Rezum Procedure Cover-up Re: Ejaculations

I did not have Rezum therapy but looked into it extensively prior to choosing Aquablation. My concern with it, in addition to what are typically very modest improvements in flow rate, was that it appeared the risk of damaging the ejaculatory ducts if the urologist treats a median lobe aggressively would be high. This is because they run through the central zone to reach the verumontanum where they emerge into the urethra. They carry ~70% of the volume of semen (originating from the seminal vesicles on either side of the prostate) with the remaining 30% coming from a network of glands within the prostate originating mostly from within the peripheral zone but also the central zone. It's easy to see how the latter glands could be affected by Rezum or any other procedure that produces large cavities in the prostate. But again that's only ~30% of the overall semen volume.

The main argument in favor of Rezum with respect to avoiding ejaculatory dysfunction is that the heat release by the change of phase of the injected steam will be confined to the transition zone tissue IF that's where it is injected. Since the transition zone is only 5% of the prostate volume in a non-enlarged prostate it does not have a significant role in producing semen or causing it to be ejected. However, if you have an enlarged median lobe (in central zone) and your urologist injects it along the floor of the prostatic urethra between ~ 5 & 7 o'clock, depending on how far it propagates, the heat it releases it could damage one or both ejaculatory ducts. That would mean either 35% or 70% (if one or both ducts are obstructed) of the total semen volume would never make it to the urethra. The urologist I consulted with who offers Rezum therapy stated he could not guaruntee that my ejaculatory ducts would not be affected if he injected the median lobe. He proposed 2 injections in the median lobe given the size of mine.

One other failure mode that could case ejaculatory dysfunction with cavitating procedures like Rezum (and most others) is if the cavity is too large, even if semen does make it into the urethra, the volume of the void is so large that there is not enough tissue to "squeeze out" the semen. I've seen some Rezum patients reporting developing RE months after their procedure. Given that the necrosis and removal of treated tissue occurs over an extended period of time with Rezum, this failure mode could explain those scenarios.

Bottom line with me was that I did not have the confidence that the urologist would have a sufficient degree of control over the extent of the effects of the steam with Rezum. I'm sure there are patients/cases where it's a great option, just not mine.

How many injections did you get, and where?

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im 7 weeks out from my rezum procedure. while my frequency, urgency and flow are improving my climaxing diring sex has very little to zero feeling at all and no ejaculation. my doctor is suggesting cialis to improve feeling. erection is not a problem and i am wondering if cialis will help at all. they can seem to give me any answer as to if this is temporary or permanent. so far, very frustrating and scary for myself and my wife

i had the rezum procedure 2 to 3 years ago... i've had RE ever since. i bet everyone gets it with rezum. this is bull.... the pleasure is almost gone. do you know of anything that helps? mike

i had Rezum procedure about 4 years ago and had no problems. My prostate tissue grew back and I decided to repeat the procedure..

I am 6 weeks post op and thus time was a whole different story. I bled for one month post op and I still have to urge to urinate often and wake up 5 times a night which is worse then before my procedure. Now I have discovered i may have retrograde ejaculation as my orgasms are dry. I feel like i should say I'm young 50's and non diabetic and in decent shape. Ejaculation was fine before my procedure. Will it get better? Anyone have a similar experience? I chose Rezum solely on the fact that RE chance was 1-2%..

My doctor during my 8 month post op visit stated RE has a 10 to 15% possibility, not the low percentages stated here. My only negative from Rezum is the RE, allelseis good.

Hi John, Yes, I"m almost 6 weeks after Rezum and have had no feeling or sensation during ejaculation since. No contractions or Kegel muscles. After a few seconds a little semen spatters out. Like having an orgasm during an epidural. This hasn't changed in the last 4 weeks and I fear it may be permanent. I don't have ER or ED and because there is some semen, I don't think the ducts from my prostate were damaged, although I had two needles in the central lobe. My prostate was big, 98ml and I'm old, 83, but satisfaction level before Rezum was 70/80%. I would not have had it done, had I ever heard of the outcome. I have contacted the surgeon and will let you know what he says. I' m sorry John, hang in, I know exactly how dissapointed you are. Steve.

I spoke to my GP today about lack of feeling during orgasm and he said not to give up on it, that it was probably just some nerve damage due to the ablation. They do grow back but it's slow. I see that in the UK where they have been doing Rezum a lot longer than we have, they say it takes 6 months for full recovery not 4. So let's hang in and hope for the best. Cheers, Steve.