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

I feel very sorry for you my friend.  I know how you feel.  Last November I had 7 painful catheterization cause  of a tight external sphincter I could have jump off the bed and I even had a nurse cry because of she never saw that happen before.  I hope things get better for you.  God bless  Ken    

I know what you went through ! 

I wound up 4 times in the ER to

have catheters put in and the pain was unbearable. I had to bite on a towel so I could bear it.

 I don’t know why they don’t make you self cath, which is alot 

less painful. My Uroligist finally 

had me do it after my 4 painful trips to the ER in the middle of the night. If I had to do it again I

would insist on self cath !

Yes my urologist have giving me some catheter and have done it.  Right not I have not had to do it.  Take it easy and let us know how your doctor visit goes  Ken

Painless ??? Great ! Compared to all the pain I've read about REZUM, Holep sounds like a winner. Congrats ! Hank

Hank you do know that everyone is different.  What was painless and easy for one may not be the same for others..Ken

Not necessarily. It might come back - partially or even fully.

I think you were one of the lucky one's.  Over the last year there have been 10 men on here that had it done.  Half improved but the other half it did not help.  All ended up with retro.  They did go see other doctors to see if there was something they could do.  Nothing.  Everything is fused together.  I look at my urologist e-mail and I don't remember what he called it but there is a surgery that can move the duct to a different place where it is not scared.  But he said that is only a 50/50 shot.  I guess we gamble with everything as we get old  Take care  Ken

I can only hope you are right, but

from all patients that had it done on this forum, I wouldn’t bet on it. Thanks for encouraging words though 👍

Make a detailed 3T MRI, end send it to Dr.K. in Houstin 

, he will  say , if is chance to  avoid RE , or not.  

Thanks, for the information. I see my Urologist on May 7 th and I will discuss it with him

My urologist wouldn't order the MRI for me - got irritated with me when I asked for it. Don't know if this will happen to you. 

I’ll probably get the same reaction. He hardly has time to see me, because he’s so busy.

Trikerjon......  I hate to say this but if he is to busy to see you or give you any information  You should have gotten another Urologist that would give you the time you need..  My Urologist is a very busy man to but I can see him or e-mail him anytime and he has gotten back to me.  I have had him for over 3 years.  I have even ask him some question for some of the other men on here and he get's back to me.

Mine got better - not all the way but from nothing to about 50% of what it was.

@ken: I think you were one of the lucky one's.  Over the last year there have been 10 men on here that had it done.  Half improved but the other half it did not help.  All ended up with retro.

---------

Ken, Are you referring to Rezum or HOLEP? Rezum has a low incidence of retro, HoLEp has a high incidence.

Jim

Correct. Very low incidence of this with Rezum.

This has been a very frustrating 

experience. I started out with a

Uroligist who shouldn’t be practicing medicine. Then I found my present doctor and really like him. Because of the

size of my prostate he chose to

inject me 11 times. Unfortunately I had no choice in the matter because I was sedated. If I had to do it again and knew the outcome I probably would not have chosen Rezum as a procedure.

would

What is the appropriate number of blasts in rezum?

Jersey ,

 I believe. It was asked to you prior whether not injecting steam on the area that houses the ejaculatory ducts will prevent re, but have not seen the response. Sorry if I missed it but would appreciate your thoughts.

Trikerjon,

I’m interested in your flow. Besides the Re, are you peeing normal again ?

I think 3-4 is the minimum amount

It depends on size.

We’ve done as few as 2, as many as 12-14 or so for a very large prostate

It is impossible to promise 0% RE for any ablative procedure. The ducts is only part of it.

Rezum has as low of an incidence of any ablative procedure I have seen.

I was talking about Rezum  Doctor tell them it rarely happens but you know that the % is 10 or more.  And it seam that the men are in there early 50's and there not happy.  Holep you also know that is a given with that procedure.  I would never consider a procedure that fry's the inside of my prostate. It does to much damage and repairing it is worse.  Ken     

How often is rezum done and the flow not go back to normal. 

@JerseyDoc: It is impossible to promise 0% RE for any ablative procedure. The ducts is only part of it.

-------

Can you please expand on that. We now have one case of retro and one case of partial retro for focal laser ablation (FLA) on a relatively small sampling of patients here. We were led to believe this shld not happen because of the MRI guided precision.  So assuming the ducts were not hit, what cld have gone wrong? We also hv one reported case of erectile failure with FLA which was helped with Viagra. Any thoughts on that as well?

Jim

So let's say it's 5 to 10% and probably closer to 5 but you said "all of them had retro" which is not correct unless I'm still reading your post wrong. 5% may be inacceptable to some but quite acceptable to others. 

Jim

And btw we now have one case retro with FLA, one case of partial retro and one case of erectile dysfunction corrected by Viagra. So given this is only out of twenty or so reported cases,  the Rezum stats seem no worse in that regard.

Jim

I’m not sure who led you to believe that, but it sounds like marketing hype. You can’t guarantee you won’t do something to a duct based on an mri.

Any sort of ablative procedure of the prostate has a theoretical risk of RE. Anyone who tells you otherwise is being dishonest 

I wish there were a natural method of shrinking the prostate, like jogging every day, or a vegan diet or something else. 

Jersey,

I understand the re risks. My major concern now is flow and getting back to normal so I don’t have to cic. I have an enlarged median lobe.

What percentages are successful in getting a pathway to open up .

If it doesn’t work, then what would be the next procedure. 

We have had great success for large median lobes. If it doesn’t work, aquablation or turp would be a possible next step

If I decided to skip rezum, would turp and aquabkation be the only effective methods on large median lobes? From what I hear of turps, they sound awful. 

The vast majority of folks who have had a turp are satisfied.

Interesting to see what JerseyUro says, but that's like saying if I skip the stent and go right to a bypass, what are my options? Why would you not opt for the simpler procedure without surgical risk or anesthesia, a much shorter recovery, lower incidence of permanent side effects and a success profile very close to that or the surgery? Particularly when you can always do something like TURP of Rezum doesn't help.

Most folks will go for a less invasive procedure first (like a rezum.) 

Some folks go directly to a Turp, but they are few. 

Does the number of times a rezum is performed by the urologist make a big difference? The uro I’m seeing has done less than 10 but says it’s a very easy procedure to learn and know well after just doing a few.

Old buzz, I understand. Trying to understand if rezum doesn’t work does it make it harder to do something else less invasive than a turp.

Understanding all the different things that have less risk is hard to keep track of.

It is an easy procedure for experienced urologists, as they have performed similar type of procedures through their entire careers.

This is just a new energy source they are using.

Over the last year we have heard of many men that had the Rezum procedure.  I remember in one week 4 men had it done all ended up with retro. From last May there have been 10.  Doctors tell us all the time it rarely happens and no worry all will be the same and you don't need at at your age.  Who are they to tell you what you need.  A doctor is only telling you in his opinion what may work.  In reality a doctor does not know if it will work until it done but by then it's do late.  I know on here we hear a lot of failed procedure but.  Let say you have 100 Rezum procedures.  Out of that you end up with 10 men that have retro.  Is that good odd's  Do you want to be one of the 10.  I also have to read some of the Rezum note I was under the impression that a doctor is suppose to tell you how many he is going to do.  He should know before the procedure if he has done the test and he knows the size of the prostate.  With 11 injection Triker's prostate inside must be a mess.  Think of it.  Take a piece of fat and put it in a frying pan.  It turns to liquid so that is what the inside of the prostate shell looks like.  I like fried chicken but I don't want my prostate to look like that.  Have a great day  Ken        

Trying rezum does not preclude you from anything afterwards if it doesn’t work well for some reason 

They have no choice after you cut out there prostate.  There is no way of putting it back.  I know men that have had it done that wish they would have not gone that way.  But whats done is done  Ken

I agree with you 100 percent. They never tell important things like the actual size of your prostate so that you can decide if the procedure is right for you or not. The only test I had was the finger test and was told my prostate was enlarged. I was never

Informed  it would take that many steam injections and the outcome  would certainly be

Retro ejaculations. Just the short time I’ve been on this forum it seems there are more

retro roblems than not!

If your doc did any procedure based on a finger test alone he's guilty of malpractice IMO. Any obstruction happens where the finger can't touch and while often, large on the outside means large on the inside, my prostate was normal size but growing in and left me with an IPSS score in the 30s. No one should have any PBH procedure without a scope an urodynamics IMO.

Buddy.  With him only doing that test you should not have had the procedure.  You needed to have more test to see what the size was and if the prostate was the problem.  I hope things get better for you  Ken  

That makes sense that he will understand the technology,  but what decides the number and placements of the shots. Wouldn’t experience guide that?

It likely will make minimal difference if he is an experienced prostate surgeon (which most board certified urologists are.)

Ken, If you take the time to go through the threads I think you will find under 10% had retro with Rezum. Not much difference from what we're seeing with FLA.  The point is not do you want to be one of the 10% because that is for men to individually decide for themselves. It's their decision after weighing the odds not your decision or mine. 

Jim

Jim that is right.  After looking at everything you have to make the right choice for yourself.  Like you picked to do CIC and it worked out for you and myself I picked the Urolift which it has done what it was made to do open up the prostate.  But one thing I am worried about are men being rushed into procedure that the doctor's have not done all the tests on them and give them the information they need to make the right choice  Later my friend  Ken  

I personally would prefer the urologist that went to the most prestigious medical school and residency programs.

Thanks Ken, unfortunately for me the deed is done and I will have to live with my choice.

 I guess the bright side is I didn’t 

wind up with ED, at least not yet.

Thanks for input and concern 👍

Any big decisions in life whether it is buying a new car that you will have for 10 years or prostate surgery that you will have for the rest of your life should not be rushed.  Instead one should take their time to research the various options that are available, discover as much information and possible, and talk to some knowledgeable experts  .This forum is just a start.

Get the opinions of more than one urologist on both your prostate's (and bladder's) condition and the various surgical and non-surgical options available.  Make sure that all of the necessary tests and imaging are done before any surgery is considered.  Even if the condition is acute (I am in AUR managed by CIC), be wary of a urologist that wants surgery immediately. 

Talking "natural" saw palmetto is B.S.  Tests against placebos have proven that. 

Yes what's done is done.  I just hope it works after 11 injections.  Take it easy.  When you see your doctor in a few days try to get him to answer your Questions.  At least see if he can tell you how big it is  Ken 

Yes that is very good advice but some men do not take it.  I feel for Trikerjon He had no test but a finger test and the doctor told if it was large.  How does he know that his prostate was the problem.  And 11 injection.  He should have been told.  I have a very good Urologist and I just him but If I have anything done I do not give him total control.  You do what you said to me what I agreed to and no extra.  To many men give up on there prostate.  That will never be me.  I will fine a way even with CIC if I have to.  Take care and God Bless  Ken 

The good news is that every urologist who has trained within the last 20 years was at the top of his medical school class; it is the most difficult specialty to become part of, and you don't generally get to train as a urologist unless you are the best of the best.

The bad news is it is self-regulated; there are far too few urologists to go around, and waits to see one can sometimes be months.

Interesting and congratulations but that seems to suggest that you might find "the best of the best" with younger urologists (under 50) or does what you say hold true to urologists who trained more than 20 years ago?

Jim

Older urologists may be from a different era, but are retiring. Most older ones also don't offer newer procedures.

Kenneth, 

Ken19524 had 10 injections and was fine, no Retro and good results on flow.

https://patient.info/forums/discuss/rezum-have-you-had-this-done--499675?page=73

He also said his Uro, Dr McVary, from Southern Illinois U has done 100s of Rezum with NO sexual side effects. He said the doctor picked locations for the injections from a TRUS exam.

I remember reading about another person here who had 12 injections and had good results with no RE and good flow.

The location of the injections may play a part.  

Thomas

My flow is stop and go and weak and erections are also weak. It make take time to get better since it’s only been 5 weeks since the procedure.

Very happy for them.  John last year only had 4 injection and it did not work but he got retro.  It all depends on the doctor.  Triker had no test and was rushed into it.  Glad my doctor does not do Rezum  He would never get me to do it  Ken

Hopefully I’ll get some answers, but it won’t change anything. As they say fools rush in......that be me !

Ken, Last time I counted the incidence of retro here with Rezum was 10%. The only other procedures that have less than that are Urolift and self catherization, both of which are not suitable for many people. As far as people being "rushed into" procedures, this is not a Rezum issue but a doctor/patient issue and we see it with all procedures although a point could be made that we're seeing it more with the minimally invasive office based procedures such as Rezum and Urolift. 

Jim

Jim, what about PAE?

Rich

Hi Rich,

I would have to review the PAE posts but from memory I don't remember retro being reported very often if at all. Urolift seems to be the safest in that regard but it's not very good for large median lobes and some men don't like the idea of a foreign object in their body. I'm pretty retro adverse and that is why I choose self catherization, which I understand isn't appealing to many. Gotta pick your poison I guess.

Jim

I did not say it was a Rezum issue.  I said the doctor  Ken

Yes, I haven't heard of retro being an issue with PAE at all.

Hello guys, been a while since I have been on the site so probably behind quite a bit on the scuttlebutt!

Just kinda lookin for some recommendations,   Had urolift 3 yrs ago and that did not last but a few months at best.   Been doing CIC for bout 2 years now, so pretty much a pro at it.   I do notice that the last 1/2” or so it takes a little more push and then presto!  so my guess is that this is a mediun lobe and would love for it to not be there!  In your opinions which procedure would y’all say that I need to be looking at?    

Thanks for the help!

Well maybe we spoke to soon. This two year old post by Nealpros suggests there can be retro (however you want to define it) from PAE although don't know what the incidence is.

https://patient.info/forums/discuss/retrograde-ejaculation-pae-fla-etc--533357?page=1

Jim

Hi Anthony, similar  experience with  CIC  -last  part of catheter "route " is blocked  , we feel significant  resistance.  Yes its  big median lobe .  If you select  "gold standard"  method,  take TURP or HOLEP with serious side effects.  If you select mini invasive ones,  just 2 methods can deal with big median  lobe.  REZUM and FLA.   I selected FLA  1 month ago , its seems to be good  ( no more  CIC, no medication, better flow - but still not sufficient , possibility to sleep  4-5 hours ( before 1 hour and break),  no  nocturia.   And no side effects  ( ED, RE ).. If you need details just PM me. I can send you  some  data more.  Stan 

Hi Anthony,

If you're not using a Coude tip catheter, that might help to go around the prostate. There are several out there but the one I use is Coloplast's Speedicath. Most people use size FR14 or FR12. You can also try putting your finger over the open funnel on insertion which tends to stiffen up the catheter a little. I also find a little twist (very subtle) back and forth at the resistance point helps. As to the newer procedures, unfortunately they all (rezum, pae, fla, etc) report some incidence of retro ejaculation although in the 5-10% range which is much lower than with the more aggressive procedures. ED is much less common but has been reported. A newer procedure called Aquablation is just coming out which promises to be a kinder, gentler type of TURP using robotic technology and no heat. You might keep your eye on that over the next year.

Jim

Jim,

I am not aware of any report of retro with PAE since it doesn't destroy the ejaculatory ducts - just shrinks the prostate. 

About the CIC. I had to do this about four years ago and found to be a scary, painful, and difficult procedure - but finally got the "hang" of it - sort of. 

Some questions about the CIC: is it normally done sitting down by the toilet, or standing up? I could only do it sitting down. It was not easy to get comfortable. Then, once the urine starts to flow, it was not easy to get it to go into the toilet - I needed one more hand. So, are the catheters you use just open on the end, or is there a collection bag at the end? 

The only type I could use was hydrophylic. I first tried the coude tip but that was very painful. A normal catheter worked much better. After my experience with the CIC I would say it was a "last resort", but it did work the few times I really needed help.

Tom

Here's the link again and it suggests that you indeed can get retro from PAE.

https://patient.info/forums/discuss/retrograde-ejaculation-pae-fla-etc--533357?page=1

Re CIC, you can do it sitting down, lying down or standing up. Personally, I've done it standing up 99% of the time, and I believe most men here also do it standing up, but no reason not to do it sitting down if you're more comfortable that way. With little experience sitting down, can't help too much about hitting the toilet, but maybe it would help if you put your finger over the open funnel and only release it when you are aiming at the toilet. And speaking of "third hands" I believe Manfred-Sauer, a catheter manufacture, makes something called a "third hand" which might help. And yes, a number of catheters come with collection bags attached meaning you can cath away from the toilet if you want, in any position. These usually require a different Rx, with different insurance criteria,  but if you only need a couple for emergencies you could pay out of pocket.

Jim

I would try Rezum or FLA first. Urolift does not have a good track record for people in retention. FLA has a lower incidence of RE than Rezum, but there isn't nearly the data on it that there is and often its not covered by insurance, while Rezum typically is. Aquablation show some promise, but still has a very long recovery and the likelihood of RE that come with TURP.

Something like Rezum will almost seem like no recovery. You're already doing CIC, so just keep doing it after Rezum, but try for natural voids first, after say, a couple of weeks. If it works, you'll start being able to pee - first a little, then more. 

@OB: FLA has a lower incidence of RE than Rezum, but there isn't nearly the data on it...

-----------

I agree not enough data but based on the sampling we've had here, I'd say FLA and Rezum are showing around the same incidence of RE or partial RE which is around 10%. Still much better than TURP of course, but not low enough for it not to be a serious consideration for at least some. Jersey Doc had an interesting explanation about RE and all ablative procedures where he stated it isn't necessarily direct damage to the ejac ducts which can cause RE but that the overall insult to the prostate can set up a situation which will clog the ducts. At this point the only RE free zones are Urolift and self catherization (CIC), both of which have their drawbacks to some.

Jim

On this line should be interesting to see what the real world RE figures are for Aquablation that uses computer mapping and precision robotic removal of prostate tissue without heat. I believe the trial data states under 10% RE which if it holds up would make it a contender with some of the minimal invasive procedures. That's a big IF of course but we should know a lot more on that within the next year or two.

Jim

Thanks for the info on CIC. 

Went to the link you sent me about RE:

"A PAE, and many medications dispensed by urologists for BPH, cause less seminal fluid, or no seminal fluid at all, to be created. The result is that when the man reaches orgasm, and his prostate contracts, even though the valve at the top of his prostate has closed, there is no, or not much, seminal fluid to be forced out the end of the penis. That is the second type of "RE", though it really isn't "reverse ejaculation" at all, since there is no fluid to ejaculate. We just call it that."

Retrograde ejaculation is defined as the seminal fluid going back into the bladder rather than out. So, technically, PAE doesn't cause this kind of RE. I had a PAE and also radiation to the prostate for cancer and despite all of that I still have fluid coming out in the normal way. My PAE allowed me to go off Flowmax and that helped as well. 

Tom

 

Tom,

This is how retro was defined by an IR who does PAE. Bottom line is that it doesn't matter which kind of retro PAE causes but the fact that no ejaculate comes out is what matters to the men itself. I doubt this is very common with PAE but I really have no numbers nor were any given by the doctor.

Jim

Jim,

My point has always been that all prostate procedures have some side effects - and they differ from person to person as would be expected as we are all different. So, My first choice was to go with the procedure that produced the best results relative to the side effects. PAE was my choice after reading all the scientific literature for several years. 

To me, reduced ejaculate is a side effect, not technically retro, which means reverse. We're just talking about semantics here. Does PAE have potential side effects? Yes. But they are fewer than with other procedures from everything I read here. 

Tom

Yes, reduced ejaculate is not technically retro but the link I sent you was referring to retro, i.e. NO ejaculate coming out after PAE. It's not semantics. I do agree that PAE has much less of an incidence of retro than the more agressive procedures although I'm not sure what the percentage actually is. This is not a reason to choose or not to choose PAE, just talking about the incidence of retro and from there people can make up their own minds. To some, retro doesn't matter at all. To others, a 5% chance is well worth the potential benefits. To others, even a 5% chance of retro is too much. 

Jim

Jim

Respectfully disagree, kenneth1955.  To be blunt, I think you're scaring a lot of guys - no disrespect intended.  A 10% chance of retrograde ejaculation?  Show me your data. 

Alan,Are you addressing this to Kenneth or myself? I ask because I recently mentioned 10% as a retro figure (full and partial) for both Rezum and FLA. As I was clear, the data is all anecdotal from user's experience here on the forum. The trial retro data for Rezum is lower but I don't have that number. JerseyDoc's anecdotal data for his practice puts it at 5% or lower for Rezum. There is no trial data for FLA. In any event, I don't think this should scare men, just give them more info to make an informed decision. For many, retro isn't an issue at all. For others 5 or 10% is an acceptable risk versus rewards and for others anything over 0 per cent retro is not acceptable.

Jim

Good evening Alan.  We have seen many on here that have had it.  One week last year there 4 men that had the Rezum procedure done with in a 6 week period all 4 ended up with retro.  You could say that is part of the 5 %.  I'm sorry but the % of retro is higher they we all think.  Whey they were doing the trial that was not even mention only that it save sexual functions  Doctors do not consider a man ejaculation a sexual function.  They feel that when you reach a certain age we do not need it or should care about it.  Ever man no matter what procedure you have I know that the doctor will tell you all will be the same and they change the subject.  I man has to take control of his body because you are the one that has to live with the outcome of the procedure not the doctor he just moves on to the next patient,  Before picking a procedure no matter what it is make sure you get all the information you can and if you have to get another opinion from another doctor.  Do not let anyone rush you into making your decision.  Take care Ken  

Alan,   Yes I agree.  10% of guys on this form is a higher number than the general population.  Guys on this forum are here because their experiencing problems. The percent in the general population will be lower.

Thomas

thomas37368,

Point well taken!  It is important to filter the bad problems and identify the good information that can be gained from this forum.

Steve 

Hi Thomas, can you tell me what IS  the TRUS  Exaim?? 

THANKS 

FRANK,

A transrectal ultrasound(TRUS) is a procedure which utilizes sound waves to create a images of the prostate and the surrounding tissue.

Eroulogist use it to determine prostate size in the exam..

Hi Ken, From what i hear about Rezum is ,there is no cutting the prostate ,its using steam to evaporate the cells that are causing the enlarged prostate.Am i right?

frank,

i wish