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

You're always going to find availability bias on online forums; such is the nature of the beast.

Bottom line is that it is probably the best of the minimally invasive procedures out currently for many patients and has had great results over the past few years we have offered it (we've done several hundred at this time.) It's also covered by most insurance plans, which is obviously a plus.

 

We've also had reasonable success with it for large glands (we have done over 150 g, and are involved in the large gland trial with nxthera.) I still think it is worthwhile to try in just about everyone without retention before Aquablation.

Are you saying that patients with retention should not consider Rezum ? Thanks. Hank

@JerseyUro: You're always going to find availability bias on online forums; such is the nature of the beast.

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

True, but "Evidence Based Medicine" is also full of bias from trial planning, to data collection to follow up, not to mention physician bias in recommending those procedures they are trained in versus those that they are not. While I believe one shouldn't come to conclusions based solely on anecdotal forum discussions, not to consider them at all can be equally irresponsible.

Jim

We have had success with rezum in retention patients, but it is preliminary. As long as expectations are realistic, I think it’s a good place to start

@JerseyUro: I still think (Rezum) worthwhile to try in just about everyone without retention before Aquablation.

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

If there's no retention, and therefore no bladder and kidney risk, what is the justification of an invasive procedure as opposed to watchful waiting strategy combined with less invasive drugs or other no surgical approaches?

Jim

Jim

Retention is generally far gone disease, and may not resolve even with surgery.

Minimally invasive procedures and medications are generally more successful when instituted prior to end organ damage 

Jersey: " Retention is generally far gone disease, and may not resolve even with surgery.

Minimally invasive procedures and medications are generally more successful when instituted prior to end organ damage . "

Thanks for an honest answer. I wish other urologists would know, and think about this, before they put patients with retention into unhelpful surgeries. Perhaps there would be less complaints from this forum.

Hank

I'm all for being proactive but I see a big difference between medications and/or lifestyle changes and procedures like Rezum which are only "minimally invasive" when compared to procedures that are more invasive. And while you're not saying so, just so no one is confused, retention and organ damage do not go hand in hand with watchful waiting under the supervision of a good urologist. Another point is that I have yet to see guidelines suggesting that surgeries should precede retention, and in fact most trials allow retention around the 300ml or below mark. Or perhaps when you say "retention" you are referring to retention above 300 or so ml?

Jim

Hank,

I don't think this necessarily contradicts what JerseyUro says, but it's really not retention per say that dictates surgical success, but it's bladder function which is measurable via urodynamic testing. That's why two people can have the same retention but one could be a good candidate for a prostate reduction surgery and the other cannot. I had retention >300ml and after a six week trial of CIC bladder rehab was told that I had enough pressure for a successful TURP. As you know I declined, but the point again is that the focus needs to be on bladder function and not just retention numbers. The other point is that the bladder can rehab a lot more than the literature suggests via CIC probably because there are no financial interests in following this course of treatment.

Jim

Hi Jim, you had great success rehabbing your bladder with CIC, but you seem to be the only one. Most people, including myself, either have only limited successs or not at all, in this CIC rehabilitation.

If I know ahead that with retention, I would have much less of a chance for success with a certain procedure, I would not go for that procedure at all. I would stay exactly where I am right now, with CIC and meds. Hank

Hank,

My main point was that a retention number doesn't predict surgical success, but rather you need a functional test like urodynamics. Again, two people with the same retention, may have different surgical outcomes depending on how they score functionally with urodynamics.

As to CIC, bladder decompression through catherization (be it CIC or Foley) is an accepted form or bladder rehab and it's what good urologists recommend to all patients with significant retention prior to prostate reduction surgery. There have been trials to this point showing better outcomes with this strategy. This doesn't mean that CIC will rehab every bladder or that it will rehab a bladder completely, but sometimes that is not necessary. I don't think my bladder is completely rehabbed, but good enough so that I only have to self cath maybe 4x/week these days. Everyone has different results but again, I'm not holding my single case as a standard, just pointing out that bladder decompression through catherization can and has worked for many. And where it doesn't, it still offers a reasonable alternative to invasive surgical procedures with unknown outcomes and side effects.

Jim

To me this does not sound right.  You say surgeons need some experience to be able to do the procedure properly.  So your looking for patients to be the guinea pigs.  I don't think any man want to be that.  You also said  that you have done 100 to 150 of them.  Out of them how many have ended up with retro ejaculation.  There are still some of us that still like it and do not want to take the risk .  Ken

Hey Jim  Maybe we should start a list of the men on this site.  Where they are having the rezum procedure in what state.  Robert and Jerry are 2 more to add to the list.  I think we are going to hit over 10%.  What a mess  Ken