Rezum, olympus button turp or other?

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Hi all, I went to the ER in June thought I had a hernia but CT scan showed huge bladder. . They drained 2500 ml. . Which was surprising since I thought I was urinating normally up until 15 minutes before the CT scan. They put an indwelling catheter in me for 4 weeks and I haven't been able to urinate on my own in the months since. I have to self cath 5 times per day. The urolift dynamics test showed my bladder still has function but not optimal. . My prostate is 42 cc or grams. The prostate has some kind of lobe not sure if it is a median lobe or not yet. One urologist recommend turp, my current one said he doesn't think urolift would be effective about 40 % chance and he is the world's most recommended physician for urolift. . He is recommending rezum. He is going to do a cystoscopy in a few weeks and then discuss to make final decision. . I think the stupid lobe thingy is causing the problem because last week I ran out if coude catheters and the straight one didn't want to go in, and all the sudden urine flooded out from around the outside of the catheter with a lot if pressure but that is just the theory. . I would greatly appreciate any recommendations or advice that you can offer. . I want to select the best procedures possible. . I did a ton of research but still at a loss. . Thank you! . Riggs

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  • Posted

    Hi Riggs,

    From what you describe, sounds like high pressure due to obstruction per urodynamic testing. The good news is that your bladder is still in the game but not strong enough to pass the obstructive prostate on its own. 

    One approach is to remove the obstruction -- turp, urolift, rezum, etc -- and hope that the bladder has enough game to empty itself. Sounds like at this point in time it's dependent on the procedure, but still questionable. 

    The other approach is to continue to recondition the bladder through self cathing (CIC). This is the approach I took three years ago in a similar situation to yours. 

    I didnt have the Urolift option back then or Rezum, but frankly I'm not crazy about either at this point, and I don't like the sexual side effects of TURP such as retrograde (dry) orgasms. 

    Unless one of these new procedures grabs your attention, I'd just continue on with CIC until either something better comes along or if your're lucky your bladder will rehab itself to the point where either you won't have to cath at all or only have to cath now and then. That's where I'm at today, from cathing 6x/day three years ago to cathing only maybe once a day or every other day now. Other than that, things work pretty normally with no significant symptons of bph.

    Have you ever done a void log? Just write down the time and amount of each void and note beside it if the void was natural or from the catheter. You want to adjust your cath schedule so you're never carrying around more than 400ml at any one time in your bladder. So, for example, if you do a natural void of 100ml, and then cath rightt after another 500 ml, you were carrying around 600 l which is too much and will keep your bladder stretched. In that case increase your cath frequency. 

    We also have several threads dedicated to CIC that might be helpful. 

    Jim

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    • Posted

      Hi Jim,

      I have a hard time keeping my amount under 500 or 600ml, with cathing 5 to six times a day. . Sometimes the amount can be 700, 800 ml, or so after just 3hrs of sleep and having drained before bed. Can drink a lot sometimes and having low 350ml throughout and drink very little and have 700 and more. .all over the place, can't figure it out. . Keep logs, everything.

      Thank you!

      Riggs

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    • Posted

      @Riggs: Can drink a lot sometimes and having low 350ml throughout and drink very little and have 700 and more. .all over the place, can't figure it out. 

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

      Although it doesn't seem like it, it will even out because fluid in pretty much equals fluid out, just not when you are necessarily expecting it!

      How much fluid are you taking in a day? If you don't know, then do an intake log, including all liquids like water, coffee, soda, etc. No real reason to be taking in more than 48 to 64 oz per day. 

      What kind of natural voids do you have? If you want to post or private message me one of your 24 hour void logs, I'll take a look. 

      In general, if fluids are 64 oz or under in 24 hours, cathing 6x/day should keep bladder volumes down even with minimal or no natural voids. And btw while they talk about " 6" as a top number it's really arbitrary. I've cathed seven or more times a day at times and no big deal. Also, my understanding is that Medicare will pay for more than 6 a day if you get a note suggesting medical necessity. 

      Carrying around 800ml is going to make it much more difficult to decop and rehab and decompress your your bladder if that is your goal. 

      Jim

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  • Posted

    Hi Riggs, you haven't mentioned any possibility of taking medications. Meds may allow you  to urinate again by relaxing the obstruction. Some people have side effects from meds and some don't. Self cathing is fine but it is not for everyone, and can be inconvenient at times. Just don't rush into surgery. You may regret it. Hank

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    • Posted

      Hi Hank,

      I tried flowmax and rapaflow but had to stop shortly after as it made my blood pressure go crazy extremely high then extremely, etc..

      Thank you!

      Riggs

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  • Posted

    I've also read that if meds don't help you, surgery probably won't help you either. Hank

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    • Posted

      Hi Hank,

      Sort of the opposite. If the drugs HELP  then surgery might also help, but no guarantee. However no drug benefit doesn't mean surgery won't help. The obstruction might hv been too much and/or your reaction not enough. 

      Jim

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    • Posted

      "Opposite" wasn't the right word because statistically you would probably do not as well if you don't react to the drugs. I think one of the PAE docs uses drug the drug reaction as sort of a poor man's urodynamic suite smile

      Jim

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    • Posted

      I think it's how my two uros did when they pushed turp and Urolift on me, without any testing. They asked me if doxazosin help me and I answered 'yes'. Hank

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  • Posted

    I had the Rezum procedure just over 5 months ago. My prostate was 54 grams, with a smallish median lobe. I had 3 steam injections on the left, 3 on the right, and 1 in the middle. The original plan was 2-2-2, but the doctor adjusted based on what he saw during the procedure.

    Like you are planning to do, I had a cystoscopy prior to the urologist saying that Rezum was a good option. This is essential data to have in my opinion.

    I picked Rezum since it seemed to be a low risk option that would allow more aggressive treatments later if needed. I sought out a urologist that had experience with Rezum (he was involved in the clinical trials and had done more than 80 before me) since my local urologist had not done any at all. He was willing for me to be his first patient, but I was not.

    I'm happy with the results thus far. My IPSS has dropped from 23 to less than 10. Recovery was relatively quick, on the order of 3 days until I felt physically normal and capable of doing all activities. I delayed sex for 21 days, just to give the prostate time to heal. The first month of sex wasn't the best, but things got back to normal after that. At the 4 month followup, I told my doctor that the enjoyment was 110% of what it was pre-Rezum. He said that he hadn't heard this before, but it just feels better.

    I'm now 62 and in pretty good health (5'8", 145 lbs), except for this pesky BPH. This may be a factor in my results, along with doctor capability.

    I hope this helps you make a decision, Riggs.

    Best wishes,

      Bill

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    • Posted

      No, not full urinary retention, as far as I know. Just slow (and getting rapidly slower) flow.

      Like you, I had taken Flowmax and Rapaflow about 10 - 12 years ago. Probably not more than a month or so each. Neither one improved my flow for more that a few days. The Flowmax killed my libido and Rapaflow caused RE. So I just struggled along until I developed a bladder stone at the end of 2016. It was removed in February and I felt that I should do something (with the prodding of my urologist) to prevent a recurrence. Hopefully, the Rezum has me in the clear (pun intended) for now.

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    • Posted

      Glad to have read your post, WilliamUSA.  I'm scheduled for pre-Rezum testing (cystoscopy / urodynamics) next month.  Your post offered me encouragement.  THANK you.

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  • Posted

    Hi Riggs,

    Glad it worked out! Experience definitely seems to count with some of these newer procedures. Being number one isn't always a good thing!

    Jim

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