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

Hi Joseph,

Thanks for posting the studies. A few thoughts...

1. Rezum does sound promising and we have had both good and not so good results reported here.

2. Studies are useful but it's not always comparing apples to apples as your individual condition could be significantly dfferent from the trial group. For this reason, it's important to study the trial's inclusion/exclusion criteria and compare it to your condition.

3. From what I've read on the REZUM web site (professional section) the training program consists of only one 45 minute session on an artificial bladder followed by one in-office session where a REZUM rep supervises the doctor on real patients. To me, this does not seem like a lot of training and I would not want to be one of the first 100 a doctor does. Your doc has only done 8 so you might wait some for more feedback on how things are going.

4. Going back to number "2", you will find here that the same procedure is sometimes very successful and sometimes not successful even performed by the same doctor. Reason again probably has to do with the differences in the pre-existing condition of the prostate, urethra and the bladder. For example, if your bladder is stretched/atonic, you cannot necessarily expect the same result as with someone who has a more normal and elastic bladder. You didn't mention your symptons or tests that have been run. Do you know your PVR (post void residual)? Have you had a cystoscopy? Urodynamic testing? 

5. Also, possibly related to both "2" and "3" above, we have had a number of reported cases of retro (dry) ejaculation. These were not reported in the study group but something you should be aware of.

-- Jim

Good morning Jim  I read both of them and to me they had like you say good and bad out comes but it is not so cut and dry when they talk about retro.  Also on the one erectile dysfunction was very high.  I would talk with the patients after 50 or so  Take care  Ken 

Dear Jim,

Thank you for the clear and detailed response. So helpful. 

Regarding your points #1 and #2, I will show study to my Uroloigst when i see him and post his commentary. 

Regarding point #3, yes I have read your previous post from some time back and was taken aback when learning of the Urol minimal training. Hence makes sense to get a Urol with plenty under his belt so to speak.

Regarding #4, "Do you know your PVR (post void residual)? Have you had a cystoscopy? Urodynamic testing?"  

Regarding symtoms and tests, this started 17 years ago when diagnosed with BPH. I had a PVR about 10 years ago that was good, but not since that I can recall, nor have I ever had a Cystoscopy or Urodynamic testing. I dont even know what they are. 

My symtoms are waking up 3 or 4 times a night. Need to pump 2 or 3 times, dribble, weak stream and etc. I am overweight (working on that) and have Sleep Apnea and Low T. Somehow I have managed to get though the past 17+ years without any procedure, etc. Just been taking 5MG Finasteride daily for the past 10 years. Present condition as bad as its been put I have improved how I manage.

QUESTION 1: Are these tests only relevent and necessary if I am considering a REZUM or UROLIFT procedure? I wonder why my Urologist did not suggest.

Regarding #5, it is strange that the study shows zero cases of Retro, yet the forum has show some. The Senior VP went on and on about how incredible this point is in the study.  

QUESTION 2: I wonder if those with Retro E that are on this forum fit the profile of those men in the study? 

QUESTION 3: I wonder if these tests were subsidized in any way from REZUM or NxThera?

Thank you again for the reponse.

 

Hi Ken,  The SVP I talked to said there was no ED. The report also states: RESULTS: "No treatment- or device-related de novo erectile dysfunction occurred after thermal therapy. "

I guess I better ask my Urol and PCP to interpret.

I have had BPH for sometime, controlled by Tamsolosin, from which I get bad side effects but which I have put up with.

Over a year ago I was going to have a PAE but the day before the op it was cancelled as my Urologist was away & because I have low grade cancer of the prostate, which has been under Active Surveillance for the last 6 yrs, none of his registrars would give the go ahead.

Three wks ago I was booked in again to have a PAE (on UK National Health this time) at Guy's Hospital, London. All was going smoothly &  even though I hadn't been given any sedative I was so relaxed I fell asleep. I was woken by the interventional radiologist an hour later to be told they had not been able to go ahead with the embolization as the artery that went to my prostate also fed my bladder, which meant that there was a very good chance my bladder would become damaged & I would land up even worse off. P*ssed off, depressed & fed up was not quite the words for how I felt. I found out about PAE about 4 yrs ago before anyone was doing it here, so had been trying to sort it since then.

I have stopped taking the Tamsolosin & started taking Cialis 5mg once a day. I'm feel much better off the Tamsolosin but as yet the Cialis appears not to be so effective, although apparently you need to wait 4 wks to get the full benefit & I've only just done 2 wks so we will see.

Having had a quick look through this forum it would appear that REZUM & FLA  are the less invasive procedures for BPH also with less side effects in that all your normal sexual functions survive. I would have thought that Rezum was also considerably less expensive to carry out.

Anyone know if or where either of these procedures are carried out in the UK & would anybody be able to comment on which one of the two might be preferable.

Just found & come upon this site so hoping I might get some helpful info. A lot of Urologists appear to have their own agenda, turp ect & even suggesting a full prosectomy!

Thanks.

Thanks for getting back.  I wish they would tell you a yes or no answer.  They kind of side step the retro.  Most doctors do not consider the ejaculation a function because they say we don't need it when we get older.  That is why I had a Urolift done in 2015  worked great.  My urologist is just stating doing REZUM and he as told me that if they do both side there is a chance of destroying the ejaculatory duct on the left because the steam will get to it.  Maybe they should only do the right side and leave the left alone.  Take care  At 61 I am not going to lose anything  Ken   

Hi Joseph,

Finding a uro with plenty of experience in a particular procedure is very important regardless of the procedure. 

Regardless of what procedure you do or don't do, if you don't know your current PVR, or haven't had it measured recently, you really want to get those numbers before moving forward with a decision. Not a bad idea in any event, but depending on your PVR, cystoscopy and/or urodynamic testing may be indicated. Cystoscopy gets a close look at your prostate and inside your bladder. Urodynamics tests the function of your bladder. At a certain point, if bladder function is inadequate, none of the prostate reduction procedures such as REZUM will work well. Again, depending on you retention, and given the amount of time you've been symptomatic, you should also consider an ultrasound study of the kidneys to check among other things hydronephrosis (water in the kidney) which can be caused by refluxed urine related to a prostate obstruction. That along with the basic bloodwork including kidney function tests, BUN, creatine, etc.

Has the Finasteride helped your symptons? How much has your prostate shrunk from it? If you don't know, ask your urologist. You also might want to find out your IPSS (international prostate sympton score). Google it and then take the five minute test online. 

As to no retro in the studies, I'm not even sure that is so the way it's worded. They use the phrase "preserving ejaculatory functions". I could be wrong but technically you can preserve ejaculatory function and still have retro. In other words you would have retrograde ejaculation instead of antegrade (normal) ejaculation. You might therefore want to purchase the full-text version of these studies and take a closer look. But even if the studies show no retro ejaculation, we have had some cass here. It could be a different patient profile or possibly a less experienced doctor performed the procedure, or something else. 

Don't know about this particular study but it's not unusual for a company to subsidize a study of their own drug or procedure. Take that for what it's worth.

Jim

 

Hi Peter,

Although FLA is gaining traction for the treatment of prostate cancer, as far as I know, only two doctors in the U.S. perform FLA for BPH. One doctor seems somewhat secretive about sharing his results and the other has done at least 3 procedures that I know of, with another ten enrolled in a limited study. John, who was the first procedure, knows more about this. John had excellent results but the other two are still in recent recovery and hopefully we will hear something positive soon. FLA is not covered by insurance in the U.S. and one of the doctors mentioned charges $20,000. Personally, I'd wait a little until more patient results are in. 

As to REZUM, I'd just read through the thread and you will get a lot of anecdotal information. Some success stories and some not so good. This btw seems true of ALL of the surgeries and procedures and I think who performs the procedure (amount of experience) and the condition of your prostate and bladder are the two factors that make a difference. In terms of the latter, you want to make sure your bladder is elastic and functioning well enough prior to the procedure. If not, the procedure can be a "success" but you will still be symptomatic. Urodynamic testing therefore is often advised as well as the usual imaging and sometimes cystoscopy.

-- Jim

Thanks Ken. Toally agree. Im 63 and dont want to give it up. I suppose it comes down to where one is in life, what are the alternatives, and just how bad is your BPH. Oe good thing is that there should be a lot of info coming out on REZUM this year it being so much newer than the other procedures. Joseph

Dear Jim, Thanks again for the well written commentary. You have made me realize that i know practically nothing about my present condtion, although i have had it for 17 years. 

I will heed you advice. I like my Urologist, although it seems he wants to jump to the procedure, and a lot less interested in the details you have mentioned.

I will have a talk with him and try to learn what i can. I will need to study your text closely so that when i do i sound like i know what and why i am asking him, otherwise he will likely dismiss my concerns.

Thanks Jim. I wish you well and will be in touch. Joseph

We will have to see.  The best thing is If you are going to have REZUM  Wait tell a doctor has done 50 to a 100 and see how the result are for your self. Ask the patients not the doctor  Take care  Ken

Joseph said: You have made me realize that i know practically nothing about my present condtion, although i have had it for 17 years. 

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

Join the club Can't speak for everyone but I didn't know squat for thirty years either. It was a few years ago, when the drained 1.5 liters out of my bladder, handed me some catheters, and told me I needed a TURP, that I started studying up. 

And yes, a lot of uro's skip steps and just want to jump into a procedure. If it doesn't work, then they might investigate why. Makes sense to me to do the investigations first!

Good luck with your doc. If he's too dismissive, you can always get a second or even third opinion.

Jim

JimJames, Old Buzzard, and Kenneth ought to Co-Author a book on Prostate Procedures "Pro's and Con's"......You might earn a Lot of Money and It Would Be Very Helpful and Reassuring to a Lot of Guys!....Thinkk About It!......

Gottathrough j12080 in that group also. He's very well versed in all procedures

Thanks Randy  Ken

I echo jimjames on getting a real diagnosis before going ahead with any procedure, whether simple or complex. Too many urologists just say, "oh, you have trouble peeing so do this or that procedure or surgery. I had Rezum done and it helped a lot, but I also have an underactive bladder, so it didn't completely solve my problem - and on paper we're pretty similar. I'm 62 and started having problems about 17 years ago.

At the very least, you need to see if you're retaining much and should get scoped. If you aren't retaining much and it clear that your prostate is blocking your flow, then it might make sense to consider doing something - even if you might have bladder issues too, because if you're obstructed and can't pee well, the obstruction is at least part of the problem.

As for Retro Ejaculation and Rezum, I believe that the study shows 4% RE, so its not unheard of, but pretty rare by those standards. My ejaculation, though not fully retro, is significantly reduced and somewhat delayed. I hesitate to use anecdotal info from blogs to dedeuce percentages, but my guess is that the effective RE risk is probably more like 10% - still low but not as rare as their study portrayed.

Last, I completely agree with himjames on never having any doc who hasn't performed a minimum of 100 do any procedure. Your urologist fails that test as well as the get a diagnosis before doing anything rule. You might want to consider finding one who has done more of them and is less quick to recommend it. I'm glad I did it (even with the parital RE) as I used to run my life around the bathroom and I don't have to anymore - but I knew flow was blocked (was scoped) and that I didn't have any bladder issues that were bad enough to cause retention.

I've posted on my experience in this thread, but its pretty long now so if you decide to seriously consider it, I'm PM you a synopsis 

Jim, thanks, that is a good summing up. As you say FLA seems to be used for Prostate Cancer by interventional radiologists so we are not going to hear much about it from your consultant urologists. I have a friend who IS an consultant interventional radiologist who I will be seeing this wk end so can have a chat with him about it. He carried out a Gat Goren on me (actually much more simple than a PAE) but with no marked change in my symptoms - all the other inter rad's always comment when they see 'the metalwork'.

Back to what John said about FLA. It would appear to be a much more sophisticated & accurate way of removing parts of the prostate without damaging vital functions which is ideal, but would appear therefore to a more expensive procedure, therefore a good reason the NHS won't be looking at it. I do have private health Ins. but for how much longer I can afford that I'm not sure. I'm soon 68 & they start to really ratchet up the payments. Could have FLA for my cancer & sneak in a little something else to help the BPH!

Thanks again Jim.

Peter. 

Hi Oldbuzzard, thanks for the response. Because of the cancer (low grade) & having been under active surveillance I have now aquired a bit of an idea of how urologists behave. Even last wk while having my 6 mth check up the consultant said, quote: '...well if you want to cure both your problems, the cancer & the BPH the best thing is a prostatectomy'. He has done 100's  of robotics so he would know what he's doing but when you mention ED or any other side effects he becomes a little vague & less specific. So I have been dodging this for 6 yrs now! The 'cancer' is not the problem at the moment it's the BPH. I'm persevering with the Cialis 5mg. Has anyone had any success with this?

PM me a synopsis?

--Peter.

Hi Peter,

You might want to wait just alittle regarding FLA for BPH. So far, we've just heard from John (great results) but two other members here have also had the procedure and shoul report back soon once they're out of the recover stage. That said, sending Dr. K. some imaging to see if FLA is suitable for your lesions makes sense. I believe he works with the newer 3T MRI's, but John would have more info or you could contact him yourself. 

Meanwhile, you might consider self catherization (CIC) in the interim. You won't need the tamsulosin or 5mg Daily Cialis and you will be able to empty your bladder ompletely any time you want. Some of us here, including myelf, have found it the right solution, either temporary or even long term.

-- Jim

True, I am one of those - my case is complicated, because I waited so long I had thickening of bladder wall, which in turn due to retaining too much put pressure on my kidneys. I had to do something straight away, so they put a catheter in me, and a week later I had the FLA - to protect kidneys I still have the cather in, 3 weeks later and they will take it out tomorrow. Dr K told me - and John verified, that improvements begin around 3 weeks, but it might not be till week 6-9 where I will really feel the difference. So I'm waiting till I write any reports. I am hoping they will let me do CIC if I need it rather than another Foley catheter

I would insist on it. There is no advantage to the foley and they are uncofortable at best and hurt a lot at worst. Also, cic allows you to excercise your bladder and track your progress.

Mike, insist on it. I had my Foley out after FLA one week later. And I had to do CIC off and on for another week, maybe twice per day. After two weeks I was peeing on my own. I was diagnosed with an Atonic Bladder also, but doesn't sound as bad as yours.

Oldbuzzard, thanks for the synopsis, I think that covers it. I will email Dr Karamanian to get his opinion.

--Peter.

Peter I am so happy that your still saying no.  Doctor should not push you in to any procedure.  Your cancer is slow growing It may take 10 or 15 years for it to cause a problem. Or it may stay the way it is.  I have a friend.  He was 49 at the time.  They did a biopsy.  His doctor told him the best way to get rid of the cancer was a Prostatectomy.  After the doctor calling him at home and his wife talking him into it he agreed.  He was told all will be fine.  Well after it had it out all was not fine.  He had no prostate but he had no sex life either.  The only way he can have sex is giving himself a shot in his penis.  It last 90 minutes.  Which is great.  But to have a orgasm he told me it takes 2 to 3 hours to have one. And he feel very little.  He told me it not the same and not worth the time.  He complained to his doctor but all the doctor tells him is well you have no cancer.  Many times he calles me and crys because he just whats to die.  I tell him to think of his wife and kids to try to keep him going.  Sometime I think doctor forget what there doing.  I know they are try to cure the patient but there killing them in other way.   When you need to have a treatment look into FLA.  It is done my mapping and they can get rid of the cancer and leave the rest alone.  With BPH go on line and look up bladder help and see what food and drinks are not good for the bladder maybe that would help.  My doctor gave me a 8 page list  been working on it.  I was going about 10 times a day down to 6 will keep going.  Enjoy all of your life Take care  Ken  

Thanks Kenneth, I'm afraid what you are saying is all true & my urologist has been 'suggesting' the way to go is a Prostatectomy, luckily the first time I got a 2nd opinion who said that there was no need.

I do know someone who recently died of prostate cancer & his brother has had his prostate removed. Tell your friend that although he doesn't have a prostate he is alive & no doubt has a beautiful wife & children so if he did die, who would be crying then. Love his family & without being too personel love his wife in other ways. I have a friend in Australia who had his prostate removed some long time ago before robotics - he is on his 2nd marriage with a beautiful wife so he's doing something right!

You are correct - enjoy your life!

All the best,

James.

Mike,

Apologies if this has been asked before, but what was your prior history such as symptons, prostate size, median lobe or not, PVR, IPSS score, any drug trials such as Tamsulosin, and if this was your first procedure.  I'm assuming your PVR was high given it appears you had hydronephrosis (water in the kidney) from too much back pressure. 

Also curious what testing Dr. K. required before the FLA. I assume he had you do a 3T MRI, but did he ask for urodynamic testing or discuss at all with you the condition of your bladder and how that might effect your FLA outcome?

Hopefully, you will have a good trial without catheter tomorrow, but if not, I would definitely ask if you could do CIC instead of the Foley. If for some reason they won't allow that, and I can't think of a good reason, a second alternative would be a suprapubic catheter with a Flip-Flo valve that would basically do what the Foley does but without anything in you urethra and no bag to carry around as long as you use the valve.

Jim

Alive and impotent is way better than being dead, but it rarely comes to that. Only 5% of prostate cancers ever cause any problem and most of them can be treated with other procedures carrying less severe side effects and comparable success rates.

There are tests to determine which cancers might ever become a problem - they don't let you post links here, but Google Andy Grove prostate fortune and you can find and excellent article that explains it in detail. It's 20 years old but still relevant.

Prostate removal is probably indicated in 1-2% of all prostate cancers. Uros call it the gold standard, but they also say that about TURP which hasn't been that for many years

Prostate cancer got my dad while he was "watchful waiting". He thought he would die of old age before the cancer spread. He had a very aggressive type, and was gone quickly. That was 22 years ago. There are better ways to detect and remove cancer today. I don't think I would watch anything for long if there is a solution.

They can determine which ones are aggressive now and treat those - most of the time with something with fewer side effects than removal.

Non aggressive tumors don't really require treatment unless/until they start to grow - and they don't in the overwhelming number of cases.

Very sorry about your Dad

Yes that is true.  It take alot of love to deal with it.  And yes there are other way of making another person happy. But if you don't have to do it find another way.  Take care Ken

Hey JimJames and OldBuzzard,

Thanks again for the helpful comments and questions. You were asking about my condition, and they are as follows:

-PVR – 13CC as of last year

-Wake up 4 times per night

-Doctor says bladder is ok, although never had UroDynamics Testing or Cystoscopy (not sure how he knows that)

- Size of Prostate is about 30 grams. ( I guess he figured this out with the Hand rectal examination.

- Weak stream

-on Finasteride 5MG for 10 years and it helped a lot, with minimal side effects (execept for maybe Low T

For 6 months Urol wanted me to do REZUM. Even called me unexpectedly for 15 minutes telling me how great it is. When I finally decided to maybe go forward, he then started saying insurance will not cover and the previous 8 procedures he performed, did did not turn out that well! (hard to know whether Insurance or bad results is the real reason, although I suspect it is the insurance not covering it).

So now he wants to do Urolift procedure. So I am trying to decide, 1) which I am better off with: REZUM, UROLIFT, different drugs i.e. Cialis or none of the above.

2) what i should ask him when i see him?

At this tie, I dont care about Insurance, I just want to know what would ideally be best, then thing about any financial issues. 

Previously I posted new studies on REZUM. Now I have just received from the same source REZUM manufacturer, studies on Urolift.  note "Sexual Function seems to be preserved, as there were no reports of de novo".

https://www.ncbi.nlm.nih.gov/pubmed/27476128

Joseph

Emis Moderator comment: I have replaced the given link with the NCBI link as the given one went to "Page not found".

Hi Joseph,

First, important to say the obvious, I'm not a doctor here, none of us are. Nor have we examined you or have your complete records.

That said, REZUM is a prostate reduction procedure but your prostate isn't very larger at all (30 grams). More so, you really don't have any retention to speak of (13ml). So, I just don't get why your uro would want to do REZUM or any prostate reduction procedure on you. 

Other than waking up 4x/night and a weak stream, what are your other symptons? You might want to find out your IPSS score. (google it and take the 5 minute test).

You might want to do a void log for a few days. Just write down the time and amount of each void. I find voiding into a plastic measuring cup is the easiest way. 

I also don't get the finesteride given your prostate size. Especially with all of its side effects. Has it shrunk your prostate?

I know your question is whether REZUM is the best procedure for you, but I think the more important question is what is really causing your symptons, and if *any* procedure is warranted. 

-- Jim

 

Hi Joseph,

Your condition seems very similar to mine - symptoms and prostate size, Mine is only about 30 grams but it growing more inward than evenly and a scope confirmed a very small opening in the Urethra. I had Rezum done and it helped a lot - I also have some bladder issues that remain, but I got a lot of relief and it was worth it.

As for what you should do, the first thing is find another doctor. Any doc that would perform a procedure without any testing beside his finger is committing borderline malpractice. You very likely are in the same boat as me - but your doc doesn't know that and should cofirm it before doing anything. And the fact that his last 8 Rezum's didn't work out well indicates one or both of 2 things: 1) He doesn't perform it properly 2) He's doing it where its not likely to help - as a result of not doing any tests to guide him and his patients.

Find another urologist who will at least scope you and who performs Rezum and Urolift and if you don't have a large median lobe, see an interventional radiolgist about PAE.

My guess is that your IPSS score will be high enough to validate looking into having something done - but please don't let this doc do it. Find someone who will do thorough testing and is agnostic as to procedure (those who only perform one almost always recommend only that one). Because of your prostate size (not conrimed either IMO), any competent doc should also investigate other causes of your problem, especially if a scope doesn't reveal a restricted urethra.

Most of all - remember there are men with big prostates who pee like kids and guys like me with normal sized prostates growing in an unfortunate pattern that have real problems. You can't be treated until properly diagnosed IMO.

Joseph

Concur with the other comments regarding your condition. Am surprised your URO wants to perform Rezum or do a Urolift implant given your prostate size, guessed from a DRE.

Have you had a TRUS done? This should give you a much more precised sense of your actual prostate size.

In any event, prostate size may or may not have anything to do with your symptoms. The shape or geometry is more important, particularly if the prostate is pressing against your bladder or growing into it (this is referred as a protruding median lobe). If that is your problem the Urolift will not be helpful, and it is not clear to me that Rezum would be the best surgical treatment for it. If this is your case you may have no option other than a TURP or Laser surgery, though it probably would not be very extensive, as it would be fairly focused on removing the tissue obstructing the bladder neck and not much else (beware though, that when they do this they typically damage the muscle that shuts off the bladder neck when ejaculating, causing retrograde ejaculation, not sure whether this could be avoided in your case).

I had Rezum done a few months ago, and was applied one spray to my median lobe that was growing into my bladder, causing symptoms similar to yours. 3 months out am experiencing severe urinary and sexual disfunction including burning during urination, urinary frequency, pelvic pain, on top of dry orgasms, lack of orgasmic sensation half the time, pain after orgasm, etc. My urinary flow has improved though. Been diagnosed with CPPS/Prostatitis type III, meaning the URO has no clue (nor is he particularly interested in finding out, given that it is not profitable for him to do so) what the problem is.

Bottom line, be warned! BPH, Prostatitis can be a very frustrating condition to treat, I have a suspicion that most UROs are biased towards performing surgical procedures, since this is what's most profitable (and exciting for them) and so they'll invariably steer you towards it.

Your URO seems a bit too eager to take under, I would be a bit leery. Most probably he thinks he can help you, himself the victim of these companies peddling miracle treatments with no downside whatsoever.

As for Rezum, looking back, I have to say that I am fairly surprised that they got FDA approval based on a clinical study involving just a hundred or so patients, studying their evolution over a couple of years. You'd think that you'd want to see at least a few thousand cases, overseen in a clinical fashion over at least 3-4 years. It may well be that this procedure works, or it might be that in 2-3 years time they realize that the downside is unacceptable, as you might run the risk of serious collateral damage.

My own concern about Rezum is that compared to all other surgical procedures, it is essentially the equivalent of dropping a thermal bomb inside your prostate and hoping for the best. Other procedures such as TURP or Laser are much more precise by comparison, with the URO being able to see exactly the tissue being removed. With the TURP on top, the URO can take tissue samples for a pathological report. There have been thousands if not tens or hundred of thousand TURPs and laser surgeries over many years (decades in the case of the TURP) so these procedures are fairly well understood by now. Rezum and Urolift have been around for only the last couple of years. Other therapies that looked promising in the past have been disproven and/or discredited with the years (such as TUNA, TUMT). Rezum is essentially a new variant of some of these old therapies. Mesh implants, which were used in the 90s turned out to be horrendous. The Urolift is the modern version of that.

Time will tell and we all hope, not just for us, but for all future sufferers, that a minimally invasive, safe procedure will one day be found. I hope for my own sake that Rezum works in my case, though at this point I can only pray and hope for the best.

I disagree with a lot of this. TURP is an outdated procedure that should almost NEVER be performed as anything but a last resort. The side effect profile, invasiveness and number of people who end up intontinent and/or impotent is unacceptable given the number of less invasive procedures available now. There are hundreds of TURP vicitms on this site who will spend the rest of their lives in diapers.

Rezum is, for the most part, safe and is not a new version of TUNA/TUMT. Its a completely different process I can't speak for any one outcome or the FDA approval process, but they have done enough of them to make it pretty clear that the biggest risk is dry ejaculations - they report 4% but my guess is that it's more like 10%. It isn't indicated for prostatitis, as its likely to further irritate an already irritated prostate.

Don't proceed with your current doc IMO and whatever you do, don't let someone who hasn't done at least 100 of a procedure do that procedure on you. IMO - get a real diagnosis that at least measures your prostate size (scope, not finger - fingers are not accurate and can't gauge how obstructed your urethra is) and possibly a bladder study too from a urologist that does Rezum and Urolift. If your problem IS BPH and doesn't include a large median lobe. I would also meet with an Interventional radioligist and consider PAE along with other treatments. Or, you could decide to wait, self cath when things get bad and hope for a better procedure to come down the pike at a later time.

In any event, if anyone (on this site, or a doctor or anywhere else) recommends TURP, be as polite as you want but INGNORE THEM!!!!

Is it not wise to have the Rezum Procedure done that involves a median lobe issue?

Quite the contrary - they can target Rezum and aim it wherever the problem is. PAE is less likely to help with a median lobe because it works evenly on the entire prostate so you can't focus it on a specific area. Not sure about Urolift - I think there is a size limit there - I'm sure there are others that can comment on it. But Rezum is definitely an option with a median lobe issue and they are doing it on bigger and bigger prostates now.

Take those studies with a grain of salt. Be particularly beware of what a marketing person for the company pitching this procedure can tell you, their are by definition conflicted and cannot give you an impartial opinion (even if completely ethical they have a very strong financial incentive to push for the procedure, and IT IS THEIR JOB to do so!).

I had the procedure done 3 months ago and my experience has not been particularly good. My life as it stands now has been competely ruined, cannot exercise, sexual performance is a disaster, cannot even attend social functions, and my job is at risk! My marriage and family well being have been impaired, as I cannot perform even basic family functions (like drive my daughters to their extra-curricular activities on week-ends). I am on the verge of a mental breakdown. The company and the studies never discuss cases such as mine, this is why you need to come look into these forums to get a real sense of whether a particular procedure works and what its downsides are.

Like you, I wanted to believe everything I read about this procedure, supported in the at belief by the medical papers and clinical studies published about it. I went so far as finding one of the doctors listed as one of the authors in the medical paper published thinking that he would be one of the most legit and experienced dr for this procedure. Looking back, I think his diligence was negligible in my case, and wonder about whether it may all but be a medical scam to pull desperate cases such as myself and rake in some money before it is discredited as just another failed therapy. All I can say is beware and approach any treatments with a skeptical mind, making sure you really understand the risks and likelihood of these in your particular case.

Were you properly diagnosed (scope/bladder study)? Did they rule out prostatits before doing the procedure? Rezum's will inflame the prostate - I wasn't in too much pain but couldn't pee for over two weeks as a result. If your prostate is already inflamed, Rezum is a set up for big problems and there is a big difference between an enlarged and inflamed prostate.

You should consider seeing a top notch specialist to help you ( I can PM you a recommendation if you need one). Maybe a period of self cathing would help your situation settle down and at the least, it should allow you to live pretty normally (drive your kids, work, excercise) unless your problem is just pain. A course of Myrbetriq might help too, if urgency is a big part of the problem,

Yours is the worst outcome I've seen yet with Rezum - you should see someone else who might be able to help.

I am so sorry for you. I can't imagine your suffering

No matter what procedure, it seems like a crap shoot.

With regards to your QUESTION 3, my guess is that the company must have sponsored the clinical study, probably by giving the equipment away to the panel of doctors conducting the study. That is probably OK. The question is whether UROs have any other financial interests, direct or indirect, in the company selling this product, making them obviously biased for the procedure. Does anyone know what the law says in this area?

Joe If your doctor is willing to do the Urolift on you go ahead and do it.  My urologist has done it and he has pull the meidian lobe out of the way to open you up more.  Try this one first it may work for you and there are no side effects.  Rezum is ok but they still have some bugs in it.  There have been to many side effects and to many men ending up with retro ejaculation.  They tell you only 5% but it way more.  If you ever watch the video they are destorying the inside of the prostate on both side and they distrory the ducts.  Be carefull and be safe  Ken  

I was told by my doc that Rezum works with protruding median lobes. My doc applied one spray to my protruding median lobe (which he remarked on incidentally while performing the procedure) and I believe this has improved my urinary flow. I still have a piece of this growth inside my bladder (atypical for my age according to the doc), not sure whether it's an issue that I may need to deal with at some point. On the other hand, my ejaculatory function has been all over the place, with both ante and retro ejaculations (impossible to tell, could be lack of fluid). Orgasmic pleasure index (if this was measured at all) ranges from 0-6, meaning that orgasmic sensation has greatly diminished since my surgery. This could also be as a result of chronic inflmmation, have no clue, time will tell.

My doc said that Urolift does not work with protruding median lobes. This sort of makes sense as if the median lobe has grown into your bladder opening it at the bladder neck be difficult with this technology. I guess it's really a function of your particular anatomy.

Would tend to agree with comment on Rezum having some bugs. In my view, procedure might work in people with just enlarged prostate with no signs of prostatitis or mild forms of it. Dropping a thermal bomb inside your prostate is probably not a good idea if you're already prone to severe inflammation. I think a lot more work needs to be done to undestand what's really going on inside the prostate before any of these therapies can be used in a safe manner. There needs to be a much more elaborate protocol for deciding which therapies are best suited to a particular individual and which conditions. Also, the medical profession needs to ensure that these protocols are followed by all doctors, essentially upping the care standards which seem to be rather poor or all over the map today (i.e. such as ensuring at a minimum a TRUS and cystoscopy before any procedure, differential diagnosis, etc). Right now, you're at the mercy of the professional you land upon, and if not informed can end up getting completely s*d up.

My urologist is only 38 and he is up on all the new procedure.  He has done the urolift on a median lobe on a few of his patients.  It just takes some time to do it.  He care enof to make his patients happy.  Good luck on what you decide.  Ken

Interesting your URO mentioned the possibility that your ejac duct could get obliterated during the procedure, before the procedure! Mine only mentioned that AFTER the procedure! I now think I understand why I have been experiencing problems producing much matter during ejaculation. I am in disbelief that nothing like this was mentioned to me!

Hi Mike588.. just wondering how you are doing now after your FLA procedure,,?  Looks like it's been about 7 week since you had the FLA procedure..?

Cheers

Good morning AJ.  How are you doing.  Did you have anything done yet.  With the report they do say no Erectile Dysfunction but they say very little about retro ejaculation because they do not consider a mans ejaculation a function.  Most of the time urologist will tell you after 50 you don't need it because your not having kids.  At 61 I still feel it is improtant to me.  It goes with my orgasm.  I have talk with my urologist which started doing the rezum 6 months ago.  He told me that retro can happy because the steam can distroy the duct and the semical vessel because the steam will distroy the tissue.  Some reports say 5 % but it more like 15% ) I don't know if you read about the 2 guys on here that had the rezum done but only had the steam injected on the right side. Not on the left  They did not want to take the chance of getting retro.  What the doctor said ( mine to ) was that with only doing one side you will not get the full results of the treatment.  But they went ahead and did it.  One of the guys was 48 and the other was 53.  Both are doing great and it did work doing the one side.  The guy 53 took him a little longer to heal but it did work and no retro.  I don't know if I told you I had the Urolift done over 2 years ago.  I was good in a couple of weeks and no side effects.  I feel doing the urolift has made my orgasm more intense.  My urolist don't know why but he said that it may have something to do with controling the prostate.  What ever you decide I hope it work great for you.  Take care  Ken