Rezum

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I am 61 with 35 cc prostate. I have a small median lobe and high bladder neck. I could not tolerate meds. My post residual is less than 15 cc. Uro-dynamics is consistent with obstruction. I wake up about 4 times a night and it messes my sleep as I am still working. 1st urologist was recommending TURP, but I thought it was a drastic measure. PAE is not the best for a small prostate with high bladder neck. I looked into FLA but I asked two physicians from reputable medical centers who use the technology to treat prostate cancer and they say it is not as accurate as claimed by the doctors who use it and there is the risk of perforation. My urologist , who is a professor of urology, is now is recommending Rezum and he has done more that 100 of those. He has also experience with HOLEP, Urolift, TURP. I am scheduled Nov 20th but I am hesitating because messing with bladder neck can have risk of RE and incontinence and the fact that my prostate is small and most of it would be cooked considering that only a small portion of it is causing the problem, but I don't know if there are other options. Any response will be greatly appreciated. Ken have been very helpful in these posts.

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  • Posted

    It's a study that you can find (it was mentioned on this site) that any thermal treatment of prostate(that will include TURP and RESUM ) will impair nerve bundles on both sides of the prostate, most likely making some neural cells to die. Why no to try Urolift. It works great on smaller prostates (35 g sounds like normal size to mine 140 g before PAE) and seemingly helps 95% of patients. Given a small size of your prostate, you might have a bladder neck anomaly ("lazy bladder" in your youth?). Then Resum is not an answer. Double check.

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    • Posted

      When there is long standing obstruction it will lead to a hypotonic (lazy) bladder. That is what I am afraid of because I do not want to end up with atonic bladder with high residual. Also Urodynamic did demonstrate very high bladder pressure due to obstruction, so it is not lazy bladder.

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  • Posted

    I went through that last year. For many years I denied having a problem until i had an acute retention after a marathon race. Months followed until I found the urologist in Houston in whom I trusted, because previous options like TURP didn't comvince or were not feasible like Urolift, due to the median lobe. The doctor I chose did a combination of Rezum and PAE. Post surgery I steadily improved, my bladder capacity improved, I had a short period of incontinence when it became urgent, but overcame that, FE is working, i go up once a night if i sleep longer than 6 hours. i am very pleased with the outcome. if you trust the doctor, go for it!

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  • Posted

    Do you have any issues with urinating, like slow flow, frequency during the day as well ? Hank

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    • Posted

      yes slow flow and I go about every 90 minutes and I have urgency and some discomfort and fullness in the area in the perineum where the prostate is.

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    • Posted

      I just reread your post. You don't have retention. With small prostate like that, I don't see how you can feel its fullness. It could be some kind of inflammation! I might not even be the prostate. Hank

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    • Posted

      It sounds like classic BPH - size isn't always the main driver. Position and median lobe presence can mean more than size. You're right to address before you go into retention, as permanent bladder dysfunction can happen if you wait

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    • Posted

      HI oldbuzzard , out of interest would a bladder ultrasound show position and medium lobe issues ? i ask because ive had two ultrasounds and I am told my prostate is normal size but i suffer typical BpH symptoms and have to use a lot of pressure to get a catheter to squeeze past my prostate .

      cheers

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    • Posted

      Your symptoms are of urethral obstruction, possibly BPH, but not for certain. Many people on this forum went ahead with a procedure and did not solve their problems, later found out that it is something else, mostly prostatitis or chronic pelvic inflammation. Many things can cause BPH symptoms, anything that can inflame or swell up down there in the pelvic area.

      I experienced that 'fullness' feelings down there at times, together with full scale of BPH symptoms, usually after a long bumpy bus ride, or after sitting on a hard surface for a long time. For others, it's a long bicycle ride. The symptoms usually go away overnight so I know it's not my prostate. It's some kind of inflammation that subsided over time. Once a while I also experience it when I was badly constipated. Hank

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    • Posted

      You have a mild urethral obstruction, otherwise you wouldn't have those symptoms. Prostate obstruction is just one type of urethral obstruction. When it's mild cystoscopy won't notice. Pelvic floor muscle tightness can cause a urethral obstruction as well.

      All said, if all else ruled out and you decided to go for it, Rezum or Urolift would be best for mild symptoms like yours. Don't think FLA. FLA has a bad record with small prostates, at least as reported on this forum. Hank

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