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

Glad your decision was the right one - it sounds like your problem is fully resolved. Awesome!!!

Hi Chuck, I've been contemplating the Urolift for a year, then I heard about the REZUM procedure. I don't have severe problems like some men. But I rarely sleep more then 2 hrs without waking up to pee. I like the less invasive of the Urolift. Keep me posted if you can. Thank you!

Kenny in MPLS

Hey Kenney.  I had a Uro-lift done April of 2015.  It worked great for me.  I did not have a bad problem.  Just prostate pushed together.  Doctor just pulled it apart.  Had 4 implants.   The PAE is a good procedure also. Only diffrence is that you will have less of a ejaculation because the prostate is smaller and the prostate cell make the sperm.  Get all the information you can before you pick a procedure.  If one does not work for you the other will.  Remember all men heal diffrent  Ken PS I'm here if you have any questions 

Thanks! We Kens have to support each other!

No problem.  If you need someone to talk to I'm here  Ken

A year ago, a Uro I know in Phoenix said that Urolift seemed like a promising procedure. A couple weeks ago, I emailed him that I was seriously thinking of getting it done. His response was that he wasn't a big fan of Urolift because of possible calcifications, due to the foreign objects in contact with the urinary stream. He now recommended REZUM. It was my research for that, that led me to this site. My Uro here in Mpls does Urolift. Interestingly, the REZUM equipment is made and/or sold in the same suburb I reside in. There is a Uro in St Paul that does REZUM.

Based on your description, you're probably a good candidate for both procedures and both have shown excellent results for someone with an annoying but not life changing sized prostate. The only way to really make an informed decision is to find a good Urologist who does both procedures and ask them which they think will work better for you.

My sense is that the post op stuff is easier with urolift, but you haven't really made your prostate smaller, just strapped it down. That said, none of the trials have shown that to be a problem. Based on what you've said, you have an excellent chance of having a really good result with either porcedure.

Hi Chuck,

Sorry if you posted this elsewhere, but when did you have our last Urolift, what were your symptons prior to it, and how are you doing right now? Do you know your Post Void Residual? Do you have to cath at all? Any non-positive side effects from the procedure. Thanks.

Jim

It may reduce the duration of Foley indwellingg. Please discuss with your doctor and share their opinion and/or experience. 

Have you done any procedures yet my prostrate is much better but I don't think my prostrate is swollen any more I have a little bit of incontinence my urologist says it will. be Gone soon

That happened to me - I couldn't pee at all for a little over two weeks after Rezum and I suggested steroids to my uroolgist and he said that there is some research suggesting the steroids raise PSA numbers and that I ran the risk of making it worse.

Thank you Dr. Park  That is very good information.  It's nice to see a doctor on here.  Thanks again   Ken

The prostate swelling is transient. The maximum may be reached at 1 week and spontaneously subside slowly thereafter. This is the reason why most patient have to get Foley catheter following REZUM procedure. This finding is described in the published paper on REZUM.

The acute swelling of the prostate 'transiently' aggrevates the obstruction of the urine flow. The prostate size, the degree of anatomic obstruction, the function of the bladder may influence the duration of Foley or self catheterization. It will improve, but it will take time.

Yes now it is nine weeks tomorrow and generally some small periodic stinging occurs and occasionally I'm having some quick urine flow and little initial control .

The reason to use steroid is to prevent acute inflammation from cell necrosis, that is the cause of transient prostate swelling after steam injection. So it should be started before injection. I'm considering  to start oral prednisolone one day before REZUM and continue for 1 week, and add dexamethasone injection just before the procedure. Short term use of steroid is usually regarded safe. But be careful in patient who has gastric ulcer that may be aggrevated by steroid. I don't recommand steroid in the patient who get transrectal prostate block, becasue steroid may aggrevate infection.   

Doctor Moon  I want to thank you again for all the information men on this site have been trying to get.  I wish more Doctors would do the same  Ken  

Thank you Kenneth, REZUM seems very promissing to me because it is the only treatment until now that can make BPH patients to the state before they get BPH.

I want to get more information of REZUM, but it take years to see many papers on new treatment. This board is also very informative to me, some information can not be get from formal scientific papers. 

I know you will keep learning and I hope you will let us know. Do you or are you looking into any of the others treatments like PAE or Uro-lift.  Thank you  Ken 

Hello Dr. Moon Soo, 

Welcome to the discussion group.

You said, "...This board is also very informative to me, some information can not be get from formal scientific papers..."

I wish there were more doctors like you. I make it a point to read as many relevant formal scientific papers as I can,  and yet it's surprising how few doctors seem to take the time to visit discussion groups like this to get s an unfiltered patient perspective. 

I'm between urologists right now and looking for somone inquisitive and open mind as you appear to be. Unfortunately, South Korea is a bit of a commute

Jim

PAE is performed by intervention radiologist not by urologist, so I don't have much interest on it. One thing I want to mention is selecting prostatic artery is very demanding, lots of variablity of anatomy of pelvic arteries and the consequece of blocking other important artery. Their are some papers on the severe complication of PAE, from blocking other arteries. 

Please find the following paper that I published long time ago.

https://www.ncbi.nlm.nih.gov/pubmed/9806186

Urolift is lauched in Korea one year ago, and I had a dinner with a doctor form USA who invited by a company importing Urolift. I asked many questions to him, read most papers on Urolift, analysed most video of Urolift procedure on Youtube, and decided not to treat my patient with Urolift. 

I performed more than thousand cases of KTP laser that switched to plasmakinetic vaporization now, and waiting REZUM. 

 

Thanks for your comments, James.

Hello Dr. 

Thank you you for taking time to interface on this forum!  Very much appreciated.

i am a healthy 58 yr young man.   Had urolift 1.5 yr ago.    I void 150-200 and my PVR is 400 consistently.     I do CIC and on  Flow max.   

in your opinion, and with this limited information where should I be looking to find a better solution?   Pref. No RE.   And maintain strong libido?

Warm Regards,  Anthony.

First,its very important to decide you have anatomic obstruction or not. If it is functional, not much can be done. If it is anatomic obstruction, you have to choose between option. Sometimes, especially median lobe BPH, Urolift can aggrevate the anatomic obstruction by lifting the floor of bladder neck. So if you didn't have large residual urine before Urolift procedure, I strongly recommand to have cystoscopy exam that can easly identify you have anatomic obstruction or not.

Someone confuse retrograde ejaculation and sexual climax, orgasm. After TURP, orgasm is preserved.

I don't like to give indivisual advice because I don't know the exact patient situation and it can influence the good doctor patient relationship that is very important, and medicolegal conflict. I hope this general information is helpful to you. 

Your input is well received, especially at his late hour.

Finding a good doctor in this field I am finding to be very challenging. However to know that doctors like yourself are out there, ones who will take interest in another's concern and not try to move you in and out like cattle.

God bless you for your sincerity!Will pass on your limited advice to my Uro.

Keep up the great work!

Anthony.

Hello Dr.

      It looks like you might have posted some links to the papers you mentioned, but the moderator deleted them. Could you give us some titles that we could google to find the papers? Thanks!

Rich

Rich,

I deleted duplicate posts - the article is linked in the post above the deleted ones.

Regards,

Alan

Thanks Alan for the clarification!

Thank you Doctor Moon for your insight on these procedures.  I read up on the 2 laser procedure And I'm not a fan of anyone cutting at my prostate but I found some trail but did not say anything about side effects. Which there are many. I did find This. During the procedure the doctor pay attention to avoid the coaqulation or electrical excision near the area of the prostate capsule to minimize tissue damadge to protect erectile function.  You may be able to have a erection but does that still cause retro ejaculation.  I feel alot of men would have more surgerys if that function can be saved.  With the laser do you have enough control to stay away from the bladder neck and the ejaclatory ducts to save that function.  I have read on here a few men have had Button Plasma Turp and the doctor stayed away for the 2 things I mentioned they did not have retro and had good resluts I don't know about what you tell your patients but I know alot of urologist tell a man when he gets in his 50's and 60's that he does not need it because he is not having kids and all will be the same. To me that is a text book answer.  No one mans orgasm is the same.  In principal yes.  I feel and so do some men that the ejaculation and the orgasm go together.  I was giving some pills early on from my doctor.  The first time I had sex after getting the pills.  The built up was there but the orgasm was flat like I just did nothing and no pumping action. It made me incomplete and I didn't want to have sex of anykind because it was not good..  I was very disapointed with that and got off them pill fast.  I did have to have a procedure done because my prostate was pushed together I picked the Uro-lift and it has work great for me.  it's going on 19 month's.  You seam like you a very kind doctor and you care about your patients I applaud you for that and you also trying to find new ways of help men out today.  I feel we need new procedure to help men live a full life with every that comes with it.  Thank you for the time you take with us on this site.   Ken    

Hi Dr. Park,

I know that steroids are used with the prostate artery embolism (PAE) procedure for that purpose. It makes the PAE so benign that there is no need for a catheter at all except for the convenience of the doctor. My PAE was done without one. At the same time, high doses ibuprofen is given for the same purpose, so I don't know the contribution of each, but together,they are effective. They are both continued for several days. That said, the steam procedure seems to be more dramatic, so those medications may not be quite as effective.

Several of the men on this site who have had the procedure, complain about the pain as the steam is injected. Shouldn't anesthesia be used to mitigate that pain?

Thanks for your contributions to our discussion. It's wonderful to hear some expert advice.

Neal

Hi Again, Dr. Park,

It looks like you are one of the founders of the PAE. Congratulations. I agree that it requires a very competent doctor to do it correctly, but, also,the technology continues to improve. All of these procedures have significant dangers if not done properly .

Thanks again for your input.

Neal

Yes, all the procedure that remove the prostatic tissue from inside to out have same limitation, leaving wide open bldder neck, the cause of retrograde ejaculation.  

But RE, ejacualtion to apposite direction to bladder, is somewhat different from absent or low seminal volume, the side effect of BPH medication. Tamsulosin (Flomax) block the contraction of the prostate to push semen out, Finasteride(Proscar) or Dutasteride(Avodart) block production of semen. So the sensation of ejaculation also different.

The bladder neck sphincter is intermingled with adenoma, so it is almost impossible to remove adenoma selectively. If I preserve the neck, the BPH will recur soon.

The erection thing is totally different. The pudendal nerve is far from the resected area. So with current bipolar system or laser, it is almost impossible to damage the nerve. Most of my patient have RE after endoscopic surgery, but not erectile dysfunction.

   

I agree with you that steroid can not totally prevent prostate swelling from steam injection, but definitely will have some beneficial efffect. 

REZUM need anesthesia, and the company recommand transrectal prostatic block. I'm planning very short IV sedation(ame for endoscopy), because the procedure will be very short. 

As a urologist not radiologist, my position to PAE may be deviated, please consider this first  From the idea that blocking the supplying artery to treat BPH as I published 1998, I tried several methods to selectively block prostatic artery that can be easily identified by transrectal doppler ultrasound. At now I think the ideal methods is realtime high intensity focused ultrasound. No anesthesia, no radiation, simple and quick. Several institute is doing research for years. Their main interest is to stop internal bleeding in trauma patient during transportation of the victim in the ambulence using simple compact ultrasound machine, but it can be nicely applied to treat BPH. If someone has big money, please collaborate with me for this promising treatment  I think PAE can be the ideal candidate competting Holep for the treatment of very big prostate. But as a standard treatment for BPH, it has a several limitation. The radiation hazard. The PAE is known to be a most technically difficult procedure in the field of interventional radiology. I means long procedure time and consequent high radiation exposure. We have to consider not only the rate but also the severity of complication in any new treatment. For example, the popular alcohol injection for the BPH treatment was abandoned after two case of severe complications, bladder necrosis that need cystectomy. PAE is not free from this rare but severe complications, becasue the branch of prostatic artery has lots of variations. It can branch from rectal artery, vesical artery and internal pudendal artery that supply the penis. Considering the technical difficulty of PAE, the situation may be different from now that only the very skilled radiologist perform PAE. And also there are reports on the complications of PAE, rectal injury, seminal vesicle infarction and also bladder necrosis. They are totally different complication from endoscopic surgeries. BPH is not just a simple enlargement itself. We have to decide the presence of anatomic obstruction and that is the cause of current symptoms, can manage the complications from the treatment... I am not sure that radiologists are capable or interested in these kind of dirty work that is very important to patients satisfaction.  The prostate artery is not end-artery like brain, heart and kidney. There are many collateral blood supply that may replace obstructed artery and repefuse the prostatic tissue regrowth.   With this limitation, I have to agree that PAE is good option for the BPH patient with very big prostate in the hand of skilled radiologist.   

Dr. Park,

Thanks for your reply.

The way you outline is how I thought the anesthesia should be handled. If the other urologists are causing that much pain, they shouldn't, and prospective patients should check on this before they choose a urologist for this procedure.

Thanks again,

Neal

Very helpful. The check is in the mail for the focused ultrasound machine

What is your take on focused-laser-ablation as discussed in the thread below? Apparently this technique was initally designed to remove prostate tumors but Dr. Sperling noticed that often patients had marked improvement in their BPH symptons afterwards. He know treats bph patients using focused laser ablation.

https://patient.info/forums/discuss/focused-laser-ablation-508907

Thank you for that information.  If we can find a surgery to save the ejaculation I think alot of men would be happy to have that surgery.  I was on Flomax and Rapaflo they gave me dry orgasm.  They did not feel right The orgasm was flat and felt like nothing.  Did not care for it.  At 61 I still have my ejaulation and it pretty good and my orgasm are intence I want to keep them that way.  Thanks again  Ken 

This treatment can be summerized as, insert the laser needle into the prostate and elevate the target area temperature up. It is one of the many thermothrapies using heat conduction like TUNA except for the energy source. Nothing to new for me.

Thanks for your take. It was presented as something new and had a very good anecdotal back story about cancer focused laster ablation patients coming out of surgery sans bph symptons. I understand that TUNA had very limited success.

Jim

I wonder if Steroids would have helped me initially. When I had Rezum done, no one had gone as long as I did without being able to pee. My doc was cool with self cathing, so it wasn't horrible, as a foley would have been.

As for the pain, it was short but it really hurt. The last spray made me scream. If I ever needed a repeat, I'd ask to be twilighted and would go on a steroid regeimen for a week or two or until I could pee again.

Your advice has been really helpful

Hi Dr. Park,

Thanks so much for taking the time to provide your thoughts on PAE.

You raise concerns in several areas, including radiation exposure, revascularation negating the procedure, and the possibility of stopping the blood flow in unintended areas.

It is my understanding that newer imaging methods are much safer than older ones because they use dramatically less radiation.

Revascularation is a significant problem. It happened to me. I am having a second PAE tomorrow. In that PAE, the doctor is going to do more arteries than before, and embolize them further from the prostate in an effort to mitigate regrowth.

I guess that the possibility of embolizing the incorrect artery, or embolizing it at the wrong place always exists. One's only hope, as in all medical procedures, is the expertise of the doctor. In my case, Dr. Isaacson is one of the top two doctors doing this procedure in the US. I learned the hard way, with a penile implant complication, that it is so important to get the best doctor one can find regardless of the cost or inconvenience.

Unfortunately, it is very difficult to do nothing.

I am forwarding your comments to Dr. Isaacson, and will let you know what he has to say.

If the PAE doesn't work well this time, I will have to explore other options. I was not clear on your objections to the Urolift procedure, which, pending your comments, seems to be the next least complicated procedure with the next least painful and extensive recovery.

Again, thank you so much for taking the time to participate in this discussion. It is wonderful that you are willing to share your expertise and experience.

Neal

I can sympathise. .....I was on a Foley for 4 months!.....Old Buzzard - Do you or did you experience leakage, dribbling or no warning voiding after your REZUM?....I am so far and I hope it resolves itself soon...

I think your experience may be very different from most because of the time you were on a foley and your bladder was dormant and unexcercised.

I had some leakage the first week or ten days, more often and worst when I fell asleep. But several days to a week prior to actually being able to pee, that stopped. Once I was done self cathing, I had some urgency - there were a couple of times that I barely made to to the bathroom, but that gradually got better over a period of maybe 3-4 weeks.

It sounds like you need some bladder rehab - I would ask your doc for a script for PT and find a therapist who specializes in urinary issues. There are excercises that can help rehab your bladder and deal with continence in general and you seem to be an ideal candidate for those.

OK...Thanks!....

I forgot to mention - make sure the PT has access to biofeedback. They can measure and grpah your muscle control in real time, so you can retrain yourself to hold everything in. The more I think about it, the more it seems that the right PT with the right equipment coould really get you back to normal.

Many Thanks!....

In conversations with Dr Bagla's office, I've been led to believe that the radiation is relatively minimal, and that the average procedure takes approximately one hour.

I'll be curious to see Dr Isaascon's reply.

Neal,

How do you know that revascularation happened with you? CT scan ?

Regards,

Michael

Dr. Isaacson told me before that with the new equipment, radiation is relatively minimal. My procedures have been longer, somewhere between 2 and 4 hours including prep, but it was unimportant because I was asleep for most of it.

Neal

Hi Michael,

All I knew for sure was that the PAE wasn't working, and revascularation was a possibility. In my more recent post, I wrote that it turns out that I have another large artery that most men don't have, that Dr. Isaacson got this time. He didn't see it last time because he didn't expect it. We're looking for better results this time. I'll let everyone know how it goes.

Neal

I had the Rezum procedure done about 4 months ago, The cather they put in me was painful felt like it was cutting me. My flow is better now but im still in pain down the shaft towards the bottom where the urine flows it burn like crazy everytime i had to urinate.. Now the pain is not really in the shaft but the head at the bottom feels like sharp needles are in there..Sometimes I dont want to urinate just so I dont feel the pain.. Im not sure if im a rare case but some of the after affects bug me..Im still having pain issues 4 months after the procedure..I can sleep through the night finally.I asked my doctor did he try an experiment on me because it felt like someone took a razor and made a slight cut down the shaft..

I bleed for a long time after the procedure even the nurse said she had never seen any patient like this before after the procedure..

Im wondering now if sex is going to be a pain experience also now.

My doctor just says ( non of my other patients are having this problem but im not worried about them and not all of us has BIll Gates money either we are not the same.

Can anyone tell me why im feeling this pain in the shaft like a paper cut on the inside or what i can do.

IT sounds like the catheter they inserted after surgery did some damage - yu should have it checked out because there shouldn't be this kind of burning pain after 4 months. Have you tried Pyridium (they sell generic version over the counter) to see if that helps? You can't stay on it forever, but sometimes the results can be dramatic and make you reasonablly comfortable til they figure out what the problem is.

Have you been checked for a UTI? Symptoms of that wouldn't get better til you treated it.

The funny thing about the UTI is I kept telling him I think I might have a UTI but he said his test said I did not but I read that you can have a UTI and the test not pick it up. I complained to death ears but when i went in bleeding all over after him ignoring me and told him look Im preparing to die since he thinks my complaints are unimportant....As far as the Catheter goes when they went to insert another one it was sooo painful i would not wish that on anyone I really did start to feel like an experiment..When the nurse took it back out she told me to get dress the whole time she was gone I stood there bleeding non stop talk about torture, it took me ten min before i could try to put clothes on..

I will look up the Pyridium and see where to get that thank you much .Somebody is praying for me and I hope you have answered that part..

Thanks soo much!!

Hi Ty,

Sounds like you need a second opinion from a doctor not involved in your procedure. As OB suggests, I wouldn't use Pyridium more than a couple of days unless I was under a doctor's care who was dealing with the issue. Pyridium will not cure anything but only mask the symptons so you may think you're getting better but you won't be. You really have to address what is causing the pain. 

Jim

I have tried to get the doctor to listen but when he feels like 1 out of 300 is not bad i get the feeling like in his mind it is who cares..But you are right I will look up another urologist ,I just hope they are not just bandaid at the hip together and someone will listen..

My Doc told me I could stay on Pyridium for a week or two FWIW. Take it on a full stomach and JJ is right - it won't cure anything but may help with your symptoms...hopefully you can get into someone soon enough to get treated before you need to stop the pyridium. Yuo can get the generic version (Phenazopyridine) in a drug store as its OTC now.

But if your pain origninated in the middle or end of your penis, the success of failure of the procedure probably isn't related. It sounds as though you got a UTI or some kind of bad irritation from the probe in the procedure or that catheter afterward which there is a good chance can be treated and cured.

No one should have to go through that.  Did the nurse not see the blood on the catheter.  I would get a new doctor and one with a better staff  Take it easy  Ken

Your doc said:  none of my other patients are having this problem 

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

If I had a dollar for every time I heard that one! But main point is that YOU are having the problem and he seems uninterested. Find someone interested who will listen.

Jim

Holy coe, are you in America? Sounds like 3rd world medicine

Thats supposed to be Holy cow. Also were you bleeding all the time or just when you pee?

Third world America in a nice 3 story building.. Its funny you can if you think about it can find enough info on this on the internet but we need to start giving good doctor names so we can all get done right the first time. Then no one has to have a horror story.

All the time!

Geeez I thought I had it bad when I peed blood. I can't imagine what its like bleeding all the time. 

She saw the blood and said I will clean it up just get dress..