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

Thank you for coming into this forum.  We all thank you.  With the Rezum procedure how many men end up with retro ejaculation.  We have had many men on here that they were told 4% but there have been many that end up with it.  We had 8 on here alone in the last 4 weeks.  I know the fluid will be less because the prostate gets smaller but alot of men don't want to take a chance of ending up with it.  There also were 2 men in there early 50's that had it done but only let the doctor steam the right side because they did not want the vessel on the left messed with  Both are happy with there out come. I guess they did 3 steams on the one side and both did great it was enough to open them up.  Any comments would help us all  Thank you for taking the time to help us  Ken

Hi JuroG,

We've had several reported instances of retro ejaculation from Rezum

on this website. Far more than you would expect from REZUM's website and study material. 

How many REZUM procedures has your group done and did you have any cases of retro?

Thanks.

Jim

That describes my experience perfectly. I couldn't pee at all for over 2 weeks and wasn't as good as before the procedure for 5-6 weeks. By 4 months I was way better than I had been in years. I did end up with partial retro - I still ejaculate but its usually delayed by some number of seconds and there is less semen than before.

Yeah, I was doing great for the first 3 or 4 months, then it just went down hill and now I am having to (for the first time) CATH. Thanks REZUM 

 

We have done over 100 cases at this point. I do not know the exact percentage of retrograde ejaculation. I am sure it is more than 0. It is not the first line therapy I would offer if that is my patient's top priority, but it should be significantly lower than a TURP (or laser) type procedure.

I called someone who is doing it on behalf of a friend and spoke to the nurse who works with the Urologist - she unofficially or off the record admitted that they have found it's about 10%. Thanks for contributing - so what would be the "first line" ? I'm guessing 99% of men under 70 would be concerned about RE, no?

alfuzosin is a generic medication with relatively low RE, and would be an inexpensive treatment to try. The Urolift has virtually 0% RE.

Most men I have seen who have completed their reproductive years aren't as concerned with RE; particularly if they are miserable with their symptoms., but it's something I always ask/counsel prior to scheduling a procedure.

Thanks again Doc! I tried Alfuzosin - maybe I didn't persist long enough, but it seemed to lower my blood pressure or something since I felt my heart beating faster walking up stairs etc. A friend of mine did Urolift when it was a trial - he said he pees like a horse now but his bladder is so bad that he still does self cath at night or he wants to be OK for a few hours.

By the way I did FLA and am post 4 months the procedure, it helped a lot but I still take Flomax - I probably also have bladder issues - long story

I would imagine that there was some bladder dysfunction inherent in his situation; I usually recommend urodynamics studies before any procedure (although many patients will defer this, as it is somewhat invasive!)

If there is obstruction for sure why would urodynamic test help? Ignoring will make bladder worse,no?

To determine if there is any underlying detrusor instability (bladder issues) which are common after long-term obstruction; these may require different treatments.

Mike,

Ditto on Jersey Doc's answer but let me give you a couple of examples.

Patient has acute retention. Dr. "A" recommends TURP without urodynamics. Patient has TURP and still cannot void without a catheter. So he not only has had an invasive procedure, most probably lost his ejaculatory function (or worse), but he's right back to where he was before the TURP in terms of voiding. Or worse. 

Same patient but Dr. "B" does urodynamics first. Patient fails due to lack of required voiding detrussor pressure. Doc "B" tells patient that TURP probably won't help that much. Patient is therefore spared TURP and presented with other options. 

This is just one example but you get the idea.

Jim

 

After I went into retention I had some kind of test where they clamped the bag - I think it was an ultrasound or MRI - they injected something to make me pee - hurt like hell - not sure if that is the same as a urodynamic test, after that the Urologist told me to do some procedure ASAP. Curious if you have time what I could have done assuming I did have the above mentioned instability. My Urologist used to do green light and I think he moved to button turp which he says is less bloody and painful. But he says when you do ANY type of procedure you change the structure of prostate so the bladder duct will not shut tight - hence retro

Did you have , Chronic prostatitis mike ? And did the fla help you on the stream , and why did you decide on the fla vs resum vs urolift !Flowmax is a issue with me sick of it , tell me the details of ur exsperisnce ?

No chronic prostatitis that I know of. Yes it helped stream. If I don't take Flomax stream not as good even though much better than before. Before procedure Flomax caused retro, now for some reason not, but could be because I take Flomax just before going to sleep so it partially out of system by then.

I decided on FLA because I spoke to someone who had it, I was desperate and had seen negative things about Rezum and nothing negative about FLA. Urolift sounds strange and I wonder what will happen if prostate continues to grow - not based on science it just feels like I would be having a ticking time bomb inside me.

Hi Mike,

Regarding your FLA recovery, are you still self cathing, or just Flomax now? 

​Jim 

Jim,

I'm doing it every other day to check - PVR's consistently down to 100 average now. I can stop according to Dr K - I forgot to take Flomax one night, sure enough the next afternoon PVR was 180. Frustrating but still I'm in a much better place than I was prior to the procedure so I have no regrets.

Regards,

Michael

I had the Urodynamics done, and what I don't understand is that while I was doing the test, the 3 tech. that was doing the test were talking back and forth, saying how good my pressure was. But when the Dr. came in , he told me that my bladder was parolized. and put me on Cath. I am wondering if he was lookiing at someone elses test? While I do have trouble peeing, I can pee without the cath. Very concerned??? 

What about PAE?

Mike,

180 isn't all that bad, even without Flomax. Glad you're doing much better. Maybe I'll find you a deal on a home bladder scanner so you won't need to check PVRs via catheter Meanwhile, if you're under 100 via catheter for two days in a row, you could probably drop down to weekly checks, then monthly. Also, you should have some guidance from the volume and frequency of your natural voids because what comes in generally comes out. 

Jim

Well pae I haven't found a doc in the us the insurance will pay for it , still like introscopic injections they want pay and I only found dr Isaac in n Carolina willing to do it got 6 grand cash

But has any one done that procedure on a chronic prostatitis patient with success ?

Less invasive except for the grion cut seems like. One guy I talked to it did shrink his prostate whisk was the size of a lemon biut later he still had to go in for green laser surgery !

Which would be less invasive for a prostate patient pae or fla ?

Theoretically you could say PAE less invasive, but the recovery phase is similar - with FLA you have a catheter for at least a week after, with PAE not except it hurts like hell to pee for the first week or so. PAE is hit or miss, sure no side effects but you'll feel bad if you fork out a minimum of 6 k and have zero results - you might get lucky but it seems even then it doesn't last that long till blood supply gets re-routed and you're back to square one.

Seems logical pad is more temp , fla is more permanent Cather would be a pain

And if the Prostatis was a issue Seems like it would be a beast ,bph is a pain but the 2 surgerys paw would not last and fla would move the black beast more seems like and longer catheter times is also a negative ,

So roll the dice if you was a prostatitis patient what would you do ? Pae or fla

Rog we are all amateurs guessing, I don't know if there is any logic. I think you should call Dr Karamanian regarding prostatitis and FLA since I know nothing about it, and maybe you are not even a candidate.

Not withdstanding that, in my opinion PAE is like rolling the dice, less invasive but hit of miss - and if it's a miss you won't know for weeks or months and maybe that waiting period will cause you more problems. FLA is not rolling the dice, there is a guarantee the prostate tissue obstructing will be ablated. How effective it is, whether it can grow back, I don't think we have enough examples yet and it will come out in the next few years.

Re having a Foley catheter, trust me it's not the end of the world and not as bad as one would imagine, and hopefully you'll only need it for a week or two.

 

What can be done for those. I had Rezum done and it helped a lot, but I'm left with residual bladder issues. Is there anything that can be done for a bladder that's become less than optimal due (probably) to years of BPH?

Hi Melvin,

I'll take a guess, and just that.

It sounds like the techs were talking about a finding of high detrusor pressure and a low flow rate suggesting obstruction, while your Doctor was saying that given the obstruction you bladder was not functioning (paralyzed). 

Did the doc suggest a procedure or surgery? Are you voiding with or without a catheter, unclear from what you said. 

Jim

as to the people doing the test. Never did they say anything about low flow.From what I got from their remarks All was good?? yes I do use catheters some of the time. Dr sugested 3 times a day.The thing is If it is parolized why can I still pee without cath? and some of the time after voiding ,I cath and almost nothing comes out? Although the flow is weakThings are not what they were two week post Rezum. Yes he said he might have to put in a pace maker. Never heard of a bladder pacemaker, have you? He also said he might just have to remove my bladder. I'm starting to think I need a 2nd openion. The Rezum was done 10/15/2016. I don't know if it is pertanent or not, but 03/01/2017 I had neck surgery 3 disks removed then 04/012017 went to see a concert, the band had everyone one their feet and danceing and my lady and I got into the mood and started doing the bump,(This is important I promiss) the next day and every day since my lower back and right hip have been a real pain,Had an MRI done, showed Severe stenosis at L3 L4 also other problems at L5 S1 and a small syst at L3 L4. I'm thinking this may play an important part in what is going on with me,Since before 4/1/17 I was getting better and after I have gotten worse. Sorry for going on about all this, but I have actually given you the short version.

 

Hi Melvin,

If he used the term "paralyzed" that seems to suggest some sort of nerve damage and therefore the pacemaker suggestion. More than that is beyond my pay grade but hopefully the doc from NJ will see this and respond. Meanwhile, you should really get full clarification from your doctor as to your urodynamic testing results, as well as a hard copy for your records. I self cathed for several years, so if you need any help in that regard please let me know. 

Jim

Usually, the first line of treatment would be an anticholinergic medication; oxybutynin is a generic medication which can be tried. When that fails and one other medication fails, a percutaneous nerve evaluation should be considered, to determine if the issue stems from a nerve issue; if the test is positive, a pacemaker can be implanted to stimulate the nerves and often helps the symptoms significantly.

Now that I take offence to.  Now that were done having kids castrate them like animal and put them out to graze.  Don't worry we can still do it but the feel won't be the same  Doctor do not feel that the male ejauclation is a sexual fuction that is why doctor don't care about it. That needs to change.  Maybe they should think like a man sometime and what there doing to another man .  I don't know most men that you talk to that don't care but there are still alot on here that do. and 10% is 10% to much Ken

I hate to say this but you have a procedure to help you and it dont and it is not the prostate it's the bladder.  That is from not having the test . So a doctor does a surgery that you realy don't need.  I have said this many time when a urologist can't find a problem.  They assume it's your prostate and cutting away. And they they keep going and going as all the problems come up.  That is way you should have all the test you need to make the right pick.  WHY HAVE SURGERY THAT IS NOT GOING TO HELP IN THE FIRST PLACE God help us all  Ken 

Hi Ken,

Are you referring to anything I have said or to Jersey Doc? I think all three of us (you, Jersey Doc and myself) are in agreement that in many cases urodynamic testing should be done prior to a prostate surgery or procedure in order to more accurately predict outcomes. Or am I missing something?

Jim

Mike I can tell you that I do not feel the inplants  I have 4 on my prostate.  They are very strong.  I think I read that the wire or string that they use can hold up a concreat block and if it grows it will hold it back for a good while.  I am 2 1/2 year into it and I would have it again if it come up  FLA is a good procedure but so is Urolift and it is done in more places.  Good luck  Ken

Thanks, as for cathing the first time I did it in front of the nurse, he said he had never seen anyone do that well for the first time. So I have no problem doing it I just don't want to, but we all know how that goes.Thanks again

 

That's great Melvin. For me self cathing (CIC) was a nightmare the first few weeks. Later, it became as painful an traumatic as brushing my teeth, but those first few weeks! Most people fall somewhere between the two of us.

Definitely find out from your doc what your exact issue is. If it's a stretched bladder, then CIC can potentially rehab it. That's what happened with me. However, if it's nerve damage, then that's something else. But do follow up here on this if you want. 

Jim

Ken thanks for the info - my fear of Urolift is not based on fact or research. I haven't been following all the discussions carefully, if it worked for you that's great and I'm happy for you. I believe that Urologists do not blindly suggest surgery, I don't know where you get that from, they do all kinds of tests to see if the prostate is enlarged and obstructing flow. Surgery was never pushed on me, in fact it was the opposite, they tried everything possible to avoid surgery. I guess like in all things there are good doctors and not so good ones.

Yes I do agree with you (  I may have said it wrong ) Doctors do many surgery that they don't need because the doctor don't test  Ken

You should never have prostate surgery until you make sure that the prostate is the problem  Ken  ( it could be the bladder or the kidneys )

that's true I suppose, but my understanding is that bladder and kidney problems are caused by the obstruction - difficulty urinating and pushing hard, then retention damaging the kidneys.

Re un-necessary surgery I think there is an old joke about surgeons, "if in doubt cut it out" lol

Thanks  Again Jim

I may be showing my ignorance here,but what does CIC mean?

As for doing something,I am SURE about the Back thing I looked at my MRI and read the report, can't see my Neuro surg. until July 11 I'm almost sure he will operate. After he did my neck, lots of feelings came back. I hope more will after the next one. spinal canel is almost closed in 1 or 2 places. So hoping for big things here.Good luck to us all

 

Hi Ken,

I think we're in agreement here. Like Mike suggested, some docs try everything before recommending surgery. Others not so much. 

My concern is that as more quick and easy less invasive procedures like REZUM and Urolift come on line, some docs will start skipping steps and/or taking more chances with compromised bladders. But then again, I don't hide my bias toward watchful waiting when you can, especially nowadays with the work being done on new procedures. 

Jim 

Melvin,

CIC is short for "Clean Intermittent Catherization" i.e self catherization. Good luck moving forward and let us know how things work out. 

Jim

 

Hi Mike,

I know we're on the same page, but for those not as familiar, I want to clarify that it's not the obstruction per say that can cause bladder and kidney issues, but it's the increased voiding pressures. That's why, for example, self catherization can protect both the bladder and kidneys even in the presence of obstruction.

Jim

OK thanks again And I will keep updating.

 

Yes there are good and bad.  But I hate to see any man go through a surgery that he is going to lose anything.  Especially if another procedure that does not cut anything out. Would do the same.  My urologist is a great guy  He does very few turp or GL because men do not want to deal with retro.  And being a man he knows. And he want his patients happy with the out come.   Some doctor only offer what they know they will not say a thing on any of the newer procedure.  Many men are talked into turps and GL surgery and after they are very un happy with the way things are.  They do not enjoy sex  anymore and just stop all together.  When we are older we should be able to enjoy our life and sex is apart of that.  Urologist do not consider the male ejaculation a sexual function.  They feel once we have our kids we do not need it.  So we are treated like animal. Castrate them and put them out in the field.  They tell you all will be the same but they are talking about your orgasm.  But that is only in principal because all men have a orgasm but not all men have the same kind.  At 61 I will never let another man distrory my prostate and tell me hes doing it to save my life.  He may save it in one way but he is killing you in another  I will not live like that.  What ever you decide that is up to you.  I wish you well and god help you   Ken  

Jim  I have been on here for the last 2 or 3 hours like most of us.  We all agree that there are good doctor and bad ones.  After some test they may tell you that you need surgery but what if they do not offer some of the new procedure,  They are not going to tell you that.  They are only going to tell you what they do even if it only.  Turp or GL.  They not going to tell you that the urolift or Pae or rezume would do the same thing.  I think that is wrong.  You know how I feel about that  No man should have to deal with the side effect all of them not just retro.  Doctor dont care about that.  That is when it get into you being a number and not a patient.  Ken

Wouldn't that be for an overactive bladder? I seem to have an underactive one.

It can be for both, depending on urodynamic findings

Hi OB,

You can have OAB and underactive bladder at the same time. So I guess it depends on your symptons (and testing) to see first if that's the case and then which is dominant in terms of treating with an anticholinergic medication like oxybutynin. Maybe the doc will comment.

Jim

 

I don't have an overactive bladder, just an underactive one. I was on Myrbetriq when I had trouble peeing after Rezum and it did help get me "going" but I surmized after awhile that it was doing more harm than good, went off of it and seem to have diagnosed that correctly as I improved a lot once I went off of it.

I'm hesitant to go through urodynamic testing because symptomatically I know that my bladder doesn't work all that well and its a big, uncomfortable, expensive test to confirm what I already know. At times, I pee really well, other times not as well, but never close to worrying about retention. Being horizontal, sleep and a lot of alcohol tend to impact me the worst and at those times I have to either really push or pump with my fingers. So its pretty clear that my prostate isn't the issue.

I'm not bad enough for a pacemaker implant to be appropriate and at this point its more annoying than anything that impacts how I live my life, which is much improved after Rezum. What I would like to know...is there a low side effect drug or something else (PT maybe) that could improve my bladder function or do I just have to live with it? And is there anything I can do to keep things from getting worse?

Ok jimjames what are the details should you ask the doc on results of the uro dynamic test

To see where one issues are ?

Now I have already seen that medium lobe was squeezing the urethrea via dopler ultrasound

I know the bph is the issue . Bladder may be issue also to . So. what info should I ask doc ? On voiding and I'm thinking I like to to get a bladder kidney scan like you stated in your previous post , the doc want order it unless they determine its needed ? Any suggestions ? I avoided the scope due the prostatitis . Did not think it was needed I had issue years ago with it on my chronic prostatitis!

Many may disagree with this, but you might consider getting some sort of BPH treatment before doing any more tests. If indeed, you bladder is part of the problem, you won't solve it anyway with a median lobe squeezing the urethra. You might want to consider Rezum or FLA and see where it gets you. Unless you're in full retention (and maybe even if you are), removing the obstruction will almost surely provide some relief and depending on where you are post procedure, you can always revisit the urodynamics test then - especially if you have chronic prostatitis.

One qualifier - I don't know what impact that prostatits has on the outcomes of any of the procedures. Research that before doing anything!!

Hi Rog,

Let me start by saying that I also have bph and my large median lobe is also squeezing on my urethra. Given that, three years ago I could hardly void without pushing the urine out with my hands, and when I finally saw a uro they drained 1.5 liters out of me after a 450ml void!  Today, my voiding functions are fairly normal and my PVR is generally under 100 and often under 50ml. 

I haven't had a prostate reduction surgery or procedure, nor have I been taking prostate reducing drugs like Finasteride. So I can safely assume my improvement in voiding did not come from a smaller prostate or median lobe. The difference was that three years ago, my bladder was very stretched, and today not so stretched from a program of self catherization (CIC). 

This may seem roundabout, and I'm not telling you try CIC to duplicate my results, but I just want to make the point that just because you have an obstructed prostate and/or median lobe doesn't necessarily mean you are going to be symptomatic. In other words, there's a difference between BPH and symptomatic BPH. The latter may need treatment, the former does not. 

So, as to your urodynamic test. What you want to find out is how well your bladder is functioning. They will measure both bladder pressure and as well as the integrity of the nerves that serve the bladder. 

There will be three general outcomes which will help dictate a treatment approach. 

1. Low detrusor pressure and high flow rate (unobstructed)

2. High detrusor pressure and low flow rate (obstructed)

3. Low detrusor pressure with low flow rate (poor detrusor contractility).

If you end up with "3" then a prostate reduction surgery or procedure will be limited in results. Same thing if your nerves aren't firing correctly. 

They should have measured your PVR as part of urodynamic testing, so try and get hold of the report and look for that. Also, most uro's have portable bladder scanners in the office and can quickly compute our PVR. The bladder/kidney scan isn't really necessary for PVR but useful for other things including checking on the health of your kidneys. 

Hopefully this is helpful, but I'm still a little unclear your history/sympton profile so please take this as general information and not specfic to your case. 

Jim

Yes fla and rezumI prefer fla but don't want the prostatitis to spread since dr Bahn had contained it to the left lobe

But hevefbghdbless I just wish I could find a success story from a chronic prostatitis patient with either treatment !

Rog,

I may be reading you wrong, but a prostate reduction treatment (fla, rezum, anything) for prostatitis alone should only be done as a last resort. That's because it may have no effect on the prostatitis. Of course, if you have symptomatic BPH/LUTS with a viable bladder, that's another issue. So I would get that all ironed out before considering any sort of procedure.

Also, since you mentioned, FLA, we had a doctor join the forum this weekend who made some sobering comments about the procedure. Personally, I think FLA is more promising than he does, but he makes some very good points and I'd advise anyone considering FLA to really think over whether now is the time to jump in, or whether waiting for more clinical data makes more sense. 

Jim

There is no medication which improves detrusor contractility (i.e. Makes your bladder push harder)- before you google it, bethanechol doesn't work.

You may wish to ask your doctor about a percutaneous nerve evaluation- a test of the nerves to see if their stimulation may improve your condition

What is Bethanechol used for? I had/have symptoms similar to Oldbuzzard. At one point prior to my procedure, I was taking that I believe up to 3 times per day to help me with voiding. I can't say it worked great, but I do think it helped me at times with being able to void. Placebo?

And I too find it more difficult to void during the middle of the night, and after having alcohol. During the day, I seem to be fine.

Bethanechol (a "bladder stimulant" works no better than placebo. I've never prescribed it.