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

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alan1951 ChuckP · 2020-07-31T02:32+00:00

Had a Rezum on April 19, 2018.

First, a word about 5AR inhibitors …

Yes. They definitely shrink the prostate and that, in and of itself, is interesting. While I was taking dutasteride; I had thought many times about switching to finasteride. The urologist who performed the Rezum has a book on Amazon called Office Urology: The Clinician's Guide. If you’re interested, you can read a great deal of it, by clicking “Look Inside.” He essentially says that these drugs do shrink the prostate, but they may end up doing very little in terms of mitigating the symptoms. My prostate was only 25 g before the procedure, thanks to dutasteride. Small, indeed, yet I was in sheer agony. His opinion was that, because of the dutasteride, the prostate grew inwardly, thereby strangling the urethra. Here’s the kicker; during the procedure I received seven treatments. SEVEN!

If we think about it, every medical intervention that we know of, started off by being a novel approach. Circuitously enough, many of them became the new standard. So it is with Rezum

My statistics:

I’m 66 years, seven months.

I used to take Avodart (chemically: dutasteride), and still continue to take once daily Cialis.

I am 5’ 9” and weigh 185 lbs (22 lbs overweight), which is probably related to my having arthritic gout, for which I take allopurinol.

Otherwise, I am in relatively good health.

Had the procedure at the Cleveland Clinic on Thursday, April 19, 2018, and it took all of ten minutes. As of this writing on May 6 2018, I am now 18 days post procedure. Mine is one of those too-good-to-be-true stories. More about that later.

If you’re considering a Rezum procedure, there are certain things of which you should be aware. Before I continue, be aware that this site is a Godsend. There is no education like the one we receive from studying something that affects us personally.

The company behind Rezum (NxThera) has just released clinical data showing the durability out to three years.

So what do their most recent data look like?

International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax) outcomes improved in subjects with moderate to severe LUTS through three years.

Urgency and nocturia, indicated significant relief of symptoms at one month and remained significant throughout three years.

No latent related adverse events occurred and no de novo erectile dysfunction was reported.

The third bullet point above warrants some discussion. Much has been made of the company’s reporting on retrograde ejaculation (RE) and erectile dysfunction (ED) on this website. One iteration of the debate goes something like this;

“the company says the chances of RE is X%. They’re probably closer to Y%.”

Without quantifying these data further, suffice it to say that the likelihood of sustaining RE is relatively small.

Sexual function was preserved in patients treated with the Rezum System, as measured via the International Index of Erectile Function (IIEF-15) and Male Sexual Health Questionnaire (MSHQ) through three years of follow-up. The ejaculatory bother score (MSHQ-EjD) improved over baseline from 12 to 36 months.

Thirty of the patients received treatment to the median lobe or elevated central zone, in addition to treating the lateral lobes; these 30 patients not only demonstrated significant improvements in symptom (IPSS) and urinary flow rates (Qmax), but also demonstrated decreased post-voiding residual (PVR) urine from 24 months to 36 months.

Surgical retreatment rate was 4.4 percent (six out of 135 subjects) over three years of follow-up. Four of these six secondary interventions were related to an untreated median lobe at baseline.

By now, you’ve probably heard about a brain-bladder-prostate connection. It’s true. All three are interrelated. I think it goes beyond that. I think there’s an interconnectedness within the entire body. I’m not qualified, nor do I know, what that interconnectedness is, though I suspect it may be hormonally related.

Things you need to know about the Rezum procedure:

Things you should probably do:

First and foremost, give yourself enough time to heal.

So many men expect fast results. Post-op, you may begin to second guess yourself. No surprise there. The improvements will come. They may take as long as three months. The older we are, the longer the healing process. Thereafter, the improvement continues, albeit not at the same rate.

Remember – the idea behind Rezum is to stop prostatic hyperplastic cell division by inducing medically controlled second or third degree burns. Once those cells have denatured, it takes a while for macrophages to come in and bat cleanup.

Do not remove the Foley catheter for at least five days.

I get the visceral impression that a lot of guys are really bothered by a Foley, and remove it prematurely, and / or ignore the requisite hygienics. If you go with a Rezum, you’re definitely going to have post-op bleeding, while you’re on the Foley. COMPLETELY NORMAL. One of the best things I did for myself was to leave the Foley in place for nearly six days. I’m now peeing independently. I have no blood in the urine, nor am I “passing pieces of tissue.” Be proactive, and leave that Foley in, following your health care professional’s best advice. Bleeding is a commonplace phenomenon with most post-op BPH procedures.

You’ll be tempted to remove it prematurely. Don’t do it. The prostatic urethra has been compromised and punctured by a rather large-bore needle, probably in several places. It NEEDS time to heal. Once removed, expect hematuria and slight loss of transitional epithelia, lining the urethra. In other words, you may have blood in your pee, and / or semen, and you may experience small pieces of tissue coming out when you pee. This is NORMAL. Foleys are notorious for UTIs. Make sure to take the appropriate hygienic precautions; i.e., showering twice per day, and washing the penis with soap and water – especially around the meatus (entrance to the penis). Make sure you understand the care and maintenance of a Foley catheter before you leave the hospital. You may experience high anxiety. This, too, is NORMAL. If you think about it, a major gland has been traumatized. Sounds scarier than it really is. If you do experience pain, it shouldn’t last longer than a few hours.

Removing the catheter was a simple, painless procedure. Had difficult urinating on day five following the procedure. As of today, peeing is much closer to normal. Nocturia has reduced from 20-25 times per night (not a typo) to once, perhaps twice. The half-lives of the two AR5 Inhibitors are notoriously long. I want to give the dutasteride ample time to wash out and, don’t ask me why, but I want to titrate the dosage down, over time.

Walking four miles per day. Almost any form of exercising has a way of releasing endorphins (the feel good hormone). They work to mitigate pain to say nothing of their ability to relieve stress / anxiety.

What follows is an amalgamation of information I’ve shared with my brothers-in-suffering via private messages. They shall remain anonymous.

I asked my urologist if the Rezum procedure would correct bladder issues. His response; "it might, but there are no guarantees, nor are there any guarantees that it will correct nocturia, though cessation of caffeine and alcohol will help those symptoms.” While I don’t drink alcohol, I did take his advice about the caffeine. He was right. Moreover, he was wrong about the continuing nocturia. This procedure put a screeching halt to incessantly waking up throughout the night.

According to jimjames – for whom I have the utmost respect - CIC is one of the best options to regain bladder tonicity. Take the following comment for what it's worth. I think a lot of men exacerbate their BPH issues when they postpone treatment / therapy. Bladder Outlet Obstruction has the untoward side effect of causing stretch receptors in the bladder to send false signals to hypothalamus. Takeaway: Don't procrastinate. That said, we can mitigate the potential for further bladder atonicity by CIC. Moreover, it seems to be the one treatment modality with zero side effects that can be performed indefinitely.

Personally speaking, I'm only sorry I didn't have the Rezum sooner, albeit the soonest I could have had it would be one year ago. What can I say? I'm a coward when it comes to invasive procedures.

As of this writing on May 6, 2018, I see small unmistakable changes every day, since having had the procedure 17 days ago. To wit: Peeing was dicey at first, though things have surely returned to normal for me. If the optimal results from Rezum are three months out, then I definitely think I'm actually well ahead of the curve.

The BPH forum on Patient.com is unique. It draws all sorts of men. It's my opinion that most men are trying to educate themselves. I know I was. Then an interesting dynamic seems to take place; I do believe the site is a good tool to help men make a better decision. They make that decision, then they move on never to be heard from again. So who remains? Those pour souls whose procedure(s) may have gone off the rails. And no disrespect to them whatsoever. (There but for the Grace …) It’s just that I don’t think this website is an accurate depiction of real-world phenomena. Horror stories about procedures abound. We got ‘em.

This is key:

PICK A UROLOGIST WHO HAS TONS OF EXPERIECE IN DOING THIS PROCEDURE, AND IF IT'S POSSIBLE, CHOOSE A WORLD-CLASS FACILITY - PREFERABLY ONE THAT HAS WORKED WITH THE REZUM METHOD IN CLINICAL TRIALS.

I live in Pittsburgh. Rezum.com has a physician locator that can be ranged out indefinitely. I traveled almost 200 miles to the Cleveland Clinic to have this procedure. James Ulchaker was so professional, I would have traveled 2,000 miles for his services – literally. In my humble opinion, when it comes to the human prostate, distance to seek medical care should not even be an issue.

The moderators on this site are, in my opinion, hypersensitive when it comes to links I’ve tried to include which, in my opinion, would have been helpful. Looking for quality, informative posts on that site is sometimes analogous to a cyber version of Where’s Waldo.

Some guys are quick to advise, and even quicker to question what we’re doing. I’m constantly studying the human body, and yet I don’t have half the bravado of some of our resident “experts.” Then again, there are guys on this site who are exemplars in humility. They’re DEFINITELY worth listening to.

I learned in anatomy and physiology that there are parallels between BPH and – of all things – heart disease. For example, consider left ventricular contraction.

If something is impeding the heart's contraction, that blood still has to go somewhere. Where does it go? Right back up to the left atrium, causing any number of problems, ranging from A-Fib, to a stenotic mitral valve, to eventual pulmonary edema, to left ventricular cardiomyopathy, to eventual cardiac / respiratory failure.

If something is impeding our urine flow – vis-à-vis – BPH – that urine still has to go somewhere. Where does it go? Right back to the bladder, causing any number of problems, ranging from an atonic bladder, to bladder stones, nocturia, retention, UTIs, and nerve problems caused by distorted stretch receptors, that interfere with the very sensitive signals sent between the brain and the bladder, thereby disrupting and distorting those signals. Let’s not even mention the potential for kidney damage.

As for supplements, if there is any benefit to them, then it probably presents as placebo, which is not to be underestimated.

I’m a huge believer in second opinions. I’ve had the same urologist for the past 35 years. LOVE the guy. He’s done right by me, using conservative approaches. A year ago, I told him I was considering Rezum. His advice; “I think you’ll regret it.” Then again, he is 87 years old and still practicing. No regrets whatsoever.

Look. You may not end up going with a Rezum procedure. Perfectly understandable. Whatever you do, you’ll end up making a decision that’s right for YOU, and that’s what counts. I swear by Rezum. So do a lot of other guys on here. Means absolutely nothing. It was probably right for US. From what I’ve read, I can’t knock Green Light, Turp, Urolift, or any of the remaining minimally invasive surgical techniques (MISTs). They have a place, and they serve a need. If you are going to have a Rezum, start a search for the urologists who have extensive experience with this procedure.

Final update: May 6, 2018 …

I get up once or twice per night. Quite a come down from 20 – 25 x per night. The procedure was somewhat painful; an eight, on a scale of 1 – 10. The most difficult part of this entire ordeal for me? Making the decision, pulling the trigger, and following through. The procedure itself? A relative piece of cake. The recovery thus far? Makes me wonder why I procrastinated. I’m peeing normally, I have no retrograde ejaculation and, as strange as it sounds, my urologist has turned back the clock 30 years on my sex life – sincerely. I have no blood in the urine, nor no untoward, lingering side effects. So gentlemen – that’s it.

I won’t be back to this site. It’s helped me immensely. My heartfelt and humble gratitude to those men who helped me. Without you, I would have inched closer to simply giving up. This condition affects Quality Of Life, and there are definitely things we can do about it. If I can somehow pay-it-forward, then message me, and I’ll tell you what I honestly think, though I’m no medical expert. Wishing the absolute best for you.

“Remember, Red, hope is a good thing, maybe the best of things, and no good thing ever dies. I will be hoping that this letter finds you, and finds you well.”

- Andy Dufresne / Shawshank Redemption

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

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