REZUM--HAVE YOU HAD THIS DONE???????

I've had this done. Only a couple of weeks ago, so still getting over it. Flow is better, but at this time EVERYTHING is supersensitive - bladder, penis (esp the underside), and anus). Pain is definitely reducing day by day, drinking only water, to flush out the dead and sometime bloody material from inside the prostate. This is what you'd have to look forward to, apart from the pain from having a plastic pipe up your urethra.

Hello, again, everyone.

I have a 72g prostate, including an enlarged median lobe. The median lobe protrudes into the bladder and causes a "ball-valve effect" that restricts my bladder neck.

Not including the median lobe, my prostate measures 42g.

Because of my enlarged median lobe, the first urologist wanted his mentor (urologist #2), who has performed many hundreds of Rezums, to see me. The mentor's recommendation was to do a Urolift, saying that the Rezum held a 25% chance of retrograde ejaculation (RE) while the Urolift would pose only a 6% chance.

I don't want implants, so Urolift is not for me; I decided to look further.

I'm not retaining (I can still empty.. and I check every few weeks by CIC), so I don't feel like I need this urgently... yet.

Urologist #3 was someone who known to have a lot of Rezum experience (more than 1500 procedures). His recommendation was to do a green laser TURP, but ONLY on the median lobe where it is impinging on the bladder neck - while minimizing any trauma to the bladder neck itself and avoiding the vast majority of the prostatic urethra - will resolve my LUTS symptoms.

He said that this approach would pose a 10% risk of RE, and thinks both the outcome and the recovery will be better than if I go with Rezum.

I asked a urologist friend of mine who performs - and likes - Rezums (but is not as experienced) about this, and he said that depending on the condition of my prostate, this diagnosis and treatment evaluation sound reasonable.

BTW, I also consulted a urologist who performs the Aquablation procedure, something that's been out for about 2 years. The urologist said that Aquablation results in RE in a third of procedures, despite the marketing literature claiming otherwise. Aquablation involves the DaVinci surgical robot, which I thought was pretty cool, but also involves significantly more bleeding as the procedure itself (using pressurized water like a scalpel) cuts but does not self-cauterize (like TURPs).

I'm scheduled for surgery in November, but I still might change my mind. I'm currently following a KETO-like diet as I've heard that it might reduce the size of - and otherwise normalize - the prostate. Depending on how carefully I eat, exercise, and plan my day, I'm sleeping about 5 hours without getting up. But once I'm up... I'm up.

Hi, I had this done a week ago. From the time I went down for the op. till the time I was driven home was 6 hours. It is necessary to be catheterized (in my case for 6 days). This is somewhat uncomfortable and led, again in my case, to bladder spasms causing urine to be expelled by bypassing the catheter. In addition the spasm can cause a bowel movement. Although not nice this can be managed with care and appropriate sanitary pants etc. I had the catheter removed today and spasms stooped immediately. I should experience a progressive reduction in urgency, flow etc. symptoms over the next several weeks. Already I feel better.

Chuck,

it may be of any interest how this did work out for me here in Germany.

Just had it done 10 days ago. Its a much more involving issue then they make you believe .

Highly advisable, and the only thing really offered here, is the Rezum procedure under full sedation in a clinic. They keep you there for a min of 2 day, better 3.

You wake up with not only one catheter, no actually two.

The other one is abdominal catheter.

They flush NaCL trough this one for the first day, and we re talking lots, about two gal over time.. On the second day they pull the ureteral catheter. You will be send home with the one in the abdomen. They expect that to last about two weeks

After all its a lot more complicated then I thought and researched on the net.

So far i can only see that the symptoms are much worse then when i got to hospital. They said it needs indeed a lot of patients. the end result is hopefully as promising as they say. Minimum drinking is 1/2 a gallon

Wanted to do a bit of a status while things are fresh in my memory. Am approaching 70. Been having problems for probably 15 years. Had a 15mm impacted kidney stone and Qty (8) 8mm bladder stones removed 18 months ago. Symptoms then was hematuria.

Had one incident during the night when I couldn't open up and urinate, and 2 bouts of visible hematuria in that 18 months... went for check up and thought things fine, but they found microscopic hematuria. Wanted to do flow test, but I couldn't pee on demand (had sort of a ritual that I had gotten used to). They said, no problem we'll put a catheter in, fill you up and you can pee in container on scale. Nurse couldn't get cath in, doc couldn't get cath in. Went in with cystoscope. Said prostate sure has grown in the past 18 months and there were two new bladder stones.

Now for prostate ultrasound. 34cc prostate, and I think they said 40g in another report. Had the REZUM procedure this morning with 5 shots, 2 to each side and 1 to the anterior.Doc said the median zone was acting like a ball valve and shutting things off and keeping stones in my bladder.

Sedation was Valium then prostate block. I felt nothing during the prostate block. He used an 18 gauge needle that goes through the ultrasound device placed in your rectum. The five shots were "noticeable" for sure, but disciplined breathing got you through it, and the sensation stopped right at 9 seconds. The doc goes, bam ... bam ... bam ... etc. Not a lot of waiting between shots.

As I had to stay on aspirin therapy there was some bleeding in the office. By the time I got home (about an hour and a half after) my shorts were spotted with blood about 8 inches, but not into my pants. I got home and showered. Then sat on towels. I dripped blood for about 20 minutes. Have now been on chair for 2 hours and have only two spots the size of quarters. I am trying to drink water... have downed 40 oz so far, and have emptied leg bag twice, and urine is almost crystal clear. Not much, if any blood in it.

Doc wants catheter in 5 days and started Aleve 500mg/twice a day for the inflamation. So far I feel pretty good 5 hours post, no discomfort in the prostate area, just feel the catheter exiting.

REZUM worked for me!

My prostate was 185cc. I got twelve shots. The next three weeks were not comfortable because of catheter and bladder spasms. Yep. I peed around the catheter, Painful and messy. The doctor removed the catheter after two weeks and I could not pee then. One more week on the catheter. I was worried at this point about getting the catheter removed on a Friday, but they gave me some straight caths and reassured me that I would be all right. Side note on straight DIY caths, It is not as hard or uncomfortable as you would think to use these when you really need them. The relief they provide is lifesaving. If you got to pee and can’t.. tuck in your skirt, take a deep breath, try to relax (haha), and do it. Anyway Friday around noon, I had not been drinking excessively, I tried my equipment for the first time. In the past I had a whole routine of straining and flexing maneuvers i used to try to flow pee. None of this was needed. I was able to open the valve and pee normally for the first time in two years. My stream is slow but steady. More importantly, I continue to pee until my bladder is empty and I can feel it. That is an awesome feeling. Also during bladder spasms the doctor prescribed Oxybutynin, but had me stop taking it two days before a cath removal trial. I was worried about sexual side affects. I believe I was experiencing retro ejaculation. With the urethra opened up there is no more restriction. WOW!! It has felt like I had been poisoned by my body for the last two years by urine retention. My whole body feels better. Muscle/joint pain is just gone. Not to mention what this effect this has had on my mental state. Before: pain, panic, where's the bathroom, I can’t wait, I can’t pee! Now: comfort, calm, I don't care where the bathroom is, I can wait, I can pee! I found this forum the night before my second and last trial and it brought me much hope. I know everyone is different but I hope everyone can enjoy the change and comfort that Rezum and Dr. B. has brought to me.

My Rezum Experience

I am 75 years old and was otherwise in good health. I do a lot of cycling and walking for exercise. My worst symptom was formation of bladder stones, for which I had three interventions in the operating room. Before they were diagnosed, I spent two years with a lot of episodic pain. The cause of the stone formation was that I was not emptying out my bladder enough due to a BPH median lobe obstruction, that is, urinary retention.

In 2020, an ultrasound measured my retention at 188 ml when less than 50 ml is the normal range. Other symptoms included frequency during the day. At night it ranged greatly how much I would have to get up, from 0 to 5 times. When I would urinate at night, but not during the day, I would have a lot of hesitancy and retention.

I had followed the development of the Rezum procedure for several years, hoping that it would solve my problem without undesirable side effects, including retrograde ejaculation. What pushed me to have it done was the formation of a 5 mm stone, confirmed by the ultrasound, after being stone-free for four years. The stone was symptomatic with small pains.

What follows is my experience with the good, the bad, and the ugly.

My urologist first needed to measure the size of my prostate and view the median lobe obstruction. That took place in his office a month before the Rezum procedure. He offered nitrous oxide gas to breathe as an anesthetic for a charge of $130 that insurance does not cover. I elected to have the nitrous oxide, but it did very little to reduce the pain. I’ve had cystoscopies in the past and valium was just as good, if not better. First, he inserted a device up my rectum to measure the prostate size. That was painful. The size was 64.5, which is within the range for which Rezum is indicated. Then he performed the cystoscopy to view the median lobe. That was also painful, but not unbearably so. And it was quick. That told him he would need to make six blasts from the Rezum device. I left the office bleeding from the rectum and penis. He said that was normal and would stop in a day or so. It stopped the next day and there was no residual pain. The urologist also said that the stones may wash out on their own if the channel opens up enough. He will check in four months with a cystoscopy.

My preparation for the Rezum treatment a month later was to take an enema two hours earlier, an antibiotic one hour earlier, and two hydrocodone pills one hour earlier. Then I went through Hell. First he went up the rectum again to inject the prostate with a numbing solution. That hurt. Then he inserted the Rezum device up my urethra and began the six blasts of a minute or so each. That really hurt. The nitrous oxide gas, again, did very little to help. The final step was to insert a catheter. He had some problems because of a mild stricture. Eventually he got it in. By this time, I was in extreme pain. I asked for a third hydrocodone pill. The urologist left. A nurse stayed with me. It took about 45 minutes before I was recovered enough to get off the table and get dressed, still very shaky.

What I now know is that this is a procedure that should be done in an operating room under a general anesthetic. It may be a simple painless office procedure, as Boston Scientific, the proprietary company for the Rezum device, advertizes. But that is by no means true for everyone. Not only is an operating room with anesthetic necessary to avoid all of that unnecessary pain, it is more sterile. I would also think that it would be easier for the urologist to be more precise in his treatment when the patient is not grimacing in pain. If I ever have to have this done again, I will insist on a general anesthetic.

My wife drove me home. I was a painful and bloody mess, literally. When I got home, I had blood come out of my penis over the catheter and blood within the catheter. At least there wasn’t blood coming out of the rectum this time. I got home at around 3:30 in the afternoon. I took two more hydrocodone pills spaced out with intervening doses of acetaminophen. I was in a lot of pain for the rest of the day.

Fortunately, the pain was gone by the next morning and I took no more pills.

Then began seven days with a catheter. That is an uncomfortable, though bearable, experience. Bowel movements hurt because of the tube. You feel dragged down. I wanted that thing out of me. I was like a prisoner, counting the days until release. That blessed day came, and I removed the catheter, as instructed. There was no pain pulling it out, just a weird pulling feeling. Freedom from the catheter!

Then began another challenge: frequency. As warned by the Rezum literature, symptoms get worst for about two weeks before beginning to improve. In my case, for the first couple of nights without the catheter, I had to get up every 45 minutes. The stream was very weak without much coming out, and it hurt (though not unbearably so.) With that type of sleep deprivation, I was miserable during the day. I did a lot of napping. But then, fairly quickly, the frequency began to reduce to 4 to 5 times during the night.

The second day after the catheter removal, I took a 20-minute walk for exercise. When I returned home, to my horror, I discovered a wet stain on my pants from leakage. The thought of incontinence completely freaked me out. But a quick internet search revealed that my experience after catheter removal was normal and temporary. Indeed, fortunately, it has not happened again.

I will now give weekly reports:

End of second week since procedure: Getting up 3-4 times a night with no hesitancy. Before the procedure, night urinations had hesitancy. There is still slight burning-type pain with urination, none between urinations. The stream is still weak, but maybe less weak.

End of third week: Getting up 1-3 times a night. There is still slight pain most of the time when I urinate, but not always. The stream seems stronger.

End of fourth week: Getting up 1-3 times a night. Urination pain has mostly ended. The stream is stronger. This is the point at which I am supposed to be back to the baseline symptoms before the Rezum procedure. For the next two months, the symptoms are supposed to diminish below baseline.

End of fifth week: A small light-colored clot came out during urination this week, indicating, I assume, that there is still healing and opening up of the channel. Two days later a bigger clot came out. This one I felt coming out. It was a pulling feeling like the removal of a catheter. Then there was a spurt of a stronger stream. The stronger stream has remained and I now have the strongest stream that I can remember in decades. I finish urinating quicker. For this week I slept through four of the seven nights without having to get up. The other three nights, I got up once.

End of sixth week: One morning, I had my second case of small leakage. It was preceded by a feeling of an involuntary slight urethral sensation. Never before the Rezum procedure had I had leakage. An internet search indicated that when BPH blockages are removed, the muscles around the urethra have to readjust, causing temporary leakage. The stream continues to be very strong and thick. I made it through the night without getting up 3 times, got up once three times, and got up twice one time.

End of seventh week: During sleep, one night, I had leakage. I contacted the urologist. He said that I should cut out all caffeine and alcohol, which are bladder irritants, while the prostate is healing for the next several months and it should get better. Guilty. I had been drinking espresso and kombucha. Total abstention ahead for me. Most nights I got up once. One night I didn’t get up, and one night I got up twice.

End of eighth week: The slight discomfort with urinating has ended for most times. I got up one night 0 times, four nights once, and two nights twice.

End of ninth week: leakage one night while sleeping. Got up one time for five nights and two times for two nights.

End of tenth week: Got up one to two times a night. I still have frequency and, occasionally, urgency.

End of eleventh week: Still frequency. Got up at night 0 to 2 times.

End of twelfth week: This is a milestone, as according to the Rezum literature, it is supposed to be the point at which there will be no further improvements. The balance sheet: The good is that my stream is very much stronger and I no longer have hesitancy when I get up at night. There is no pain at all when I urinate. The bad is that I still have a lot of frequency during the day and most nights I have to get up twice. I wonder whether I still have bladder stones causing the frequency. I contacted the urologist. He says that the frequency takes a lot longer to resolve, which is different than what the Rezum literature says. He will see me in a month to check on the Rezum results and whether there are still stones. He says it is okay for me to begin kegel exercises, which I am.

End of fourth month. Appointment at urologist’s office for retention test and cystoscopy to see how much channel has opened up and if stones remain. The residual urine has reduced dramatically from 188 ml before the Rezum procedure to just 9 ml, well within the normal range. The cystoscopy revealed that all preexisting stones were gone. The procedure was a total success. I will see the urologist a year from now. If all is fine then, I will be released from his care. This may be the end of 34 years battle with episodic prostate/bladder/urethra/stone issues. There is still a urethral stricture. But it is probably slight enough not to cause problems.

Most nights I am getting up once. I’m working on bladder retraining. I still had frequency at the end of the fourth month—averaging a urination every hour and a half during the day. I then started bladder retraining on my own. The progress has been rapid. Within a week I was in the normal range of urinations every two to four hours. My goal is to have a three-hour minimum between urinations. The stream remains strong with zero discomfort. I’m pretty sure the leakage is over. There is no sexual dysfunction.

Final thoughts: Rezum appears to have worked very well for me without lasting negative side effects—what I wanted to avoid. I’m, in fact, thrilled with the results. The experience would have been much better if it had been performed with a general anesthetic in an operating room. I wish I had known ahead of time about the possibility of temporary leakage during the recovery period. That would have spared a lot of anxiety. The anxiety kept me awake at night for fear of bed wetting. To help with that, I took up meditation and it helped.

All of this took place after my retirement. Returning to work was not an issue. But I would think, that anyone still working should take two weeks off before returning. You could probably do so earlier, but not without a lot of discomfort and anxiety.

October 30, 2020