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

Hank  Have you pick something yet..  You do know 9 pf the surgery that doctors want to do will cause retro ejaculation  Get all the infor mation before you get anything done  Ken

It's to late the procedure has been done. Had I know about a 1% chance maybe I would not have ejaculation, I don't think I would have done the procedure.

Well lets hope as you heal you may get lucky.  I will say a prayer for you...Lets us know  Ken

I think the actual occurance of RE is close to 4%,

I am a long term medical device professional who incurred early onset BPH.  I had the Rezum procedure about 13 weeks ago. I added the information about my profession to let you know I really did my research prior to selecting the Rezum procedure.  Here's my story.

I've had BPH for about 2 years.  Been on Flomax.  About 4 months ago, I incurred a bad urinary infection, caused by BPH.  Not being able to empty your bladder creates a hotbed for infection.  Had high fever and massive urination pain for a week.  My plan had been to hold out on a prostate procedure for 1-2 more years but the infection put me over the edge.

There was no way I was going to have TUNA or TURP, or the more invasive surgical option, and suffer those side effects.  Knowing that, combined with the detailed information I was able to obtain on Rezum, and my professional experience, making the decision to use Rezum was easy.  Next step was to gain access to most experienced Rezum physician in my state.

The procedure was very short, about 10 mins in total.  This included the time for local anesthesia to take effect.  It was uncomfortable.  If I had to do it again, I would ask for a valium pill about an hour ahead of time.

For the first week, I had to self-catheterize to urinate.  While it was no fun, it was no big deal.  I incurred all the bleeding they told me I should expect but most of that was done after 1-2 weeks.  Blood in semen lasted longer.

My biggest struggle during the recovery procedure was urgency.  It was almost to the point of incontinence.  This did not abate until week 11, then it was just gone.

So how is my current condition? I used to get up 3-5 times per night.  Stream was very weak.  Couldn't fully empty bladder.  Tried all the tricks like double voiding.  Now I get up about once per night.  I used to have to go to the bathroom many times during airplane flights.  Once or twice during a movie.  Now it's a non-issue.

My stream, while not that of a young man, is much better.  I don't strain to pee.  My bladder empties easily.  I have not incurred retrograde ejaculation.  I'm easing off my Flomax now.

Hope this helps.  It looks like some of you have had difficult recoveries.  Mine had its difficulties too but much less than the competing procedures.

Hi Nick,

Thanks for sharing your story and congratulations on what appears to be a very successful procedure. Please come back periodically and let us know how you are doing.

The REZUM procedure seems very promising, but there are several things I've noticed in a number of the reports here: (1) Doctors often don't mention that there is small but real chance of retro ejaculation (5%?); (2) lack of proper pain control/sedation during the procedure; (3) lack of proper doctor/patient communication as what to expect during recovery. Hopefully, as the procedure matures these issues will be addressed better.

Jim

Jim,

Thanks for the thoughtful response.  I agree with your 3 points.  I have found these are common traits across many procedures.  I think it's incumbent on patients to do this research and make our own decisions.

As as far as Rezum goes, I still believe the advantages of it are so significant vs. the competing procedures that I chose it.

Best, Nick

Hi Nick,

Yes, these three traits are common across the board with most of the procedures now offered. It's good that you put in the time and effort and therefore avoided the "gold standard", ie TURP, that is often offered as the one and only way to deal with BPH.  

PS I sent you a private message.

Jim

Jim James, Old Buzzard, Nick12501, - I had a 2 month wait follow-up appointment with my URO Doc today...During the 2 months, the Number of Times I went to the RR per 24 hours was to be Reduced to 1-2 at night and 3-5 during the day from 4-5 at night and 4-5 during the day...Also, I took Finasteride and Trospium, at different times) to help Reduce the Number of Times too..The drugs didn't help plus I was told tby my URO Doc the drugs could cause Retention, because of my neurogenic bladder muscle... Also, my URO Doc stated that if I stopped taking Tamulosin (flomax) that would cause Retention too....My URO Doc ran an retention ultrasound today and determined that I had 150ml of urine left in my bladder..Since I've had a Rezum and my prostate is now OK, I feel the Tamulosin is causing the Large Number of RR visits....The Large Number of Night RR visits makes it hard for me to  go back to sleep....Finally, after the 4-5 times, I can go to sleep and wake-up rested at ~ 10AM..The Catch 22 is I'm a Substitute Public School Teacher and have to be at work at 7AM - 8AM and up by 5AM-6AM..Otherwise, I have to pass on the work or try to get to sleep by 8PM-9PM.....Another problem is Dribbling During the Day...I feel that's caused by a Defective Prostate Sphinter Muscle that fails to close completely due to problems caused by 1 to 3 of the URO Docs during their tests and.or procedures....My Uro Doc stated today that he doesn't know when my neurogenic bladder muscle might correct itself...Thus, the condition May Never Be Corrected and I'll have to Live With Going to the RR the Large Number of Times in a day that I'm already experiencing...These Conditions Prevent Me from having a Normal Life and being able to work as I would like...Your suggestions would be appreciated...

Are you still getting up 4-5 times a night or has it been reduced to 1-2 times? 1-2 times isn't all that bad for many of us. Same question during the day, how many times are you currently voiding?

150 ml retention is kinda border line and an argument could be made to self cath. Are you still doing CIC or have you stopped. CIC could also help with your day time dribbling and it could also more accurately pinpoint the problems you're having if you log your natural voids and PVRs (measured by CIC) throughout the day.

Other than CIC, there are some short term strategies to make your life easer. For example, a condom catheter with bag could discretely help with dribbling due to incontinence untl a more permanent solution is found. If getting up at night is taking a toll, some have found using a Foley only at night is a good trade off producing a full night's uninterrupted sleep.

Beyond that, there are drugs and other therapies for neurogenic bladders as well as surgical procedures on the sphincter but probably too early for the latter at this time.

Jim

Why would flowmax cause retention & peeing too many times? Its supposed to relax muscles so you can pee.

Jim, when you say borderline on the 150 ml are you saying thats not really considered retention?

Oh, lately I've been measuring my urine output. I've noticed I usually pee 300ml - 400 ml when I go.  Thats at the point of I feel so urgency to pee but not OMG I gotta go now. Is that in normal range? I've also noticed if I wait to pee until I really gotta go I need to double or even triple void because my bladder won't empty all at once. Anyone else notice this?

50-100ml is usually considered "normal" in the elderly, which most of us here are.  I thought I saw somewhere that this went up to 150ml but not sure. Also, keep in mind that at your uro's office he only measured your retention at one point in time. If you measure it at home via CIC you will get a better picture what it is around the clock.

But borderline or not, I still think CIC might help with some of the symptons you're experiencing. You have self cathed before, right? Was it difficult for you or fairly easy? If it wasn't that difficult, you might consider it again as part of the process.

Jim

Uncle, I was addressing my answer to Randy, but I now realize you asked the question so please disregard what is not relevant. To your specific question, even if 150 is considered high, I think it comes down to what symptons a person has and what they are willing to put up with. I was probably carrying around 300ml for many years before my I reached my tolerance to seek help. Looking back, I should have dealt with things earlier.

Jim

I've never self cathed. My BPH symptoms aren't all that bad. I have a bleeding problem supposedly cause by BPH but there is no direct proof. I have had cystoscopy & ct scans that showed nothing. Every few months I just star peeing blood. 

300-400ml is a good void and within normal range. My voids are mostly 250-350ml also within normal range. Sometimes I feel the some urgency earlier, especially in the morning. 

Now in my case, for example when I void let's say 300ml, my PVR is usually around 50 so that means my bladder was holding 350ml. I know my PVRs because I periodically check them with CIC.

But how do you know how much your bladder is actually holding when you void 300-400ml? That would mean knowing your PVR. Are you self cathing at all or what are you basing your PVR on?

Jim

So Jim, what volume would you consider to be considered a normal "bladder movement" 

To add to the above, "300-400ml" is a good void if your PVR is say under 100ml and ideally under 50ml. However, not so good if your PVR is say 200-300ml. That would mean your bladder is in a continual stretched state. As an extreme example, I had a void of 400ml at my uro's office three years ago but another 1500ml came out of the catheter. Not a good void

Jim

If I constaly had a PVR of 300 ml wouldn't I feel like I had to pee all the time? When my uro was checking my PVR in Summer of 2016 she gave me a number but I forgot what it was. She did say that it was good though. It sticks in my head it was an once or 2

Randy - didn't you say that the dribbling had a nasty smell? And I'm sorry to say this, but if you're peeing normally, then stopping flomax shouldn't hurt at all. Makes me question your urologist - I still think that you're not necessarily getting the best advice from your doc.

I'm not a doctor , but it doesn't seems as though flomax is the problem, although it probably isn't helping at this point  and I'd get off of it. I think you would be wise to get ao script for some PT and to find a place known for dealing with incontinence and other uiinary issues. My guess is that long run on the foley did some damage to your bladder function and that over time it will return and with the aformentioned PT maybe sooner than it would otherwise. Make sure you go to a place that can provide biofeedback, you may just not be contracting properly and with excercise and feedback you can fix that problem.

150 CCs is borderline - that's one of the reasons that you're going 4-5 times/night. You might want to self cath overnight - because you'll be empty each time, you could probably cut the number of times overnight in half, which could allow you enough sleep enough until you can empty more completely. You can wear a pad during the day until you get the dribbling under control. Also - get tested for a UTI - that could explain some of the symptoms too.

PT/biofeedback, self cathing at night and a pad during the day could allow you to go back to teaching. Your bladder should rehab itself some over time, but I think you should consider finding a better uro who might be able to diagnose and treat you better. Where are you locatied?

 

Unkle,

Probably. On the other hand if your bladder got really stretched, you might be able to lose the feeling for long periods of time but then you'd probably be holding more than 300ml. This is more or less how I lived for probably over ten years. Finally, things just gave way and I couldn't void without pushing my bladder with my hands and literally pumping it out. Believe it or not, I kept doing this for several months before finally going to the uro for help. That day, after an ultrasound, they cathed1500ml out of my bladder after a natural void of 400ml. That's when I started self cathing. Moral of story -- don't wait so long!

Jim

OB and Randy,

OBuzzard has given you some good strategies. I gave you some others before. The best strategy is the one that works best for you and fits best into your lifestyle. So experiment. As OBuzz said, no reason not to go back to teaching. And yes, if your urine has a nasty smell, you might have a UTI. Why not just drop off a urine sample for culture? You can also do a preliminary test at home with urine dip sticks. I always try and keep some around.

Jim

Thanks for the advice....I'm in Atlanta...So far, I've been to 3 URO Docs and None have totally corrected my problems..My current URO Doc ran a test last week and I don;t have an Infection...He states I have a Neurogenic bladder and retention history which prevents him from using certain drugs that could help..We're stopping the Tamuloson for 1 week to see if that helps, but he states that might cause retention...I started self cathing last night to reduce RR visits, but it didn't help. ..I still went 4 times...

Jim & OB - See my comments to OB...- I doubt my URO's assessment of a Neurogenic bladdder because normally the patient has a long history of that and I don't...Th URO states I'm hard to treat with drugs, etc. as he would normally, because of the history of a  neurogenic bladder and a history of retention...I disagree.., My retention history just started after my lung operation in June, 2016, and, likewise, I had Urgency & Frequency problems for just 1 year prior to the operation caused by an overgrown prostate per the URO Doc then.. So that's Not a Long History in Either Case...I self cathed last night, but I still had to go 4 times...We're stopping Tamulosin/Flomax for 1 week to see if that helps.....Per the URO Doc, it seems any treatment he might try may cause Retention...Thus, I'm in a Catch 22 without treatment options...,

Were you under general anathesia for your lung operation. That can often preciptate retention. You might want to read up about it. 

When you cathed last night before bedtime, how much was a natural void and how much from  the catheter? Did you cath during the night when you woke up? What you want to do is keep a void log so you can attack this mathematically. For example, depending on the numbers, you might only have to get up once at night if you cath that time and before you go to bed. On the other hand, if you're producing let's say 1600ml or more during the night then the problem is not neurogenic or even retention but probably age related nocturia which requires a different approach. Again, a detailed void log will help with what strategy you should try.

Jim

Yes, I had a general anesthesia...And, yes, I/we determined that that caused an allergic reaction that caused the Retention...The 1 self cath last night produced ~ 100ml and a void earlier produced ~ the same amount.Thus, I appear to have a very low retention...A Retention and Natural Void Log would provide a clearer picture....All previous Retention amounts measured by the URO Doc after I was taken off the Foley have been Less than 200ml...Thus, I guess that's what lead the URO Doc to believe there's a Neurogenic Bladder problem vs. a Retention Problem...Your comments?...

Randy,

Not as good as an actual log, but  here's a hypothetical urine log based on what we can infer from what you just said. Tell me if this is more or less correct so we're on the same page.

Last night

before bed time: NV 100ml      Catherized void 100ml

night void 1     NV 100ml      Retention 100ml

night void 2      NV 100ml      Retention 100ml

nightt void 3     NV 100ml      Retention 100ml

night void 4       NV 100ml      Retention 100ml

Just want to add that a neurgenic bladder doesn't rule out retention and in fact retention is often one of a number of symptons of a neurogenic bladder. Neurogenic bladder by definition means the nerve pathways are impaired. My understanding is that urodynamic testing will show if there is any nerve damage or not. So before deciding your bladder is neurogenic, I would have it tested as proper treatment follows proper diagnosis.

Jim

I have a vouple of thoughts - 1) You're not voiding a lot when you go at night, suggesting to me that you may just have to retrain yourself. 200 CC isn't all that much and most people can hold more than that before they have to go - and based on how much longer you can wait during the day, I think there is some support for that. Try taking some melatonin when you wake up to pee and see if you can go back to sleep. I think this is mostly a cycle that your system has become accustomed to and you might be able to break it.

As for drugs causing retention, your doc seems to think that everything causes retention. Tamuloson is a prostate drug and your prostate isn't really the issue anymore, yet your doc is afraid that if you go off of it you'll end up in retenti on, but there is no medical reason this long after Rezum that should happen. As for the other drugs he thinks could help but could cause retention, if they do, you can stop taking them and self cath until they're out of your system. I still think that time will fix all or most of it, that PT could help with your leakage and if you only go 4 or 5 times a day that you can train yourself to only get up once (or occassionaly twice) per night and go back to living normally. Last but not least, my doc told me that urgency could last up to a year after Rezum.

If you can afford the plane ticket, I'd recommend seeing my urologist at the Cleveland Clinic. He is top notch and a decent guy on top of that,

YES

Yes what?

Thanks for your comments...

Hi Randy,

So, if my hypothetical log is correct then you could cut down your night time bathroom trips from 4 to 2 or even 1 if you cath the first time you wake up. The other thing is bladder retraining. Here, instead of relieving yourself when you feel the need (in your case 200ml) you keep adding 15 minutes before you void until you're holding let's say 300-350ml instead of 200. Kegels are often combined with this.

Jim

OK....Thanks..

OB --I was answering Jim James question regarding my average void amount which is ~ 100ml...

hi Nick , I also had the procedure after about 8 years suffering with bph . I am in my eighth week of recovery and also have some of the same simptons that you had though no self cathering  for me , had bleeding for about 6 weeks , my flow is a lot better but still have some urgency . Based on the information that you have posted i have a lot to be hopeful for a better and continued recovery.

Edo, your recovery sounds much like mine.  I'm glad my story is helping your mindset about it.  I was very frustrated, then week 11 it all changed.

i read the other tough stories in this blog.  BPH is a struggle and I feel terrible for these guys.  I lucked out and got it treated relatively early in. Y diagnosis.  Maybe that helped?   Nick