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

Hi jcl,

Good luck, if there is no blockage then the bladder control sounds like a good possibility. I would, if it was my situation, hope it was simply that. Therapy good ??, turp bad 😟. 

Stay away from the Turp.  The Urolift will relive the pressure on the bladder.  Also the Company NeoTract will not stand by the Urolift.  Doctors are not aloud to use any procedure with the Urolift.   Take care  Ken   

Hi Guys

Thought I would check in and provide some updates. So since my Rezum procedure August 2017 I have not had any relief of symptoms.

Was referred to another urologist and he performed a cystoscopy and order a video urodynamics flow test.

Cystoscope did not show a reason for my symptoms and the video dynamics did not show a reason or a need to move forward with removing the prostate.

The urologist has recommended that I get physical therapy for pelvic floor tension. I have started the p/t but so far their test show that I do not have pelvic floor tension causing my weak split stream and frequent need to urinate.

I am on treatment #4 and they started internal tens therapy which just costs me more money and requires them to do less work on me.

I am really back at square one - I have no answers as to why for over 20 years I cannot pee with a strong stream.

Meds have not worked, Rezum only lead to pain and RE, now physical therapy. 

I have 6 more p/t visits before I see the urologist once again.

It would not be as bad if I just knew why!

I went to physical therapy for my overactive bladder/cystitis and it has largely helped. I do the physical therapy exercises to help strengthen the transversus abdominis. I know my situation isn't the same as yours JCL123 but maybe the physical therapy exercises will help over time. 

JCL,

Other than a weak and split stream, what are your other symptons? Are you in retention? Do you have urgency? Do you know what your IPSS score is?

Jim

I think the IPSS score was a 27?

I do not have retention. The problem started over 20 year ago. I cannot pinpoint when or what event caused it, but thinking back, when I was in my early 20's and started going to bars and drinking I would get bathroom shy and could not go. It kinda built up from there and became an issue everywhere and anywhere. I need to go, cant so I would wait (I can hold it for hours) would get home then could go but it would not come out all at once and this has just been my pattern.

Doctors have always said it was my prostate. I dont know, maybe it is part of it, or maybe its not at all.

The p/t lady said I bet you have very tight pelvic muscle and thats the reason. She did a test with a machine and it showed that all my muscle are very relaxed - the opposite of what they thought, but still they want me to do tens rectal therapy for 6 weeks and stretch more.

Its just so frustrating that no one can tell me what is the root cause. I have had so many cystoscopes and the Rezum and the meds and a uro dymanics video etc etc.

I did get my hand on some generic cialis from an underground source. Took 5mg everyday and I did notice a bit of a better flow, but that could have just been all in my head placebo effect

I still don't understand what your symptons are other than a weak and split stream. As long as you don't have retention, a weak stream isn't really a problem and doesn't need treatment. Does it really matter if it takes 30 seconds or 60 seconds to void. Based on what you have said, I would look elsewhere than the prostate, and certainly do not have any more prostate procedures. Have no idea why they did a Rezum if you were not obstructed. You might google "paruresis" and see if applicable.

Jim

If you would like me to email you a .pdf file of the physical therapy exercises I received let me know.

I also am very bathroom shy. 

Hi davidaami,

I would be interested in the PDF too.  I suspect some other people on this forum would interested be too.

Steve 

I do not empty in addition to the weak stream. I will go and only get enough out that I can at least function, but I will need to go again within 5 minutes to get the rest out. If I am consuming beverages you can imagine how this compounds the issue. It is troubling to me that the images from the video urodynamics did not show a blockage or restriction. The Urologist said it shows starting and stopping of the flow, although to me I do not notice that it stops and starts its just a weak flow. I also had weak ejaculation volume and force prior to Rezum which after Rezum I now have full RE.

I also would ask every Uro, if Flomax does not help, why do you think its the prostate?

I had another P/T session yesterday and they did around with their finger in your anus trying to get the muscle to relax, then they use a tens probe to relax the muscle for 20 minutes. I have not noticed any improvement since starting this.

 

Have they mentioned overactive bladder syndrome to you? It could account for your symptons.

Jim

Hi jcl123,

I’m not sure if this is helpful but my urologist mentioned damage to the bladder neck is typically the cause of retro and a host of other problems. If it is damaged by the rezum procedure it may explain some of your side effects. I have no idea if this applies to your situation but it may be worth investigating the possibility. My urologist made all effort to avoid that area knowing all too well the potential side effects and the impact on QOL.

I was given a medication for overactive bladder. After 2 days of taking it I could not pee at all. Was told to stop it immediately. I forgot the name of it. I do remember the doctor telling me it was a very strong medication and very expensive. He gave me 30 days of sample packs.

Other than medicine, they often recommend bladder retraining through timed voiding as well as pelvic floor exercises.

Jim

jimjames,

Are you referring to overactive or underactive (i.e. BPH related) bladder for the above exercises?

Steve 

I was referring to overactive bladder.

Thanks.  That is what I thought but I was just checking.

S 

It is likely unrelated to your prostate; you may want to consider a bladder treatment, such as percutaneous nerve evaluation to determine if you're an appropriate candidate for Interstim implantation.

Hi Jersey, changing gears a bit here. I was all set to get Urolift done, and my Dr did a scope and said I had a " high bladder neck". He said Urolift and a TUIN would be best. What I failed to ask is what is a high neck bladder and, how does it impact me. I urinate frequently and rarely can sleep more then 2 hrs at a time. I have had all the tests possible within the past 2 yrs.

Thank you

Ken in MPLS

A high bladder neck means that there is a portion of the prostate blocking you that won’t be treated well with the urolift. The TUIN is meant to open up this area a little.

It is important to realize that your frequency may not improve after treating your prostate- a discussion you need to have with your urologist.

Thank you. I don't see TUIN mentioned on this forum. Are you saying that if I had that procedure that it may not help? Does a TUIN cause sexual problems, such as RE?

I'm a 62 yr old newlywed : )

Thanks again.

K49,

If what JerseyUro says is correct, that your frequency may not improve after treating your prostate, then what is the purpose of TUIN and/or TUIN with Urolofit. I believe you said that you don't have retention so the problem may be primarily with the bladder requiring a different direction. Have you had a full urodynamic suite of testing done? Unfortunately too many docs put the cart before the horse (procedure before the diagnosis) when it should be the other way around. There are just too many toys (procedures) out there now but that doesn't mean you have to try them on if they don't fit. And btw, could be wrong, but TUIN may leave you with retro ejaculation, as bladder incisions sometimes do.

Jim

Hi JerseyUro,

What does "TUIN" stand for? I couldn't find any online references. The closest was TUIP.

Jim

I've had every test...

It certainly could potentially cause RE.

There is no guarantee it (or anything) will help.

What did your urodynamics tracing show? If you don't know, meet with your doctor and discuss.

It's an abbreviation used in lieu of TUIP occasionally. 

My current Urologist mentioned that if physical therapy does not improve your symptoms after 12 weeks we will discuss urolift and a modifies TURN to open me up. Something new there doing. Instead of a full TURP start with urolift and then I guess remove remaining blockage using TURP

Hey Buddy.  Are you in the US.  Hows the Physical therapy going  Ken

To be honest after 6 visits I have not noticed any improvement 

Hey buddy.  I was just reading all of your post and you may have some like I have When you had Rezum did your prostate get smaller.  Also when the one doctor did the scope he saw no blockage.  I would have him try you on this pill my doctor just gave me a week ago.  I was in the hospital in November for 11 days.  I was not able to pee the first time was 32 hours and the second was 17.  Had 7 very painful catheterization.  I could have jump off that bed.  Even had the nurse crying.  My doctor did a cystoscope and he found that the clips of the Urolift I had 3 years ago were in the same place and my prostate was wide open.  He found out that I have to problems.  A very tight external sphincter and my bladder was inflamed.  Over the last month I have been have a lot of back pain and was peeing all the time.  I would pee 10 minutes later I would pee again and 15 minutes pee again.  But not much.  He gave me Flexril 10 mg for the sphincter and Vesicare 10 mg That is the one I think you should try before you have you prostate taking out.  I have a lot more force and I can tell that I am empty.  Morning are the best.  During the day I go once or twice and have no problem sleeping.  Physical Therapy never did any thing for me either.  Vesicare helps relax the bladder.  I think it's worth a try  Take care  Ken   

Here is the thing. Every Urologist told me I had an enlarged prostate based solely on the finger exam. When I finally had a rectal ultrasound to measure the prostate (prior to Rezum) they said the prostae measured 30 grams. Is that big? Was that the problem? Was it the only problem?

After Rezum the prostate size was not measured by the treating urologist. All he wanted to do was a scope and I was terrified to have this done beacuse I was in so much pain. I had never experience pain before, just weak flow and split stream with multiple bathroom visits.

This did not change after Rezum, Rezum just added pain and RE! Awesome right?

Now the USF Medical doctor said I cannot treat you unless I do all these tests again and ever more may be needed.

The finger exam indicated h to him that I still have an enlarged prostate. He said we need to scope now. The scoped did not show any blockage or scare tissue. It did show I have a high bladder neck.

He order the video urodynamics - this was actually a difficult exam for me- why? They could not get the catheter to go in. With a lot of effort and pain it finally did go through, but they had to try 3 different styles to get it done.

The doctor said the exam images do not show a blockage, but a start stop type flow. I do not see it start or stop its a flow with no breaks once I finally get going, but it is very weak and usually splits or sprays all over like bead lets. Again this had not improved or change since Rezum.

Meds have not worked at all either and I have been on all of them for an enlarged prostate.

So now the doctor is thinking pelvic floor dysfunction. I have been to therapy now 8 times and these treatments include internal message and internal electrical stimulation. But again I am not having any improvement. 

Now they the therapist wants to try rectal suppository valium to relax the muscle tissue.

We are waiting to hear back the the doctor if he thinks I should try this, stop p/t and move on to maybe a urolift etc.

Once I know more I will update.

 

Hi, its very sad what you are writing .   It seems that no doctor  knows your exact diagnosis.  The only method to  see  inside  in details is  3T - MRI.  Thats my case - years of suffering.  After MRI was  clear the main reason - Huge and long median lobe  fully covering  bladder neck acting like "pressure valve " and caused retention .   I'm now  13 days after FLA in Houston  and first  relief is coming.

Pls ask you Dr for MRi  and then you can select the right treatment  .    Good Luck,  Stan 

I am sorry that the Rezum did not work on you..  It does work sometimes but not all the time.  30 g is not the big.  I think the Urolift would do great for you it would open you up and relax the bladder neck.  Don't let them touch the bladder neck.  You need that to close right.  Have the Urolift first and then go from there.  Ken

Prostate size as measured by a digital exam doesn't tell them all that much. 30 is normal, but depending on the structure, it can still cause problems. Mine measured 30 and I had pretty severy BPH symptoms with an IPSS score in the low 30s and with an enlarged median lobe and overall a lot of blockage. By contrast there are men with prostates 3 times bigger than that who can pee fine and completely empty. The only way to test for obstruction is with a scope, unfortunately. It seems odd that you have no obstruction yet they had trouble getting a scope up there.

If your muscles were really tight, its possible for you to have trouble peeing yet have no visible obstruction. If that was the case, Rezum would't have helped. Maybe you need to get a fresh pair of eyes on your situation.

That seams like that is a good Idea.  Get another opinion 30 g is normal.  I have notice the last 5 or so of the men that had Rezum the procedure did not work and all it did is left them with Retro.  Something is not right.  I wonder if they had the right training...Ken

I have seen 4 different urologists. Each one did their own cystoscope. Each said they did see a blockage and blamed the problem on the prostate. This is why I finally did a procedure after 20 years of dealing with this and ALL urologist blaming the prostate - Rezum.

To my surprise there was no improvement from having this done (Rezum) so when I returned to the urologist that performed the procedure he said "must be your bladder, here take these pills and Ill see you in 30 days" He did not know what to do, it seems none of them do. Doctors today are kinda like mechanics and field technicians. They do not all know what the hell they are doing and your lucky if you can find one that cares about you and knows what to do. We all assume that because they are doctors they are smart and know everything - not the case at all.

Anyway the doctor I am seeing now also does not know for sure what is causing the problem. As I have stated, he did not see a blockage, he did not see any scare tissue, he did scope me and it went in and out easily - although after having this scope done I now have this pain that I never had before when I have to pee or sometimes just standing there or sitting I get this stabbing pain. This is now going on 3 months and its not going away. Never had anything like it until after Rezum and the follow up scope.

I did hear back from my current uro yesterday, He will not prescribe valium for possible pelvic floor tension. He says it a temporary fix. He now wants me to see a new physical therapist that he recommends for men, so I back at chasing my tail. He is not happy with the one I am using now so thats $400 down down the drain again.

How can all of these scopes and the video urodynamics not show the cause?

I am so frustrated with this and to top it off its always 30-60 or days before I can get back to see a dr., or a new P/T so again I am kicking this down the road for months again. 

It was about this time last year that I started this journey. Took several visits to my primary and the urologist just to get them approve a procedure them scheduling it then waiting 90 days after Rezum etc etc. Back at square one just now I have pain and RE. 

I wonder how would doctors fell if their A/C tech or car mechanic was not reachable for 90 days or after a year your A/C still did not work?

Fix the patients you have before you take on more! Make me wait 6 weeks to see you when I am already an established patient who has spent $400 dollars additional to the $500 for the video dynamics and still have no relief now tells me go for a different treatment that o ya they cant see you for 4 weeks from now. Plus add in all the wait time to have a 3 minute office visit that accomplishes nothing but more testing, we could have done that by phone. Instead make me wait 4 weeks to get my video dynamics results, wait for an hour and half to see you, just to have you say I don't see anything try this. This could have taken 5 minutes on the phone.

blah blah blah. I am done ranting for now.

What did your video urodynamic report say?

Jim

Only MR scan can show you the real situation inside.  Do it , send to Dr. K in Houston  and he will explain you the reason in details- all this for free.  Stan

As is the norm, the urologist really did not say. I had not even looked at it until I was in his office. He had it 4 weeks prior. Thats how long it takes to get into him and 4-6 to schedule tests, then 4-6 to see him again. Its crazy and there all like this where I live at least.

As for the test results. I he said to me was this look normal but it appears your stopping and starting throughout the process. I said no, I do not its a constant stream once it starts. He said it may appear to me that way but the results show otherwise and I think you may benefit from pelvic floor therapy before even discuss prostate removal options. When I go back in late May and mind you I was last there Feb 15th. thats how long takes to get back in, I will ask for more clarity on the results and a copy

Stan is correct. You do need a diagnosis to know what is going on. The best an easiest way to do that is MRI. The urologist may not want to support that because all the money goes to the radiologist. If that happens, get another urologist who puts your interests first, and does support it. Those folks work for you, and you can fire and hire them.

Neal Pros

You should ask for a copy of the report. The language should be fairly standard and not that difficult to analyze. I take issue with the suggestion of some that a 3T MRI Scan will tell you the story. It's may be useful image wise but it can't diagnosis because bph/luts is a functional condition so functional testing like urodynamics are more useful.

As to those saying urologists are not recommending 3T MRI's because "all the money goes to the radiologist" does that mean that IR's don't recommend urodynamic testing because all the money goes to the urologists? Just asking.

Jim

Jim

Yes Jim your right I should have copy of all my tests but I dont and when I ask for them they usually say there is a fee and it will take time to get them and then they blow me off.

I did get a call from the new P/T yesterday, she is able to see me today instead of May 11th. So I hope that after today's meeting with her I will at least know if physical therapy is worth trying again with a more experienced male pelvic floor P/T.

When I go back to the uro in May I am going to get clarity from him and what exactly the images show him or revealed and I want to know what size is my prostate now in grams.

I would think that the video urodynamics test result should show if my bladder work correctly? If it does then why is urine not flowing freely out? Is it still the prostate? was it ever the prostate? Those images should show the flow and if it s changes indicate the problem right?

So why still do they not know? And why is he so resistant to trying the valium to see if the muscles need to relax?

 

I would read them the riot act regarding the test reports. They have a legal obligation to give the to you. No reason to go through another series of tests just because you don't have the report. Are you saying you had video urodynamics or just regular urodynamics? Video Urodynamics should be very helpful in diagnosis. Just keep in mind that there's the prostate, bladder, and the nerve conduction between everything. Either and/or all may be impacting your issue. So you not only need the right tests but the right person to take the time and analyze them.

Jim

Yes it was a video uro-dynamics test. It took 2.5 hours to perform and they used x-ray when I thought it would be more of live video feed. He did not give my the results he just looked them over very quickly and said lets try therapy first then we can discuss other options.

Update: I did go for therapy Friday with a NEW therapist. The doctor was not pleased with the therapist I chose in St. Pete and made me see a therapist he uses in Tampa. She did her whole explanation of the male urine process and pelvic muscle purpose etc. Then she did an exam on me.

She said my prostate is very large! So again my prostate is still large (how large) IDK, but didn't Rezum take care of this and again why am I in physical therapy if my prostate is enlarged?

She said the prostate may be the main problem, but over the last 20 some years I made my pelvic floor dysfunctional and now it need to be retrained. So she is asking for 3 visits before we say for sure its not my pelvic floor.

I will update once I finish the 3 visits and the urologist mid May.

Later guys

He should have told ou the results.  I would ask for the test results and what is the size of the prostate before and after the procedure you had done.  It should have gone done some at least.  In a way I have the same problem.  But my prostate is wide open from the Urolift but the external sphincter is to tight.  I was suppose to go for therapy but I'm not in town now.  I am on a muscle relaxer and it seams to be working well only pee 3 to 4 times a day.  Morning are the best  Take care  Ken  

Has anyone had experience with the Urolift more specific Urolift after Rezum? The physical therapist I am now seeing told me that as far as my pelvic floor muscle operation I am in good shape. I am able to hold and release, in fact my ability to flex the muscles is on the highest level her system reads so she does not believe that I have a pelvic floor problem, She reiterated that my prostate is very large. I go back to see the urologist May 15th. I am hoping to discuss prostate procedures with him. The Urolift sounds like an option, but the idea of having metal object in my body and what if I need an MRI later etc. 

IT sounds like yo need a new doctor - and in the meantime, insist on the test results in writing. you paid for em, they belong to you, not the doc who seems rude, out of touch and generally clueless. Where are you located? I'll help you find a good qualified uro. If your PTs all say you have an enlarged prostate, you probably do - which means Rezum didn't work and its possible, maybe likely that your doc is giving you the runaround because he doesn't want a failure on his outcomes scores.

What your problem is and/or what you should do next is contingent on your test results. Get those however you need to and lets find you a qualified, ethical experienced URO to address whatever is your issue.

I don't have an issue with the current urologist covering all the bases first. I think he looks at it like this, I have had this problem since I was 24ish I am 47 now. Meds have not worked. Rezum has not worked. The problem has not gotten worse since the age of 24.

I see it as him covering his butt. When I go back in May, I do expect a lot more from him.

I think he will recommend a Urolift and possible at the same time remove excess tissue, not sure I am saying that in medical terms. He said I have a high bladder neck and a medium lobe in addition to the large prostate size. He said at some point we could look at doing a Urolift and while I am under he could do a mild version of the Turp to remove what the Urolift doesnt open - if that makes sense?

I don't have an issue with the current urologist covering all the bases first. I think he looks at it like this, I have had this problem since I was 24ish I am 47 now. Meds have not worked. Rezum has not worked. The problem has not gotten worse since the age of 24.

I see it as him covering his butt. When I go back in May, I do expect a lot more from him.

I think he will recommend a Urolift and possible at the same time remove excess tissue, not sure I am saying that in medical terms. He said I have a high bladder neck and a medium lobe in addition to the large prostate size. He said at some point we could look at doing a Urolift and while I am under he could do a mild version of the Turp to remove what the Urolift doesnt open - if that makes sense?

Sort of. First, did Rezum not work because it didn't shrink your prostate or did it shrink your prostate and not provide any symptomatic relief? Does he think your problem is and has been BPH...since you were 24? If so, while not unheard of, its quite unusual. I'm not a fan of Urolift because it doesn't reduce the size of your prostate and the anchor for the straps is permanent.

If I were you, before doing any procedure, I would want to see the results of the tests, confirm that prostate blockage is the cause of at least most of my symptoms and find out why Rezum didn't work. The term TURP (mini or not) scares me - so much can go wrong.

You might want to show your test results to a doc who does FLA. That could be a much less invasive way to accomplish what your doc wants to do with Urolift and some roto-rootering.

 

Buzzard,

You mention that so much can go wrong in a turp. I hear that a lot but can you tell me what those things are? I know Re is a definite issue, but what are the other negatives of turp or turp like procedures 

Changejobs - there are two levels of difference - the typical differences in recovery time and issues, the the permanent devastating side effects that are uncommon, but possible with TURP that are unheard of with Rezum.

As for the first - recovery from TURP can vary a lot from person to person. But you ca typically expect weeks to months of urgency - it can usually be managed, but it can be messy. Many people who ultimately do well with TURP are incontinent for 3-12 weeks. Diapers, pads, accidents while not a certainty with TURP are not that uncommon. Permanent incontinence and permanent impotence are rare with TURP, but they are possible and do happen. Further, TURP is a surgery that requires anesthesia, has you under for awhile and brings all of the typical surgical risks with it.

By contrast, most men can pee at least passably with Rezum after a week or so. Other than some blood and urgency (far less than with TURP), if you're OK self cathing, you can live pretty normally a day or two after the Rezum. I was doing squats 5 days later. You don't need to be put out for Rezum, although it can hurt a lot in short bursts so I'd recommend being twilighted if you have it done. RE is more common than the 3% they cite on the website - its probably closer to 10 or 20%. Also, devastating side effects like I described as possible with TURP are virtually unheard of with Rezum. Worst case scenario is it doesn't work. And if it doesn't, you can always opt for something surgical (even then I'd suggest Holep over TURP).

Bottom line is that for most men, Rezum offers acceptable results with very little risk other than time and money. TURP at its best has a longer, messier recovery, guarantees RE and carries all of the risks of a full blow surgery. And it can, in the worst cases, leave you impotent, incontinent or both.

I hope this helps.

oldbuzzard,

Well said!

Steve 

Old buzzard ,

Thank you for the detailed explanation. It is extremely helpful. How can one tell the differences of turp, holep , green light and all the similar procedures and possible issues and recovery .

I have also read about the newer procedures of rezum, pae, fla and urolift. 

My issue is a large median lobe causing retention. Just started cic. 

Out of the newer prosecutes itsounds like fla is best for that, although rezum may be a possibility( but I may be wrong) I’d really also like to know which of the older methods are best for median lobe but also want to know the differences as they all sound similar and their recovery and side effects.

Changejobs,

        I had the problem of a large median lobe with a 68 gram prostate. It was bad enough that I was CIC-ing for several months before the procedure in January 2018. Rezum worked for me. I had sedation, and with the self-catheterization after the procedure, the whole thing was a breeze. No pain at all. And I started noticing a difference just a few days after the procedure. And no sexual side effects whatsoever. 

Yes, FLA does sound very interesting. But at a very high price. Urolift also sounds interesting, but it's typically not indicated when there is an enlarged median lobe, especially when it's growing up into the bladder as mine was. The results from PAE seem to be so unpredictable that it wasn't really an option that I considered. RIght now I really believe that Rezum is the best alternative for many guys, if they are properly tested and qualified for the procedure.

Ken,

Where did u have your rezum procedure ?

CJ,

      Springfield, Illinois at SIU Urology. Dr. Kevin McVary was the lead urologist for the double blind study for Rezum over three years ago. He has been very open and honest about the procedure and the results. In fact, when I mentioned that I wanted to self-cath after the procedure to avoid the Foley, he was very positive about it. 

In my 1 month followup visit, I asked him how many shots of steam I got. He said that I got 4 on each side and 2 in the median lobe. I'm glad that I got the sedation. 

This is a really difficult decision. I haven't done it yet. It seems Urolift is the way to go. There are less post op issues, fewer days with a catheter 1 day vs 3 or more with Rezum, quicker recovery. Isn't that what its all about getting this resolved fast? I don't want a catheter any longer than necessary. I want as little pain as possible and want to pee normal as quickly as possible. From what I read Urolift does that.

TURP and GL for normal size prostates. HOLEP for larger prostates. Ep TURP (ejaculation preserving) a theoretical option if you can find someone capable. PAE and Urolift not good choices for large median lobe. Rezum and FLA should work. Results from anecdotal data seems similar to Rezum but no reports of retro. On the other hand, there was one report of erectile dysfunction post FLA requiring Viagra to correct. I personally would hold off on FLA until there's some published trial data and lots more cases reported.

Jim

Oldyank,

Ken had a large median lobe. Rezum effective for large median lobe, Urolift isn't.

Jim

What he said :-)

Two issues with Urolift, assuming no median lobe.

1) It's the only procedure that doesn't actually reduce the prostate size, it just straps it down to open the path.

2) The anchor for the straps can't be removed - its there permanently. The difference in the number of days on the cath is in the single digits for almost everyone and if you self cath, its not bad at all - in some ways less time and trouble than trying to force out a pee with a big prostate.

I would talk to your doc about which procedure, given your physiology is the most likely to offer the most and longest relief and go with that one.

What would an 80 gram prostate size be considered?

I also sent you a pm.

Thanks CJ 

Has anyone had rezum done in nyc or Nyc area? Or knows who the most experienced in nyc or Nyc area are?

I'm told the anchors can be taken out. Think it says so on their website. It's NOT good if prostate is bigger than 80. Mine has shrunk with meds but I hate the meds. My doc mentioned Rezum but I just don't think I like the time it takes to work. I'd rather get fast results. Of course Rezum may be better for me because prostate cancer runs in my family.

My doc said the anchors are permanent. I was a really slow healer with Rezum and was better off than when I went in after 6 weeks. I don't know if Rezum is the best option for you or not, but I recommend that a few weeks of recovery not sway you. Its not like you're miserable after Rezum - there is some urgency and blood and a period of weeks before you're better off.

If prostate cancer is an issue, I would think at the very least, those anchors would add to the problem if you ever needed treatment.

There are lots of docs doing Rezum around NYC. IF you don't mind traveling to S Jersey - Frequent poster Jersey Urology has done a lot of them and has lots of offices there. If that's too far, you might want to PM him and see if he can refer you to someone closer to home.

Yes it does and no side effects.  Over 3 yesrs for me.  Ken

It does say on the Urolift site the anchors are removable.

i read articles where they say with surgery/treatments there are issues in diagnosing prostate cancer and the surgery. You still have to watch it if there's history. Maybe Urolift is better. I'm going to speak to a few doctors before I decide. 

Hi OB, I read where you had Rezum? I need your help on this question? I' live alone ,88years of age.Do you think i could handle the Rezum alone? Are there side effects that require someone  to help out?

THANKS VERY MUCH

frank,

Frank - I handled it all myself, including driving home after the procedure. My wife was out of town for the first week or so after I had it done (just worked out that way) and I was fine on my own. You already know how to self cath, so for as long as you need to that should be no problem.

Here's what I experienced. For about 8 hours after the procedure, it was what I'll call moderately painful. From then on any pain was minor and between ibuprofen and pyridium (both otc) handled it well. It took me forever to be able to pee (over 3 weeks) at all and close to 6 before I was better than before the procedure - but you're already doing cic so the only change you'll notice is if you start being able to do natural voids. Just don't agree to a Foley - those are hell and unnecessary if you're comfortable with CIC. 

That said I was almost 30 years younger than you when I had it done and in good shape and health. I don't know if your 88 year old body will react as mine did - I would expect the pain might last longer, but once that subsides other than some burning while peeing (which hopefully you'll get to) life was pretty much normal for me. I was doing heavy weightlifting 5 days after the procedure with no ill effects.

What's your general health like? Do you have any physical limitations that keep you from normal function now? Two thoughts - the chances are good enough that something in the future could make CIC too difficult or impossible and then you'd be stuck with an indwelling catheter for the rest of your life and that would suck. The other is what does your urologist say? Does he think you can handle it? Do they have any data on older patients and if they react differently than guys in their 50s-70s?

Can you have someone on standby in case you need some help in the beginning?

Frank - I did have it done and handled it all myself, including driving home after the procedure. My wife was out of town for the first week or so after I had it done (just worked out that way) and I was fine on my own. You already know how to self cath, so for as long as you need to that should be no problem.

Here's what I experienced. For about 8 hours after the procedure, it was what I'll call moderately painful. From then on any pain was minor and between ibuprofen and pyridium (both otc) handled it well. It took me forever to be able to pee (over 3 weeks) at all and close to 6 before I was better than before the procedure - but you're already doing cic so the only change you'll notice is if you start being able to do natural voids. Just don't agree to a Foley - those are hell and unnecessary if you're comfortable with CIC. 

That said I was almost 30 years younger than you when I had it done and in good shape and health. I don't know if your 88 year old body will react as mine did - I would expect the pain might last longer, but once that subsides other than some burning while peeing (which hopefully you'll get to) life was pretty much normal for me. I was doing heavy weightlifting 5 days after the procedure with no ill effects.

What's your general health like? Do you have any physical limitations that keep you from normal function now? Two thoughts - the chances are good enough that something in the future could make CIC too difficult or impossible and then you'd be stuck with an indwelling catheter for the rest of your life and that would suck. The other is what does your urologist say? Does he think you can handle it? Do they have any data on older patients and if they react differently than guys in their 50s-70s?

Can you have someone on standby in case you need some help in the beginning?

Frank - I did have it done and handled it all myself, including driving home after the procedure. My wife was out of town for the first week or so after I had it done (just worked out that way) and I was fine on my own. You already know how to self cath, so for as long as you need to that should be no problem.

Here's what I experienced. For about 8 hours after the procedure, it was what I'll call moderately painful. From then on any pain was minor and between ibuprofen and pyridium (both otc) handled it well. It took me forever to be able to pee (over 3 weeks) at all and close to 6 before I was better than before the procedure - but you're already doing cic so the only change you'll notice is if you start being able to do natural voids. Just don't agree to a Foley - those are hell and unnecessary if you're comfortable with CIC. 

That said I was almost 30 years younger than you when I had it done and in good shape and health. I don't know if your 88 year old body will react as mine did - I would expect the pain might last longer, but once that subsides other than some burning while peeing (which hopefully you'll get to) life was pretty much normal for me. I was doing heavy weightlifting 5 days after the procedure with no ill effects.

What's your general health like? Do you have any physical limitations that keep you from normal function now? Two thoughts - the chances are good enough that something in the future could make CIC too difficult or impossible and then you'd be stuck with an indwelling catheter for the rest of your life and that would suck. The other is what does your urologist say? Does he think you can handle it? Do they have any data on older patients and if they react differently than guys in their 50s-70s?

Can you have someone on standby in case you need some help in the beginning?

Frank.  I think you should try Rezum since you can't find a doctor that will do a Urolift on you. You have to do something 10 to 12 time a day is to much for any man.  You should be able to handle yourself.  You have been doing CIC for over a year.  So please talk to a doctor And if it does not help you can still do CIC. You never know.  Good luck  Ken

I've read that suprapubic catheter is not bad. I'd rather have it than having to self cath 4,5 times a day forever. Hank

Hi Ob, Thanks for that info. You say can i have someone stand by in case i need help? What kind of help would i need? I imagine it would be painful to CIC after surgery {Rezum}?Of coursse i will discuss this with the URologist. I'm still not to crazy about having this done. I 'm doing fine with CIC,if i could find a way to cut down on amount of times I do i might just keep on doing CIC.My energy level has of course slowed down . I will be  89   soon. I have high blood pressure. I don't know if this something to be concerned about. You say the changes are good enough that something in the future could make CIC to difficult. or impossible,i would be stuck with an indwelling foley catheter .I wore one of those 5 months, once a month to see if i was out of retention ,no luck. It was my idea to do CIC, THE URO WAS THINKing ALONG THE LINES OF TURP. I got another Urologist. I have been to 5 urologists,  now

i/m looking for the 6th one.One who does Rezum  AND THE OTHER PROCEDURES..Are you still doing CIC? Are you satisfied that you had Rezum done?Did you have a natural void before Rezum, or were you in complete retention like me? 

 frank,

Hi Ob, Thanks for that info. You say can i have someone stand by in case i need help? What kind of help would i need? I imagine it would be painful to CIC after surgery {Rezum}?Of coursse i will discuss this with the URologist. I'm still not to crazy about having this done. I 'm doing fine with CIC,if i could find a way to cut down on amount of times I do i might just keep on doing CIC.My energy level has of course slowed down . I will be  89   soon. I have high blood pressure. I don't know if this something to be concerned about. You say the changes are good enough that something in the future could make CIC to difficult. or impossible,i would be stuck with an indwelling foley catheter .I wore one of those 5 months, once a month to see if i was out of retention ,no luck. It was my idea to do CIC, THE URO WAS THINKing ALONG THE LINES OF TURP. I got another Urologist. I have been to 5 urologists,  now

i/m looking for the 6th one.One who does Rezum  AND THE OTHER PROCEDURES..Are you still doing CIC? Are you satisfied that you had Rezum done?Did you have a natural void before Rezum, or were you in complete retention like me? 

 frank,

Frank - From my experience you wouldn't need any help. As I said, other than some moderate pain that was pretty much gone in 8 hours, I was OK almost right away. I'm just being cautious because of your age and I know things that are non events to most can be much more impactful to someone older. That's really a question for a doctor with access to data on recovery from Rezum on older vs. younger patients.

CIC wasn't painful as a result of Rezum - peeing was at first, but not unbearably so. One thing to be mindful of - your prostate will swell from the procedure so if cathing for you is a tight squeeze now, you might need a smaller cath until it shrinks down. They can also give you a temporary stent that will help too. As for future changes - there are a lot of older people who start to lose fine motor skills - many a lot younger than you. If you lose enough of that in your hands, it could make CIC a challenge. Here's the big question...have you had enough testing to get a good read on how much of your problem is a big prostate? There are people like jimjames who were in complete retention and got way better without any procedure - which means that the prostate, while contributing to the problem, wasn't the main issue. If he had Rezum done prior to his year of CIC, my guess is that he would have gotten little to no relief. Have you had a full test regimen (scope and urodynamics)?

Yes, I'm glad I had Rezum done. I wasn't in full retention although I had a few scares - I did go into full retention once and that's when I was shown how to do CIC. I went into partial retention twice after that (over 4 years) - once after surgery (anesthesia related) and once just because. Each time it was a non issue because I was able to do CIC and both times it was one and done. One was on a business trip and that catheter spared me what would have been a very embarrassing trip to an out of town ER. 

But I lived my life around my BPH, was in constant fear that if I waited too long I'd lock up (would take several attempts when that happened) and could never go more than 2 hours without a bathroom break. Rezum didn't make me perfect, but much better.  IPSS score went from the low 30s to mid teens. I hope this helped - feel free to ask more questions or PM me.

Lets say the Rezum procedure was not done correctly or the urologist did not give me enough treatments to do the job. How would or could we know this for sure? Would it make sense to try Rezum again with a new doctor? Dont know and dont think I would go through it again if we did.

This has taken another year away from my life. It was last June 2017 I started this process and here we are nearly a year later and I am no closer to having relief or answers.

I am not a fan of having an object placed into the body and one that cannot be totally removed. I am also not a fan of having the prostate compressed or any organ for that matter, But what else can I do other than the TURP or Greenlight. That PAE thing is not proven to work in all cases and try to find a center that is doing it.

Could I have other problems after 24 years of this? Yes. I am sure I have done damage to my baldder kidneys and muscles of the pelvic floor. But again if my prostate has been large since 24 I would think that was the main problem. I have never had retention issues or even once have I had an infection. I can pee and I do pee, its just that I pee a lot and it hard to start and its a weak split stream. And no matter what I will need to pee about 10 minutes if not sooner after a pee if I having anything to drink.

When I fist met the urologist I am seeing now I asked him why he did not offer the Rezum? He said why? There are better options with much better results. True or not, Rezum is not the end all fix either. Your prostate is going to grow back and your not fully open with Rezum either, plus the healing process and time can be awful for some.

I dont know what he will recommend when I see him May 15th - he may not have an answer either.

 

Suprapubic vs CIC is not generally recommended unless CIC is too difficult and/or too many complications. Suprapubic is definitely superior to Foley for longer term use but has its own set of issues versus CIC including higher incidence of UTIs and less patient satisfaction per surveys, among the reasons the fact that you have something sticking out of your abdomen 24/7 that needs to be periodically changed. That's why CIC and not suprapubic has been the go to method of voiding in the SCI (spinal chord injury) community, where many CIC for life.

Jim

Definitely large but most of our prostates here are. Remember size alone is just one factor with BPH/LUTS and there are men with large prostates and no symptons and vice versa.

Jim

I've also heard that the anchors are permanent. The Urolofit materials seem misleading in that respect when they talk about how it can be completely reversed.

Jim

Frank, Are you actually self cathing 10-12 times a day as reported? If so, you are either drinking much too much fluid or are cathing more than you need to. With a fluid intake of 64 oz a day, you will void ballpark 2000ml in 24 hours. So even if you cathed when your bladder was only holding 300ml, that would be just a little over six times a day. You might do a void log writing down fluid intake (include coffee, tea, soda, etc) as well as the time and amount of each catherized void.

Jim

OB, Not sure if this is consistent with your advice not, but from what I've read here, twilight anathesia is recommended for Rezum and I believe Jersey Doc does all his Rezums this way. Maybe he will comment. That may be why they recommend someone to pick you up after the procedure. Doesn't mean that everyone has extreme pain without twilight but some have reported it akin to torture. Torture not good

Jim

Jim

JJ - it was torture when I had it done (I remember someone commenting that they should replace waterboarding with Rezum) and if I ever had to repeat it I would be twilighted for sure. That said, the implications of twilighting for an 89 year old might be different than for someone younger. I would suggest someone driving him home anyway - I wish someone had driven me as I was in a fair amount of pain.

I would hope that if Frank decides on Rezum that he consults an anesthesiologist regarding how dangerous twilighting is for someone his age.

When backed against a wall, UROs often revert to TURP - which I don't recommend. I don't know why Rezum didn't work for you - have they done a scope to confirm that, or are they just assuming it because you aren't peeing better? Its possible that it shrunk your prostate but something else is causing your problem. It doesn't work 100% of the time for various reasons.

Where do you live? I would suggest getting another set of eyes on your issues - ideally one of the top people at a large hospital. I can help you find one if you need some guidance. 

I am currently seeing a Urologist at Tampa General Hospital's Urology Department which also happens to be the University of South Florida's medical training center for Urology. So I am seeing a teaching urologist.

Jim, I agree with you on the thing sticking out of the stomach concern. However, on UTI issues, I happen to know several people on this forum with suprapubic, and UTI is generally not a problem. There is one lady with supra on for 31 years and she had only one UTI at the beginning. Hank

Teaching urologists or not. Big name hospitals or not. They all tend to recommend only what they do and either bad mouth or are not well informed on procedures they don't do. So if you want a big name consult for Rezum then you have to find a big name doctor that does Rezum. My former bigname uro only did TURP so guess what he recommended?

Jim

 

True dat - unless you can find a doc who does them all. 

Even if the Urolift anchors are removable, I would think that it's not easy coming inside the uretha and dig and cut them out. Hank

Hank, It's in the literature. Studies show more UTIs with Suprapubic than CIC but less than with Foley. Doesn't mean that will hold true with everyone. I considered a suprapubic when I first started CIC because I was having all sorts of issues. Happy I waited them out. Suprapubic has its place but in the long term, and in most cases CIC makes better sense.

Jim

 

I'm guessing most Rezum docs once did (and probably still do) TURP but not vice versa. Also keep in mind that Rezum is now more profitable than TURP under many insurance plans given both the reiumbursements and the fact that it can be done in office. This could also influence things.

Jim

Like trying to open a sardine can when the tab breaks off

Jim

Sad but true. 

Just to second what jimjames is saying based on my conversations with the family member who is an MD for over 40 years and I have known for over 60 years.  "You have to find a big name doctor that does Rezum" and talk to them.  The big name doctor that only does TURP will most likely recommend TURP and may possibly be negative about Rezum.

So I am looking for a big name doctor that does Rezum in Colorado and when the time comes, I will talk with them.  I have found one so far that was involved in the clinical tests and they are within a reasonable distance for me.  Does anyone on this forum have any recommendations for Rezum in Colorado?

In the meantime, I am self-cathing, taking flomax and finasteride, and starting to feel but not see positive bladder results.  The urodynamic tests will be in about a month or two.  So what are people seeing in the progression of their bladder recovery?

Steve 

Four years ago I was in near acute retention with PVR as much as 1.5L with an IPSS score of "Severe". After a program only of self catherization starting at 6x/day , today I have natural voids of 250-400ml with acceptable PVRs, an IPSS score of "Mild" and only self cath a couple of times a week. This matches well or better than any surgery.

Jim

JJ - I think your results are awesome and you took the right path for you. Having done Rezum and had a longer recovery than most (made MUCH more tolerable thanks to CIC), I would chose it again, if only to go from CIC a few times/week to never. Its not that CIC is so bad and with some creativity it can be pretty much undetectable, not having to ever worry about whether or not I can pee is something wonderful to me. Even at twice/week, if I were in your shoes, I'd still have to bring a catheter everywhere I go. Now, I don't even think about that, or where the restroom is at a bar, or whether I'm going to lock up because I waited to long, etc.

So I guess my point is, maybe not as good as a surgery/procedure that was fully successful - but the best route for you. And thank God you took it - your guidance and encouragement have saved a lot of men on this forum from Foleys, TURPs and who knows what else.

Frank, Jersey Doc recommended Dr. Kevin Mcvary in the Chicago area for Rezum.

Jim

JIM, Dr Kevin Mcvary is not in Chicago. He is in Southern Illinois.

I was just told by a urologist that my prostate is to large 74 grams. Rezum won't work. He also said normal size is 30 grams. A stricture at my age could cause problem doing CIC.Does this make sense?

Thanks 

frank,

Frank, you are correct. Dr. McVary is at SIU (Southern Illinois University) Urology in Springfield Illinois. His did my Rezum in January of this year. Highly recommended.

He was also one of the lead urologists for the double blind study over three years ago. 

Frank,

      If your urologist says that 74 grams is too large for Rezum, then you definitely need to get another opinion from someone who knows what the procedure is capable of. My prostate was almost the same size, with an enlarged median lobe. 

The comment about a stricture causing problems with CIC doesn't makes sense either. Yes, the prostate will swell up some from the Rezum procedure. If you use prelubricated catheters, I don't see why you wouldn't still be able to pass a catheter through a stricture that was caused by swollen tissue.

Again, it really would help you most by seeing a urologist who has experience with the Rezum procedure. Those of us on this site can offer out own opinions and offer other ideas and advice, but everyone's situation and body is different, so you need someone to give you a proper exam first before you take the next step. 

One piece of advice that I can give is for you to find an experienced urologist and make an appointment. He/she will give you a proper examination and the proper testing and only then can you decide whether Rezum or some other procedure would best fit your particular situation.

Frank, Given all you've been through, it might be worth the trip, at least for a consultation. He does both Rezum and TURP so you might get some knowledge and the objectivity that your urologist may be missing if he doesn't perform both procedures. Did your doctor tell you that you have strictures? But even if you do, if they're not causing a problem with CIC then they're not causing a problem.

Jim

Interested in what JerseyDoc says about prostate size but a quick look at some rezum studies seems to show that 75 grams would not exclude you. You could also go over the rezum thread and see how others did with prostates of similar size.

Jim

I just read Ken's endorsement of Dr. Mcvary. If it were me, and I couldn't find anyuone comparable local, I would make the trip, at least for a consultation. I agree with Ken that you will get much better info about Rezum from someone who actually does it and also does TURP as a benchmark. Apparently Dr. Mcvary does both.

Jim

We have had very good success with large prostates (including larger than 100g) and are currently involved in a large prostate clinical trial- long term results are of course pending, but it works well for the right candidates.

Also, I sent a private message to Frank, offering to talk to Dr. McVary when I see him on May 15th for a followup visit. Since Dr. McVary was previously at Northwestern, he may have a good recommendation for a urologist for Frank's situation. I know that it's hard to get to talk to a physician on the phone, so that is why I offered to talk to him in person. 

Ken

Frank I don't know why that one doctor told you your prostate was to big to do a Urolift Cut off is 80.  I remember last year when I ask my urologist for you.  He told me that it may work for you or it may not but it would make it easier to do CIC.  Good luck Ken

I'm sure Frank will appreciate your going the extra mile but sounds like he would best benefit by taking the trip along with his complete records, at least for a consultation. If it turns out that they both decide that Rezum is worth a go, Frank could then decide whether to have Dr. McVary or someone more local do it. At this point, the decision seems equally mportant than who does the actual procedure.

Jim

Thank you Ken.  I think that would help a good deal.  I feel sorry for him.  These doctor have been giving him the run around for over a year.  Thank you  Ken  Orlando

We have not had good success with urolift for men with urinary retention

Yes I do know that.  My Urologist said that would be the only procedure he would do on a man of 90.  He would not take the risk of doing surgery on a man of that age.  He said it may work but it may not but it would make doing CIC easier for him  Thank you  Ken

JerseyyUrology

If a patient just has a plain old large prostate causing their problem and Urolift or Rezum would resolve it - which is a better choice with all things being equal?

Is there a downside to going with Urolift and having those clips inside you if your younger and very active etc?

I am 47 and lift heavy weights 5 to 6 times per week. I squat 405lbs and Bench 385. I am thinking that since the Rezum did not work for me and physical therapy for pelvic floor tension has not worked the urologist I am see now Dr. Wiegand at USF Urologist Tampa General is going to recommend we try Urolift and he said something regarding he may need to TURP out some areas at the same time?

I will have a more in depth conversation with him May 15th when I see him next for a final follow up to all the P/T he had me doing to discuss or next move.

Thanks

If you're benchpressing that level of weight, I would think your physical therapy for the pelvic floor is going to have to be equivalently more effortful otherwise perhaps you aren't getting the full effect of the exercises. 

The physical therapist said the fact that I do deep squats is actually a benefit for pelvic floor muscles. She does ask that I cut back on max weight and go to more of a light weight more reps routine. 

I am worried that if I had the Urolift I would blow those clips out!

Also this is my second round of physical therapy. Neither therapist was able to find what they call a trigger point within my rectum to show that I have pelvic dysfunction, and in fact the new tests they just conducted actually showed her I have max level of control on both the flex and relax and 50% flex hold then 100% flex hold back to 50% then relax. Not sure why he doctor is putting through all this. 

Hes putting you through this because he doesn't know what's causing your problem and his just throwing darts at this point. From what I understand, if a simple enlarged prostate is causing symptoms, Rezum is successful over 90% of the time. If your doc has done a lot of them, there is no reason to assume he botched it. Did he scope you before and after to see if the prostate shrunk but that didn't help, or the procedure just didn't work?

I'm a weight lifter too - not as heavy as you but I bench 225 in sets of 5+ and squat about the same. I had PT before Rezum was available (which did help) and they did a digital exam of my muscles and biofeedback to check my reflexes. If you passed both test, there is no reason for you to do further PT. I was told that squats in particular would tend to make people tighten their sphincter and to make sure to do the pelvic floor exercises on leg days after working out.

I'm not a doctor, but I've had extensive conversations with mine (one of the top at a nationally renowned hospital and have been reading these stories for over 2 years on this forum. My gut, FWIW, is that your prostate isn't the problem, its something else - possibly your bladder, possibly something else. If you're willing to travel, PM me and I'll give you the info for my doc. It takes forever to get in, but its worth the wait IMO. He does all of the procedures, is involved in almost all of the clinical trials for new ones, is honest, cares and really knows his stuff.

 

I meet with the Urologist today at 2:30

I know this sounds crazy, but I am looking forward to this. I hope he has a plan of action and that we can schedule it quickly so I can finally and hopefully get some relief after 20 plus years of this problem.

I will fill you in on what he recommends tonight or tomorrow am.

Later

Okay. So after meeting with the urologist and going over all of our options (TURP - Greenlight - Urolift - waiting) I have decided to have the Urolift procedure. 

I am getting a PSA test today and will schedule the procedure with the hospital. Since it is a hospital they only put me under.

Urologist said that Urolift is now approved for medium lobe prostates and although there are always possible side effects with doing any procedure, he feels that the Urolift is the least likely and the makes the lost sense at my age. Save the TURP etc for later in life if I should need it.

My prostate is only 25 grams I found out. Which he said is not big. Its not the size it is how its growing in or outward and the bladder neck being high with a medium lobe that is most likely causing my urine flow problems.

He said that when he scopes he is looking for scare tissue not a restricted prostate urethra as that is not visible by scope.

He said that there is no definitive explanation for my situation, this is why we tried the physical therapy first. My bladder works well, my prostate is not BIG and do not have any scare tissue.

After I have had the procedure I will update, I hope it is done by the end of the month!

Glad to hear you are going through with the Urolift  It will do what it is suppose to do.  Relieve the pressure of the bladder neck to help you pee better. 25 grams is not big but the way it going in word.  It is best to stop it now.  Did your doctor say if he will have you have a catheter  It is up to the doctor. Before I had mine I thought  it was best  I only had it for a couple of days.  It gave the prostate a few days to relax.  I had it done because after researching it I found out that most men after the procedure most men can pee but being the prostate will swell up.  Sometimes you can't and then you end up in the hospital to have one put in.  I would rather have it put in when I am out then when I'm awake  Take care  Ken     

kenneth

He did not tell me much after I agreed to have the procedure done. He left the room and a nurse came in. She told me go get your labs and we will call you to schedule in a day or 2. So I am thinking I will get a call from his team before the procedure informing me of everything to expect.

It is a teaching hospital so he always has a resident with him. The resident goes through what they think with me then he steps in. I assume there will be others in the O.R. as well learning.

 

When the nurse calls to to set it up ask questions .  You may not see the doctor until the day of the procedure..  He can agree or disagree at that time.  That was when we talked about it.  I found it was much easier and that was the first time I had one  Good luck  Ken   

JCL - when you sign the surgical consent form, you may want to amend it to say that only the surgeon can perform actual work on you. I didn't a long time ago and ended up with a crooked septum with a hole in it. And it wasn't the head of Urology and Emory who made that mistake.

Good idea! Thanks

Urolift is scheduled for June 6th. Urologist said I should not need a catheter or pain meds, expect some mild discomfort that will pass.

I will let your guys know how it went a day or so afterwards. 

Good luck hope all goes well  Ken

I sure hope you have relief with urolift.

You have been through a lot. Way too much!

My REZUM procedure is scheduled for two days from now, May 24. Uro said urolift wouldn't work for my blockage. I have not been able to pee since my left hip replacement surgery in Feb 2017. Been on meds and Foley catheter since then waiting on Medicare to start paying for it in Colorado.

JCL  pls  be sure about your median lobe anatomy.  If median  lobe is big and protruding to bladder ( IPP diagnose),   Urolift is not proper  for treatment.  Consult with another  Uro, too. Stan    

They have been working on them for a while.  My Urologist has done them with no problem you just have to use more clips and bring the median lobe to one side.  Ken 

Urolift was cancelled. The hospital calls me the afternoon before procedure and says "your insurnace has not provided us authorization" so it is cancelled until we get that. I call my primary and they said it was an issue with my Urologist's office. They did not submit the clinical notes explaining why I needed this procedure done. 

Finally I get all the clinicals etc Humana and guess what? They denied the request. Humana says that Urolift is experimental and not an accepted procedure for BPH.

 

Have the office put in the request again.  But with different numbers.  My insurance did the same but it was in the code that they put in.  Try them again  Ken

Humana denied the doctor's peer to peer appeal. I have to now submit an appeal on my behalf and request and independent review.

Humana claims Urolift is experimental and does have enough study time, although they will approve it if I was on Medicare through Humana. So it is Okay for some but not all a this point.

I did submit my appeal, have to wait 30 days now for an answer.

JC  When I had my UROLIFT  I have WellCare  My doctor put in for the procedure and got approved .  4 week later I had it done.  I paid only $200 for the center I had it done.  2 weeks later I got a letter saying it was not approved.  I told my doctor.  It was something to do with the code for the procedure.  You will get it straighten out.  Ken

No it is Humana. We spoke with them directly. In their opinion Urolift is not standard practice and is still considered to be an experimental procedure and it is not accepted for use for mediam lobed prostates. Does not matter what code you use or submit. They accepted REZUM however and it is on their approved BPH treatment codes.

JC.......I know some insurance have approved it and some don't.   I was lucky I have WellCare which is medicare I was only 58 when I had mine But I was on SSD till I turned 62 and then it went to regular SS  I hope you can get this straight.  Urolift has been around longer then Rezum  Ken.  

Jim Your story is a remarkable one. I have a question of importance to me. Were you on any special diet, that you can remember?

Thanks Jim,

frank,

Hi Frank,

No special diet. There are a number of men here who have seen improvement in bladder function from CIC and there are some that haven't. I think a lot has to do with the condition of your bladder when you started CIC and the fact that of course we all react a little differently to any type of therapy for a number or reasons. I always looked at bladder rehab as a possibility and a "bonus" but the fact that one doesn't see progress doesn't mean CIC is not necessarily the right course. Progress or not, it's still a viable alternative to surgery or a way to extend the "watchful waiting" period until something more suitable comes along.

Jim

@frank74205:  Were you on any special diet

-----

Hi Frank,

I have been looking at what I eat whenever my CIC numbers go over 400 ml.  The family-member-MD says to keep my salt intake down as that is the cause.

I have found that my Friday night Mexican burritos and my Sunday night Chinese dumplings were followed by CIC numbers over 400 ml.  I looked at the ingredients and both were high in sodium.  I have since cut these in half and now my CIC volumes are staying below 400 ml.  I have also replaced my high-in-sodium ham lunch meat with low-sodium chicken.

About the bladder rehab, about 2 months into my CIC, I got my first urge to pee but could not do so normally.  I am now 4 months into CIC and I am consistently getting urges to pee when my CIC volumes are 220-250 ml and really strong urges to pee when my CIC volumes are over 300 ml.  I am still completely blocked though.

I have a urodynamics test scheduled for July 30, which should hopefully be able to better quantify my bladder recovery.  I will post to this forum a little before then to get some pointers on the proper preparation for the urodynamics tests.

Regards,

Steve 

Hi Steve, since you do not have any natural void , how do you decide when to cath ? Is it by time or by urges? Just curious. Hank

@hank1953:  Is it by time or by urges?

---

Hi Hank,

The short answer is by both.  I am trying to self-cath 4 or 5 times per day or every 5 to 6 hours.  If I have an urge, I try to go within 1/2 hour of that.  I have found that results in volumes of about 220-250 ml.  If have have to wait longer from when I get the initial urge, as when the urge hits while I am on my 1 hour and 3 mile evening walk, I have found that the urge gets stronger and the volumes are over 300 ml.

Steve 

HI STEVE Sodium intake is really bad. I was takin blood pressure meds.I cut way down on sodium ,and now don't take blood pressure meds anymore.Diet is the answer.Is this your first urodynamics test?

frank

Stev

I have an enlarged blader and asked my urologist about rehabbing it and she's said It"s a theory that we have but there have not been any clinical trials data to prove it. She went on to say that I should pull out my Foley catheter plug to drain urine every few hours.

I did not have to do anything special to prepare for urodynamic testing except for shaving around the penis.

The PA removed the plug, drained bladder, removed catheter, placed all electrodes and probes, then ran the test.

Dr placed results in my records.

Results are below:

"Patient unable to void for uninstrumented uroflow. Has catheter. Cystometrogram: no detrusor instability. 1st sensation 517 mL, urgency 728 mL, capacity 803 mL. Voiding pressure study: no DSD. Detrusor contraction demonstrated but very poor flow. Evidence for obstructive voiding on Abrams-Griffith nomogram. Qmax 4 mL/sec, Pdet at peak flow 32 cm H2O. Voided volume 63 mL. UPP: max urethral closure pressure > 100 cm H2O. 16 Fr coude reinserted at conclusion of study for PVR 775 mL. Candidate for Rezum (or TURP if medically fit enough). . ."

New Foley catheter was inserted and I returned home. Just another day in the life of full retention people.

Technically, you are not in full retention. You can still urinate a little, when your bladder is about 800 mL full. I wonder if you've tried meds to see if you can urinate at lower volume level ? Hank

@frank74205:  HI STEVE Sodium intake is really bad.

---

I have not put salt on my food for over 30 years.  Any salt that I get is from what is already in my food.  I am therefore cutting back on the food that has lots of salt in it.  This will be my 1st urodynamics test at the end of July.

Steve 

@allen98488:  I have an enlarged blader and asked my urologist about rehabbing it and she's said It"s a theory that we have but there have not been any clinical trials data to prove it.

---

Hi Allen,

I think that Jim has proven that bladder rehab can be done, given enough time and I suspect that many urologists do not give their patients enough time, when their solution to the patient is surgery, usually TURP which fixes one thing (the obstructions) and may break another thing (the prostate).

As i noted above, "about 2 months into my CIC, I got my first urge to pee but could not do so normally.  I am now 4 months into CIC and I am consistently getting urges to pee when my CIC volumes are 220-250 ml and really strong urges to pee when my CIC volumes are over 300 ml. "

This means that the distended bladder that once held 2000 ml of pee has recovered enough that it is now much smaller and can send a signal to the brain at 220-250 ml that it wants to pee, but that the obstruction by the prostate is preventing this.

Your volumes above look very high, considering that the purpose of self-cath for bladder recovery is to keep the volumes in the bladder under 400 ml,  There as been some discussion on these forums about being made to drink too much before the urodynamic tests resulting in bogus test results.

As I wrote in one of these forums, I will consult here on advise on how to prepare for the urodynamics tests.

Steve 

Allen,

Your urologist is wrong. There was at least one study that showed better TURP results when a bladder was rehabilitated/compressed by a Foley for I believe 8 weeks prior to TURP. No doubt there aren't many or any longer term studies because there's no money in catheter rehab but I can attest personally and direct you to others here who have rehabbed their bladder to one degree or another via CIC.

Jim

Steve,

Re: your comment: "There as been some discussion on these forums about being made to drink too much before the urodynamic tests resulting in bogus test results ".

It is hard to understand why anyone would be "made to drink too much" due to the time delays from drinking to processing urine.  How would they know how much was in the bladder when you began to get the urges?

Urodynamic test are interactive with the tester person after they drain your bladder.  They then connect all the sensors and insert the probes. Next they begin pumping distilled water into the bladder and continue asking you about what that you are feeling as they continue to pump the bladder up, feel any thing?, slight urge?, bigger urge?, urgent urge?. All the while making notes of the incoming bladder volume when you respond to their questions.  Once one you reach the urgent stage, they stop pumping and remove the penis probe and tell you to try to void which is caught and measured to determine how much urine retention the bladder has. I was able to see all of the sensors outputs on the device video screen during the test.  That is how mine was done July 2017 in my Urologist office.

Good luck and best wishes for your test.

Al

 

Hank,

My test results are from July 2017, since then my retention has gotten worse.  End of April 2018  month test, 650ml in, not enough out to measure.

I have been on Tamsulosin .4mg since March 2017 and Finasteride 5mg April 2017.  Was on Cialis for a one month trial.  Also quit drinking on Jan 1 2018, thinking that it might be somehow interfering with the meds, but all that did was weight loss

There are a few study's on that but like you say they don't want to deal with it.  They would rather cut hte prostate cut and be done with it.  But it can be done in time.  Have a great day  Ken

@allen98488:  It is hard to understand why anyone would be "made to drink too much"

---

Hi Allen,

Thanks for the clarification on the urodynamics test.  I was just noting that in these forums, comments have been made about being "made to drink too much" giving bogus results.  Because of how these forums are organized, tracking down these comments will be a challenge. I received my urodynamics test instruction pack in the mail today and I have not had time to read it in detail yet.  It says to arrive with a "full bladder" but does not say how much I should actually drink.

Steve 

Hi Allen?

I am on 0.8 mg Tamsulosin and 5 mg Finasteride since February with no sign yet of improvement.

I am approaching the 4 month point which was the average time for the Finasteride to work  in the study of over 3000 men that I read in the New England Journal of Medicine.  When I did a Google Scholar search for "treatment of acute urinary retention with finasteride", I could not find any studies on treating men that were already in AUR and severe BPH.  I could only find studies on treating men that were not yet in AUR to prevent their BPH from progressing.  This included that well known CombAT study.

Has your combination of Tamsulosin and Finasteride resulted in an improvement for you?

Thanks,

Steve 

@Steve: There as been some discussion on these forums about being made to drink too much before the urodynamic tests resulting in bogus test results.

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

Sounds like something I said but it was in reference to the kidney/bladder ultrasound, not urodynamics. There is a reason they have you over hydrate and that is because it gives them a better picture of the bladder but at the same time it can make voids more difficult for some of us eith compromised bladders and therefore does not recreate real world conditions where we don't drink 8 glasses of water one right after the other which does tend to unload the kidneys.

Same problem often in urologists office when they do a bladder scan for your PVR. To get you to void on their schedule, they often tell you to keep drinking water which again can create an artificial situation resulting in a PVR higher in the doctor's office than in real life. This can effect treatment decisions. Always best therefore to wait if possible rather than over hydrate and/or time.

Jim

That said, urodynamics can also produce incorrect results if they fill the bladder to fast which was the case with me. I knew from my void logs that I would feel the urge to urinate at say 600ml but they pumped water into my bladder so fast that I finally said, "how much have you put in" and he said "1200 mil". I then asked him to please stop and explained that my real world void point was 600ml which he was supposedly trying to measure. He stopped and noted what I said. Had I not intervened, the results would have been skewed. Lesson -- know your void point and ask them to fill up to it very slowly and wait a bit at that point which creates more of a real world experience.

Jim

Jim

Good afternoon Frank  I have not forgot about you  still waiting for them to get back to me.  Call again today.  Lets hope I will get some information for you and a doctors name so they can help you out  Don't give up hope  Ken

Has your combination of Tamsulosin and Finasteride resulted in an improvement for you?

Steve,

No, they did not work for me after taking them for more than 15 months.  

Allen

 

@Jim: That said, urodynamics can also produce incorrect results if they fill the bladder to fast which was the case with me.

Jim, sorry you had that experience.  I got lucky, there are 6 urologist at my urol location and her PA does the test.  She pumped it in slowly and asked I was doing after each pump. 

Allen

Hey Frank  I been on the phone all day trying to get some information for you.  I will be sending you some.  I did fine something that I think will be good news for you. The young lady on the phone was very nice and the doctor seam well liked.  I think this may be the one in time to help you.  Ken 

I am still trying to get Humana to approve the Urolift. We are now in phase 3 of my appeal. This is an independent review now. I should have an answer by August 1st.

I have also been in touch with Tampa General Hospital to look into PAE. This is done at TGH which happens to be where my Urologist works out of. The PAE team has ll of my medical records and are suppose to get back with me soon. If Urolift is experimental in Humama's opinion I am sure PAE is also.

I found an interesting video on YouTube showing a Urologist at TGH performing a median lobe turp with Urolift. Check it out if your suffering from a median lobe issue as I am.

I did ask my Uro why are we are not doing the median lode TURP with Urolift- answer - there is always a risk of sexual dysfunction with TURP regardless of how much they resect

As far as I know tthat is not suppose to be done at the same time.  The urolift company will not stay by the procedure if it is added to another.There was a doctor in the UK and one in Australia that they had a talk with because it cause more problem for the patient One doctor did a Urolift with a Bladder neck incision and the other did a urolift and then clip the bladder neck open.  I still say that they are not putting in the right codes.  The doctor has a code the procedure has a code and the hospital has a code  I had the same problem with Well Care.  Fist they said yes , 4 weeks later they said no.  I sent them a letter saying make up your mine.  There in and they not coming out.  2 week later I got a letter saying it was approved and I owned them a penny.  These company's need to make up they mind  Ken  Have you check the Urolift trails they are doing them up to 100 g with median lobe.  I saw that in May of this year.  My doctor has all ready did a few guy's and just clipped it to the one side Ken 

JCL,

I asked my Uro about Urolift being used to 'clip a median lobe to the side' and the response was that "it is at experimental stage".  

Best wishes!

Allen

I think they are in the second trial.  There doing prostate size 100 g with median lobe.  The first one went well.  My urologist has all ready did a few and the men are doing great no side effects.  Hope the trail go well  Ken

Hi allen

It is my understanding that the FDA has already given approval for Median Lobe Urolift and changed the age from 50 to 45 when they did so. As you stated, I do not think it is common practice currently. My Urologist said he has not done the Urolift with a Median Lobe - so I would be the first if we get approval. The approval I need from Humana is not for the median lobe it is for the Urolift itself.

I heard back from the PAE doctor office on Friday afternoon. Unfortunately they will not accept me as a patient. Reason they provided.

1. I am to young at 47. Not enough data to know long term effects.

2. They prefer to only do this on very large prostates, 90 grams or larger. Mine is not even half that size.

I am still waiting for the Urolift appeal from Humama' s Independent Review Board. That could take up to August 1st they said.

@JCL123:  They prefer to only do this on very large prostates, 90 grams or larger. Mine is not even half that size.

---

If the enlargement is not that big and you are having obstruction, then there is a high probability that it is a medial lobe obstruction so you should seek out the appropriate procedure for that.  As I recall, Urolift is best for lateral lobe obstructions.

Steve

Hi Guys

Just another update. The Federal Appeal was upheld as well. The reviewer and their Urologist said Urolift is graded a C by AUA and therefor not a good choice for treating BHP currently.

So I am giving up at this point. REZUM failed, Urolift is not an option, Rapaflo and Flowmax did not help.

So frustrated

How bad is your BPH? Are you in retention? FWIW, PAE is not very effective on large median lobes. If you're not functioning (needing some sort of cath or going every hour) you might want to consider Greenlight. But that said, Rezum almost never fails, if the prostate is the issue. Have you been scoped before and after? What were the results? Is it possible that your issue is mostly bladder related?

Good Morning.  I do not know where you read that But I just read this in the Medical News. Printed May of 2018 It said that AUA recommends use of the Urolift for managing lower urinary tract system.  The AUA notes that given the strong observed relationship between erectile dysfunction.  The Urolift is the only minimally invasive treatment option that has shown to provide rapid and durable symptomatic and urinary flow rate improvement with out side effects.  The AUA provides support of the Urolift as a treatment in the best interest of patients.  Following treatment with the Urolift system thousands of men have avoided invasive surgery no more medications without giving up there normal sexual function.   There was just a 5 year study on Urolift all men that were treated with Urolift are still doing great.  The company are hoping for 5 to 7 year.  I am at 3 1/2 years and still wide open.  If you want to keep your sex life and ejaculation this is the only treatment to do  Good luck with whatever you do but do your research before you get any cutting done  Have a great day  Ken

How about GL, FLA or CICing ? Hank

Are they the best for large median lobes hank?

Hi CJ, Greenlight is basically a TURP done with Lazer, with much less bleeding. CIC is another name for self catheterization, which you already know. As for effectiveness with large median lobes, FLA is probably the best, according to many testimonies on this forum. The drawback of FLA is it's cost, since insurance is not paying for it. There is also a question regarding it's effectiveness with smaller prostates. Take care. Hank

Changejobs, Urolofit can be problematic for large median lobes. I defer to Jersey Doc on Rezum. Fla has only anecdotal data. I have a large median lobe and CIC works just fine but of course doesn't get rid of the lobe, just allows complete emptying and protection of the bladder.

Jim

I argued the same info with the insurance company. You have to look deeper into the AUA guidlines. They rate Urolift and REZUM as a C. Because of this insurance can say it is not proven tested enough data etc to justify its coverage. Believe me I have fought and fought this, and got nowhere. Yes the AUA lists Urolift as a treatment but TURP gets a B grade and they compare everything to TURP, If the grade is less they do not cover it. And that is directly from the 2018 AUA guidlines Urolift is grade C and not for median lobed prostates.

I think all the insurance company's list it different.  I know I had a problem 3 1/2 years ago when I had mine done.  It was the coding of the procedure.  I think I read on the BCBS form that they will pay for it if it is needed.  I wish they would just get real and have one thing for all.  No man should have to be forced to have a procedure that they don't want Turp is a major surgery.  I will have to look into it more.  I have Well Care it was covered  Take care  Ken 

jcl,

when was your rezum done and how many shots did you get. if i asked that already, i apologize,

i posted this elsewhere and was hoping jersy could answer but would like to see if anyone has comments.

I spoke with 2 drs regarding the rezum procedure and have 2 questions for you.

1 dr said he can make a judgement on rezum based on a cystoscope and the other dr said he needs a trus. They both do a exam and ask about past.  1- Can a rezum procedure based mostly on only 1 of the tests.

2 - one of the drs that has done about 50 rezums said I’d be in great shape in 2-3 weeks, while the other dr whites done about 100 rezumz said it can take 2 months before swelling goes down and see improvements and if it doesn’t work would recommend other procedures .Which is more accurate?

JJ,

Early in 2018 Urolift  was approved by the FDA for treatment of obstructive enlarged median lobes.   They have a new procedure that uses a suture with clips to pin the median lobe to one side. A clinical study has been done that shows it's effectiveness.  They are in the process of training doctors for the new procedure. Information can be found by searching Google for "fda approval of urolift for median lobe".

Thomas

Looking over the Rezum sites they have a a lot of different answers. I was under the understanding that they do test to find out the size of the prostate.  We are all different and we all heal at different rates.  It does say sometimes it takes up to 6 month's to see improvement but who knows you may be a quick healer.  No one know.  With the Urolift they tell you 4 weeks I was good to go in 1 week.  We never know.  Ken  

You won't be in great shape in 2-3 weeks but you'll probably be functional. I was an outlier, and couldn't pee decently for about 5 weeks (and not at all for over 3) but most are passable after 7-10 days. Take note, the procedure doesn't start to work for 4 weeks at the earliest and most of the benefits come in weeks 6-12. I was a slow healer and at 6 weeks I was better than when I had it done. so look for 1-3 weeks to function adequately (a few outliers are faster or slower) and 4-6 weeks to be glad you had it done.

Thanks ob. 

I have an appointment for Friday but have waiting on my records from current uro. I’m hoping get them soon so I don’t ha e to reschedule.

It’s been a while ob, how many shots did u have?

cg - I had five shots. Two on each side and one to the dreaded median lobe.

Jim, when did you find out that you have large median lobe ? Hank

5 shots sounds to be textbook. 

One of the ken’s who went to dr mcvary got 10 shots and seemed to get great flow, quick recovery on no Re.

When your flow came back, was it strong and has it stayed that way?

August 1st 2017. I had 4 injections - 2 on each side. Insurance covered it even though AUA also rates REZUM a grade C which is not good and why they refuse to pay for Urolift currently.

I do not know if REZUM failed because the Urologist made errors when doing the procedure? He was recommended to me by REZUM directly or if he just did not do enough injections or if it just was not right for me and the shape of my prostate.

It could be a blessing that my insurance will not pay for Urolift currently. I would hate to have that clips inside me forever and not have major relief of symptoms.

Does not matter. The AUA just released for 2018 states that Urolift is not for median lobe prostates and is rated a C as is REZUM. The TURP is a grade B which is what they compare all procedures to.I do not ever want to go through a TURP! I do not care what grade they give it.

JCL  Maybe it is a blessing.  I hope it give you some relief It should Why do you feel that he made errors was he in a rush 4 may be all you needed.  I wish they would make up there mind.  Urolift is covered through medicare.  I had the Urolift done almost 4 years ago and I would never know I have them   I wish you good luck please let us know how it goes.  Rest and reax  Ken

It’s the a green light good for median lobes also?

Do you know what procedures were rated A by the AUA ? Thanks. Hank

http://www.auanet.org/guidelines/benign-prostatic-hyperplasia/lower-urinary-tract-symptoms-(2018)

I Google 2018 AUA Guidelines. Click BPH on pain page. Everything AUA recommends is there and graded.

Good Afternoon.  I looked on the internet and could not find anything.  I sent a e-mail to the AUA to send me a list  Ken 

I didn't see anything rated A. Hank

JJ,

When I called NeoTract to ask about the urolift procedure for median lobe.  They were careful to distinguish an enlarged median lobe from an obstructive median lobe, OML.  Their procedure is for an obstructive median lobe.  Apparently an enlarged median lobe does not necessarily cause problems unless it is obstructive, interferes with urine flow. I think this is something like a flap or ball valve that blocks the bladder neck.  This may be why some procedures still work on a person with enlarged median lobe while it fails on others. It is important to pin your doctor down when he is looking at your median lobe as to whether it is obstructive or not. If he is going to do a cystoscopy ask him to look for OML before he goes in.

Thomas

Have any urologists ever made this distinction when discussing this with their patients ?

CG - I wouldn't say it was strong - I'd call it moderate, but its no longer an issue. I had an IPSS score in the 30s and now its in the mid teens. There are times when its strong, times when its weaker, but the differences amount to annoyances, not anything functional. I used to live my life around the bathroom and now its a non issue.

I haven't bothered to have another scope done, but I think I had some bladder damage from years of BPH - supported by the fact that I pee worse after a few drinks than any other time. My guess is that Rezum did its job by my bladder is running at less than full speed. FWIW, in the past year, its actually gotten better - maybe its slowly rehabbing itself. And Yes, its stayed much better and as of today, hasn't regressed at all.

David

I have not heard a Urologist discuss obstructive median lobe. Two Urologist told me I had an enlarged median lobe though.  The Urolift rep talked about it and it is in the title of the Urolift clinical data report for the median lobe procedure.  Search the internet for "Urolift  for obstructive median lobe".  Also search for just "obstructive median lobe".  

Thomas

Good Morning guys.

Just an FYI, when I did pelvic floor therapy the therapist recommended that I try CBD oils. I did not get any symptom relief using Rapaflo or Flowmax and REZUM did not for me either except cause an new pain and urgency that I am still experiencing a year later.

I just approved for the medical card and I am going to try the CBD oils along with Cialis that I was able to get insurance to approve for BPH but it is still $3 a pill. I am going to give it a try for a few weeks.

Have any of you heard of success or tried CBD oils?

Guys,

I started a separate thread about the rezum dr I went to see saying he would do 12-14 shots on me. I’d appreciate it if you’d look at that thread and commment. I especially like to know about anyone that 10 or more shots and how it worked out. I’d also like to hear about anyone that got scare tissue and had to have a 2 nd operation