rezum pre-Op advise

Hi Fred Your report is interesting. I went to DrMcVary also,however he said my prostate was to large for rezum 116 gr.I am in total retention,have been for 3 years. I was very disappointed when Dr Mc Vary said Rezume would not work for me ,he then suggested Turp. Maybe my age had something to do with his decision. I'm 90 years young. How are old are you Fred? Did you have a cystoscopy done before Rezum.How long has it been since you had Rezum done?

Thanks for this info?

Sincerely

frank,.to

Hi Frank,

I'm 70. I had a cystoscopy, an ultrasound, an MRI, a biopsy, and a urodynamic study done before surgery. I had a 93 gram prostate with a median lobe and was in total retention and doing CIC for three years. I'm about 5 1/2 weeks out from surgery. I've been passing clots and blood periodically for the last 10 days or so, but I can pee. So far no obvious side effects. Ejaculate is reduced but not gone. I had 13 steam injections. For me, it was not exactly a minor operation, but IMHO, better than most of the alternatives. The other one I seriously considered was FLA.

Best wishes, Fred

Dr. McVary is wrong - way wrong. 1) They do Rezum now on prostates as large as 150 grams. 2) At 90, the risk of anesthesia is considerable. To not recommend a less invasive option with no anesthesia required is borderline malpractice IMO.

Frank, Get a HoLEP in Jacksonville at the Mayo Clinic. I'm 4 weeks post op for a HoLAP and doing great. And no RE.

Bad advice IMO. Holep has a 75% incidence of RE and for Frank that'd a deal breaker.

38 grms is still quite small. Though when mine was first discovered in 1995 it was 35 grms and I was told that I needed a TURP as a matter of some urgency. There was not much else around im the UK then but I said no I'll wait for one of the laser treatments that are being researched. It was a long wait for GL in 2004 but in the end it was the right choice despite what my local Uro's said.

I am in Bermuda and will fly up to Canada for the Rezum..

the green light laser is available here in Bermuda but one of the high probabilities is sexual side affects.

I'm too young to take on that too.

No sexual side effects with me or with friends who have had it. My hospital in Newcastle and others were doing a bladder neck sparing version. A friend anxious about the outcome had sex on day five. I was more conservative and waited fifteen days 😃 Actually the day after my GL I woke up with an erection.

Strange going from Bermuda to Canada for it as many Canadians complain about their health facilities and Uro's. My cousins husband in Toronto had his prostate and his heart bypass done in Florida during their winter vacations.

I have family there in Canada and my wife is from there.

The Uro I'm using is Dr. Dean S. Elterman he is highly respected in Canada. But you are all right and i am doing my own research. As many for as I find that aren't. 😃

My doc told me 50/50 on RE with Greenlight. Higher than Rezum, but much lower than TURP/Holep.

The problem now it that there is so much choice that patients are confused.

I had my GL when they were doing trials of it in England. They were possibly being selective in the patients they took. The team had only done 38 procedures and I was the sixth patient of the most junior Uro but I had utmost faith in him. They kept me for a second night as I was not voiding completely and I had a long train journey home . Day three I went to the races and friends asked if my operation had been cancelled as I was out and about as normal and looking so well. I usually went straight to a toilet when I got off the bus but not that day. I did go later and had several coffees and had to remind my self to go again before leaving.

They later did a 92 year old patient with a very large prostate as they said it is a very gentle procedure. It will be even better now that they re on the third generation machine.

When my prostate regrew I had moved and the original hospital was too far to go to... Distance though is evidently not a consideration for you. The first person to have GL used to post to an old news group and flew to Japan from LA on day three.

I did have an appointment later when my prostate regrew with one of the two urologists who pioneered GL in England. He said that many of them had thought that GL was a very easy procedure but later realised that it needed more care.

Everything has its price. ER worries some more than others.

Why are you advising a GL laser? If frys the prostate and almost always leads to RE so sex life is crap. Everyone with a prostate larger than 80cc should first try PAE. Urologists dont' like it because they don't do it. Beware the medieval procedures done by urologists.

RE was a dealbreaker for the guy who opened this thread - so maybe GL isn't the best first option for him. It was for me too so I waited for Rezum. I agree that many men don't care .

I talk from the experience of having had it.

It most certainly does not fry it. The laser accurately removes tissue and does not burn deep into it as frying would indicate to do that. Google for how the procedure is performed accurately leaving a smooth inner shell and is blood free as the laser seals as it goes. Were it as you suggest would Uro's still be using it as their procedure of choice after fifteen years. It's only possible drawback is that it does not save tissue for histology as Holep or newer procedures do.

How many years did you wait and how much did your prostate grow in that time ?

10-plus years of data show the GreenLight laser achieves outcomes equivalent to that of TURP.

For 30 years, lasers have been evolving for the treatment of urologic conditions. Investigators focused on lasers for BPH to achieve results similar to transurethral resection of the prostate (TURP) without the bleeding, fluid overload, blood loss, inpatient hospital stays of two to three days, and erectile dysfunction associated with TURP.

For BPH, a laser must be able to vaporize tissue, coagulate the understructure, and have low absorption in water. It should be preferentially absorbed by the prostate. Of the lasers listed, the GreenLight KTP-532 is the ideal wavelength because it has a high affinity for oxyhemoglobin.

The wavelength of 532 nm is produced by focusing a neodymium YAG laser 1064-nm wavelength through a crystal that doubles the frequency, but halves the wavelength to 532 nm. The high absorption coefficient of blood for the GreenLight laser permits heat-induced coagulation, which creates a hemostatic surgical field. Precise tissue vaporization in a highly hemostatic environment promotes effective destruction and targets tissue ablation with minimal thermal coagulation.

Use of the KTP wavelength in high peak powers in excess of 280 watts with short pulse frequency allows high-density energy to be deposited in a shallow layer of tissue with an optical penetration depth of approximately 0.8 mm (Surg Clin North Am. 1992; 72:531-558; Urology. 1997;49:703-708).

This allows the targeted superficial tissue temperature to reach a vaporization threshold of greater than 100 C. A thermal gradient allows for heat diffusion to create a coagulation zone approximately 1-2 mm in diameter under the treated area (Appl Opt. 1983;22:676-681).

KTP lasers have been used for more than 20 years for urologic conditions such as urethral strictures, condyloma, and bladder carcinoma. The original KTP laser had low-power settings (16-38 watts), which limited vaporization for BPH. In the late 1990s, a high-powered 532 KTP GreenLight laser was developed (Laserscope/AMS, Minnetonka, Minn.) to implement the character-istics of the 532 KTP wavelength with increased power for rapid vaporization, using a solid state Q-switched KTP laser base.

Rapid, complete eradicationEndoscopic treatment of BPH by whatever surgical process should accomplish complete eradication of the entire adenoma causing outlet obstruction, and it should do so in a rapid manner that can be easily assessed at the conclusion of the operation. The method should also produce precise coagulation with limited blood loss and the ability to preserve erectile function and limit the potential for retrograde ejaculation (Contemporary Urology. 2005;17: 30-37).

The 532 GreenLight laser is the medical laser with the characteristic that best meets these criteria. The development of a high-powered KTP laser, capable of generating 60 watts, permitted creation of a large prostatic cavity (3 cm) in canine prostates (Urology. 1996;48:575-583). These studies led to clinical applications of 60-watt KTP laser vaporization prostatectomies, known as photoselective vaporization of the prostate (PVP). In 1998, researchers reported the first clinical series of PVP utilizing the KTP laser at 60 watts (Urology. 1998;51:254-256).

The study revealed no significant bleeding or fluid absorption. Foley catheters were removed within 24 hours in all patients. Mean improved flow rates of 143% were accomplished with minimal dysuria, hematuria, and no incontinence.

A study published in 1999 demonstrated a mean 124% improvement in peak urinary flow rate, and a mean 46% decrease in international prostate symptom scores (IPPS) at six weeks following laser therapy (BJU Int. 1999;83:857-858). Malek et al in 2000 reported on 55 men, demonstrating 82% improvement in the American Urologic Association (AUA) Symptom Score and a 278% increase in peak urinary flow rate at two years (J Urol. 2000;163:1730-1733).

Power increases to 80 wattsLaserscope accomplished an increased power to 80 watts in their subsequent laser. A multicenter clinical evaluation was established with patient evaluations pre- and post-study for symptom scores, urodynamics, and ultrasound imaging of the prostate.

In 98 patients, the study showed significant improvement in AUA Symptom scores, quality of life scores, peak flow rates, and postvoid residual volumes. None of the patients required transfusion, and there were no instances of erectile dysfunction (J Urol. 2003;169;suppl:465).

Malek and Kuntzman in 2003 reported their five-year experience with high powered KTP laser. This study showed durability in improved flow rates, symptom scores, and quality of life scores (J Urol. 2003;169:suppl:390. Abstract 1457). Malloy et al reported on a two-year follow-up of the multicenter study in 139 men (J Urol. 2004;171 [4 Suppl]:399 Abstract 1517). Patients were consistently treated in outpatient or 23-hour stay units. Results were comparable to TURP but with shorter hospital stays, minimal blood loss, less strictures, and no erectile dysfunctions. Most patients could return to work in 3-5 days and exercise within 14-20 days.

In 2006, investigators reported three-year results using the 80-watt power GreenLight Laser. Long range durability again was observed, and the PVP was also reported to be efficacious in patients on anticoagulants such as heparin, warfarin, or Plavix who could not have their drug ther-apy discontinued. Average operative time was 38.7 minutes, with an average prostate volume of 54.6 grams (BJU Int. 2006;97:1229-1233).

The 120-watt laserIn 2006, Laserscope-AMS introduced a new, higher power KTP Laser called GreenLight HPS, with power that could go as high as 120 watts. The unit was air cooled and could be used in any operating room. The 120 watts of quasi-continuous power allowed for higher vaporization efficiency and decreased operative time.

The laser featured a dual power mode with two foot pedals that allowed for vaporization or coagulation without the need to adjust power settings. An improved fiber with a reflective coating limited the back-scattering effect, which reduces the risk of lasing non-targeted tissue. The 120-watt power and beam characteristics required careful surgical technique so as not to injure the trigone, ureters, bladder neck, or membranous urethra.

The 80-watt GreenLight has a maximum focus and power density at 0.5 mm from the fiber to the tissue. This requires near-contact to the prostate for maximum vaporization. The GreenLight HPS, on the other hand, has a fiber with a beam that maintains focus with little divergence up to 3 mm from the fiber, and with limited divergence at 5 mm. The power density is maintained. Effective vaporization is obtained with increased distance from the target adenoma, allowing consistent vaporization even with variable distances from the fiber to the prostate.

The 120-watt power is a 50% improvement over GreenLight PVP, resulting in increased vaporization efficiency. For this reason, surgeon training is imperative because this laser is more dangerous if not operated with strict adherence to technique and consideration of anatomical landmarks. The ideal operation of GreenLight HPS should use a non-contact technique where possible. This limits damage and overheating of the fiber with maintaining maximum vaporization efficiency. The laser should never be operated unless the surgeon can see the GreenLight beam and it is focused on prostatic adenoma and not on the bladder.

At 120 watts, severe damage with perforation of the bladder or injury to the ureteral orifices will result if HPS power is inaccurately applied. The laser beam should be applied with a continuous sweeping technique producing bubbles from the vaporized prostatic tissue. If the beam remains on one area for a protracted period, deep coagulation occurs with potential for subsequent sloughing of tissue in the postoperative period. Proper continuous irrigation with saline is required to obtain clear surgical view of the operative area.

The laser power can be varied from 60 to 120 watts depending on the location and characteristics of the tissue being vaporized. Lower power settings should be used initially to test the efficiency of vaporization. In larger glands (greater than 100 grams), more power is used once the non-contact 3-to-5 mm distance from fiber to tissue can be obtained. The fiber should be cleaned periodically, to remove adherent tissue or carbonization, to preserve fiber efficiency.

The dual-power foot pedal allows instant application of lower 20- to 30-watt power, which is ideal for coagulation. This can be obtained without decreasing the power utilized for vaporization, which was necessary in the GreenLight PVP machine.

The GreenLight HPS allows the surgeon the flexibility to deliver efficient vaporization with minimum adverse effects and complete vaporization. Smaller glands (less than 35 grams) should be treated with 80 watts of power. Prostates up to 80 grams can be treated ideally with 80 to 100 watts. For adenomas greater than 80 to 200 grams, initial use of 80 watts and then increasing to 120 watts is recommended for the maximum efficiency. Prostates with large intravesical middle lobes should be vaporized with 80 watts to limit the possibility of inadvertent damage to the trigone, or bladder.

From the August 01, 2007 Issue of Renal and Urology News

When I research the various options with the help of the family-member-MD, GLEP was my 2nd choice after Rezum. TURP was at the bottom of my list because of it's well know morbidity and complications (ED and RE).

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Also at or near the bottom of my list was PAE and Urolift for a few reasons, one of which was that I had a significant median lobe obstruction resulting in total retention and these 2 procedures do not address the median lobe.

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My Rezum was successful with minimum morbidity and no complications (RE). Because GLEP "seals as it slices" (actually vaporizes), it has less morbidity than TURP, but complications (RE) is still up at about 50 percent.

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Personally, while the long term data is unavailable for how long a Rezum treatment will last, I think that as a minimally invasive out patient procedure, it is a game changer for treating BPH. It also costs a lot less too.

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Steve

The short answer is I don't know how much it grew because I only had it measured prior to getting Rezum - but here's my history. I started having BPH symptoms in my mid 40s, but didn't seek treatment until about 55. I was offered greenlight then, but didn't like the RE odds and chose to tough it out. I was given flomax, but it didn't help enough to be worth the RE so I stopped taking it. A few years later I saw a different Urologist who suggested Alfusozin, offered Greenlight and told me about Rezum, which was in clinical trials at the time. He offered to get me into the trial, but I didn't want to be an experiment that could go awry. When my doc had done roughly 100 Rezum procedures, I had it done.

I definitely developed some bladder damage from years of BPH so I don't pee like a 15 year old like some do after Rezum, but I'm much improved and functionally pretty close to normal, which I hadn't been in over 15 years and without RE - so for me I made the right choice. If I had Greenlight done and had been one of the 50% without RE, I'd be better off and wouldn't have suffered as I did for years. Had I ended up with RE, I would have been really unhappy, so I think if I had it to do all over again, I'd do the same thing. FWIW, 3 1/2 years later, things are stable.

Afterthought - my prostate was never large - 30 grams, but it grew the wrong way with and enlarged median lobe.

Cost, that is why Rezum is now a favourite with our National Health System.

I very quickly stopped taking Flowmax/Tamsulosin because of RE prior to my second laser procedure.

That's the problem with prostates shape rather than size. A friend with a 30 grm one was self cathing prior to his successful GL in 2005. His flow is a bit reduced in the past two years but his original Uro said its not to bad and to take daily Cialis.

Thank You for the comment.

Getting lots of useful information but allot is not applicable to the question posted.

I have experienced the opposite in Canada. While people on their national health plan often complain about wait times and who they were assigned to.. Because my insurance is paying I picked the dr and date.

I will be with a Dr that is part of their University Health system in Toronto, my wife had a brain tumor removed and my daughter has had treatment in this system. Each time I was over the moon impressed with the results, professional services and attention to detail.