculation.

Men have had it done and they have lose there ejaculation after 6 month's. Some men do not want to lose that. Peeing better is good but I don't need to pee like a 16 year old A 40 year old is just fine. I should not have to lose anything.

To me it is odd that in the UK where the trail were done that it is not approved by there insurance. I know when Barber brought it to the US FDA did not approve the new way he was helping to stop the bleeding. They still had to put in a catheter and blow it up in the cavity to stop the bleeding.

Every man has a right to any procedure that he feel that will be good for him. I will never have a procedure that will remove any part of my prostate. At 64 I like it just the way it is. I may not be having anymore kids but I will not give up any of my sexual function.

I will take a look to see if anything has change and I may send a email to Mr. Barber to see if he has been doing any here.

Ken,

I am primarily concerned with your statement above, based on your conversation two years ago with just two patients: “Men have had it done and they have lose there ejaculation after 6 month's.” I’ve just listed in one of my prior responses quotes from a scientific study published June 2019 that says the positive results (including no dry ejaculation) lasted throughout the two year period of the study. Everyone can decide for themselves which is more useful information. Perhaps both are useful.

I take no issue with your preference for any procedure, Urolift or otherwise. As you say, you don’t want to remove any tissue. That certainly is the beauty of Urolift and PAE. But I’m sure you agree that there are plenty of nightmare stories with Urolift. Just read Urolift discussions in this forum if you haven’t heard of any.

That’s why I feel studies are so important. We each have to make a decision based on our personal objectives and accurate data. Yes, statistics vary from study to study (as you alluded), but when the winner in all the studies is clearly always procedure a over b, it’s worth paying attention to.

In response to your comment, FDA approved Aquablation in May. We’ll see what happens with NHS. Neither of these institutions move quickly, however, relative to other approvals, the FDA moved with lightening speed on this one. It is a much safer version of TURP that takes surgeon skill out of the equation.

Thank you for sparking the discussion. I hope our difference of opinion, and the points raised, proves useful to all BPH sufferers.

Marty

Marty

Remember what we say on here is just our opinion. Being we are all different that is what happens. If we had the same opinion this site would be very boring.

The 2 men that I talk about were on this site about a year ago and that is what they said.

I went on line and looked at some of the new reports and there was only one that said that retro has a lower rate. I also look at a trail of 21 men that had it done. They only mention 11 that were still into sex. All that was said that they had no problem with ED but retro was not even mentions.

I have been on here for over 4 years and most of the men that have had any procedure there doctor was only concerned with getting them to pee better they are not concerned with there sex life.

As for the Urolift most of the men that it did not work had other problem either it was not the prostate or the doctor did not take care of the median lobe. That is why the company came up with the MedLift

But a long story short. Men have to pick what they feel is right for them. A Turp is a Turp no matter if it is done with a coil, laser or with water. I would not deal with any Turp. This is my opinion.

But if that is what they want it is on them and if any side effect come up it is on him not the doctor.

All the best. I did find a clinic in Georgia that are doing Aquablation. 2 doctor are train to do them a Dr. Sharpe and a Dr. Kriteman. They have done 10 so far. I sent a email to them to see what there results are for that 10. I asked to see if it worked and how many in the 10 ended up with retro. Also with not having the prostate what was there orgasm like. Did it stay the same or is it different.

Be safe....Ken

We should do as much research as we can to pick what we feel is right for us but we should not be anyone test subject.

Yeah, Ken, it is great when studies are done primarily in men who dont have sex, when you want RE info.

They're out there though. Check out the Barber study mentioned earlier. Also, the NICE study from september 2018.

On page 13 of 38 of the 2018 NICE study comparing TURP vs Aquablation, it says 42% of TURP patients (with beginning prostate sizes 50ml or larger) developed anejaculation, whereas only 2% of the Aquablation patients developed the same problem. I quote from NICE:

“In sexually active men, mean erectile function scores (IIEF-15) were stable after water jet ablation and decreased slightly after TURP except for overall sexual satisfaction where water jet ablation was statistically significantly better (p=0.0492).

Ejaculatory function scores (MSHQ-EjD) were stable after water jet ablation but worsened significantly after TURP (p=0.0254).”

Neither of us wants to pick another man's BPH procedure, like you said. AND STATISTICS VARY! I would expect st least 10% RE regardless of what a study says, just because Ive heard different numbers. Thank you for your open mindedness.

Marty

Marty

When we were talking about this in 2018. A lot of the guys could not believe the numbers. You know if you talk with a doctor and he want you to have a Turp he tells you to be ready for RE 100% and 2% is not right. I talk with Mr Barber he told me that it is more they 2% I think the trail was with 181 men.

I think where you read that was in the Phase 3 trail. That was the only one that said anything about retro. But think about.

The Aquablation get rid of the whole prostate. The connections are cut from the seminal vesicle to the ejaculatory duct. Where is the ejaculation coming from. Maybe the cowper glands But that is where per cum comes from. It does take time to clean out the tubes. Maybe that is why men go dry.

Your volume is cut down way low because nothing is connected.

All I want is for all men to do there research before they pick a procedure. They did to be aware of all the side effects.

There was a guy on here he did not know what he was going to do. His name was Mike.I have been talking to him and he picked to have a Holep done. His prostate was 130g the doctor took out the central zone and the median lobe. That was 55g He is doing great. He said that he pees like a 40 year old. No problems

Also here is some information about Frank 90 year old He was doing CIC for 3 years and was doing well His prostate started to bleed. The doctor try to get him to do a Turp but they also told him that he will never have a natural flow. So way have it in the first place

Thy put him in the hospital and cauterize the prostate 2 time. Still bleeding. They sent him to another hospital and they did a PAE on him and the bleeding stopped. He is doing very well now.

Be safe everyone...Ken

Ken

I'm not sure what you mean when you say, "Aquablation gets rid of the whole prostate."

They remove as much or as little as they deem necessary to improve flow. The doc can be as conservative as you want him to be. It's a very precise process done on a multidimensional real time ultrasound with a cystoscope also involved. The doctor draws on the screen the region he wants removed, avoiding the seminal ducts and sets the robot loose (with a kill switch under his foot) and 4 minutes later the procedure, which he watches real time, is completed.

i ejaculate as much, if not more, than prior to my Aquablation. I'm sure not having a full bladder all the time, post void, certainly doesn't hurt.

Anyways, both of us are happy with our results, which further goes to demonstrate your point that different procedures work for different needs.

Marty

Marty I'm very happy for you that it works

I have not looks it to it much after my talk with Mr Barber when he wrote and told me that the procedure can not be a justed.

I still have his e-mail. What I asked him was can it be started a little farther away from the bladder neck to avoid the seminal vessels. That is when he told me that the procedure cannot be a justed. That was also the email that he told me that if I wanted a procedure that was 100 % no side effects to have a Urolift because it does have a good outcome and no side effects.

We can go back and forth. Men can pick what they want and for me it not a go

Be safe and I hope all stays well for you.....Ken

Ken, I just have to jump in here and push back on some of the comments you are making as they are inaccurate, misleading and potentially harmful to others reading the forum.

Aquablation does not remove the whole prostate ("it's the whole prostate or nothing"). That is a preposterous statement. I just returned from an appointment with one of the two urologists you mentioned at Ga Urology. I explained my situation to him, that I've needed to have something more aggressive than a Urolift done for over a year but have been on a quest to find a doctor and a technique that will minimize the risk of the side effects you're referring to. First words out of his mouth - it all depends on what the patient needs. He said he had an elderly (70+) aquablation patient told him he didn't care about RE and just wanted to get rid of the BPH symptoms. So he programmed the ablation contours to remove the maximum amount of adenoma, including the area around the ejaculatory ducts. The patient is happy. He said in my case he would design the contours so that the bladder neck would be left intact and the veru, its surrounding tissue and the path of the ducts to the veru would be undisturbed. He did say he cautions all of his patients regardless of the BPH procedure to assume you will get RE because there is always that chance with the exception of Urolift. That is just a doctor counseling his patient to understand the risks.

Moreover, what would be the point in a company developing a new approach to a problem (damage caused by heat, lack of precision and long operating times) and then have it set up so the only thing a surgeon could program the machine to do would be to ablate the entire prostate? That's just nonsensical on its face.

It is similarly inaccurate to say that all TURPs are alike and 100% result in RE. There was just a guy posting here recently who had a bladder neck sparing TURP done at Stanford. I consulted with a Uro after at least two of his patients posted here described him saying he doesn't hear about RE from his TURP patients and thinks the % who get it is a few %. He told me the exact same thing and explained why. He resects to create a void with a different shape and less volume than most surgeons do with TURPs. Those two guys told me they had no RE after he did a plasma button TURP. The term TURP stands for Transurethral Resection of the Prostate. It doesn't specify how much is resected, what the shape of the void is, whether the instrument is monopolar or bipolar, what functioning parts of the prostate are removed or not, etc...and most importantly, it doesn't specify who does it. You're painting with way too broad of a brush with your bashing of TURPs instead of thoughtfully examining each aspect of a large number of variables that when performed as a given procedure becomes a unique event with varying outcomes.

Aquablation is attractive for many reasons. The surgeon doesn't have to continually make decisions on what and how to resect as he goes, in real time. He has the luxury of less time pressure because he can design the contours using live TRUS imagery before single fiber of tissue is ablated. Only when he is satisfied with the plan does he begin cutting, and that lasts only a few minutes. He monitors the ablation as it occurs both on the ultrasound imagery and video from a camera on the instrument. He doesn't have to deal with a bad visual field that can happen with bleeders or disorientation. If he doesn't like what he sees, he just lifts his foot off the pedal and makes whatever adjustments he feels are needed. The most obvious benefit is it generates no heat in the tissue that could damage parts of the prostate or nerves that need to be spared. The uro I just met with compared traditional hand-held techniques to the old-fashioned kind of milling machine that was operated manually. They are both subject to human error in performing the process. Aquablation is analogous to a CNC machine that mills a block of aluminum exactly and precisely as it was programmed to do in software. In my humble opinion it represents the future of surgical intervention for BPH.

So I for one would appreciate it if you would stop being so cynical and negative towards any BPH procedure other than UroLift. Resecting, abating, vaporizing, cauterizing, etc., tissue have been surgical methods used for decades and centuries. If you don't like them, fine, but please try to be more accurate in your criticisms. Likewise with your fear of having any tissue removed. This ain't rocket science, if a pipe is stopped up, you have to remove what is causing it to be stopped up. UroLift is a unique way of dealing with the problem but is not without its own risks and shortcomings. In my case the benefits were noticeable and only lasted for a couple of years, but now I have foreign objects in my body that are serving little to no purpose. I hope it continues to hold up for you for many years. We should all be so fortunate.

Russ I'm sorry that you don't like what I'm saying but I am only telling you what I read. I have not looked into Aguablation since August of 2018. It was nothing I would do. If they have work out some of the bugs that great. If you feel it is right for you go for it.

But 2 years ago they were not adjusting anything per Mr Barber. If they can do what you are saying that is great.

I do know there are many Turps and The newer ones are much better then the old stand by. With the button Turp the doctor has more control of what he is cutting. But these take more time so you must find a doctor that care about your concerns.

Over time any procedure can fail. You said that your Urolift only lasted 2 years Did the doctor check if there is another problem. Could be you sphincter or your bladder The prostate can't always be the trouble maker

As of 3 years ago when I had a Ridge Scope done my prostate was still wide open but my pressure was not good. I had no problem peeing I found out I had a very tight external sphincter. That was slowing everything down I take Vesicare 10 mg It is a muscles relaxer. And I can tell the difference.

Like I said you can't always blame the prostate you have other parts that can go wrong.

If the doctor can do what he said then that would be great but you never know if you are going to get retro. That I will not live without. God gave me that function and I am going out with it.

Also the last thing I'm going to say is When you talk to the doctor in Georgia. Did they fix the bleeding problem. I know 2 years ago after the procedure that had to put a balloon in where the prostate was and leave it there for at least 2 hour to stop the bleeding. I hope they fix that problem

This was because the water jet did not stop the bleeding like the other procedure.

Ken

Ken, how could the aquablation contour mapping software not be adjustable? By saying that you're implying every single prostate it is used on is identical. Of course it's adjustable. The entire concept of the Probeam system is based on that. Maybe you mean something different from what I'm interpreting from what you've written.

2 years after my UroLift my uro ordered a urodynamics study. It showed conclusively that my issue is obstruction, not detrusor weakness. That was visually confirmed by cystos last December and this past August. From the operative report on the cysto done in August: "None of the Urolift surgical clips were visible." I had 5 implants. My lateral lobes were/are obstructing the channel and median lobe is pushing up into the bladder neck.

In the WATER I and WATER II studies done both electrocautery and a "tamponade balloon" were used at different points. By the time they got to WATER II I believe they were using a custom designed tamponade balloon exclusively. The uro I met with said he uses both for different purposes, though he only cauterizes one small area where the rotational motion of the shaft can cause bleeders. But the balloon Foley needs to be in place 2-5 hours post op to achieve haemostasis. That's the main reason aquablation patients need to stay overnight. As with almost everything else in life, that drawback with aquablation is a tradeoff. The benefit gained is no collateral thermal damage to tissue, nerves, etc. that need to be protected.

I'm happy that they fix that problem with the bleeding.

But one last time I am going to say this. I was told 2 years ago from Mr Barber that it could not be adjested that is what I am going on. If they fixed the problem good for them.

Also 2 years ago when Mr. Barber brought the procedure to New York they were still using the old balloon way. Glad they fix that to.

If you want that procedure go for it. That is your choice.

Ken

Russ,

Balloon Foley is what was used on me. I didn't realize that was its purpose. Thanks for info.

Marty