Rezum prostate surgery - my experience

I have used this forum extensively to research prior to my Rezum procedure, it is only fair if I contribute back hoping to help others who are looking to have it done. I initially started this post 5 days after my procedure, and intend to continue updating it as a detailed reference to anyone considering this procedure.

My profile

57 y.o., type 2 diabetic, BPH symptoms for 7 years, tried Tamsulosin for a few months, hated the side effects (heart racing, dry ejaculation), switched to Alfuzosin (Xatral XL), lower volume but at least not dry. Alfuzosin gradually stopped working for me, for past 6 months my symptoms became really bad. No solid sleep, can't sit through a meeting at work without going to toilet ..etc. After extensive research I chose Rezum, which I discussed with 3 different Urologists, chose the one I am most comfortable with. At this stage my Max flow was 3.9 (horrible, normal people are between 15 and 20) My prostate size was measured at 45cc and 55cc by 2 different radiologists, so I will assume a 50 cc prostate with a small median lobe.

Day of Procedure

Took a cab (Urologist told me not to drive), checked into hospital at 6:30 AM, they took a urine and blood sample, checked vitals..etc and gave me a silly hospital gown to wear. 2 different doctors (not my surgeon) asked me about allergies..etc, and asked me to sign a bunch of forms. By 8 AM I was wheeled into surgery, given anesthesia , woke up about an hour later, no pain. 30 minutes later I was in my room. Doctor had told me he can send me home same day, or keep me for 1 night. Since I live alone, I preferred to spend a night. Overall no pain, just discomfort from catheter (both minor bladder spasm and tip of penis discomfort, both quite tolerable). Managed to walk around a bit, with urine bag concealed. At night couldn't sleep from penis tip discomfort, male nurse gave me some lignocaine numbing gel, slept like a baby, didn't get up again at night for the first time in months.

Day 1

Woke up at hospital, asked for more lignocaine, nurse said I could keep the tube! Otherwise no pain. Doctor visited, told me he had applied 3 steam treatments, one to either side and one to median lobe. I had agreed with him to keep it to a minimum, he was supportive of that approach. Removed urine bag, was given a valve for my catheter, a prescription for Ciprofloxacin(antibiotic), Voltaren suppository (anti inflammatory), a laxative and lignocaine gel . Also took a sick leave note for work. Took taxi home. Valve is much lighter, a lot more comfortable than a urine bag, but still annoying. Am fitted with a 20 french catheter, relatively larger diameter, doctor said those are a bit more uncomfortable, but don't typically get blocked by clots.

Days 2-4

Stayed home, from bed to couch, delivery food, drinking water only, no pain, only slight (very tolerable) discomfort from catheter (occasional spasm, basically urgency to urinate) and tip of penis minor irritation, the lignocaine gel every 4 or 5 hours fixed that. I shower twice a day, and when moving my bowels I kept the tap on catheter open, had read that somewhere, good advice to avoid pressure build-up in bladder. Day 4 in the morning I drove my car for the first time, couldn't sit straight but it was OK for the short ride. Urine varies from normal light yellow to darker shades, indicating bleeding, which I know is normal for a few weeks.

Day 5

Drove to work, I have desk job, catheter nicely concealed in my trousers. Can't sit normally to avoid pressure on prostate, but otherwise OK. Looking forward to day 8 when doctor scheduled me to remove catheter, he generally prefers to keep them in a bit longer and not risk re-catheterization. Hope removing it doesn't hurt. I will stay on Voltaren and Antibiotic till catheter comes out, and on my original BPH medicine (Alfuzosin) for 2-3 months. Doc also wants me to take finastride for a few weeks, helps with bleeding.

I hope this information has been useful. Overall, so far, my experience has been quite tolerable. Am pleased my doctor's conservative approach (full anaesthesia, fewer treatments, catheter for 8 days, antibiotic despite no UTI, option to spend 1st night in hospital).

Update Day 9

On Day 6 passed some blood clots, scary at first although expected. They looked like dark red pieces of yarn. On Day 8 catheter came out. Took a voltaren suppository 4 hours prior to removal, may have helped a bit. Not painful but not very pleasant either. Nurse was very gentle and kind. Drank a litre of water and waited 90 minutes till I felt some urge, first urine was very bloody, and it stung a bit. Went home. Passed a bit more at home, with more blood. Flow is so weak, but I have a flow, so I'm grateful. Doctor told me it will gradually improve, expect to be where I was pre surgery in a couple of weeks. Wants me to stay on medication for another 2 months. Got up at night 6 or 7 times, but I'm urinating without difficulty, just a bit slowly. Today (Day 9) urine is clear, flow is around 50% of pre-surgery (which is fine) and I need to go every 3 hours on the average.

In general feeling optimistic, and relieved the catheter is gone, happy where I am today, and hoping things will get better from here. Since the beginning I have been blessed, no pain, just varying levels of discomfort, mainly catheter related - now that is hopefully behind me.

Update Day 12

Flow improved slightly, I would say around 60% of pre-surgery levels. Is worst in the morning, but improves during the day. Usually clear, occasionally a small clot, which is expected. Last night I slept 7.5 solid hours, didn't get up once. I also started having 1 coffee (or diet pepsi!) a day since day 10, is tolerated, but just one. No burning or stinging. Am still on medication, intend to stay on it for a few more weeks. Still can't sit for long periods, sitting at an angle on one butt cheek or the other helps a bit. So far no regrets.

Update Day 15

Flow a bit worse (40% pre-surgery) , but still acceptable. No pain or serious issues. Yesterday had to get up at night a few times, I think it is because I am back to coffee and soft drinks, will stop again and see. Passing mostly clear urine, with the odd clot every other day. Now it's basically a waiting game, I noticed many people have a breakthrough around week 4 or 5. Am still on duodart medication as advised by doctor. Today I used an NSAID (voltaren suppository) for the first time this week to ease the discomfort while urinating, recovery has it's ups and downs.

Update Week 3

2 days ago stopped Duodart, not sure I need the finesteride component any more. Switched to Alfuzosin alone. I am also happy to report that the department down under appears to we working fine. Doctor told me to abstain for 4 weeks, I didn't, after 3 weeks it seems OK, it seems no ED or RE, I feel relieved. Also surprisingly no blood in semen, I thought it was a given. Flow today is back to around pre-surgery levels, which is good progress (although still on Alfuzosin). Am scheduled to see Urologist by week 6. Intend to keep this diary updated. So far am recovering slowly but surely. Only had 3 treatments (injections), which is a bit on the light side, so wondering maybe that is why side effects are so far mild, but also wondering if this may dampen the long term efficacy of the procedure...

Update Week 4

All stable, flow improving very, very slowly, some days better than others, mornings typically better than evenings. I must say urgency is improved though, I no longer have to go right now, I can hold it a bit. I still wake up once or twice at night (vs 4-5 times before). Anyone considering this procedure should be prepared for a very slow recovery. Not painful or disruptive, life is normal, but recovery is slow. Overall I think flow is 10 to 15% better than pre surgery, can't confirm that scientifically till I pee in a machine in 2 weeks. Nothing major to report. All is comfortable, and I remain optimistic. Still on Alfuzosin, hoping to get off that soon.

Update Week 5

Off all meds now, decided to reduce to every other day, tried for a day, then another, and I am fine, so I stopped completely. Flow without any meds is still better than pre-op with meds. Texted my doctor who told me it will hopefully get even better with time. Seeing him next week.

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