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

I am very happy that it worked out for you.  I hope it stays that was Good luck  Ken

Hi All. What a great forum. I'm thinking of REZUM. Question- I know that there is pain involved in the procedure and with urination as well as pain/discomfort with the cath. Other than those things, how does the pain rate?

Thanks, Mike

I am also would like to hear more about REZUM,.and it looks like finnaly, we found a perfect surgery, with one problem,..PAIN !

In my experience (and there seems to be a wide variety of them) there were two points of pain. The first was during the procedure which was very painful in short bursts. If insurance won't pay to putr you under (or at least twilighted) I would take some strong tranquilzier and pain pill before the procedure. I was pretty sore for about 8 hours after but that initial soreness went away then and never returned. The second time was when I started peeing, there was a lot of burning - enough that they tested me for a UTI 2 or 3 times (I never had one so it was the procedure). That went away in tne days or so and that was it for pain. Pyridium helped the burning and even the post surgical pain wasn't horrible - the only noteworthy part was the procedure. On the last spray I screamed.

Hi Alex,

I would make sure that if you choose REZUM that the doctor performing the procedure has done at least a hundred unasssted procedures. I looked at the REZUM website, and unless I got it wrong, the entire training process before a doctor works on the first patient is 90 minutes!!! The next half dozen patients or so are supervised by what sounds like a REZUM rep in a single day! After that they are on their own. This may account for some of the less than stellar results we have gotten here, including a number of instances of retrograde orgasm. It's also important to make sure that your bladder is not atonic (stretched) as none of the prostate reduction surgeries or procedures will produce good result if your bladder is not strong enough. Bladder integrity can be tested through imaging, cystoscopy and urodynamic testing.

Jim

Even dentist gives no pain this days,.And REZUM, even the name sounds very painfull, i hope they fix that soon.

Jim,

Regarding your comment on Atonic Bladder. I was diagnosed with an Atonic Bladder 4 years ago. Several doctors told me that removing any obstruction would make it easier to urinate. And being easier to urinate may actually rehabilitate the Bladder some.

Just recently had an MRI of my prostate (and Bladder). The doctor that reviewed it told me my Bladder looks fine, not floppy at all, and seems healthy. So maybe I had a false diagnosis all along, or was able to rehabilitate my Bladder. I had the pressure test several years ago. So maybe that isn't the gold standard after all.

Thank you for your answer Jim. If my bladder is streched, i have to do something to stop the streching further. With the prostate reduction, i am sure the bladder will have more space, and recover with the time. Even if there are no immidiate results after the surgery.

Hi Motorman,

Your doctors's weren't necessarily wrong, or right. It's really dependent on the degree of both bladder dysfunction and the degree of the obstruction. So, in some cases removing the obstruction will allow an impaired bladder to function must better, but in another case if might. Again depending on how stretched (atonic) the bladder is. Imaging, urodynamics, and plain old diagnostic skills, experience and motivation, in theory will lead the doctor to give the patient the correct advice as to whether  a prostate reduction surgery or procedure will likely have a good or not so good result. Unfortunately, we have seen some of these steps missing here with various doctors and no doubt that has contributed to some failed procedures. 

That's great your bladder looks good! Like you say, either a false diagnosis or your bladder was rehabbed, or a bit of a combination. Urodynamics is called the "gold standard" but without the right urologist interpreting the results, probably not so gold. 

As an aside, I think part of the problem is the rushed way medicine is practiced today. So little time time given for diagnosis and interpretation. Last year I had a cystoscopy by a very eminent urologist, but I caught him on a bad/busy day. He was literally in and out of the room in a couple of minutes and when I asked the nurse if I could speak to him as I had some questions, I was told he was not available and in another procedure. When I finally got to ask the questions at later time, I got the distinct impression that his memory (and notes) did not cover my concerns. The best uro in the world is going to make mistakes if they rush through diagnosis and testing. So think of the rest of them will do.

Jim

Hey Mike.  Have you asked your urologist how many has he done ome many of the men end up with retro ejaculation.  There is a 5% chance of it.  Maybe talk with him and only have the left side done and leave the left side alone where the ejaculatory duct and seminal vesicle are.  It's worth asking  Take care  Ken 

Alex,

It depends on how much your bladder is stretched and how well it's functioning. In some cases a prostate reduction surgery or procedure  will give it "breathing room" and help it to decompress thereby regaining lost elasticity and detrussor function. In other cases, the bladder may be too stretched and atonic for a given procedure to produce good results. 

The point of ample testing before the operation or procedure is to try and avoid the trauma and side effects of those surgeries that will have little chance of success. Unfortunately, too many uro's cut corners and go with the logic, "let's see if reducing the prostate will help your bladder perform better". You owe it to yourself to have less guessing and more testing.

Jim

Aex just because u have the prostate reduce does not mean that it will fix the bladder.  It may cause more problems.Ken 

Ken and Mike,

Nothing scientific, but the incidence of retro (dry) ejaculation is much more than 5% of those reporting here. I mentioned in an earlier post that I read on the REZUM web site (the for professionals section) that the training program only takes 90 minutes in the convenience of your own office using an imitation prostate!!! Scary!!! Then, they send someone over (probably a rep not a doctor) to assist you on your first day of real patient procedures. Then you're on your own!  Good luck to the first group of patients after that. 

Jim

Yes I know that is all they say and it is higher.  That is why I say only do one side It would open you up to pee better.  I'm sorry but I may be older but I still don't want to loose it Ken..  

And it's even more complicated than that. You can be diagnosed with a bladder that's too stretched to rehab and it can be rahabilitated anyway - Jimjames was told that he couldn't rehab his and (throught self cathing) did. Had his prostate been so big that he couldn't void, he would never have been able to get to where he is.

jimjames - feel free to correct me if I'm worng about any of this. Also, there are other bladder issues that can impact the results. I have an underactive bladder that kept me from getting complete relief. I'm way better, feel that it was worth it, but although my urethra is wide open, sometimes I have to pump myself to fully empty. I'm not sure if they could have ever diagnosed that with an obstructed urethra and even if they could have, I'm not sure that they time and expense would have been worth it or if offered anything actionable.

I certainly wouldn't consider something like TURP or another surgery with a flaccid, overextended bladder that I was told couldn't be retrained. But I might consider Rezum/PAE/FLA/Urolift as they are pretty simple and even with say a 20% chance of getting to normal, I might consider that worth the effort expense and discomfort.

Hi OB,

I'm in general agree with what you say. It's a very complicated system and one size definitely does not fit all, and therefore any decisions should involve taking into consideration multiple factors such as the amount of obstruction, how flaccid the bladder is, and how motivated someone might be to try alternative approaches such as long term bladder rehab through CIC, as in my case. Personally, I'd love to relieve a little bit of my voiding pressure with a prostate reduction procedure if someone could guarantee me that I would not end up worse than I am now. I realize no one can. That said, if I ever became more symptomatic, then it would make more sense to take the chance. Outcomes aside, none of these procedures are without risk, but "yes" the procedures you name are in the lower risk category. iTind and ejaculating preserving TURO (or Holep) might be added to that list although you might have to go to Europe for the latter.

Jim

ejaculating preserving TURO (or Holep) I've never heard of this. I couldn't find much about it with google. Its only available in europe? 

Try googling this for TURP and you should come up with the 2014 European study:

Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique.

-----

I thought I read something here about similar for HOLEP but I may be mistaken and could not find anything in the literature on it. 

The techniques seem to exist. It's just finding a uro motivated and experienced to do it. As you know, most U.S. uro's don't seem to think retro is a big deal for us older folks. I would never let someone with that mindset operate on me.

Jim

Thanks for all the advice and info guys. My uro. put me on Flomax ( working really well and hardly any side effects so far) and told me that if the Flomax doesn't do the trick = empty the bladder (I had 2 bladder infections and ongoing UTI) that we would need to look at REZUM. I'd like to wait as long as possible as the uro. just started doing the procedure recently her in Louisville, Ky at "First Urology". I'd like for him to have done a bunch - like 100- before opting for him to do it. His name is Dr Meiers.

I've read about ejaculation sparing TURP. I kind of think they're doing it in the US also. The thread about ejaculation sparing HOLEP  might have been mine. I seemed to recall reading about it somewhere but can't find that information now. So I posted the question here to see if anyone heard of it. I assume if they can do it with TURP they should be able to do it with HOLEP. 

Uncklefester,

Good to hear that some docs are starting to do it here. Again, not sure what I read about preserving ejaculation with HOLEP.  If I find anything I'll post. I can't believe some of the insane language I've read in medical studies on this topic. Things like "some men prefer to preserve their normal ejaculation".  Really? I'd like to speak to the other men who don't! I think some of these docs don't have a clue. And if they don't have a clue they're not going near me with a knife or laser!

Jim

Hi Mike,

Yes, wait until the doc has done at least a 100 and then quiz him on what kind of results he's getting including any retro (dry) orgasm. Meanwhile, you seem to tolerate the Flomax well and if it's working I really don't see a rush or even necessity. (An alternative is daily 5mg Cialis which should work just as well, or better, with a sexual boost) 

Curious if you've done your IPSS (international prostate sympton score). If not, "google" it and take the 5 minute test. Helps put things into perspective.

Jim

The ante-grade ejaculatory preserving procedure is really just a variant of the TUIP, which instead of removing large chunk of tissue, just makes a cut to open things up. It is typically done on younder people (30s-40s) and even then there are no clear studies involving the antegrade ejaculatory function. In truth there are no magic bullets or therapies, it's all a function of your particular anatomy, etc, so there will always be a chance factor with any of the surgical therapies being pitched. Best thing you can do is try to become as best informed, but keep in mind that even as best informed as you can get these days, the prostate/bladder/pelvic area is a very complex area anatomically and no one, even the most accomplished professionals, have a real understanding of how the various parts interact and work.

Ablumen,

Not that much information on ejaculatory preserving Turp (ep TURP), so I would appreciate any links you may have to learn more.

My information seems different from yours and comes from a 2014 study which you can find by googling:

Ejaculation-preserving transurethral resection of prostate and bladder neck: short- and long-term results of a new innovative resection technique.

The second hit, on my browser (Firefox) is full-text by Mary Ann Liebart Publishers.  If you go to the "surgical procedure" section you will see that it is more of a TURP variation than a simple cut like TUIP. Also, the age group was 50-70, not the "30's and 40's" you state.

Jim

Hey Jim.  It's called a Button Plasma Turp.  David75878 had it done.  The Doctor only did the one side and completely around the bladder neck.  That was because the prostate was very large.  It took the doctor 1 1/2 hours.  He pees great and did not lose the ability to ejacuate. The doctor also stay away the the duct and the spincter.  He had a doctor that cared  I wish I could get a hold of him  I would like to know how he is doing.  Tback in November  Take care  ken 

Yes, this is the same study I had run into. I referred this study to a URO in Philadelphia associated with Jefferson and he associated with the TUIP, but don't think ever looked at this paper.

Another doctor in NY, this one afiliated with Mt Sinai, mentioned that he did perform some epTURP and/or Laser, though his sample was pretty small (5 patients) and success rate sounded quite poor (I think only 2 or 3 of the 5 were able to preserve their ante-grade ejaculation).

Perhaps the best thing would be for you to interview this Dr in Germany and/or have another professional in the US study the paper and give you his/her best professional procedure as to whether it is legit. I have heard that you need to be careful with many of these supposed "studies" published in medical journals. Make sure the study is published in a reputable journal (no idea about J.End were this paper was published). The last thing you want to do is believe blindly in a study, have the procedure done, to then find out that it was far from delivering what it promised.

Don't want to accuse anyone of quackery, but I have a suspicion that the medical profession, even to this day, is rife with the problem, not necessarily as a result of unscrupoulous professionals, but rather out of a genuine hope to find a "cure" by many professionals, who might be carried away a bit in their enthusiasm (pressure to publish promising results may also be a factor if you're at a research institution).

Just because someone published a paper in a medical journal that seems legit and promising doesnt mean it is. Make sure you do as much diligence as you can. Ultimately, if a technique really works you'd think it would be picked up by other professionals, specially if it's been around for a few years. There should be other studies confirming the same results. Look for those (I couldn't find more than that same paper). Call and ask the Dr or hospital that performer this procedure and ask them how many more have they performed, with what results. Ask them whether they know of any hospitals or Dr in the US or elsewhere that perform that same procedure. Ask them if they have published any new results or are planning to, etc. Don't just go on one study or medical opinion for something that is not yet fully tested or vetted.

Hi Ken,

My old uro did the Button Turp and told me to 100% expect retro ejaculation. David was lucky fortunate that his doctor took the time and effort to preserve his normal ejaculation, but most doctors that do the button TURP will not. The study I mentioned goes about preserving ejaculation a little differently if you look at the "surgical procedure" section. However, the takeaway, at least for me, is that TURP and TURP like procedures can be performed in such a way that there's a good chance (not 100% but good) normal ejaculation will be preserved. The problem is not only finding a doctor willing to try, but finding one with a track record on this procedure variance.

-- Jim

Ablumenc,

I don't disagree with anything you said, just wanted to point out that contrary to your first post on the subject: (1) epTURP is not like TUIP; and (2) the study group was not younger men (30's and 40's) but men 50's-70's.

I do agree the uro associated with Jeffereson probably just glanced at the study, if that, and that is typical. 

Personally, I'm not interested in any surgery or procedure right now, but just wanted to correct the record. If I was looking for an epTURP, I would investigate more, including taking the steps you mentioned. 

--Jim

Yes most doctor will not take there time.  They just go in and start cutting away.  I think it because they do not consider the ejaculation a function.  Because we don't need it when we get old because we are not having kids.  Just because I'm not having kids does not mean that I don't want it.  If any one has this done I would get it in writing before he would put anything in me.  Can't trust them all of them  Later  Ken

Jim

Appreciate correcting the record, your comments are absolutely correct.

A

Ken,

It's economics, it's laziness, it's being non creative, it's a mind set.

I read one paper or study where they were talking about a procedure that did not cause retro, and the wording was something like "for those men who would prefer to preserve their normal ejaculatory function".

Now tell me, who are the men, given a choice, who would not want to preserve their ejaculatory function!

And worse, as you so often point out, are the doctors who don't even mention retro prior to TURP. And worse than that, are the ones who tell their patients, "yes, you will still be able to orgasm"  totally misleading them into thinking that orgasm equates with normal ejaculation. Unbelievable!

-- Jim

I think the ability to have ante-grade ejaculation is key to orgasmic pleasure. I have experienced it myself first-hand. You can also experience it by requesting to be put on a dose of Rappaflo for a couple of weeks. There's a reason why nature made it that way!

Agree totally with Jim, I was appalled at my first URO when he casually suggested I get a TURP, only speaking to the benefits ("gold" standard, less than 20% chance would need another in 10-15 years, etc), and not even mentioning any of the downside.

There was an article in the NY times not long ago that mentioned how many plastic surgeon specializing in preventive mastectomies are now selling so called nipple sparing mastectomies, telling prospects that the procedure preserves the "feel", but being quite vague as to what that means. As it turns out, the meaning of word "feel" is used in very broad context, meaning that to someone touching the breast and nipple, it would "feel" like a normal breast or nipple, without disclosing that to the woman that had the mastectomy most of the arousal feeling when touching the nipple would not be there. When looked at a little closer, what they fail to disclose is that while the capillaries or blood vessels delivering the blood to the nipple is preserved in the surgery, many of the nerves impacting this area are not, loosing sensory feelings as a result!

The same thing goes in the male urigenital area, with even urologists affiliated with some of the top hospitals fail to fully disclose the effects of the procedures they perform.

I find it criminal if not in the law, certainly in the intent!

Yes they never give them the whole thing.  They suger coat it and only tell them what they think they need to know.  I think alot of men should get everything in writing.  Actually you should get a gaurantee.  Because in reality the urologist does not know if it going to work at all.  I can hear doctor saying I think this will work.  Just like Frank.  They give him 50% to  60% on a turp working for hm and told him that he may have to still do CIC.  Why do it at all.  That are not good odds.  Maybe thinks will get better in a few years..I can only hope  Ken

My reply was moderated because used a more colorful term for peed. Any way my first uro had the scope still inside me when he said I needed surgery and said he would schedule TURP. He then took the scope out and walked out of the room. I had to schedule a consultation to fing out how he was going to remove the excess tissue. He said, heated wire or laser or microwaves Blah, Blah , Blah. He wouldn't not be specific. I request a prescription for fernasteride, left and never went back to that uro. I'm on my third uro now. I picked this one because I was planning on haveing HOLEP surgery. Now 'I'm trying to work out having FLA done. 

My knowlege base has come a long way since that first wncounter with a urologist. Thanks to this web site and all the men on here sharing their experiences and their knowlege. Hats off to the men on patient.info Prostate Forum. 

Ablumenc...........When I first saw my urologist he put me on Flomax and Rappaflo.  Was never told any information about it. Just told it would help my flo.  I was on it two week when I has sex.  I can say I still had the built up but when the orgasm hit.  It went flat.  No feeling at all. NOTHING  and without a ejaculation.  It was like I did not have sex at all.  That is when I started looking this up.  I went off that right away.  And when I saw my doctor he told me about it.  I think all doctor should give you all the information on any pill they are going to give you.  4 month's later I had a Urolift done My prostate was stuck together and I was forcing myself.  It has been 2 years and all is good.  Right now I am dealing with chronic prostatitis.  Doing ok no pain or numbess.  Take care  Ken 

Hi, Mike. Don't know if you had the procedure yet, but no real pain from my experience as I had a great doctor. I was also knocked out for the procedures, and great pain meds after. I told them I didn't want to feel anything, and they made sure I didn't. I don't understand why some of the people in the discussion didn't get pain relief. That's just wrong! Anyway, hope all went well for you if you've had the procedure. Its been about 5 months for me now, and everything is great!

I am glad it was all good for you. Did you get retro or were you one of the lucky ones.  Ken

Hi, Kenneth. I had the retro effect when I was taking the prostate reduction pills for two years. After the procedure, everything works as it should. No more retro! Same effect for a friend of mine.

Very happy for you.  Take care  Ken

Hi All- First- because there are so many "procedures' talked about under this topic, I think it would be really helpful if we identified the procedure's name. For example- I THINK Alohamc2002 is talking about having REZUM done, but I can't be sure unless I read a ways back at all his earlier posts.

And thanks for all your replies Alohamc!

 

Hi Mike. Sorry for the confusion. Yes, it was the Rezum procedure.

I had it done and it hurt a lot during the procedure, a bit after and not much at all by the next day. The reason they didn't twilight me (and others I assume) is that insurance wouldn't pay for it.

Are you sure you had Rezum done?I did and it didn't hurt.

That may be a bit simplified;

while the "training" on the steam process is brief, the surgeon who performs the procedure will have performed thousands of similar procedures prior to this (assuming they are board certified and graduated from an accredited residency program)

They will have had to visualize and perform almost identical actions to the Rezum thousands upon thousands of times prior to performing the Rezum procedure, which is largely a small alteration of procedures they have done throughout their professional careers.

Sounds like you might be replying to an older post of mine where I stated that the REZUM web site suggests only a few hours of training and then a half day or so of guidance with a REZUM rep.

What you say makes lots of sense but I'd still probably not want to be the first patient after the REZUM rep leaves the office. That says, obviously someone has to be or none of these procedures would move forward. You mentioned you've done over 100 which is the number I personally would be looking at in a surgeon. 

Jim

Our group has done over 100 total.

I am unsure whether any physician has personally performed more than 100.

When I last had access to the data from another area, for instance, I believe the busiest surgeon in NYC had done roughly 60.