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

Hi Scott, John here.   Per your request I have some recommendations for you based on my Rezum experience.

I'm 65 yo and generally healthy.  My prostate before the procedure was 48 grams. I’ve had BPH for +20 years; I’ve dealt with it through meds. I had the Rezum procedure 48 days ago.  I'm still in recovery and not able to urinate as well as I did just before the procedure; but, I’m slowly improving.  If you read this forum from start to finish (and I recommend that you do if you have not already) you'll find that recovery time is all over the map; some men recover very quickly with good results, some take weeks (6 to 12 weeks); and, for some, the procedure does not work.  I pray that I'm not in the latter group but I might be.  Here are my recommendations, in no particular order:

1) Just before the procedure commences make sure that the Urologist has fully emptied your bladder.

2) Rezum is relatively new; ask your Uro how many times he has done the operation.  Get happy the with answer or find another more experienced Uro.

3) Have the Uro provide a script for anxiety and take it just before the procedure.

4) During the procedure, the Uro will give you several shots for pain.  For me, the procedure was not painful, but based on posts in this forum it has been for others and may be for you.  For me, it just felt weird.  During the procedure one of the Uro techs stroked my leg. I thought this was incredible kind of her and it really reduced my anxiety during the procedure.  I’ll never forget this act of kindness.  

5) Have the URO provide a script for pain medicine for after the procedure.  My Uro gave me a 7 day supply of codeine which I ended up not needing (aspirin worked for me).  It’s better to have the pain medicine and toss it out if it is not needed than not to have it and wish you did.

6) You’ll need someone to drive you home.

7) You'll go home with a foley catheter (catheter + pee bag strapped around your leg).  If this is your first time with a foley (it was for me) it is a pain and you’ll have trouble sleeping.  I’m retired so thankfully I did not have to go to work with a foley; instead, I could lay around the house all day to the point that my wife started calling me a lazy butt, ah!  There are posts in this forum outlining how to manage your foley in order to reduce pain and allow sleep.  I found these foley recommendations invaluable.

8) If your recovery is prolonged you may find yourself wearing the foley for a longer period. I wore mind for 5 weeks.  As far as I'm concerned that was 4-1/2 weeks longer than needed (see point 9 below). 

9) If your recovery is prolonged and your needing a cath during this recovery then ask your Uro about dropping the foley and going straight to self cathing.  If you have never self cathed before then it sounds scary (it did to me), but once I started self cathing I realized how easy it was; it made my life so much better (a pee bag around the leg is such a pain.)  Self cathing has been so easy for me that after recovery I may continue to self cath from time to time as a matter of convenience when I take a long plane flight or and a long drive.  Why not!

10) Understand what the Rezum charge will be and if the charge includes expenses during recovery.  I thought the charge for the procedure would include recovery time – I was wrong about that. During recovery (the first 5 weeks), I would wear the foley for 4 days then go back to the Uro office, get the foley remoived and I return home for another 4 days without the foley to see if I could urinate.     I went through 5 foley change out cycles over a 5 week period.  Each time that they removed or installed the foley the Uro charged me $450.   Errr!!   Good thing I had insurance but still.

11) In case of a prolonged recovery make sure that your Urologist will provide support during this period, including the ability to make a last minute appointment to drain your bladder if required.  My Uro provided excellent support.  But, it’s worth clarifying and confirming this support with your Uro prior to the procedure.   Also, ask your Uro if he has a vacation scheduled immediately after your Rezum procedure.  If so, then reschedule the procedure until after he gets back; you’ll want him available if your recovery is complicated.   If your Uro can not provide recovery support, then I would drop him for another who can.   Also, work up a contingency plan in case you need to be drained outside Uro office hours

12) Read this forum as a means of understanding the experience of others with respect to Rezum.  I was told that my recovery would take less time than it actually has. Normally, by now I would have been freaking out wondering what went wrong and if I was going to die (ha!); but, by reading this forum I have a much better understanding of the process and I’m completely at peace; praying for the best.

13) I’ve had no sexual side effects.  

I hope that what I have written will help you.  I pray for your quick recovery.  And, I hope that most of what I’ve written above never becomes an issue for you. 

After your procedure, and during your recovery, if you could share your experience with this group that which be great. 

Good luck, take care- John     

It sounds as though you've had experience self cathing - make sure that you have that option from the start. As soon as there is no bleeding in the bag (for me the same day) there's no reason not to switch to self cathing. Much less pain and you can live a normal life. DO NOT LET YOUR DOC LEAVE YOU WITH A FOLEY FOR A MONTH OR MORE!!. There's no reason for that - and no reason to stay on one until you pass that stupid voiding test. I think excercising my bladder daily helped my recovery - you can manage without any catheter LONG before you could pass the voiding test.

I had it done in March - my prostate wasn't big, just growing toward my urethra instead of more normally - but my symptoms were pretty bad. Only had retention twice in 4 years, but I lived my life around bathrooms. I couldn't pee at all for a little over 2 weeks and it came back slowly after that. I could manage without the fear of cathing after about 31/2 weeks, but wasn't as good as when I went in at that point - I crossed that threshold at about 6 weeks. It got progressively better from there abd at just under 7 months I'm way better than before, but not perfect, but its still improving, My problems are more bladder related than prostate at this point so any improvement is from better bladder function.

Its all over the map, but my procedure hurt a lot when they did it - screamed at the last spray and hurt for about 7 hours after. By the time I woke up the next day, the pain was gone. I had quite a bit of blood when I started peeing, which my doc said was normal - it pretty much subsided within 10 days. 

I now get up once/night to pee and its over an done in under a minute. I used to be good for 2-3 times and up to 15 minutes to get empty. I have gone as long as 4 hours now between pees during the day and having to go bad no longer locks me up the way it did. Before, if I waited too long I would need 4-5 shots before getting empty.

Good luck - let us know how you do.

 

Excellent Post!!

Neal

Hi Scott

I'm 54 went into this with the same goals as yourself. My median lobe was enlarged causing blockage.

I am recently out of my Rezum procedure. I had it done on the 27th of September. I guess I am one of the fortunate guys so far anyway.

My Uro put me under, so I had no recollection of pain or the procedure. The procedure from the time I went under until I walked out the door was 35 mins.

This was a Tuesday, I had a catheter which I removed on Friday morning. Almost no blood during that time. I did force myself to drink a lot of water to continually flush my system. I drank approximately 32 oz every 2 to 3 hours. I emptied my bag more I think then I had to p*ss a day before the procedure. I also was given a 6 day prescription of Cipro( antibiotic).

I had little discomfort. Definitely some but not enough to keep me down. I only used Tylenol for the first 2 days. I walked my dogs, went to work for a few hours each day, but took it easy. I'm a farmer so it's hard to keep me sitting long.

After I removed the catheter, which for me having that caused the most discomfort, I have been great. I still feel slight discomfort but went back to work full time in the 3rd of October.

Results so far are great. Stream is strong, trips to bathroom during the day greatly reduced , at night I went from at an average of 5 times down to 2 or 3. When I do start and stop urinating there is an interesting sensation but it is slowly becoming less. When I went back for my follow up appt on the 3rd I asked about ejaculation and how soon before I should even consider trying, he said "when ever you want at this point." That has been working great too, lol. I'm looking forward to continued improvement.

I know some guys have had some trouble occur after things started out really well like mine has. I'm praying that things keep going smoothly as I go forward. I'm still forcing myself to drink a lot of water. I really think that can only help early on.

If you haven't I would ask your Uro if there are patients that he has performed the Rezum on that are willing to talk with you. My Uro called three guys off his patient list from guys that had it done in April. They were very willing to talk with me. They had different experiences like the guys here in the forum but all were glad they had it done. This put me at ease prior to having it done.

Hope this helps some. Best of luck to you and all of us guys going through these decisions and procedures.

Steve

Scott,

I had the proocedure done on September 7 and had a cath for two day after which it was removed.  I am very fortunate that so far my procedure has worked.  I have a lot better and stronger stream and it is easier to go places and know that if you have to use the restroom that it won't take forever.  I am still in the recovery period, and I understand it will improve further.

Based upon what my experience has been, I say go ahead and get the procedure done.

Paul

Thanks for your input,  I appreciate it.   I am excited to be moving forward with a solution to my problem and will keep you posted.

Scott

Thank you.  Your posted have been a real help.

I am excited to be moving forward. . .will keep you posted.

Scott

Thanks Paul. 

I will be very happy if I can be off the foley catheter in two days.

After two days, did you need a an intermitent catheter or no catheter?

 

Scott,

You are welcome.

I needed no other catheter after they took out the foley.  I was lucky that I was able to pee right away.

Good Luck

It's been ~ 2.5 months since my RESUM procedure and I haven't been able to have a sucessful TRIAL VOID. Thus, I'm still on a Foley Catheter. My Uro Doc states Self Cathing would cause more problems for me....What do I do?...

You find another Uro doc. You will probably NEVER pass the trial void until you get off the Foley - especially becuase its been so long now - so the path your uro has you on is a Foley for the rest of your life.

Some things to consider:

1) I had Rezum done in March and while my recovery has been somewhat uneven, I'm WAY better than I was before. But if they pumped me full of liquid and told me to empty on demand, I probably couldn't pass that test now.

2) What thay means is if I had your doc, I would still be on a Foley - 7 months post surgery, despite the fact that I haven't needed to self cath since week 3, have been better than before since week 6 and am still improving. Tons of guys on this forum have self cathed temporarily after Rezum and none have had any issues because of it.

3) The bladder is a muscle of sorts and if you don't use it it stops working - so once you've gone a month or two without passing that idiotic trial void, you'll likely NEVER pass it unless and until you can start exercising your bladder.

Find another URO - and to all who are considering Rezum, if your doc plans to leave you on a Foley til you pass a trial void, get another doc to do it, or get him to say in writing that he'll let you self cath after a week. The sooner you can get things working again, even if only slightly, the sooner you'll get back to normal function.

Any URO or URO nurse can show you how to cath. Get a cath prescription, order those speedicaths that everyone on the forum likes and I'll bet within a couple of weeks you'll start piddling (maybe sooner - there is a lot of middle ground between all or nothing) and within a couple more you'll be at least functional. You can also consider PT to help get your muscles moving again - and some may be tight, a PT can loosen them.

THis is long winded, I know, but what you're URO is having you do IS NOT what they company recommends. Find another doc who will get you off the foley ASAP - you probably won't ever pass the voiding test until you do - and you could function well and be happy and still not meet that standard.

Hi Randy,  Yes, I agree with Oldbuzzard, get off the Foley and move to self cath.  Question your doctor about his position.  I'm +6 weeks into recovery and still not there yet but I'm getting better slowly (had mine Aug 23).  I had the foley forely for 5 weeks until I went to self cath. Self cath is so easy and allows me to work my bladder muscles when I urinate as I'm not wearing the foley 24/7; what a pain the foley was...eeerrr!!     Again, question your doctor about his position.  - Take care - J

The main problem with Rezum is its limited availability. Many urologists are reluctant to integrate Rezum into their practice. The generator is expensive and requires special training. If you are interested in Rezum, don't go to an urologist who doesn't perform it. The doctor doesn't want to loose business,so he will find some way to discourage your preference, such as by stating Rezum hasn't been on the market long enough to justify its durability. They favor more invasive procedures like TURP, which requires making incisions, anesthesia and at least one night in the hospital.

David, Yes, that make sense.  FYI, my Uro had done it les than 25 times when he did mine.  During the procedure he had two representatives in the room from the Rezum group to provide guidance. 

Your urologist will probably argue there is less chance of a UTI with a Foley, since the catheter stays in place for days or weeks. Self-cath requires more insertions, so it is a logical argument there are more opportunities for bacteria to enter the system. I strongly favor self-cath, they are more expensive, but require fewer office visits. I'm not convinced that self-cath results in more UTIs.

You may have hit the nail on the head with point#10. $450.00 each for 5 Foley changes. Self-caths, to the best of my knowledge, are sold by independent providers and shipped to your home. No profit for the MD in this case.

I'm not sure what the statistics are on which has a higher incidence of UTIs, but if you wash your hands and wipe the tip of your penis you should be fine. And in any event, you probably can't ever recover unless you can start using your bladder. From what you said (accident on the way to the doc) you're not completely unable to pee, so once you're doing it regularly you should improve enough to ditch the cath and that won't be an issue. And even in the unlikely event you end up with a UTI, its a small price to pay for getting your life back.

Anyone considering Rezum should understand one thing - you'll have a period of time where you're functional but not good. For some its just a few days - for me it was about 6 weeks. Its part of the recovery process and any doc who thinks you can go from surgery to perfect without that middle period doesn't understand the recovery process IMO.

'You may have hit the nail on the head with point#10. $450.00 each for 5 Foley changes... ' Yes David, the charge... that is really nuts especailly if you can do self cath instead.  

In May 2016 I had my Rezum done at the Cleveland Clinic.I was patient#20. One urologist did all the work, while my primary uro watched. I assume by now he is doing them on his own, No company reps were present when I had my done. 

I had mine done at the Cleveland Clinic too - in March. My urologist did the procedure but there was a salesperson from the company there. I think I was his patient #21 or 22. 

I'm very lucky in that when I had problems peeing in the beginning, he stuck with me, was responsive and never made me live with a Foley. I wish everyone getting the procdure had a URO who was as concerned and accessible.

Although my Uro made me wear a foley for while, which I did not much like, he did stick with me.  I the beginning, just after the procedure, when I was confused and did not understand what was going on, I could make an approintment during office hrs with every short notice. And, I did numerous times.  They always could see me. (it helped that Uro the office was 10 miuntes from my house,   He indicated that I was the toughness Rezum patient that he had and that he would be there to support me.  And, he was.  Now I'm self cathing and life has fallen back into a nomal routine, thank God.

Hi David,

The literature shows that self cathing results in less frequent and less severe UTI's than indwelling (Foley) catheters. 

Jim

 

Nothing like having an audience 

I would ask your doctor to elaborate on what "more problems" he is talking about? Six weeks on a Foley is a reasonable time period to decompress anad rest the bladder if that is your doctor's intent. Beyond that, unless your doctor as a persuasive reason, self cathing would make more sense. And frankly, even if he had a good reason why you can't self cath, at the 2.5 month point I would strongly insist on a suprapubic catheter which functions similar to a Foley except that it drains your bladder through a small hole in your abdomen, negating plumbing in the urethra. If you get one with a flip valve, you also free yourself from wearing a bag.

Jim

Hi John,

I just answered an earlier post of yours not realizing that you are now self cathing. As I suggested in that earlier post answering your question about passing the "void test", you can now check your PVR yourself by measuring the amount of urine that comes out of the catheter right after you take a natural void. A good urine log, noting both natural and catherized volumes, can be really helpful in tracking your progress as well as keeping your doc up to speed. I've been self cathing close to three years now so just give a holler if you have any questions, or feel free to check out one of the self cathing threads here. 

Jim

Hi Jim, Yes, I agree with you 100%.  In fact, I started measuring right after I went to self cathing just as you noted above.  What I regret is not measuring output just before the Rezum procedure.  If I had I would have had a basis to give me a better understanding of my post Rezum progress.  Oh well, who knew!   Now I've got an Excel spread sheet filled with data on how much I'm peeing.  If, several years ago, a fortune teller had told me that in 2016 I would have a spread sheet fill with my pee volumes I would have laughed myself silly.  Well, I'm not laughing anymore ...well... actually.. I am laughing, just a bit.  Hell, a sense of humor to deal with this situation is good medicine, I guess - take care!

Prior to your Rezum, did your urologist do any bladder scans in his office of send you out for a post void imaging study? If so, he should have your pre-Rezum PVR numbers. So curious, what is your current PVR and what are you carrying around in your bladder (PVR plus natural void)? As I have stated in the self cath threads, in order to rehab a flaccid bladder, ideally you would not want more than 400ml in your bladder at any one time. As to PV

(cont)...As to PVR, hopefully the numbers will keep coming down, however since you will be emptying the bladder to zero daily (if you cath every day) you should be well protected from UTI's which are often associated with stagnant urine left in the bladder.

Jim

Good point. I've always felt that factors, like anxiety and caffeine, affect the outcome of the void test. Case in point: about a year ago I failed the void test at the Cleveland Clinic, so they sent me to the nurse who educates patients on self cathing. During the thirty minute wait I had a tremendous urge to void and had to use the restroom to partially empty the bladder

A typical post void residual test has the patient drink a very untypical large amount of water which in and of itself stretches and stresses a bladder that already is stressed and streched. One should therefore be skeptical of such results even though I'm sure many surgeries were recommended in part because of such artificial tests. Not just my opinion, but also the opinion of the  head urology at a large teaching hospital, who was my urologist at one point.

Much better, if possible,  is to simply schedule your doctor's appointment at a time when you might naturally urinate anyway. Resist the instructions from your doctor to keep drinking water so you will urinate to accomodate the doctor's schedule. Then, when you naturally urinate, without artificial fluid loading, have the residual measured by a portable bladder scanner. THAT will be you real post void residual, not the numbers generated from artificial fluid loading. Of course, if you happen to self catherize like I do, you can check your real post void residual very easy simply by measuring the  amount that comes out of the catheter after you have a natural void. 

Jim

My first reply was unsuccessful soI'll try again. I assume you are referring to Dr.U. If ever an MD was cut out to be a urologist, it was him. He has a short video, along with his bio,on the CC website.

The Pre-Trial Void Preparation you describe is the method my current URO uses AND I HATE IT!...I "cut" and "remove" the foley catheter, drink fluids for 3-4 hiours until I need to void, ~ 300ml+; then, I'm suppose to VOID after the 3-4 hours and Before I have an afternoon, ~ 1PM-2PM appointment, with my URO........On His Schedule!...The first time I tried that, I peed all over myself in my car on the way to the URO's office....Very Embarrashing!....What A Mess!....The Second and last time ~ 1 month ago, ~ 1 month from the date of my REZUM, I couldn't Void and the URO Doc had to empty my bladder at his office. Then, he re-inserted the foley and stated we would try again in 30 days which will be next Thursday, October 20th...He states that if I can't Void then, we'll try again after another 30 days. If the last Trial Void doesn't work (end of November), then He Wants To Do A TURP which I'm totally opposed to....I may Self Cath as you are, rather than have any new Prostate Operations, Procedures, etc...Chances are, I'll Drop my current URO Doc next week, possibly add a URO DOc that has been trained and has plenty of experience treating Post Operative Urinary Retention (POUR) and go on Self Cathing...The REZUM should have solved my BPH...Emory University Medical School & Hospital, a teaching hospital, stated today that they will assign a POUR URO and other Docs if needed to treat me for the POUR....They are to call back after obtaining my medical records and set an appointment...Hopefully, after 4 months, we'll start experiencing some relief and progress.... 

He states there's too many risks about injuring, tearing the urethra, etc. to do Self Cathing...This URO is ~ 62 years old and set in his ways...He's a highly recommended BPH URO for REZUM, TURP, TUNA, etc...Per clinical  trials, etc. REZUM is the #1 Successful BPH Treatment by URO Docs. PAE is #1 for Radiologists, but I was told bt a PAE Expert Doc that I was not a good candidate for a PAE...That's why I did the REZUM.......Jim and Old Buzzard - What type of careers have yiou had?.....You guys are great!.....Many Thanks for your concerns and help for me!....If you want to know  the  financing availabe for businesses or real estate, please contact me. Those and banking are my expertise...

Randy,

I'd find another URO and start self cathing. The longer you wait, the longer til things start working normally again. If Rezum didn't solve your problem then TURP wouldn't either - even a successful one. Your problem is pretty obviously your bladder. Tons of guys have self cathed that are on this group for years - none injured their urethras.

I agree with Jim. The artificial void test, loading your bladder is used to sell TURPS.

Neal

Thanks for your reply and support.....

Glad to be of help if I can. Good luck and let us know how you do.

What's the Costs for Self Catheters and Does Medicare Pay for Them?......I met with new URO Doc today...He states the other 2 URO Docs treated my BPH first and, once corrected, would have treated my Post Operative Urinary Retention....He's to look iInside my Prostate Next Week to determine if the REZUM procedure removed-killed enough tissue, as well as, to check the status-size of my medium lobe...If those are OK and my prior Urodynamics prove the Bladder's muscle had worked prior to inputting the extended time Direct Foley Catheter. Then, he'll try Self Cathering + medication for a while...If that doesn't work, he states the only remaining solution is a TURP...He states he's the #1 URO performing REZUM and TURP in Georgia and has had a lot of success with very few and minor complications...What Do You Advise?....Likewise, Jim James....What Does Jim Advise?...Please Respond Quickly....

Medicare pays 100% of the cost for up to 200 catheters a month which is more than enough for 99% of people needing them. Of course, check your particular Medicare plan as it may be different from mine. Several members here, including myself, highly recommend starting with Coloplast's Speedicath FR14 with Coude Tip. Your doc, may or may not be familiar with various catheter styles and brands, many -- even the very "good" ones, surprisingly are not. I guess it's a bit beneath them since it doesn't involve a lot of cutting, recuperation and expense

As to your plan -- seems that you could start self cathing now and still have what sounds like a cystoscopy as well as reviewing your prior urodynamics. Not sure why you have to wait. Ask him why! 

I also don't understand what he said about "the only remaining solution is a TURP". If the prior urodynamics showed no bladder elasticity (or nerve damage) then a TURP wouldn't work anyway, because you would still retain. In fact, with no elasticity (or nerve damage) the only remaining solution is self catherization, not any of the operations. Ask him to explain his thinking!

As to mixing "medication" with the self cathing -- in general medications are not needed since self cathing will empty the bladder completely all by itself. That said, I guess since you are currently having no natural voids he wants to try a combo approach to get things moving faster. But do ask him specifically what medications he will be putting you on and please report back. Hopefully, if and when the natural flow starts, he will transition off the drugs and let your bladder rehab on its own with self cathing. 

Self cathing will get you off the Foley, empty your bladder completely anyone time you want, and hopefully it will help your recovery from your post operative retention problem. It will also buy you time to make an informed decision on whether you really want to go ahead with a TURP, something else, or simply continue to self cath as I have. If you read my self cath thread you will know that I started out with almost complete retention a couple of years ago and today my bladder functions pretty normal. That was without drugs or surgery, just self cathing alone which did an incredible job in rehabiliating my bladder.

Lastly, the fact that your doc is "the #1 URO performing....in Geogia" is only persuasive if it's a TURP operation you really need. My doc likewise was on top of all of the lists, plus the head of Urology at a major teaching hospital. All he did was TURPS so that's pretty much all he knew. I will tell you in all modesty that a number of people here, myself included, know a lot more about self cathing and its potential than your doc and my prior doc combined! It's just not in the field of interest!

Jim

Meant to say, "It's just not inTHEIR field of interest !"

Jim, I really appreciate your quick and thorough response...Based primarily on your and Old Buzzaed's positive experience and encouragment regards Self Cathering and that there's nothing more to be gained by doing a TURP or repeating the REZUM, I will do everything I can to Self Cath...The "Catch 22" is getting a URO DOC to write prescriptions for the Catheters....I, too, don't see any sense in "enriching these URO DOCS anymore than they've already made from me", if there's nothing to be gained which you have confirmed...I Don't Have Very Good Opinions of Urologists!....The 3 I've seen seem not to be that interested in their patients, they seem more interested in their self-importance...What a Shame!...I've Hated being on a Foley for 4 months!....It's been very embarrassing and a real pain...Many Sleepless Nights, because of the pain caused by the Foley...I Want My Life Back!.....

Randy,

If your current urologist won't work with you on self catherization, go find another. You're on Medicare right? If so, you don't need a referral, you just need to pick up the phone and call another urologist. If you're in a large urban area, then probably there are a number in the same town, but always best to get one with a different hospital affiliation as within the same hospital they tend to support each others diagnosis. If you're not in a large urban area, then maybe a little travel is warranted to a large city teaching hospital. 

To save time, always a good idea to ask questions first before booking the appointment. You most probably won't get the doctor but try and get his nurse, or at least the office manager. Ask straight out if they have many self catherization patients and listen to what they say. You will get a good idea of their experience (and willingness) with self catherization by the answers on the phone. No need to go into your full medical history unless asked, but usually a simple question like "I might need to self catherize so wondering if the doctor has many patients in his practice who self catherize and if you support them with training and prescriptions?" 

Good luck. It's your body, your urethra. Unfortunately, it's sometimes a little more work than it should be to explore all your choices.

Jim

Hi Jim,

Self cathing is something new to me. Does it work while the urine blockage is 100% like I have. i guess I will have to self cath every time I want to pee. That might be every hour or two hours - a lot of caths in a month!

I have an all time catheter for last 2 months. It replaced another one that was there for 3 months. Replacement gave me uti that took 4 weeks of cipro, so makes me scared to go for replacement

I would imagine self cathing may be more prone to infections. Do you think so?

Nktoronto,  Unless you have a very tiny bladder (or you are drinking a lot of liquids) its not likely that you will be cathing every hour or two.  I empty my bladder once in the morning and once before bed. 

If by "100% blockage" you mean that you can't urinate anything on your own, the answer is "yes", self cathing (CIC) can work for you. And later down the road it can also work even if you are able to urinate some on your own but still don't empty your bladder completely. 

As to frequency, unless you're putting down the beers, a good starting point is 6x/day for someone who either can't urinate on their own or where most of the output is from self cathing. That translates to around once every four hours. 

Later, if you start to naturally void some the frequency can be decreased using a very simple formula. "Johnguild" for example mentions he only cathis once in the morning and once before bed. In my case, I know longer cath every day or even every week, however I did start a couple of years ago at 6x/day. 

Infections (UTI's) are associated with self cathing but much less so than with indwellling (FOLEY) type catheters or suprapubic catheters. Some here have self cathed for years without UTI's. I average around one a year but I also have a bladder diverticulum (pouch) which makes me more prone to UTI's than someone without a diverticulum. 

Jim

Randy  I agree with Jim.  If the doctor will not work with you go fine another.  They should listen to want you want not what they want to do  Have a great day   Ken 

Alot of men and women self cath.  That may be good for you.  Try it before you have the turp in November.  If it works   you can hold off on the surgery .  Try to limt your iquid.  Ken

Hi Nktoronto,

What you might not understand is that when folks like us, with prostate blockages, DON'T empty our bladders completely when we urinate. That's why we urinate so often. With self cathing, you WILL completely empty your bladder when you catheterize. That's why you will be able to do it much less often.

Neal

Hi again Nktoronto,

I mis wrote. I meant to say.... When folks like us with bladder blockages urinate, we don't completely empty our bladders....

Neal

The only reason for more surgery is if for some reason the REzum procedure didn't kill the prostate tissue it was supposed to. IF it did, then a TURP won't help. I don't see a problem in looking at it with a scope, but I do see one in keeping you on the foley. I'm sorry to say this, but find another doc who will write you a script for caths and start self cathing.

He doesn't need to prove that your bladder worked before. You peed your pants on the way to your voiding test and that's all he needs to know. And even if it didn't work before, the only way to get it moving again is to try to pee. The longer you wait, the longer it will take to return to normal function. Spinal cord patients self cath (with absolutely no bladder function) for their whole lives without a problem. Your lobe size doesn't matter either - if they can repteatedly get 18 and 20s up their for the foley, you can use a 14 with no problem.

I don't understand what these docs think the risk is - all signs point to your bladder being at least a part of the problem and it won't start working until you get off the f*cking foley. And if the REzum was performed properly the overwhelming odds are that it removed plenty of prostate tissue.

If you can afford it, I'd go to some country where you can buy caths without a prescription, remove the foley yourself and start self cathing. There are pletny of youtube videos that show you how and there lots of guys in this forum who will help. If you see another URO, I would start out by telling them that you want to self cath NOW  - and if they push back just leave. You're getting screwed by UROs and they are actually working against your recovery at this point.

I'm sorry to be so emphatic but its unfortunately true. Good luck, let me know if I can help.

That is true.  Some doctor want to keep the patient at there mercy.  If the urologist wont let you self cath get another one that will   Ken

For me, one thing for sure, it's really nice to be able to empty my bladder.  It's a great feeling.

Yes and that most doctors are very paternalistic in the way they practice medicine. At times treat us almost as children and often are reluctant (or threatened) if we want to participate in our own medical care. Self cathing fits into this paradign because it empowers the patient to take actions that replace what a doctor can do, ie indwelling catheter. There are some good docs out there who are not like this but many are on either a conscious or unconscious level. That, and the fact that most urologists don't even know that much about self cathing, can make it difficult for one to get started. I was lucky in that my first urologist did support self cathing but when I ended up switching urologists I actually had to educate the new doc about self cathing. Fortunately he was open minded but a lot of docs aren't. If you're able, keep switching docs until you find one that will work with and support you. If you can't switch docs then make the best case possible and insist if you have to. 

Jim

If every Urologist had to spend a week every year wearing a foley, they would probably be a lot more open to self cathing

What I don't like with some urologist is.  Let's fix the first problem and if you have a side effect lets fixs that. It goes on and on. I know my urologist first thing is to the patient and making him happy   Ken 

Jim, there may be several other reasons that a Uro Doc appears to be paternalistic or overly cautious:  1) In the US we live in litigious society and, 2) at least in my arrangement with my Uro, he does not charge for services related to issues that develop within a 90 day period after a procedure (i.e. recovery issues relative to the original procedure.) 

Further to this last point, my Uro also indicated that if my Rezum procedure did not work and I wanted a second procedure within a 90-day period (like a second Rezum, or a Lift, or a TURP or whatever), he would not charge me.   He called this a policy of ‘ownership‘ on his part. 

BTW, I’m nearly two months out from my Rezum procedure and there has been no improvement compared to my original condition just prior to the Rezum procedure.   In fact, my condition is worse.  In mid-November my Uro and I will be discussing other options.

I strongly agree!..

Yes, a litigious society no doubt plays a part but I think it also goes toward a certain type of know it all temperment. Ironically, the best docs  -- the ones that really know it all -- usually don't have it nearly as bad as those down the knowledge chain. That, and probably a lot is our fault, not many of us here but those who show up at the docs without a clue.

Sorry you haven't had any improvement. Not familiar with your pre-Rezum condition but I'm sure I don't have to tell you that just because you have 30 days left in your "ownership" window doesn't mean that getting another procedure is the answer.

Again, don't know what was going on, is going on, or what your IPSS score was, etc, but if it boils down to a retention issue then self cathing by itself might be the answer at least for now. As I have discussed in other threads, self cathing by itself can rehabilitate a bladder to near normal functioning given time. At least it did in my case. A few years ago I was in near acute retention with residuals constantly over 500cc, near the end unable to urinate without pushing my bladder hard with my fingers. IPSS score "severe". Short story is that TURP was suggested but I opted for self catherization instead starting at 6x/day.  Today, I empty down to 50cc or less much of the time, only cath when necessary which averages around once or twice a week, and my IPSS score is borderline mild/moderate -- really "mild" if you eliminate the "flow" question which to me is more diagnostic of a condition as opposed a sympton affecting quality of life. 

My uro, very esteemed, told me that I would be self cathing multiple times a day for life if I didn't have the TURP, but it turns out he was wrong. Don't know how relevant this is to your condition, but again if it boils down to retention and bladder tone, you might want to forgo the operations (and drugs) and stick with self cathing for awhile. I didn't notice significant improvements until the second year but by that time self cathing wasn't really all that big a deal. The fact that I don't have to do it every day is just a very nice bonus. 

Jim

And I thought I had it bad. Some suggestions:

1) My uro felt that my problems were probably more bladder than prostate related and prescribed a relatively short course of Myrbetriq. It helped get me going (literally).

2) Probably time for a scope to determine whether your problem is bladder, prostate or both. 48 isn't all that big - unless yours is growing in (like mine was) 48 shouldn't make you all that symptomatic.

3) have your uro check and see if your muscles are tight - that can happen and make it hard to pee.

4) Do some PT to lossen everything up.

Good luck and remember, if your urethra isn't constricted, no other procedure will help. Open urethra and no pee usually is a bladder issue. 

Good luck!

I go for a bladder test Nov 15th.  I'll post what they find out.  In the mean time I cath twice a day. 

You say PT, I assume you mean physical training. Kegel exersizes? I pee fine during the day. Waking up at night is a whole different ball  game. Sometimes it just dribbles out other times stream is like during the day. Can't figure it out. I doubt its dietary. I'm on fernasteride 5mg 1X and Tamsulosin .4 mg 1X.

Physical Therapy - it can incluse biofeedback and excercises - kegal and some others too. It helped me quite a bit initially.

 was much worse in the middle of the night than during the day pre rezum also. Ruzum pretty much fixed that, but I'm still worse (better than before but not all that good) after drinking alcohol - that can't effect the prostate so its obviously bladder related.

Alcohol has a significant effect on me as well- and it doesn't take much. If I drink 2x as much water (vol) than alcohol that helps, as long as the amount of alcohol consumed is still small. While I've never drank that much - I've all but stopped due to this issue.

Sitting for 2+hrs (or laying on my side when sleeping) also has a negative effect. 

 

I'm much closer to normal now post Rezum, but still have issues with alcohol - its like my bladder (which ain't great to start with) goes to sleep when I drink more than one or two. I literally have to pump it out with my fingers. I wish there was a drug that did the opposite of what the overactive bladder drugs do.

Instead of pumping out with your fingers, why not just self cath on those occasions? I used to have to do same prior to self cathing.

And even during the first year of self cathing I would also pump it out on occasion to try and decrease the frequency of self cath's.

But I think I started to make real progress when I decided never to force the bladder to do what it doesn't want to do. If the urine wanted to flow easily, I let it. If it didn't want to flow easy, I cathed.

There were times I went from cathing a few times a week back to six times a day. I just followed what my bladder was telling me. It seemed to work with me as my bladder functions pretty normal 90 per cent of the time without cathing or drugs.

Jim

Can you elaborate a little on your history? Peeing fine during the day with difficulty at night could be symptomatic of bph combined with larger night time bladder volumes called nocturia. A larger bladder volume combined with a flaccid (stretched) bladder from bph can result in dribbles as the bladder doesn't have enough tone to push the urine out through the obstructed urethra. You don't want to force the process because that can result in more bladder stretching plus back pressure to the kidneys which is not good.

Have you thought about self cathing? Self cathing will release all that pressure and let the urine out emptying the bladder completely. Again, don't know your history but you may only have to do it occasionally, maybe just a night, depending on the specifics of your retention issue. Self cathing could also get you off the drugs if you're not tolerating the well, as many people aren't. 

Jim

I drink infrequently enough that remembering to bring a catheter when I "might" have more than two drinks is more trouble than it's worth. I doubt the four times a year that I have more than two drinks and have to pum will have any impact on my bladder function.

ther than when I drink a lot, based on how I'd doing now I don't forsee needing to cath - I'm about as good as I was 15 years ago. So I'll either watch how many I have or pump as needed.

Self cathing is way better than a foley, but "look ma, no hands" is a whole lot better than that.  :-)

Thanks for the reply jimjames. I haven't thought about self cathing, I plan on having HOLEP and washing my hands of these problems. Strange thing is, some nights my stream is fine, some nights its terrible. Most nights I only get up 2 or 3 times if I don't drink alot after supper. I don't drink alcohol, caffine berverages or eat spicey foods. Sometimes I think salt is the culpret

Un.   Maybe you should try it first before you have the surgery.  It may work and you will not need to have it.  It seams like you don't have that big of a problem There are aot of men on here that do it instead of surgery..  Good luck  Ken

YOu might want to try self cathing and see if it gets better, or try one of the less invasive procedures before going for Holep. It works, but has a longer recovery and will give you RE

Here's the thing. You could end up having Holep and still get up 2 or 3 times a night because the problem may be something else like nocturia. That's why it's important to diagnose and identify exactly what the issues are before you try and fix them. Holep, TURP, Green Light, and similar are like shot gun approaches to BPH. One thing you will be sure of is that some or all of your blockage will be gone -- plus retrograde ejaculation -- but again that doesn't mean your bladder will function properly. There are tests that can be done prior such as urodynamics to give you some idea of what you might expect from these procedures. 

So again, if night time urination is your major problem, don't just rush into a shot gun approach like Holep that may not even fix it. One thing you can do is to start a urine log and measure those night time volumes. If you're putting out normal volumes each void then Holep will not fix that.  

And yes, I've always thought that one of the factors with my intermittent nocturia is salt. What appears to happen is that the salt retains the fluids during the day and then unloads heavy at night. 

Jim

Forgot to ask what is your IPSS score? (see link below if you don't know). This will help a little in putting your condition in perspective and also highlighting what lifestyle problems you are having. Again, uro docs tend to be trained in one particular operation or procedure and that operation or procedure becomes their "go to" for bph. Problem is that bph is not any one thing and not the same for everyone and the "go to" procedure may or may not be the best way to proceed. 

https://patient.info/forums/discuss/what-is-your-international-prostate-sympton-score--453484

Jim, Ken, Oldbuzzard, One thing I forgoit to add. I've had 2 major bleeding episodes. I mean peeing LOTS of blood. Massive clots that I can't believe I passed. I also had 2 smaller episodes of just pink urine , then just a couple of small clots easily passed.  Couple that with a median lobe that protrudes into my bladder I believe the only solution is surgery. I originally thought I had prostititis but that was shrugged off by 3 urologists. My GP, an urgent care doc and 3 RNs said I had classic prostitis symptoms ( pain at tip of penis, perinium, around rectum etc. )

Sorry for hijacking your thread ChuckP

IPSS 8

QL 3

I'm 58

The absolute worst part, I haven't sex since March. I'm afraid of bleeding. Mrs. isn't pleased 

IPSS of "8" is borderline MILD. It's hard to believe that any urologist would recommend a HOLEP for someone with an IPSS of "8". Either I'm missing something or you should run as fast as you can and find another urologist who can take care of whatever problems you are having without a very invasive procedure that not only seems unecessary but that will leave you with permanent sexual side effects. 

Still not clear what your problems are other than getting up a few times at night which really is sort of normal at your age and in and of itself does not require an operation. 

Why are you afraid of bleeding? Bleeding can sometimes occur with or without sex for various reasons including prostatitis but again that doesn't mean you need an invasive operation.

Jim

OK. Just read your follow-up post regarding the bleeding. I still think HOLEP is over the top for someone with an IPSS of "8". In all due respect to your GP, urgent care doc and 3 RN's, non specialists tend not to know very much where the prostate is concerned. You owe it to yourself to see at least one other specialist, preferably at a large teaching hospital who can offer you alternatives to HOLEP.  Not to minimize the bleeding, and I'm certainly no doc nor do I know your full case, but I've had episodes of both pink and red urine going back a number of years and not one urologist back then recommend surgery.

Jim

Try a condom.  Just in case  Ken  Did you doctor say why your bleeding.  I have to look it up but I thnk you can still do CIC with a median lobe  Ken

UN  Jim is right.  That is low.  Have you see any other urologist.  While you still have the time go get a second opioion Please   Ken 

Yes, you can do CIC with a median lobe, I have one, many who do CIC have a medin lobe. That said, I'm not even sure "unklefester" requires CIC given what he has so far written. To put a IPSS score of "8" in perspective, I'd venture to say that score is better than most who have had a *successful" surgery or procedure of some sort. Without knowing all the details, seems that the bleeding has to be attended too although if it's the sort of bleeding that I had from time to time, a good urologist would probably not make too much out of it. 

Jim

Thanks Jim.  I don't have to look it up now. I ask him but he did not say if the doctor told him why he's bleeding.  I  know when it happen to me.  It was right after a repair of one of my implants Went back on my blood thinners to soon.  Had 3 blood clogs around my prostate and I broke one when went to the bathroom. At 5AM I sat down  Had to have EM surgery they burn them.  Had to have a 24 hour  flush done with a 3 way catheter.  That was the worst part of the whole thing.  24F   Ken  The bladder spasm were bad to   

Lots of reasons for bleeding and you just added another one. Hope it finally worked out for you. Unklefester needs a urologist who will take the time to sort things out and not rush him into an operation. 

Jim

I don't think this urologist is doing him justice.I think to him he's just a number.  All is fine with me.  My prostate got smaller for some reason.  Had a prostate infection took 1000mg cispro for a month.  My urologist thinks that what did it.  Im just glad   Hope your doing well take care  Ken   

For the record, I requested HOLEP. My first uro wanted to do TURP right away. Didn't even mention fernasteride.  I asked for fernasteride and have been taking it for 8 months. along with tamosulin for 4 months. My second uro adopted a wait and see approach. I was fine with that until the very weak strean when waking up  night time to go pee. Some nights it just dibbles out. Other nights its fine. She didn't do HOLEP so she referred me to another uro within they're practice. Going for a cystoscope in December. Again I requested HOLEP because I got tired of pee running down my leg at night. 

Ken what is CIC?

When the bleeding starts, its bad. I had 2 bad episodes 7 - 10 days of bright red, or brownish colored urine with very large clots ( 1/4" diameter 3/4" long ) pee squirting in all directions. If it wasn't for the fear of bleeding I would wait it out. I used to have a difficult time sitting down but I think fenasteride has shrunk my prostate enough 

No my first uro never said why I was bleeding. By the time they got me in for cystoscope bleeding had stopped. I don't know if a CT scan ( I've had 2 with contrast ) would show a weak blood vessle but it was never mentioned if one showed up.

Holep or Turp, their idea or yours, both very invasive and both will most probably leave you with retrograde (dry) orgasms for life. Also, it's unclear from your last post if either of those procedures would actually fix your bleeding problem. Have they located the source of the bleeding? If not, how can they recommend an operation to fix it?

As to the dribbling, given your low IPSS score (mild), you might want to explore less invasive methods to deal with it than HOLEP or TURP. Not to say you even need them, but many here have had success with Urolift, PAE and the newer REZUM procedure. All less invasive than TURP or HOLEP and all without retro orgasms. There's also CIC (self cathing) that might very well take care of that dribble with only one or two cath's a day depending on how much retention you have, assuming you have retention.

And again, your IPSS score is probably lower than many of the men here who have had HOLEP or TURP. So be cautious of what you want, because you may end up with a higher IPSS score after the operation than before.

Jim

Thanks jimjames. I read many of the horror stories of the men on this site. I am thankful my problems a minor compared to their's. I have no onterest in self cathing.  My biggest gripe is the lack of information available from my CT scans. The radiologist only said I had an enlarged prostate but didn't a number. Both uros using DRE guesstimated 50 grams or CC whatever unit of measure they use That was 2 ct scans by different radiologists. Unfortunately the only game in town for HOLEP is the urologist I'm at. He has done numerous HOLEP procedures, trained other uros, and  written many papers on it. I agree there is no guurantee bleeding is from prostate. When I had my cystoscope about 10 days after my first bleeding episode uro said prostate was swollen and inflamed and bladder had no sign of bleeding. Everyone is just assuming its my prostate. Prior to bleeding sex was not that great. Orgasm was a burning sensation with very little fluid. 

To my knowlege urolift and PAE aren't very good for large median lobe maybe I wrong though.

Finally, I figure at some point I will need prostate surgery I'd rathe do it at 59 than at 69 or 79. I'm reasonably young so anesthesia isn't the worry it would when I'm older

Unclefester,

I hear your pain and frustration and it's natural that you want to do something about your condition. But it sounds so far that you don't really have a diagnosis of any sort? So here's one and there is no bill attached

Chronic non-bacterial prostatitis. I had it when younger, still probably have a mild case of it from time to time. It's pretty common. And frustrating because no quick and easy cure. Look it up if you haven't already because it's consistent with all the symptons you have mentioned.

But guess what? Even though they throw everything but the kitchen to try and and cure it, the one thing they rarely recommend is surgery, of any kind. It's just not that kind of thing. 

So unless your doctor comes up with a better diagnosis -- or any diagnosis -- I would be remiss to once again tell you that agressive surgery like TURP or HOLEP just doesn't make any sense. And in all due respect, your argument that you might as well have it now, as opposed to when you're older, makes even less sense. 

You simply don't have major surgery like HOLEP because you think one day in the future you will need it. You have that kind of surgery only if you really need it now. 

Try and step back and evaluate what is happening. 

Good luck moving forward.

Jim

Jim

Thanks Jim, Yes I had classic non bacterial prostatitis symptoms. My first uro offered nothing but TURP for relief. No one has pushed HOLEP I just want to be done withe this problem but I understand it may not solve it. I haven't mentioned prostatitis to my latest uro. I'll discuss it with him whe I go for cystoscope. Just tired of all the jerking around for the past year. I appreciate you, Ken and other trying to talk sence to me 

So what your saying  your gave up. You don't care why your bleeding  Just distroy the prostate   Why do you think you have a large median lobe.  None of the doctors told you anything about that  And the burning orgasm I had a prostate infection December of 2015  It hurt like hell. And the pain lasted for a hour after the orgasm . Was on Cispro 1000 mg for  month  Thats what my doctor did for me  He did not say lets take it out your having a problem.  I'm sorry but you own your body explanation why.....Don't rush into any surgery just because  you my need it in 20 years Giving up is a waste of your life   Ken

Uncklefester,

Kenneth put it very well. Don't take your frustration out on yourself, because that is what you will be doing if you keep pushing for a HOLEP, which apparently your doctor is only too happy to oblige. 

Reality is that doctor's can't cure everything with a magic bullet and non bacterial prostatitis is one of those things. 

As frustrating as non bacterial prostatitis can be, the good news is that it's often self limiting, can wax and wane and even disappear for a long time, or forever. It also tends to get better for some reason as we age.  Mine did, and I guarantee I had as much, probably more, of a blood gusher at one point than you described. 

You need patience, possible another urologist, and need to understand that an operation like HOLEP is not indicated in anyone's book for non bacterial prostatitis. I think you know this already or you wouldn't keep sticking here. 

You're 59 and in my book relatively young. So try the antibiotics if you haven't already. Try some lifestyle changes perhaps. Look outside the urologist's doc's at some holistic approaches. Just don't give up and do something stupid.

Jim

 

No one should never give up without a fight.  Your worth a full life   Ken 

I came to this discussion to read about Rezum results. Is anyone having this done, because the discussion is way off track!

I had it done last March. I've summarized my results previously, but this is a long thread, so let me know if it would be helpful to re-summarize.

Motoman,  yes I had Rezum done Aug 23.  It has not worked.  If fact Rezum made it worse.  I'm now having to self cath twice a day; I never had to do that before Rezum.  I would be happy just to get back to the condition I was in before the Rezum procedure.  In mid November my Uro doc and I will have a discussion  regarding forward options. 

I have developed a 12 point list of lessons learned with respect to the Rezum procedure that I can send you're if your interested.

Some suggestions:

1) Why wait til mid November to re-evaluate? IF you're not improving at all, its just another month of misery.

2) Time to get scoped - to figure out if your prostate is still swollen from the procedure or if the problem is your bladder. For me, that was why I was having so much trouble and a short course of Myrbetriq helped a lot.

3) Don't consider any other procedure without a confirmed diagnosis. Further work on your prostate is only indicated if a scope shows that its still enloarged and that there is no reasonable expectation of that swelling going down over time.

Good luck - at least your doc isn't making you suffer with a Foley.

I had my Rezum on 8/27, so a few days past the 4 week mark. I am 54 and the median lobe of my prostate had grown so it was causing blockage to the urethra. The overall size of my prostate is not an issue.

My issues were getting up 5 to 6 times a night, very weak stream, very slow starts, and frequent runs to the bathroom during the day.

I am extremely pleased with my results so far. A little over 4 weeks in as I said, I have a very strong stream, start right away, I'm getting up 2 times a night most of the night, a few times only once and  sometimes once other times 3 depending on my fluid intake in the evening, and I would say normal trips to pee during the day.

Once I removed the catheter, 3 days after the procedure it has been steady improvement. Only twice have I experienced and blood, it was very little, and one of those times was with my first ejaculation.

My overall experience has been good..

I mentioned early when I first joined the forum. See if your doctor will  get permission from prior patients to talk with them.

After reading a lot of the post, there are many of us that have had different experiences. I do believe the doctor doing the procedure, what your actual physical issue with the prostate is, post procedure instruction all have huge effects on the outcomes..

I talked at length with my Uro and 3 patients that had the procedure done 3 and 6 months prior to me. They were happy and told me what to expect and I ended up having similar experience to them.

Hope this helps!

I think your assesment is generally right, My sense is that this is a simple procudere to perform and that the doc doing it should't impact the results all that much, asuming they were trained properly. My uro described it when it was in clinical trials as something that any Uro should be abel to do well.

Most people can pee within a week and most do really well with Rezum. The problem is there doesn't seem to be a way to predict who will have problems or a systematic protocol for how to deal with it when things don't go well. They know now that bigger prostates take longer to fully respond, but other than that its pretty much a blind alley.

The post op care seems to be the biggest variable  - poor guys that have been stuck on a Foley for months causing pain, embaressment and actually precluding revocery in some cases. The parent company should do some analysis and make firm recommendations regarding cases that don't prgress normally. My guess is that there are only a couple of issues that cause most problems and knowing which one which patient has and how best to treat it would go a long way toward making this procedure work better and be less of a crap shoot IMO.

Thanks for the replies. It seems like a mixed bag of results, some good, some Ok, some not working. And it sounds very painful. 

I will have to search for some docs that do this, as there is no one close to me. I'm sure this or a HOLEP is in my future, not a question of if, but when. 

I had the Rezum operation this morning.

It was uncomfortable, and awkward. 

But, it was definitely not painful.

Hi John,

Hopefully your regression is temporary. Have you had a current scope or imaging to compare to pre-op? Also, when you say you would be happy to go back, could you detail a little what symptons you had prior, and if possible what your IPSS score was pre-op per link below. As to moving forward, it seems that given the procedure was so recent that your best bet might be just to be patient and see how things develop over the next several months.

https://patient.info/forums/discuss/what-is-your-international-prostate-sympton-score--453484

Holep is a surgery, with all of the accompanying risks that guarantees Retro Ejaculation, Rezum is a procudure with a less than 3% chance of RE. No anesthesia, no hospital stay, ect. You can always get a Holep done if less invasive measures fail. You should consider Urolift and PAE too - neither require anesthesia and the recovery is way shorter.

I’m not really in misery.  My issues are more of inconvenience and a bit of disappointment ... my post Rezum expectations did not include self-cathing twice a day 2 months after the procedure   

My mid-November date to discuss post Rezum options with my Uro is to allow him time to do furthering testing including a urodynamic bladder test.  I will ask him about a scope.  Also, I wanted to give it more time to see if things would improve; by mid November that would be nearly 3 monhts.   At this point I urinate naturally 50 cc at a time and I get between 350cc and 600 cc when I self-cath which I don’t think is very good.

I’ll ask my Uro about Myrbetriq.  Thanks for the tip!

Jim, My IPSS is 19.  My issues prior to the Rezum procedure were frequency and urgency plus UTIs several times a year.     In my mind, one option is to give it more time.  I have not a scope done yet.

Yeah, I know what HOLEP is all about, as well as PAE, Urolift, etc. I had Itind done, but don't think it is gonna last. That was my try at something less invasive. That is why I am researching Rezum. It might be a better alternative to HOLEP, but from what I am reading maybe not.

i don't care about RE. Been married 30 years, sex is less and less all the time, and I don't beat off (not too much anyway, LOL), but I do care more about the daily function of peeing. And not peeing with a catheter, that is a last resort for me. 

The only way to gauge the prostate involvement is with a scope and that's the only way to see if Rezum worked. If your uro balks at myrbetriq, ask if it can hurt to try and if he says no then beg him, It helped me a lot - and at a point it became counter productive and I got off of it and got even better. But he can't know the results of the procedure on the prostate without a scope. Time to look - and FYI - my uro says the majority of the results happen weeks 6- 12, so you could well improve a lot.

You mentioned to Oldbuzzard that you urinate around 50ml and right afte that you cath around 350-650ml. I know it's difficult to know what your natural retention was prior to Rezum, as most void tests involve artificial fluid loading, but do you have an idea how much you were able to naturally urinate prior to Rezum? I guess what I'm trying to determine is how much worse off are you really, or are you about the same as before and it's just that your urologist decided you need to self cath based on the void tests from the Foley?

Related, and I've written about this in more detail elsewhere, as long as you're going to self cath, the general rule is that if you cath out more than 400ml you should increase your frequency. Personally, I took it a step further and used what I believe the guidelines should say which is that I tried to limit my total bladder volume to 400ml or less. So, for example, if I naturally voided 100ml and right after cathed out 400ml, then I would have a total bladder volume of 500ml which would mean I would then increase my frequency. 

Have no idea what happend to your bladder, but I see no harm in increasing your frequency so that you are never holding more than 400ml in your bladder. I think the more you keep the bladder decompressed by frequent cathing, the more chance you will have of regaining tone which hopefully will translate into larger natural voids and less retention. 

If I were in your shoes, I would definitely get more agressive with the cathing and up it to 4 or more times a day at least for now. 

Jim

OK thanks Oldbuzard for your inpu!. I am hoping for the best

Thanks Jim for your input. I was thinking the same thing. I need to go

to 3 times a day. I will do that.

Studies suggest that there is no health downside to cathing up to 6x/day. In fact, the more you cath (up to 6/day) the fewer the UTI's. Sounds counter intuitive with more microbe exposure, but the reason is that the more times you empty your bladder completely, the less suseptible you are to UTI's.

So it really comes down to the time/hassle factor. I worked at home so 6x/day was a non issue back when I needed it. As I've discussed elsewhere, keeping total bladder volumes low did wonders for my bladder rehab. In two years I went from near acute retention with PVR's over 400 to pretty normal bladder function with PVR's often below 50ml. And as of now, I only need to cath maybe once or twice a week.

So, if you have the time and/or inclination, get agressive as you can up to 6x/day and hopefully it will help. 

BTW are you using Speedicath's? I highly recommend them because of the hydrophillic coating. Slips in super easy. I started FR14 but dropped to FR12 after a month or so. Even the FR12 is stiff enough for me so that I can hold it by the plastic funnel and "dive bomb" it in to the urethra basically mimicking a totally sterile field since nothing and no one touches the part of the catheter that goes into the urethra. 

Jim

Thanls Jim  Your story gives me hope.  I just retired (hey!) so I can cath as frequently as needed.  Your right, it can be a bit of a hassel but I've been doing it for 3 weeks now so it is getting easier.  I tried several types including Magic3 FR16  and now Coloplast FR16.  Both are easy to use.  Each each time I use one I can feel pressure as the tip of the cath passed my prostate area and again as it enters my baddler.  That kind of troubles me but I have gotten use to it. 

I'm leaving town for a few days (with a fist full of catheters.  I'm not sure that I'll have continuous access to the internet but, again, thank you for your input.  You have been very helpful.  - Take Care, JG

Hi John,

Are you using Coloplast's "Speedicath" model? They are the ones with the hydrophillic coating so that you don't need to use a lubricant with it. If not, call Coloplast and they will send you free samples as long as you have a doc's prescription. 

Also, you should really try FR14 and even FR12, which I use. I'm surprised they started you at FR16 which are much larger. Rule of thumb is to use the smallest catheter size that will do the job.

And "yes", you will feel some pressure at those two points during insertion -- around the prostate and entering the bladder. Both are normal and expected.

Since I've been cathing for a while, my body sort of takes over and lets the catheter in easy at these points, but I've read others slow down, push very gently and sort of let the sphincter muscle release itself. If resistance is more significant, a very, very slight twist back and forth sometimes gets it in easier.

You should also sample the "coude tip" versions if you aren't using them. They are designed to go around large or inflamed prostates. You may feel less of the pressure you talk about with the coude as it goes around the prostate as they are designed with a slight bend at the tip so they can't "stick" you turning the corner of the prostate. Coude tips were prescribed to me initially and that's all I ever use. Tried a straight catheter a few times but too hard to get around prostate and didn't want to force it. 

Jim

Jim. I have used both Coude and straight cade both work for me

equally well. I will go to a FR 14 or 12 when I work thru

the ones I have now. I am using speedicath now