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

Hi Laura,

I'm not sure if this will be helpful, but a supra-pubic catheter can be fitted with a bag, OR a valve . The valve would allow your father to empty his bladder when he wished, without having a bag strapped to his leg to deal with. Of course, he would have to be able to deal with the valve with one hand. Someone would have to show him one to see if he could do it. Using the valve is a more normal situation, and perhaps it might allow him to retrain his system so that he could eventually urinate normally, without any catheter. Perhaps JimJames can supply more information on this.

Neal

Hi Laura,

NealPro mentioned the suprapubic with bag and/or valve, so let me comment a little on that and sort of summarize some of the other options including your idea of a Spanner Stent.

So from the beginning. Your dad had a cystoscopy because of retention and came home with a Foley. We have to then assume that his bladder is stretched, inelastic, and therefore not able to empty effectively on its own.

The Foley allows him to void completely and also has the potential to rehabilitate his bladder by giving it a rest (decompression). A suprabpubic can accomplish the same thing with but is better tolerated and associated with fewer UTIs. There is literature to support this and the literature also states this is MINOR procedure under local. I would therefore challenge anything you have heard to the contrary, either from your doctor or on the internet, and urge you to do your own research on reputable medical sites to confirm this.

As Neal mentioned, the suprapubic comes with both a bag and valve (Flip Flo) option. There are many handicapped and partially paralyzed men who use Foleys, Suprapubics and self cath, so there are techniques and devices that may allow your father to use any of these options. We haven't talked much about the self cath option, but that is actually preferable to even the suprapubic, if you dad can master it.

The Spanner is an interesting idea but given his history it may not work. The spanner in theory gets rid of the obstruction but you still need a viable and elastic bladder to be able to void. Your dad may not have that. If you're thinking of this route you would want to first find a urologist who uses the Spanner and lean on his opinion whether he thought it worth a try or perhaps if it's too early in the process. But it's important to note that the Spanner is a temporary and not longer term solution which your dad may need.

Down the road your dad may want a prostate reduction surgery or he may find that one of the methods described -- Foley, Suprapubic or self cath -- meets his needs. Surgery is  not without its risks. He also may not qualify for a surgery such as Rezum because of his stretched bladder. The traditional way to qualify someone is with urodynamic testing, video urodyanmics being the gold standard. The Spanner has been used as well (test by stent) with mixed results. Remember the Spanner does not exactly duplicate a surgically reduced prostate because it just doesn't open the urethrea it also opens the internal sphincter since it is anchored into the bladder with a balloon similar to a Foley.

Hope this is helpful and please keep us updated on how your dad is doing.

Jim

Hey Laura and all,  Altho I agree that I much prefer SPC to FOLEY, it is definitely not a walk in the park and I have had some very bad days, even weeks.  And yes, it is pretty painful after the surgery for several days or a week at the incision site, and not completely unnoticed after things calm down.  I've had periods where I could do most things and didn't even notice it, but also have periods where I cant do much of anything without causing jabbing pain.  I would still choose it over a Foley, tho a lot of that is for sexual reasons, and/or the incredible discomfort of waking up in the middle of the night or early morning with nocturnal erections with a tube up the urethra that constricts and deforms everything!!! I am not sure how much either sex or discomfort from erections are an issue for her 87 year old disabled dad. So the pros and cons may not be as numerous as they are for someone 20 years younger.   And to be clear, the SPC also does require an actual surgery, again with General Anesthesia, which is part of what brought Laura to her concern about  HOLEP in the first place. Its certainly not 2 1/2 hours, but it is real surgery and General Anesthesia with intubation.   So there are definitely things to consider there.   I've also spoken to Laura off book and have talked about the dilemma of which way to go. It's a tough one. I am not sure why they've said Holep and not TURP, but they are both pretty similar, and TURP might be a little less time consuming,  altho it may be an age related  bleeding concern. I believe Turp would be more prone to bleeding. But it's hard to say whether its worth the risk of  general Anesth. to go the traditional more invasive route (TURP or HOLEP), with  quicker and more definitive improvement (assuming the bladder can get working again)  and a catheter for just a couple days,  versus avoiding the general Anesthesia but having to decide whether her dad would be able to tolerate the patience of waiting for improvement from REZUM (with the chance that it may not work) and possibly requiring another month or two of wearing the catheter, while also going through periods where it will likely get worse before it gets better , including possible severe constant urgency and heightened discomfort from the catheter due to added irritation from the procedure , etc.  Of course, if Rezum was a quick fix, like TURP,  with only a 40 minute twilight as opposed to 2+ hour general, then its a no brainer. But it's not, and at 87 there are definitely pros and cons on either side, and something to be said for getting it overwith with TURP or HOLEP  if they felt he could tolerate the general. But I would also ask about whether a TURP  could possibly be done under twilight ????   

  Remember, this isnt the case of  a younger guy trying to avoid retrograde ejaculation, which is a primary reason a lot of us look for alternatives like REZUM, but  is about the concern for tolerating a 2+ hour surgery under general. Otherwise, I dont think there would be any question that a HOLEP or TURP would make the most sense at 87 to get him peeeing again as quickly as possible and not have to wait through a couple possibly very uncomfortable  months of not being sure if it worked, possibly all  while still wearing a catheter.  On that note, I am at 3 weeks from my REZUM procedure, and still no real improvement to speak of.    By the way Laura, another thing to consider with the cath, Foley or SPC, is that he wouldn't necessarily need to wear a bag. If he is able to pullout and push back in a plug, or flip a lever on a Flo valve plug, he could just have a tube with a plug at the end that he removes when he needs to empty.  Or for that matter, even if he wasn't able to do either, it would still most likely be more comfortable for him and be just as easy for you to help empty, as I suspect you may have to help do with the bag as well. The plug would also still allow his bladder to fill and empty more like it would naturally. And if you did decide to go with  a SPC, it also provides the unique option that he could also still try to pee naturally  when his bladder fills (as opposed to having a constant flow into a bag ),  since he would have either option,.... the tube or the penis!!   ;-)   Anyway, I know there are no obvious or easy answers. All of us here have certainly learned that, But I hope I've given some more factors to consider from real life experience that can help Laura and her dad decide what's the best route. PEACE, Scott

A word of caution to laura00828, and to my other brothers-in-suffering.

Greetings!

Laura, something you said caught my eye:

"In the room where we were waiting for the consult was the Rezum machine.  The nurse came in and was preparing it for the next patient."

Rezum machines are single use machines.  In other words, it's a one-and-done.  The urologist pays, on average, $1,600.00 per machine, for the privilege of using it one time.  It is then discarded, recycled, refurbished, etc., not reused.  To do otherwise is to fringe on medical malpractice.  Hope this helps.  Stay vigilant my friends!

Alan  I read that to.  What if the doctor is recycling or refurbishing the machine himself.  I would think that machine would be in another room where it would be a way for germs. The nurse should not have been doing that with patients waiting.  Ken 

Alan,   what you are saying is not correct. There is an 84 page manual on the Rezum site that explains how to clean and reuse the device. What you are probably hearing or reading is that the machine is to be used for one patient at a time. In other words, it must be cleaned after each use. It's likely that the needle is a one-use needle, but clearly, the expensive steam generation part of the system is intended to be used many times.

Hello,

This was a very expensive looking machine with a cord and pistol like device with a long applicator attached.  Probably just he applicator is "one and done" . Nevertheless I wouldn't have let my dad have the procedure there as the conditions were so unsanitary. I did take my father to another Rezum dr and he said he wouldn't do that on my father and that it takes 3 months to work.  I guess they don't want to take a chance on an 87 year old on blood thinners.  However, he would "think about" doing Green light laser (isn't that even bloodier?) I haven't given up though and am trying to find a doctor who can show my mom and dad self-catheterization to see if it's doable (much better than wearing the catheter 24/7.) Thanks for everyone's input.

Laura good evening.  To me that does not sound right.  He would not do the Rezum on your father because of the 3 month healing time But he would put him through major surgery that may take just as long to heal on a 87 year old man?????Ken

@laura00828:  This was a very expensive looking machine with a cord and pistol like device with a long applicator attached

---

I am inclined to say that the overall Rezum machine is reusable and the "just the applicator is "one and done"" as you wrote.  I am thinking along the lines of other medical instruments that I have seen.

I talked to the family-member-MD who knew someone who had a greenlight laser TURP in his 80's.   Yes TURP is more bloody, but the greenlight laser cauterizes the tissue as it cuts, sealing the wound and reducing the bleeding.  I know someone who had a greenlight laser TURP in his early 60's (I will see him later this evening) and says that if one has a TURP, it should be a greenlight laser TURP.

The family-member-MD has an off-color "doctor's joke" about (pre greenlight-lazer) TURP and post-op bleeding but I wont go there on this forum.  The really difficult thing with your father is his overall health at his age.

Take care,

Steve

Kenneth1995, Good point. Steve

Hi Ken, That's odd, Because I was also told it was a one time tool  (the probe) that they have to pay 1600 for the procedure. Since my insurance wouldn't cover, they itemized the costs, and I also spoke to the doc about it.  I suppose they could have been referring to a "rental" cost, but that was not the impression that I got.  Perhaps the probe portion is one and done?

Hi Laura, Green Light is probably a little bloodier than REZUM, but its the less bloody version of the more traditional and invasive "TURP" becasue it cauterizes as they go. I think thats also why the one doc suggested HOLEP as opposed to TURP.  Kind of the same thing.    Since your dad is on thinners, i think they probably all want t to stay away from the straight ahead TURP, and are posing the options with less bleeding.   See my other posts about the pros and cons of a "TURP"- type procedure versus REZUM. I don't think its such a slam dunk that REZUM makes more sense for your dad, but I totally understand the concern about sedation.   Have you talked to any of the docs suggesting a more TURP-like procedure to see if  any of them can possibly be done under Twilight???  Given your dad's age and disability, I understand the one doc's point about REZUM being a more long term  process that may or may not work , and may involve significant discomfort during the waiting period. I also understand Ken mentioning that the other more invasive procedures take some time to heal as well, but the difference isn't the healing as much as it is the effectiveness. The TURP type procedures are effective right away, but yes, there is some healing, tho not necessarily any more than with REZUM. The difference is that the period of  REZUM healing is also the period of time that it takes to work at all, assuming it does work. As I mentioned in other posts, a lot of us here talking about the benefit of a procedure like REZUM over TURP type procedure may have factors that are on the REZUM or other alternatives pro side of the column that may not be relevant to your dad, such as retrograde ejaculation, or maybe a little bit of erectile dysfunction for a little while during healing, tho the risk of anything significant long term with TURPs (as opposed to removal) is pretty low.  So the pros and cons checklist won't necessarily look the same for us as it would for your dad who is 87 and partially disabled.   I think immediate relief from the problem is a much bigger PRO for him than it is for a lot of us who were willing to wait out the few months to give it a shot, and then go back to square 1 if it isnt enough relief.    I would really explore whether any of the TURP type procedures can be done under twilight. Perhaps you can ask your green light doc whether he is aware of any cases of that (for green light or any kind of TURP).  (By the way, as you probably know, he'll have to stop blood thinners for a couple weeks even for REZUM. or any procedure really.)  Hope you've gotten more helpful info and are getting close !!  Wishing the best for your Dad. It's a hell of thing to go through at any age. 

Scott,

      I misinterpreted the statement in a previous post, and that lead me to say what I did.

The steam generator is a multiple use device. However, the 'delivery device', which is connected to the steam generator and is inserted into the patient, is definitely a one-time-only device. My apologies for the broad statement that was misleading. However, I'm surprised at how expensive the delivery device is...    oh wait, no I'm not surprised at all!

Ken

Laura,

      I know that you're getting a lot of information thrown at you, and I hope that it's helping you and your family with this difficult decision.

      I know that the doctor that you talked to was being very cautious when he mentioned a 3 month time period before the Rezum would be effective. My personal experience was closer to a week. Granted, we're all different, and I'm a bit younger at 66, but I went from almost complete retention to being able to void naturally within a couple of weeks after Rezum. I'm told that this is not that unusual. 

I understand that it's not good to over-promise what the results might be, but it also doesn't help to be overly negative either. 

Ken

I printed up the procedure.  It explains how its done.  I think they either buy or rent the Rezum Generator.  I guess that is up to the doctors office.   That is reusable  But they have to buy the delivery device kit for ever patient.  I will ask my urologist when I see him next week.  When the Rezum representative came to there office to sell the procedure my doctor and his partner told them no because of the damage it does to the prostate.Take care and do your research   Ken

Hi Ken,

Thank you-I appreciate all the input.  I think the Rezum doctor said 3 months just because he didn't want to do the procedure for my dad and was trying to dissuade him.  He may be 87 but he comes from a family where people live to a 100.  He has the right to get some help too.  I am trying to find info about CIC so he doesn't have to suffer with the catheter 24/7.  I read about the ITIND which sounds promising, but I believe my father may have the dreaded median lobe so I don't know if he would qualify for the procedure.

Laura,

      I think that you hit the nail on the head there. That urologist probably sees your father as a potentially difficult patient (because of his age). But, as you noted, some people are in better condition than others at a given age. 

      I too had an enlarged median lobe. The Rezum procedure is well suited to that condition. I had two shots of steam to my median lobe and 4 shots on each lateral lobe. My prostate was initially estimated at 68cc and is now estimated at around 30cc. But of course the flow restriction is gone, which is the aim of the procedure.

     If I sound like a cheerleader for Rezum, it's because I've experienced the procedure, and found it to be an easy and painless procedure. I did however receive the twilight anesthesia and self-cathed for a couple of weeks afterwards. Other patients who received a local anesthesia and had a Foley catheter for the first week or two have experienced some level of pain and discomfort. However, I would guess that most of those men would go through the procedure again.

Ken

Hey Ken.  This is just for my information.  So you had 10 injection into you prostate.  It worked great  I am happy for you.  Can you tell me if you ended up with retro.  This is just for my file on Rezum  That you  Kenneth

Ken,

    I wish you weren't so obsessed with retrograde ejaculation. It seems that is the only thing that you care about. 

    To answer your question (and actually I've answered your question on this forum before), the answer is no. Like the vast majority of men who have undergone the Rezum procedure, I did not end up with RE.

    If you're that concerned with RE, please focus your efforts on the forums where people are talking about TURP and other surgical procedures where the chances of RE are near 100%, about opposite of Rezum. 

Hi Ken,

Yes I had high hopes that Rezum would be the answer for him but there must be a reason they don't want to do it.  The second Rezum doctor said that it was only for prostates up to 75.  My dad is 85.  I am thinking about trekking out to JerseyUrology as he said they treat larger prostates. I see how this totally turns your life upside down and I'm glad it worked so well for you.

Well pardon me.  This is for my survey.  And by the way out of the last 36 men that have had the Rezum procedure 20 worked 16 did not work.  Out of the 36 men 16 ended up with retro ( 6 or more injection ) and out of the ones that did not work 5 had so much scare tissue they ended up with having a Turp to fix the problem which they did not want in the first place ( That is why they had Rezum ).  Every man can pick what ever he want.  He just has to do his own research.  Not ever man has the same concerns like not all procedure are for everyone. I am sorry you think I am obsessed with retro.  I'm not the only one on here. My concerns are mine concerns. .At 63 I'm not giving up anything even if I get cancer of the prostate. No doctor is going to tell me that I have to have it removed.  If they can't guarantee I will keep my ejaculation.  I will live with it till the day i die.  That is my right.  If that is the way I'm going to go so be it.  Have a great day I'm glad your worked You doctor knew what he was doing    The other Ken

An anonymous forum will have inhenerent bias.

Statistically, about 2-5% of men will have retrograde ejaculation after rezum; the vast majority of men will have significant improvement of their symptoms measured by a standardized scale such as the aua symptom score.

I always tell men that there are no guarantees; if the thought of retrograde ejaculation bothers you to the point that a 2-5% chance of it is a deal breaker, stick to medication or consider a urolift procedure.

Urolift is what I had 3 1/2 years ago and still wide open.  Retro with the Rezum is more then 5 % and it does not work for all men. What I wrote in the other post was done from the men on here for a year in a half.  I think Rezum is a good procedure and you should be told before they go in how many injection you need.  And if you don't agree with that number you should have the right to say no.   I have notice from the men that had over 10 injection that it may work but they end up with retro and they are not happy.  Most of the men that only have 4 or 5 work well and have no retro.  But all men have a right to do what they want.  And yes retro is a deal breaker.  I will say it again.  If I get cancer of the prostate  It is going to stay right where it is at till the day I die.  Have a great day.  Ken  

Jersey,

I have been off the board for about 6 weeks as I have been out of town.

I decided that I want to try rezum. My prostate size is 80 and I have a median lobe.  I tried to cic to keep my bladder good but I had a lot of trouble doing it and stopped. My current urologist who mentioned rezum to me has done very few and when I bring up specific about it he is very vague. I’m in nyc and was told of a specific doctor that has done at least 50 of these. Do I need anything to bring to this dr to discuss rezum or should I just go to him , tell him I want to do rezum and see what he says he needs to do first.

What would u ask for or need to do if I came in and said I want to do rezum.

Everyone who is interested in this therapy is recommended to have:

Medical history

Physical exam

Pelvis ultrasound to estimate prostate size (if another modality hasn’t been performed already)

Urodynamics to evaluate bladder functionality

Cystoscopy to rule out structure and other pathology

Does a “weak bladder” automatically disqualify someone from the procedure?  Couldn’t it just be weak from having retention?

1- I assume that the new dr does and exam and an ultrasound in office. Is that correct?

2 -I have not had a recent urodynamics. Would I have my current urologist do that and bring it with me or does the dr I want to discuss the procedure do that ?

3 aAlso , I have seen my current urologist for many years and it may seem strange but don’t want to hurt his feelings or ruin our relationship as I’d like to continue using him .How do I mention that I want someone else to do the rezum with more experience?

I don't think you would hurt his feeling.  He would want the best for you.  Take any test you have had done all ready but the new dactor may want his own.  Good Luck  Ken.    

Hello-

My prostate size was identical to yours. I’m 65 and in good health otherwise. I had Rezum on 5/16. Nothing but good results. I highly recommend it. Even if it doesn’t work well, you can always go to something more radical later.

I had complete blockage of urine prior to Rezum. Now I feel like an 18 year old again. I wish all surgeries worked as well.

Take care, Joe1953

Joe, thanks for sharing. I am curious. How long did you suffer from BPH before, or you just decided to go for Rezum after your blockage ? Hank

Thanks joe.

How did u pick your rezum doc?

How many rezums has he done prior? 

Did u talk with a prior patient?

Do u have large median lobe and had he done them before?

Thanks

Laura - I think Jersey Uro would be an excellent choice if your Dad can handle the trip. Many docs (including Jersey Uro) do Rezum on prostates even larger than your Dad's and it typically works well, but the recovery is longer. He's familiar with your Dad's history and sounds like he might be more willing than many to consider doing Rezum on him. I'll bet he can fit him with a superpubic cath with no anesthesia too.

Ken, Keep asking the retro question if not offered. This is an important piece of information that many here are interested in. The more data we have the better.

Jim

Jersey also selectively sends patients home with a Spanner Stent which I believe Laura has shown an interest in.

ChangeJobs,

Your current doc may or may not react well but at the end of the day you owe it to yourself and family to go with who you think will perform it the best.

Jim

Laura,

JerseyUro mentioned having urodynamic testing prior to Rezum. Urodynamics will give a good indication whether your husband will qualify.

Jim

Sorry to hear that you stopped CIC because it didn't work out. I know you did try. CIC is not for everyone, regardless what some lucky people claiming that it's easy as brushing teeth. I know because I have been there. What are you doing currently to alleviate your problems, while waiting for Rezum ? Hank

Hank,

Who ever said CIC is for everyone like you infer? For many of us CIC is as easy as brushing our teeth and had radically changed our lives for the better. For those who can't or find it not to their liking, there are other options. The last I heard, you still self cath on occssion. If you don't like it, maybe time for you to try something else.

Jim

 Im just trying to go more. Before I went away the dr told me I was still able to pee enough on my own without worry to the bladder. Unfortunately since I’ve been back it’s getting much harder to get out pee out so realize I need to do something.

I would consider traveling outside nyc to go to a known dr like jersey or the guy in Illinois ( think McCabe) but concerned about followups. It seems that you have to go back to take stent out and also what happens if something isn’t right- if the dr isn’t near you, whom do u go to take care of you?

Hey hey Jim, I am not inferring any thing. You must be reading the tea leaves. I am just saying that regarding CIC, some people are luckier than others, just like any procedures discussed an taken. I am self cathing still, but with reluctance and difficulty, instead of ease and enthusiasm, like some people. Hank

Depending on what part of New Jersey, it maybe a Subway from NYC, if I remember correctly. Nothing is guaranteed but Rezum is the best currently when all things are considered. Wish you the best. Hank

Hi--My dad already did the urodynamics test which showed a weak bladder.  However, the Holep dr didn't seem fazed by that and seemed enthusiastic about the outcome.  Nevertheless two Rezum doctors said they wouldn't do that procedure on my dad. They were not clear why. I think they don't want to take a chance cause he's almost 87 and on blood thinners?

Hi Laura,

You might call and find out the exact reason.

Jim

Hank, I'm lucky if I can read the paper sometimes.

CIC works differently for people. In my case, it rehabbed my bladder to the point where I may never need a surgery. In your case, it's buying you time to decide how to proceed. For others, it's a better alternative to a Foley or Suprapubic. So I think we're all "lucky" in that sense that one more option exists and that's all I try and point out here.

Jim

@laura00828:  Hi--My dad already did the urodynamics test which showed a weak bladder.

----

Hi Laura,

Just to second Jim on asking the exact reason why the Holep doctor seemed enthusiastic about the outcome when the the urodynamics test showed a weak bladder.  That would be a big red flag for me.

When the bladder is weak from being badly stretched out from Acute Urinary Retention from BPH, it does not have the compression to push the pee out so prostate surgery wont much.  A few of us on this forum had a lot of pee taken out when the first catheter was put it.

So self-cathing is like physical therapy for the bladder.  Unlike my shoulder which was twice dislocated so I had to lift (light) weights to rehabilitate it, you can't lift weights to rehabilitate the bladder. After 6 months of self-cath, I am seeing positive results.

In 8 days, I see the urologist for my urodynamic tests which will help to determine the next step.

Take care,

Steve

Hi Steve,

Right--I understand that but he said you can get a lot of that back.  I've even read on here where some had "floppy" bladders but did well. My father's right arm is paralyzed but I'm seeing if my mom can help him learn CIC so he doesn't need to wear the catheter 24/7.  It's a long shot but we won't know unless we try. Question:  How is CIC like therapy for the bladder if you're not using the muscles to push the pee out?

CJ,   When you tried CIC did you use the red rubber catheters, with water soluble lube ?   They are the least abrasive.  I was trying some of the hydrophylic  catheters and found they didn't get lubed well by the  breakable water pack,  They were actually sticky and caused abrasion and bleeding,  I found they worked alot better with the water soluble lube applied, but then you might as well use the red rubber caths with lube.  The Coloplast speedicath is lubed well because the water is in the packaging but it was too stiff for me.

Regards,

?Thomas

CJ,

The Urologist in Illinois is Kevin McVary at Southern Illinois University in Springfeild.  He participated in the Rezum clinical trials in 2015.  Someone mentioned a doctor at the Cleveland Clinic also.  Jersey Urology can't be too far from NYC.  He has mentioned good results as far as RE goes and uses twilighting if requested.

Good luck,

Thomas

Jim,

I agree that it’s a great option. I may have to go back to it or use it as needed.

I don’t know why it caused false passages. If I could get it to work I would keep doing it

Which catheter are you using currently ? I am using Coloplast speedicath, but experience occasially bleeding, even after 2 years, perhaps because like you mentioned as too stiff. Thanks. Hank

I do not know the red rubber caths. Who makes them and do u add lube separately ?

Do you still cic?

How would you do follow up on someone that’s not close?

Jersey is probably the closest but a few hours by train

Sorry Laura, but if your father can not do CIC by himself, because he can only use one hand, he shouldn't try CIC. CIC can be difficult even for people with 2 hands, especially at the beginning. There are serious risks of getting his uretha damaged if doing it incorrectly. Having someone else doing it for him will even raise the risks further.

Did you consider Green Light Lazer ? It's basically a TURP but I've read that bleeding is minimal because it's done by Lazer. Hank

@laura00828: Question:  How is CIC like therapy for the bladder

---

Hi Laura,

This would be a good question for Jim to chime in on.  The first part of the PT is to keep the bladder from overfilling by self-cathing so that it can recover and shrink from being so stretched out.  It was overfilling (I had 2 liters taken out), due to BPH blockage that created the bad bladder in the first place.

From my own observations over the last 6 months, after the bladder recovers from being stretched out and is back to a normal size, I notice that at 200 plus ml, I feel like I need to pee.  At over 300 ml, the feeling is even stronger.  Finally on those occasions when I go over 400 ml which is not advised, I have a super strong urge to pee.

This is telling me that my bladder is getting bigger and smaller depending on how much pee is in it, the second part of the PT process perhaps.  Of course, the BPH is totally blocking me so I need to self-cath to get anything out.

I hope that this helps.

Steve

Hank,

     Which Coloplast Speedicath are you using now? I started with FR16's and found that they worked fairly well for me. Then I tried the FR14's which are smaller in diameter, thinking that they might be easier to use. But I found that they were a little too flexible. So I went back to the FR16. Those all had the coude tip, which I found to work well in getting around some of the anatomy.

The convenience of the prelubrication is certainly a big benefit to keeping everything as free from contamination as possible. I don't have experience with any other brands, but after reading that JimJames liked them best, I stayed with them. I still have a few dozen that I need to donate somewhere. 

"When the bladder is weak from being badly stretched out from Acute Urinary Retention from BPH, it does not have the compression to push the pee out so prostate surgery wont much. "

Steve, this isn't true. Many people on this forum with a weak bladder and with acute urinary retention recover by prostate surgeries. Hank

Thanks Ken. I am using 12fr straight. Tried 12fr coude before but it caused bleeding more often. Tried many other Coloplast speedicath but the 12fr straight is the best, but still caused occasially bleeding, which is more disappointing than problematic. Actually, the 10fr straight is the best as far as not causing bleeding, but it takes a long time to empty. Hank

Laura, "weak bladder" is too vague. We men here with prostate problems most have weak bladders, and many of us recovered nicely with surgeries. The urologist should be able to tell your father how weak or too weak it is to be helped by surgeries. Hank

@ Hank: Sorry Laura, but if your father can not do CIC by himself, because he can only use one hand, he shouldn't try CIC. CIC can be difficult even for people with 2 hands, especially at the beginning.

-----------------------------

CIC is the "go to" method of bladder emptying in the SCI (spinal chord injury community). Many there don't have full use of both hands. There are techniques and devices available to facilitate CIC for the physically impaired. You are also overstating the risks and there is absolutely nothing wrong with someone helping, it's done in hospitals and nursing homes all the time and routinely taught to family members who act as caregivers. I'm not saying that this is the best course for Laura's dad, but if they are willing to try, the benefits far outweigh any of the risks you mention.

Jim

 

CJ / Hank

The red rubber caths I use were ordered for me by my urologist.  They are made by Bard, in Covington Georgia, and have the word GentleCath on the packaging. If you search the internet you will find other manufacturers that may be cheaper, but I don't know about the quality, Bard seems to be good quality. I think the material is actually red latex.   The lube is applied seperately and was made by McKesson.  The Urologist said it is the same as KY jelly,  the sex lube.  There may be other brands like surgilube, but whatever the lube it has to be sterile.  The last shipment I got had small individual packets of the lube that you squeeze out, which are useful for cathing away from home.  One other thing is that the red rubber caths can be washed and re-used.  I have used them up to three weeks 5 times per day, but if you had to, you could use it once and throw it away, when cathing away from home.

I got samples of another catheter, Cure HM14C hydrophylic that did not work well by its own lube, (caused bleeding), but worked very well with the water soluble lube. It has a stripe all the way down the length of it, as well as a ridge on the funnel, so you can always tell the exact orientation of the coude tip. It is a single use catheter.   The catheters I have tried with a breakable water pack to activate the hydrophylic coating do not seem to lubricate well.

Hope this helps,

Thomas

@ Hank: Sorry Laura, but if your father can not do CIC by himself, because he can only use one hand, he shouldn't try CIC. CIC can be difficult even for people with 2 hands, especially at the beginning.

-----------------------------

CIC is the "go to" method of bladder emptying in the SCI (spinal chord injury community). Many there don't have full use of either hand. There are techniques and devices available to facilitate CIC for the physically impaired. A family member helping out is another possibility and any good urologist or their nurse will show you how. It's not rocket science. Another poster talked about the possibility of urethral injury but this was overstated. Again, CIC is used in the SCI community where many have no feeling whatsover to protect them from trauma and yet the benefits outweigh the risks. Within a short period of time CIC is a quick and painless procedure for MOST men. And if it isn't, then your dad has always has the option to discontinue CIC and try something else. Bottom line is that if he wants to give it a try, no reason not to.

Jim

I'm not saying that this is the best course for Laura's dad, but if they are willing to try, the benefits far outweigh any of the risks you mention.

Jim

Bard has a nice line of red rubbers in both straight and Coude. If you're used to stiffer plastic catheter, you might have to go one size up iwith the more flexible red rubbers. You use an external lube with them like Surgilube. A single catheter can be used up to a week or more so if your insurance doesn't pay the savings can be very significant.

Jim

Hank/Steve

It seems to me that if you have a procedure that widens the urinary canal, it would do something similar to catheterization in allowing you to empty the bladder more than before.  At first you would not be able to empty completely but over time the bladder would shrink until you reach a more normal condition.  In other words you would not have instant improvement from the procedure but may take longer to recover.  

Thomas

@thomas37368:  The red rubber caths I use were ordered for me by my urologist.

---

Those are the same caths that I have been using.  They are reusable.  After getting a minor UTI (quantitative and not qualitative - the numbers showed a UTI but I never felt anything), now, before and after each use, I soak them in isopropyl alcohol.  A little bit of lube goes a long way, KY or other.  I can't say that I love them, but I have no complaints

Steve,

I tried wiping them with alcohol before use and letting them dry but had a burning sensation a couple times, so now only wipe them with alcohol after use.  How long do you let them dry out before use ?

Thomas

thomas37368, Good point. Steve

@thomas37368: I tried wiping them with alcohol before use and letting them dry but had a burning sensation

---

I can't say that I have ever timed how long I let the catheter dry.  About as long as it takes me to wash my hands and shake them out to dry before I self-cath.  Once and a while, I get a minor burning sensation from the alcohol.  When I apply the lube, it mixes with any remaining alcohol which probably dilutes what has not evaporated off.  I don't use much lube.

Steve

To oversimplify, CIC gives the bladder muscles a rest so that they can potentially become strong enough to work like they used to. A Foley actually does similar, but CIC is potentially better because inbetween the catherizations your father can try and use his bladder muscles which can help the process along. As I mentioned in previous posts, many people who self cath have physical disabilities and overcome them with practice and/or specialized devices like a "third hand" apparatus. Having your mom or caregiver do it for him is another option. If it doesn't work out, no problem, you just go back to either the Foley or preferably a suprapubic after consulting with your doctor or possibly a new one who does more of these. You may be surprised that you dad can figure out a way to do it himself with one hand because you really only need one hand on the catheter. The penis can be held in place by a specialized apparatus. Go to the Manfred Sauer website, and search under "products" then" ISC Single use catheters" and then scroll down and  and check out: penis support, freehand trouser hold, Cath-hand and Ergohand Insertion Aid.

Jim

 

"When the bladder is weak from being badly stretched out from Acute Urinary Retention from BPH, it does not have the compression to push the pee out so prostate surgery wont much. "

Steve, this isn't true. Many people on this forum with a weak bladder and with acute urinary retention recover by prostate surgeries. Hank

----------

I don't think there's much of a disagreement here if you insert the word "may". In short, a weak bladder may not respond well to surgery depending on how weak it is. Urodynamic testing will help determine this.

Jim

Ken, Someone mentioned putting your index finger over the plastic hole on insertion. I have tried this and it seems to be the equivalent of stiffening the catheter half a size. So an FR14 might pass through the urethra like an FR15, which of course doesn't exist. I also find that once I hit the resistance with my FR 12, I also get that flex bending, however if I sort of stop at that point and regroup for say a second while still exerting just enough pressure short of the bending point, and then give it a subtle back and forth twist, it will just slide past.

Jim

Jim

Thanks Thomas. My experience with Cure HM14C was exactly as you described, not enough lube and bleeding. I might try the Bard. How do you keep it clean to be reused ? Hank

Thomas, what uretha widening procedure are you taking about ? Hank

Hi Doc where do you get the statistical results? I asked one of my Urologist's partner's and his nurse told me they were seeing about 10% - is surgeon skill a factor?

Hank,

I usually wash the Red Rubber cath with the same anti bacterial hand soap I use for washing my hands.  For a week or two I also used plain hand soap with no problems.   I also run water through the center to flush out the inside of it. After I have washed it I wipe it first with a paper towel then with an alcohol wipe I got from walmart, 100 wipes for $1.67. Then lay it on a clean towel to dry.  I have been using this method for about two months with no UTIs.   The longest I have re-used one catheter is 3 weeks, 5 times per day.

I found the Cure HM14C can be used by applying the water soluble jell for lube, otherwise it is like using a cathter with no lube.  The thing I like about it, is the full length stripe, that tells you the exact location of the coude tip.  It can be used only one time though.

Thomas

Thanks Thomas. Do you just wash your fingers before applying the lube to the catheter, or do you wear gloves ? How often do you bleed, if at all, from CIC ?Hank

Hank,

I meant any of the procedures, TURP, Rezum, Urolift, FLA, etc.  If your bladder is stretched out you will not even get a signal to pee until you reach your high pre surgery volume, then just empty a little until the signal stops again, leaving a large post void residual. This gives you and the Surgeon the impression the Surgery did not work, and it skews the statistics for the surgeon, so they are reluctant to do a procedure on someone with a bad Urodynamics test.  However over time more urine will be eliminated each time, with a wider urethra, until your post void residual becomes more normal, and the bladder shrinks. It may take a few weeks to many months.  However there may be some bladders so badly stretched that they never recover.  

Thomas

 

@thomas37368 :I usually wash the Red Rubber cath with the same anti bacterial hand soap

----

Just to second this:

Before:

1) Soak in glass jar of 70% isopropyl alcohol for a few minutes

2) Air dry on fresh paper towel for a few minutes while I wash my hands

3) Remove with forceps that were also soaked in alcohol

4) Lube and go...

After:

1) Wash with anti-bacterial liquid hand soap that I use to wash my hands

2) Rinse outside and inside with 120 degree F water.

3) Soak in glass jar of 70% isopropyl alcohol for a few minutes while I record volume

4) Remove with forceps that were also soaked in alcohol

5) Air dry on fresh paper towel for a few minutes

6) Put in plastic bag until next use

No UTI's for at least 3 1/2 months!

Steve

thomas<

How do you apply the lube? i was using the one time  the bard go hydrophlic , the bard magic3 go which are prelubed or the speedicat which are also prelubed.

the bard go has a sleeve so you dont have the touch the catheter directly, which i like.

my concern on putting on lube has also been uti's.

I bleed alot putting the caths in. if i didnt, i would cath more often

 

Thanks Thomas. I know those procedures. When I read "urethra widening", I thought it was something else, perhaps a new procedure that you just invented. 😀 Hank

Wow Steve ! So many steps to prepare a catheter ! No wonder that have pre lubed ones. Hank

It's probably between 5-10%; better than anything other than Urolift. Most patients don't really care, but certainly the treatment can be confined to one side if it really is an issue for someone.

CJ,  At the Urologist's office that showed me how to cath, they squeezed some of the lube onto a sterile gauze pad.  Then they stuck the tip of the catheter in it while rotating it and coating the tip on all sides. You can also go up higher on the catheter while rotating to coat it higher up.  I have also just squeezed the tube onto the catheter then spread it around with pre washed fingers, trying to use a finger other than the ones I use for advancing the cath.

Thomas

thanks, the little I know about Rezum is it's done with imaging and guided by computer ? Does that mean any decent surgeon can do it?

Mike,

The Rezum steam probe has a camera which allows the doctor to view a video screen showing where they are placing the  probe.  The doctor does the placement there is no computer involved.

Best way to learn is to visit YouTube web site and search for Rezum.

The best one is about 35 minutes by a doctor who was on the team doing the clincal Rezum trials.

You can also go to Rezum web site.  My Urogolist was happy that I had did educate myself on Rezum,  so that I could ask more informed questions and she had to spend less time on the bacis and more time on what she knew was important for my paticular situation

Hope this helps you out.

Allen

allen98488@ :The Rezum steam probe has a camera which allows the doctor to view a video screen showing where they are placing the  probe.

---

Somewhere (maybe here), I came across something about also using real-time ultrasound that has sufficient detail to identify and then avoid the places in the prostate that would result in RE.  Maybe this was done at a research/teaching hospital.

Steve

Steve

Thanks Jim  I will  Men need all the information they can when picking a procedure.  They need to know all the pros and cons.  They need to voice there concerns.  And they need to ask if it is not talked about  Ken

Hi ken19524,  Maybe it's me, but the following is taken straight from the PDF manual on the Rezum site:

10.2 Rezum Delivery Device

The Delivery Device is shipped sterile. If the package sterile barrier is broken or missing, do not use the product .The Delivery Device must not be reused or re-sterilized . It is for single use only

My take was that while the generator can be reused, the so-called "delivery device" cannot be reused.

Hope this helps.

.

 

JerseyUro,

Is it hitting the ducts or the overall insult that causes retro? I thought you previously said it may be the latter. If so, how would treatment confined to one side translate into both retro and overall results?

Jim

Jim

You can get the lube, for example surgilube, in small, single use packets. Just was the outside in hand cleaner, open them up and either squirt or run the catheter through it. That's pretty close to sterile. Add non powdered gloves if you want.

Jim

Yes Alan  That is one of the safety issue.  There are a lot that a doctor has to know before he does the procedure.  I printed up the 24 page booklet and it give you all the information on how the doctor does the procedure.  It also tell you that The Rezum generator ( Reusable ) and The delivery device kit and accessory. ( Disposable ) I think this is from the same article that you read. It is very interesting to see how it is done.  I like the one statement.  2.1 Warnings: Prior to each treatment know where the verumontanum is in relation to the tip of the shaft.  All treatments should be place proximal to the verumontanum.  They avoid this to stop retro.  I think this article is very useful Men that are looking to have this done.  I would suggest printing this up or just reading it to know what is going on Take care  Ken

@kenneth1955 :  I printed up the 24 page booklet and it give you all the information on how the doctor does the procedure.

---

Ken,

Can you please post the link where we can download the 24 page booklet?

Thanks,

Steve

Hello,

(sorry if this is not the best place)  but does anyone know how big a prostate that UROLIFT can be done?  I never pursued it because my father has 85 g prostate, but now I read they are doing larger prostate sizes. 

 

Hello Hank-

I had had BPH for about 4 years prior.  I used Flomax until it quit working.  All at once I was desperate. My urologist is in a practice with 32 other urologists but only several do surgery.  He told me of Urolift and Rezum.  I requested an appt with the surgeon that does these.  He examined me and told me urolift would probably not work due to my anatomy.  He said he preferred to do green laser but I could try

Rezum.  I chose Rezum due to the less destruction that's involved.  Worked wonderfully for me.  Very painful but worth it.  My only concern is .....how long will this last?  Will it grow back?  The surgeon could not answer these questions.  It's just to new a procedure to know.

take care, Joe1953

Hello-

The urology practice that I go to is HUGE.  Thirty-two docs doing nothing but urology.  They seem to be well versed on the latest things.  My primary urologist referred me to the surgeon in the group that does laser,urolift, and Rezum.  I believe he had done in excess of 30 Rezums prior to me.  I DID have the enlarged median lobe.  This is precisely why he told me that urolift might be a waste of time.  It was either green laser or Rezum for me.  Believe me...I had to do something.  Oftentimes the BPH left me in pain.  I had the resume done and have never been more pleased with modern medicine.  I've had surgery (on other body parts) that didn't always pan out as I'd hoped.  This did and i'm grateful.

Take care,  Joe

@Joe1953: My only concern is .....how long will this last?  Will it grow back?

---

Given how Rezum kills prostate cells and then relies on necrosis for the body to get rid of the dead cells, "how long will it last" is the big question and yes it may grow back.  Still, I would rather do Rezum than any TURP (greenlight laser being the best), given TURP's "damage factor".

Because Rezum has not been around for long, we don't have much of a period of record to know what happens over time.  If Rezum results last 10 years though, we have 10 more years for the technology for prostate surgery to improve and 10 years is a lot of time for technology to improve.

Steve

Good evening.  I just read a few articles on the Rezum procedure.  The trails they did was only a 2 year trail.  They have no more data on it.  ( I think they should get a hold of them guy's that were in the trail.)  In another article they said that they are hoping for 3 years or more.  They have to do more research.  Just for your information.  Urolift is over the 5 year mark  Have a good day all  Ken

@kenneth1955 :The trails they did was only a 2 year trail.  They have no more data on it.

---

Ken,

Take it from a retired scientist, there is now more data than just the 2 year trial.  NxThera did 2 years of trials before the FDA approved Rezum at the end of 2015.  I just read an article in the April 2018 issue of The Journal of Urology (Volume 199, Issue 4) and there now are publications of results with a 3 year period of record.    Here is the link:

https://www.sciencedirect.com/science/article/pii/S002253471842753X

This is to be expected with a new procedure.  My experience has been that it can take up to a year between when a publication is first submitted for review and when it is actually published.  I would surprised if there are not already other publications with a 4 year period of record that are currently under review and will be out in the next year.

Steve

Jim,

So u open the single pac on the top and bottom and run the cath through that way?

Kenneth,

Can you post the link to the 24 page article, or can you PM it to me ?

Thanks,

Thomas

Sorry this is so late.  I am not getting notified of e-mail been like this for 3 days.    Thomas the one that I printed up  You can get to it on internet.  Just put in Rezum Procedure Instructions.  It will be down like in the middle of the page.  It said instructions for the Rezum procedure  Hope it help it does give a lot of information on what a doctor has to know and other safety figure.  Take care  Ken

Sorry Steve I have not be gettin e-mail for 2 days  I don't know how to do it. ( link it to the page )  I just check again.  If you put in Rezum Procedure Instructions It is in the middle of the page. You can't miss it. There is a lot of information about the machine and what the doctor has to know to do it. There is also a picture of section of the prostate where the needle show be placed.  Good information for anyone looking to have it done.  Ken  

I twice posted the link to the PDF from NxThera entitled "Instructions for Use Rezum ®  Delivery Device Kit for BPH Model D2201" and both times I got the following message: "This reply is waiting to be moderated."  Just do an Internet search with the search engine of your choice for "Rezum Procedure Instructions" as Ken recommended.  The 24 page PDF looks like some good reading for tomorrow

So who is the moderator for this forum anyway?

Steve

Steve that is the way it happens sometime.  There is a lot of information with in the pages.  Ken   MODERATOR  if you read this I am not getting any e-mail going on 3 day.  I have to check every 1/2 or so if I have any that comes in.  Sorry Steve      

Hey Joe.. I had REZUM 1 month ago, after being Cath dependent for 6 months. Still on the  supraPubic   cath, so not enough improvement to be confident  enough to remove it yet... But I am peeing a little more consistently on my own. How long was it before you had really obvious improvement?..., and did you continue to improve after the 1st month ?   BTW, theoretically ALL the non-removal procedures have the possibility of regrowth, even a TURP.  Its just that the TURP is patently more destructive. It is generally not a problem to expect ten years of durability.  But there are definitely TURP redos as well.  That is the big question with Rezum,,, will it go beyond the 3 or 4 years that are the extent of most studies at this point. Who knows. My guess is it won't last anywhere near as long as TURP, since it isn't causing the same  level of destruction.  BUt we may very well find that they can last as long. My doc was hopeful and says there is no reason why it couldn't end up lasting 8 to 10 years, but no one yet knows  :-) !   On some level , each person is different, and there are already many cases of it not lasting more than a year or two, while others  are 3 and close to 4 years out and still effective.  Of course it will ultimately come down to what is the average for durability. But at this point, even if I get another 2 or 3 years (assuming it improves further from here and I get ANY years!!!), then at least it opens up the opportunity that there will be even more advanced effective  procedures by then .  Let's keep our fingers crossed that it lasts for many years to come!    Scott

Good afternoon.  Every man has the right to pick any procedure that they feel that will be best for them.  But Rezum should show improvement in 1 to 3 months Scott I feel sorry for what your going through.  I hope it improved faster for you.  I read the same thing about going to last at least 3 year.  It is still new How many injections did they give you..  I have been following Rezum for the last 2 years on this site.  There are a lot of men that the doctors have gone overboard and giving them 10 to 12 injection Most of them did not work and they ended up with retro.  5 ended up having to have a turp done because there was to much damage.  Most of the men that had no more then 6 injection and under have all work well.  Within a month they were peeing on there own.  I did not have the Rezum procedure  I did not want any side effects.  So after being on Flomax and Rapaflo.I had the Urolift done  Had 4 clips and it's has been 3 1/2 years.  They said it should last 5 years but they have talk with some of the men that were in the trail and most are doing fine.  That is like 7 years.  I would do it again.  If my prostate get bigger I would have a couple of clips put in. No problem.  I wish you well and I hope all go in your favor.  God Bless.  Ken  .  .

I was definitely one of the Unlucky ones. I really wish I could have done CIC. I don't think I would have accepted it as the final solution, but I definitely would have preferred it to getting the SupraPubic (or any Stay-in catheter) until deciding on and scheduling a procedure.  But for me it was excruciating....I mean more painful than I ever even could have imagined--- literally self  torture the handful of times I tried to force myself to get used to it. Also caused lots of damage and irritation, so ultimately just contributed to my problem getting worse due to even more inflammation, etc.   Docs said I was just one of the unlucky ones whose prostate was positioned to just not allow passage without extraordinary pain.  I did try a few different types,  but my pain was so extreme that I know there is no brand of CIC cath that would have worked for me. I was pretty bummed.  The irony is that when i first tried, I thought OMG, this is going to be amazing...I can't believe how easy and painless it is.  My fear was that even just the initial insertion was going to be unbearable!!    But I didnt even feel a thing!!!   Then about 2 or 3 inches in (every time), even BEFORE getting to the prostate, which I have never understood, it was as tho i was shoving sewing needles into the tip. I think I may just have some overactive nerves as part of my plumbing! ( since I have issues with the balloon in bladder also that come and go).   If I could manage to somehow Push through shoving the sewing needles into my penis, lol,  then the resistance from the prostate came next and there was another entirely different intense pain to add to the party.   I was so upset, because for that first inch or two, I was able to experience how easy and like brushing teeth (even easier!!) it would be for men whose entire  experience is like that first couple inches for me.    So oddly enough, the moral of this story is that  for sure every guy should try it first, because there is definitely the possibility that it will be easy and completely painless all the way through!!! , as it apparetnly is for most.   But I was one of the unlucky ones,  so I had to bite the bullet and have a Supra put in several months ago.

 Had REZUM one month ago. Still have the Supra in as insurance. Not enough flow yet to go without and feel safe, but still hoping!!!  sooooooooo hoping!!!!!!!!

Hi Laura, they can definitely do prostate larger than 75.  By some accounts mine waseven  larger than that, tho I think the more accuate Accounts had it at around 60 to 70. But my doc performed REZUM on a patient with 110 gram prostate, and it was successful (so far a year and a half out). He was cath dependent before the procedure, and had cath removed at 4 weeks and has been peeing on his own with no problems since!!! So his  was even more successful than mine, with a much larger prostate!!!  A lot just depends on the person, as well as where the problems are, as opposed to how big it is overall.   He also only had one more injection than I did!!!   I really think another main reason docs have been reluctant to do REZUM  for you dad at 87  is the concern about the long post procedure issues and road to improvement, versus getting immediate relief from a more traditional procedure.  Were you ever able to figure out if there is any possibility of doing any of the more TURP-type procedures under twilight ??  I suspect Jersey would  know the answer to that....Hoping you and your dad have gotten further along!!   Best, scott

@scott95643:  That is the big question with Rezum,,, will it go beyond the 3 or 4 years that are the extent of most studies at this point.

---

That gives us 3 or 4 more years for the prostate surgery technology to improve and a lot can happen in a few years.  Maybe there will be a Rezum 2 or something better?

What we do know about TURP, the so called "gold standard" is that is is more destructive than Rezum, even with the greenlight laser technology which cauterizes while it cuts (or seals as it slices should you prefer).  Before greenlight laser, TURP patients bled for a long, long time.

As long as men continue to get BPH, there is incentive for prostate surgery technology to improve and for urologists to adopt the new and improved technology.  We should not settle for yesterday's technology which is why we are on this forum!

Steve

Hi Scott, do you have any problems with the Supra ? Hank

i"ve been able to pee on my own for the most part, but still not steady and confident enough to remove the Catheter. We are doing a test for next two weeks and I wont unplug that catheter at all, unless i get to serious retention emergency. Going to see if I pee enough to get thru the whole two weeks peeing on my own. Wish me Luck ! 

Scott I wish you all the luck I can give you.  I will say a prayer for you.  God Speed  Ken

Its hit and miss. First week or so was painful at the incision, but ok. After that, was great for a while, and could pretty much do anything, maybe a couple months. But then started having a lot of irritation and sensitivity with the balloon rubbing against bladder.   On and off  very difficult to get around in any active way. Might have something to do how i had been taping it down and angles inside the bladder, so I am trying a little different method. Also leaving it uncovered with no tape or bandaids  more often so that it moves more freely and sits at the angle it wants!  Past couple days have been better,  so i may be on to something, I hope!   Either way, I certainly prefer it to Foley in urethra, and you can  otherwise do everything normal sexually, and also have the option to pee on your own. It's allowed me to have periods where I was able to pee some on my own, which makes it a lot better when you're out and about. At least you're able to do a quick visit to the Loo and pee enough to hold you over for a bit instead of having to deal with emptying a bag,  unplugging the cath  or doing a CIC.  So as options go if you have to have a catheter, it is definitely better than urethra Foley, and maybe even more convenient than CIC if you are at least able to pee some on your own. I think having the Supra allowed me to develop a little more ability to pee on my own, or at least left that option/door open in case things happen to shift a little bit, or  the prostate calms down and gives you a break for whatever reason.   I was unfortunately completely unable to CIC. For some  doing CIC is probably preferable to having an open hole in ur abdomen and another hole punched in your bladder!!!  But for me it  the Supra was best option.  And when the irritation in the bladder isn't acting up,   it does not limit your activity at all  (i use a plug).  That may be all the time for most people. 

Believe me, I am fighting with my insurance and Appealing though the Department of Managed Health to make exactly the same point!!! Much of adhering to yesterdays procedures and technology is the fault of the insurance cos. !!

 

Scott,

I feel your pain. I too have too much trouble with cic.

How large was your prostate?

Did you have a large median lobe?

How many shots did you get?

Did you get twilight or just pain killers?

Thanks

Thanks Scott. I've read that SPC is just as good as CIC, and both are better than Foley. Since you had problems with CIC, SPC is definitely the way. It is better that you did not force CIC onto yourself and risk urethal injuries. I wonder if you can take something for the irritation. Hank

Hank: I've read that SPC is just as good as CIC, and both are better than Foley.

-------------------------

Not according to any literature I've read in fact they all say the opposite.  All there are equally good at emptying out your bladder but in terms of overall user comfort, satisfaction and incidence of UTIs -- CIC is the best, then suprapubic and then Foley. That said, some people can't or don't tolerate CIC which would make suprapubic or Foley a potentially better choice.

Jim

Hey Jim  What are you doing up so late.  How are you feeling  Ken

From what I've just read, from several studies, SPC has the lowest incidence of UTI, but higher incidence of bladder stones over long term, comparing to CIC. Hank

I go with the American Urological Societies 2014 guideline paper which is consistent with everything else I have read:

"According to evidence-based guidelines, CIC is preferable to IUCs or suprapubic catheters in patients with bladder emptying dysfunction.7,9 A recent Cochrane review noted low-quality evidence of benefit for using CIC over IUCs in selected populations, as there is a decreased risk of symptomatic UTI.28 Hakvoort and colleagues noted that CIC results in shorter catheterization duration and reduced risk of UTIs. Also, many patients prefer CIC to an IUC.29"

The "selected populations" are those with nerve damage. So, unless you have nerve damage (cannot feel the catheter being inserted) then you are better off with CIC versus suprapubic or Foley. And I would even dispute that since CIC is the hands-on go to choice of the SCI (spinal chord injury) community.

I am sure you google enough you may find some studies, somewhere that disputes this, but the overwhelming body of research supports CIC unless one cannot or chooses not to self cath.

Jim

Hey!  Mine is/was around 60 grms, and yes, I have/had median lobe problem. Had 5 shots, 2 on each side and one in the median lobe. Given my CIC history , and knowing I already have a pain issue  with the procedure itself, let alone once they start the injections and steam bursts,  there was no way I was  going to do it without Twilight!  I actually went to a second  group in my area because the first group I went to does only the  office version, no twilight.   I also did not want to have the pain profile implanted in my experience. I figured it would avoid  any association during the recovery, since I really had no idea what to expect in terms of comfort level post procedure.  I hope it continues to improve. Better after 1 month,  but not quite enough to be a solution.  Best, Scott 

I think with any of the you'll tend to have bacteria and/or be colonized.  JUst from my personal experience,  as far as UTI's requiring treatment, I have not had any since changing over to SPC (5 months).   I had one while doing  CIC  combined with  being emptied in the docs office, and had at least one while I had Foley, which was only a couple/few weeks.  s

Hey Hank, Yes, I agree, i definitely could not continue with CIC, and for me, SPC is definitely a better, safer option.  Knock on wood, I have not had any UTIs, tho i do often have bacteria. Being colonized is not uncommon with any regular Cath system, and is to be expected with a "line-in" , whether Foley or SPC.  UTI definitely worst with Foley.  I also had one while doing CIC, but that was probably also due to the severe retention, since I could not CIC enough to resolve that problem.   Knock on wood, I have not had anything requiring treatment  since the SPC (5 months).   I do have heavy duty  NSAID (diclofenac) that is for other problems, but helps when the irritation is really bad, as well as the very occasional painkiller.  We were talking about another med that subdues overactive bladder symptoms, that might also have been useful if the irritation  became constant, but it has been on and off (currently not bad), and we did not want to add that (or other) med unless necessary. Fingers crossed that things keep improving post REZUM  !!

Scott, I know one woman on this forum who have had SPC for 31 years, with only one UTI, and it was at the beginning.

I also know a man on this forum 6 months after a Green Light, did CIC, had a false passage, then a urethral stricture, and ended with SPC anyway. He wasn't sure the cause of his false passage or stricture. They might be from CIC or might be from the procedure. Hank

Hi Scott,

Personal experiences are very valuable but sometimes we miss the bigger picture. All I was saying is that IN GENERAL self cathing (CIC) is the preferred method of emptying the bladder with SPC second an Foley third. This is based on numerous studies an surveys. It is also backed by logic in that with CIC you do not have anything inside your body 24/7. Is CIC for everyone, absolutely no, but unless there is a good reason otherwise, it is the first of the three to try except when the catherization period is very short and then a Foley probably makes the most sense.

Jim

Most of the benefits come in weeks 6-12, so hang in there.

 

hank, did the greenlight not work? is that why he had to continue cic?

OB,

how many shots do most people get when the get a rezum? has there been any guidelins on this?

scott,

sorry to ask again, but this forum is hard to navigate. i see you received 5 shots.

were you able to void naturally at all prior to rezum?

where are you located?

what were your weekly experiences since the rezum procedure.

what tests did the uros look at or do prior to the rezum. since im going to see 2 different uros, i am curious also if they redid any tests.

thank you so much

Hey Buddy.  It is up to the doctor when he get inside.  But I feel that he should tell you before he get in.  Because he all ready will know the size of the prostate.  Over the last year in half.  They can go up to 12 injection.   I have found that the men that had under 6 injection do the best.  Some of the men that the doctor does over kill of the injection 10 to 12 end up with to much damage.  5 men that had that done ended up with having a Turp to clean up the damage.  

cg,

According to Jersey Uro, they've done as few as 2 and as many as 12. Originally, it was supposed to be 4, but anecdotally from posts here they seem to be doing more - probably 6 on average, but that may not be representative. They gave me 5.

I’m wondering how many if you have a large median lobe adds to the overall number

Hello changejobs-

For what it’s worth, my prostate was 81 (quite large). I was given 9 injections. My surgeon must have been good. He placed them exactly where needed. Very good results!!!

Thanks

Joe, 

My prostate is 80 with large median lobe. Where did you have it done?

Cj, the green light did work for several months. Then he noticed that the flow was slowing. It was how he started self cathing. He found out that he only had to cath once every few days to maintain regular flow. He did this for weeks, or months, until one day he could not get the catheter through, instead only blood coming out. He tried again, and again, many times and many days later, same result. Eventually he had a complete retention and went to the emergency, but no one was able to get a Foley catheter in him. Finally one doctor figured out that he had a false passage and a stricture. A doctor gave him SPC and the last I heard, he was looking into a procedure to fix the stricture. Hank

Hey Joe that is very good news.  I will add you to my file.  Can you tell me if you ended up with retro.  Stay well  Ken

Mine was 68cc with an enlarged median lobe. I got 4 shots of steam on each side and two on the median lobe (10 total). Excellent results. I went from self cathing for several months prior to the Rezum procedure to the nice flow today. 

Mine was 68cc with an enlarged median lobe. I got 4 shots of steam on each side and two on the median lobe (10 total). Excellent results. I went from self cathing for several months prior to the Rezum procedure to the nice flow today. 

—————————————

Ken, are you the person that got there done by McVary in Illinois ?

Hello changejobs-

I had mine done at “Urology of Indiana” in Carmel Indiana. Just north of Indpls.

Hello Kenneth-

NO retro. Everything back to what it once was!!!

Hi  Change, lol,,, sorry, I don't know ur name ;-) ,   My voiding ability prior was spotty. Before I got the cath, I got to the point that I could not void at all.  Then I was about 2 or 3 weeks with a Foley cath, and when we removed it, we checked again to see if maybe anything changed or it opened a little bit.  I was only able to void very little, leaving at least 3/4s behind.  It was clear that I was not going to be able to function without a catheter or treatment. I got the SPC at that point while researching further what to do next. I always used a plug once on SPC. While on the SPC, there were times I could void enough on my own to relieve the urgency and get from point A to point B, and it seemed to be a little better in the last week or two before the Rezum, with ALFUZOSIN. It was  still not enough that I could rely on it alone.  And there were still occasions , if i went too long and my bladder got a little overfull, where I couldn't go at all. Especially if I slept past a typical time void.   So My experience was a little all over the place. But before I was catheterized, i was to the point of sever retention, emergency level, and not able to pee at all on my own. 

   The weekly experience since rezum was dicomfort the first day, almost no discomfort at all the following week to 10 days, but pretty much unable to void first few days, and a lot of blood in urine on and off. Then  gradually was able to pee on my own about the same level as pre-Rezum, but a couple weeks in I started having real urgency issues, feeling like I had to pee every hour, and bladder feeling irritated and pain from the cath balloon. I occasionally had that problem even before the Rezum, so it is hard to say, but it felt like the added irritation from the procedure itself, combined with the occasional pain and irritatio from the cath inside bladder generally, made that issue worse and  more consistent. Pretty much was the experience for the next couple weeks, tho I would have good periods/days here and there.  Through that period, I gradually was releasing more volume when I peed on my own, tho flow was still pretty low.    But it got  to the point about 3 weeks in where I was only peeeing on my own for the most part, and would very rarely open the catheter.   The urgency i think kept my bladder volume pretty low, so i wouldn't pee much at any one time, but in retrospect , i think it was because my bladder volume probably never got above 200. In that scenario, i probably peed half or a little more, and retained half or a little less, each time.   I would have occasional good episodes where flow seemed better, and I released more volume. I think the first few weeks came down to having just the right volume in the bladder. Too little, and I would pee modest amount and low volume, too much, and it would be tough to get started, and flow would start tight and slow.  But after a few weeks, it  seemed like I was now able to at least start a flow when overfull, whereas before I would just give up and unplug. At a "Just right" volume, between 300 and 400,  my void volume and flow seemed the best. I can say that now because at the 1 month void trial, we added about 120 ml  to my existing 200, and I peed with a pretty good Max flow (tho not sustained at the max level), and voided 240 of the 320 on my own.  That was  a much better void and feel than my frequent voids when my bladder was at 200 or so. Since then, I can sense when I am voiding a little at a time for a low volume bladder, going often, versus a good flow and ratio when I am voiding in the 240 to 300 volume range with a full , but not overfull bladder.  So thats where I am now.  Seems like volume is getting a little more consistent, and I am currently ONLY peeing on my own as a test until my next visit, tho I did empty about 80 to 100 ml last night after a little discomfort issue with the cath and wanting to make sure it was settled/seated correctly. I was a little surprised I had that much in retention, as I had been peeing regularly on my own up to the point that I unplugged and emptied.  But that was also after 4 full days of not unplugging the cath and only peeing on my own.    And that is still a hell of a lot better than FULL retention.   Before being catheterized, I had individual emergency cath incidents of emptying 1100 ccs!!!!  And  over 600 was a norm!! 

  I had every test done prior....Cystoscopy, Urodynamics and then some.  The  UroD was a little spotty for me because I had so much pain and discomfort from the procedure itself, that I couldnt really get settled and good readings. Another indicator of how tuff CIC is/was for me!!  But it did show at least in spots where we were able to get a read that my bladder was contracting and trying to work.  So...here we are. 

     It's hard for me to do a true A/B comparison pre-Rezum and Post, since I had so many variations of my issue pre-Rezum, going from full retention, to trying to CIC, to getting Foley, to getting SPC. And each of those had varying levels of difference in terms of my ability to void with it improving a bit by the time I was 4 1/2 months in with the SPC, and a couple weeks before the REZUM. But I am pretty confident that I could say I would not have been able to rely on my void level without that Cath back up, even when it was at its best in the latter period of my SPC and before REZUM.  I would still occasionaly have those episodes where I just couldnt go, or could go much at all.  And at the moment, close to 5 weeks post rezum, altho I am not where I ultimately would want or hope to be, I think I can say that I am able to rely on my own ability to void, and would not have any serious retention problems. But I'll be able to answer that better after this two week test period of never unplugging (other than that one little bit last night ;-).   So the real proof in the pudding will be  how it goes between now and next visit on Aug 7, and then what my flow and volume looks like at that visit.  Fingers crossed

oh...and forgot to mention I am in L.A.

 

I agree. Thats why I was saying that even though for me it was horrible and caused more damage and not an option, it would still have been my preference if it was an option for me, and that I would still advise that anyone try it first. That's especially true since even for me,  I could see how it would be COMPLETELY painless and easy to do, based on my shock and surprise about how easy the first couple inches was!! My sense is  that is probably generally how it feels for most guys.  Before I tried it, for me the most horrifying thought was just the initial insertion itself. But that turned out to be absolutely without any pain or sensation at all!   For me, it just became a problem of my specific situation and where the prostate sits relative to everything else, which is a totally individual matter.   That's also why some guys can have severe retention with a 35gm prostate and others can have no symptoms to speak of with 85grms!!  Anyway, each person is different, but I would of course have preferred CIC to having a hole punched in my abdomen and bladder, and having the frequent irritation and discomfort of a balloon hitting the bladder walls, etc.  CIC should of course be the first option, not only as a possible long term solution, but especially if the plan is ultimately to have some procedure done and you want to buy a few months of time to research, see different Docs, etc.  No way I would have gone the SPC route if CIC was comfortable/bearable for me.

Thank you  Take is great  I will add you do the file..Enjoy all you can  Ken

CJ,

      Yes, Dr. McVary in Springfield Illinois did my Rezum. FYI, Dr. McVary is moving to the Chicago area at the end of August. I believe that he said that he will be at the Loyola Urology department.

Scott,

       I'm glad that you're doing better. For the benefit of those who might be reading this forum and pondering what options there are out there, I want to say that, in my very humble opinion, I think that the most important factor in the success (or lack of success) of CIC (for those reading for the first time, that's Clean Intermittent Catheterization) may be related to how good the instruction is for the first time. I say that partly because the Urology PA who instructed me did an excellent job of explaining a little about the anatomy as we were going through the procedure for the first time. This Urology department used the prelubricated catheters, so there was instruction on how to avoid introducing any bacteria by not touching the lubricated part of the catheter. She also made sure that the I knew that the coude tip was a benefit for most guys, but had to be oriented correctly. But for me, the most important information was about the two sphincters, and how to gently and slowly go through the sphincters. For me, the sphincters were the challenging part of the procedure, because I had to find a way to avoid tensing up. Somehow I was able to relax myself enough that there was rarely any pain, and I recall a couple of drops of blood only one time. I found that the relaxing part was made a lot more difficult if m bladder was full. 

Jimjames has provided some very good information on CIC on this forum's site, and again, I want to thank him for that information. It really helped me get over the fear and ignorance of how to do it correctly. 

Ken

Scott - the majority of the improvement comes in weeks 6-12 so the signs are very good that you'll have an excellent result. My guess is that 4-6 weeks from now you'll be long past any concern of retention and may well have few if any BPH symptoms at all. Good luck and keep us posted.

ken,

is the sphincter area the area you hit prior to the prostate? and are there 2 spots you have to get by?

ken,

how many shots did he give you? i remember that your prostate and median lobe was like mine.

I spoke with my urologist today. he said if i'd like someone whos done more than him, he'd be happy to send records. while he's only done 2, both came out succesfull. he said on mine it would either be 5 or 6 shots. 2 on each side and 1-2 in the median lobe.

he also told me that he feels , im going to have some inflamation for a few weeks so i will probably have to cath myself after the foley comes out. does that make sense?

I got 10 shots, 4 on each side, and 2 on the median lobe.

I'm not an expert, but it certainly makes sense that there would be some inflammation and swelling of the prostate tissue after the Rezum procedure. Because of that swelling, the urethra would likely be completely shut off until the swelling goes down, so that's why a Foley catheter is normally inserted after the procedure. I had been self-cathing for several months prior to the procedure, so the urologist was happy to have me continue to self-cath afterwards instead of using a Foley catheter. I did use catheters for about 3 weeks after the procedure, but I probably could have stopped after about 5 days. It was then that I noticed a marked improvement in flow. I don't know how typical that is, but I felt fortunate that the Rezum procedure worked out so well for me.

My understanding is that there is a lower sphincter at the 'base' of the prostate, and the primary sphincter is at the junction of the prostate and bladder. For me, anyway, these were the places where I felt resistance, and had to concentrate to relax these muscles so that the catheter would pass. 

CJ - O strongly advise against being someone's third Rezum patient. Ideally, you want to find someone who has done 100 - certainly at least 50, minimum. Recovery varies a lot - some can pee passably after a day or two - I couldn't even dribble for 3 weeks. Self cathing was a godsend for me - 4 weeks on a foley would have been absolute torture. I pretty much went back to normal life after 5 days - back in the gym, etc. I never could have done that with a foley.

Thx Ken ! Very good points and observations for newbies. Make sure to get good guidance. I did get all the same/similar instruction and advice, and was using the pre-lubricated coude tip (as well as tried others). Just was not an option for me in remotest sense, even well before I got to the sphincter and prostate passages. Of course, only got worse if I managed to get that far. But just wasn't in the cards for me. Believe me, I wanted it to be, and tried.  Last thing I wanted was to have to be catheterized Foley or SPC.  May be something to do with nerve layout for me, combined with where my prostate sits...Who knows.  :-(

Makes sense to me :-) I also had 5, 2 on each side and one in median. I havent had the remarkable quick success that Ken has had, so am wondering if maybe he should have given me 2 bursts in the median. But a lot of docs are of the "less is more" school of thought with REZUM since it is casuing sweling, etc., and also maybe having to do with RE issue. I've seen success stories and failures at this forum, however,  with either approach. So I think it is all up to what the doc sees when he gets in there, what his general philosophy is, and each persons natural healing tendencies....Kinda random I suppose :-) ;-) !

 

Scott,

      Maybe you should have had 2 shots in the median lobe, but it also depends on the size of the median lobe and how it's positioned (at least that's my assumption). My total volume of prostate was 68cc, so that might be part of why I got so many shots. Yours may have been smaller. You'd think that there would be some pretty standard recommendations for the number and placement of the steam injections. I say that because they pretty much know how much of a diameter of tissue that the injection will treat. The urologist should know the size and shape of the patient's prostate and therefore where and how many times to inject. 

 

Hey OB, Can u remind me whether you had median lobe?? I only got 5 also, but one was in the median, 2 on each side.  THX@!

I have been saying that for month's.  After the test are done.  He will know the size and shape of your prostate.  He must have a idea how many he is going to do.  It can't be just a blind eye.  He should talk it over with you before hand so you can talk over your concerns.  Take care all  The other Ken .   

Mine was about the same size, tho not sure if median lobe itself was bigger or smaller. But it seems pretty random generally from doc to doc how many bursts  they tend to do.

Scott - I did have a median lobe and the same 5 spray regimen as you did. I don't have the energy to look through the threads to see how long ago you had it done - but as a reference, I couldn't pee at all for close to a month (and could before) but was better than before at about 6 weeks. Most of the benefits come in weeks 6-12 and your're as good as you're going to get at 6 months. So if its been 6 weeks or less, take heart - the best hasn't happened yet.

THX!! 5 weeks for me as of today :-)  I was able to pee some after a week, and can pretty much pee on my own now (i don't...or very rarely open the plug on my SPC), but it's all on ALFUZOSIN. It's still pretty low flow and still leave more than I would like in retention, or I pee in 2 or 3 episodes over a handful of minutes  to get most out, depending how full.  I originally couldn't pee at all before the SPC, but after a few months with SPC , and in the last few weeks before the rezum, I  was able to pee a little on my own on meds.  So it's Hard to say how much better it is now, but I can definitely pee more on my own now than in the couple/few weeks before the procedure. Looking forward to continued improvement I hope ! :-) 

I spoke with 2 drs regarding the rezum procedure and have 2 questions for you.

1 dr said he can make a judgement on rezum based on a cystoscope and the other dr said he needs a trus. They both do a exam and ask about past.  1- Can a rezum procedure based mostly on only 1 of the tests.

2 - one of the drs that has done about 50 rezums said I’d be in great shape in 2-3 weeks, while the other dr whites done about 100 rezumz said it can take 2 months before swelling goes down and see improvements and if it doesn’t work would recommend other procedures .Which is more accurate?

changejobs,

I don't know how they can measure prostate volume with a cystoscopy and they need to know the volume of your prostate to do Rezum.  A transrectal ultrasound (TRUS) can measure prostate volume.  Personally, it would be a big red flag for me if the doctor did not do a TRUS.  When I called a urologist about Rezum, the first thing that they mentioned was that a TRUS was required before doing Rezum.

We can see what others in this forum who have already had a Rezum done have to say.

Steve

Thanks steve.