Rezum resection on a very large prostate

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I am in my mid seventies, weigh 280 lbs, am moderately active and had a >180cc prostate. I am told that is quite large.

I had my Rezum procedure in mid October 2017. The device appears to me to be a microwave generator with a wave guide tube ending in a 5/16 inch rod with an incorporated camera. The rod is inserted into the urethra and manipulated to the desired position where it is inserted into the prostate and the microwave is turned on for a few seconds to cook a section of the gland. This is repeated a total of 8 or 9 times progressing through the prostate.

            Injections of anesthetic blunt the discomfort of having ones urethra realigned by a metallic rod. I rate the experience as undesirable. While mounted in the stirrups jutting from table with a catch pan below my lower orifices I was treated to a parade of nurses totaling I believe eight ladies plus the Rezum sales rep. I felt for the insurance claims processors who were excluded from the tour, though there is nothing to see there, but felt the experience must have been akin to people’s fascination with beached cetaceans.

            The heating process is like a kick in the balls on the pain scale, at each application.

            The doctor inserted a catheter and told me to take it easy a couple of days at the end of the procedure. An appointment was set for two weeks hence to review progress.

            I was warned by the nurse that there would be a lot of blood in my urine. Well let me say that was understatement at it’s finest.

Having dealt with an enlarged prostate for more than twenty five years I had a stock of catheters and couple of leg bags along with a couple of insertion kits. From the fourth day following the procedure onward it  became a round the clock battle to clear the catheter, tease out blood clots too large to pass through the catheter and avoid putting pressure on the bag. I was passing so much urine and blood around the catheter that I had to use old t-shirts in my skivvies to soak up the leakage.

I got a work in visit with another doctor in the office on the sixth day and my wife had to drive me because I was in such distress. The doctor performed lavage and told me to do nothing active while I was bleeding so heavily. I saw my regular doctor the following day and he blew off my problems and concerns as inconsequential. The nurse had been impressed enough by the volume of clots in my bag that she chose not to empty the bag before the doctor saw me. The doctor did find the root of my immediate problem in that I had gotten the catheter in one of the holes left in my prostate by the procedure. He was unprepared for the urine release he triggered when he relocated the catheter. Trays of blood, blood clots and urine, Oh My!

At the thirty days point there was still a lot of blood in my urine but we took out the catheter. I had one catheter left from my stock and when I couldn’t pass urine used it to perform lavage to flush out large clots. I had to use the same catheter for a week until I got urine pretty clear of the clots and bleeding became infrequent.

Thanksgiving evening I birthed a kitten. I was unable to pass hardly any urine and

couldn’t exert enough pressure to expel the blockage. On my third try over a basin I passed a blood clot the girth and length of my middle finger (I wear XL gloves). The impressive part for me was the torus of meat which separated from the clot on expulsion. The meat was about half an inch in diameter and half that in thickness with a not quite through appearing cavity at the center. I had to share that little horror with my wife because it can not truly well conveyed by words. In after thought a picture would have been of value but I needed it gone, flush.

            I passed at least two more pieces of similarly shaped though smaller meat in the following days but didn’t monitor productivity during the night.

I now have two weeks of relatively clear urine and have survived two months since my procedure. The morrow shall bring a follow up visit with the good doctor.

In the interest of being able to provide a full picture of my status I tried to get my rocks off last week. I haven’t been sexually active or capable for more than ten years. That part of me still doesn’t work but it did make me bleed and pass more blood clots. The attempt was more painful than had been the case before the procedure and still burns four days hence.

Other than the crisis periods and the kitten issue I would have to rate the procedure as an improvement. I was more comfortable and generally felt better until I tried sexual activity. I had been accustomed to discomfort when walking and to urination every thirty to forty five minutes round the clock for more than twenty years.

The improvement I had noted before has pretty much dissipated. As of twelve weeks I have no blood in my urine, sex still broken, constant pain is back and discomfort walking is better but not good.

I have had my six month follow up and learned that my really big prostate is the cause of my less than satisfactory result from the procedure. Wow! Really? I should have told him I had a big prostate? I thought that was the purpose of the cytoscopy. So if 6 or 8 applications on a journey through a prostate a quarter the size of mine are required what’s with 8 or 9 in mine? The areas that were treated are large depressions in the prostate and the urethra narrows well before reaching the bladder.

Doc says we can do it again to obtain a better result. Well no, no, no, no.

I am still using finasteride daily so can urinate without a catheter. For that matter I haven’t had to use a catheter since starting finasteride save post procedure. I believe my urinary problems at present come from the intrusion of my prostate into my bladder causing a wait for the other lobe to empty and discomfort from low volume of urine.

I told the doctor I had prepared a negative review of the procedure. He admonished me that I may prevent some people from getting needed care. I feel that an informed decision is better than a guess. I couldn’t any information relative to the results of the procedure on very big prostates before I had mine and I know now that I needed to have a conversation about accounting for size on the first attempt. My impression is that an adjustment to spacing could have improved the outcome.

If necessary I will go back to catheters before going through another procedure.

When your doctor tells you he’s not a god he doesn’t believe that.        

 

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18 Replies

  • Posted

    Thanks so much for your post - amen and amen and amen!! I also have a large prostate like yours and my uro wants to do rezum. Please know that your post saved at least one more victim. Thank you and all the best to you. Howard
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  • Posted

    Thanks for sharing. I've read that HoLep is more effective for very large prostate. Also, the hole that was left after the procedure is called false passage and should be looked into, if you need to be catherized in the future. Hank 

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  • Posted

    My god you have been thru the ringer and then you have poor results He should have know the size and shape of the prostate before he did it.  I can't believe he want you to do it again.  Stay away from him.  And you are right by telling your story.  Men need to know what is going on good or bad.  Take care and i hope all works out for you  Ken 

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  • Posted

    Did they not do a scan in addition to the cystoscopy?   I am really surprised that they did that procedure without a general anesthesia too.  For some reason, my doctor insisted on my being out patient in the hospital for even a urethrotomy to relieve a stricture.   Those are real differences in standards of care in my humble opinion.

    By the way, your writing is excellent.  Beats reading the opinion section of the morning paper.

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    • Posted

      I meant to add that I was also under sedation for even a short urethrotomy procedure, so that I had no consciousness about what was going on.
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  • Posted

    How many opinions did you get before you jumped into this?
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  • Posted

    You should’ve had prostate artery embolization with that large of a prostate. You should contactMy doctor Dr. Bagla who did my procedure and also pioneer this in the United States
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  • Posted

    WOW, what an incredible story and thanks so much for your detailed post.  I'm scheduled for REZUM mid July and this will definitely make me rethink it. I can't believe that your Dr attempted to dissuade you doing your post. I view it as incredibly helpful and one of the best posts on this topic. Thanks & God bless.  I hope your doing better, 

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    • Posted

      Ron.  I'm happy that you are going to rethink your decision.  Have not heard of to many that worked lately not saying they don't.  Did your doctor tell you if it does not work to clean up the damage that you have to have a Turp There have been 5 so far that I have heard of.  The men did not want a Turp that is way they picked the Rezum.  But it seam to me a little funny.  A procedure you wanted to stay away from you end up having to repair the damage from another procedure.  Seams like there working together????.  Good luck  Ken .          

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  • Posted

    Thank you all for your comments and suggestions. You made the effort well worthwhile. I don't like to snivel but my doctor must have been an outstanding debate club aficionado because my concerns have always been met with deflection. I am on Medicare and have learned not to expect much from providers. My capacities being somewhat diminished leave me more accepting than in my productive years and I've well learned beggars can't be too choosy. Keep the shiny side up!   

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    • Posted

      You will get that form some doctor not all.  I am on WellCare which is Medicare.  I had the Urolift done 3 years ago and my doctor will do anything he can to help me.  I can see him anytime and if I have any questions All I have to do is e-mail him.  And he get's back to me either by the end of the day or the next morning.  I have also ask him many questions for some of the men on here and he has never said he does not have the time.  Take care and take it easy  Ken  

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  • Posted

    Fats13, My sincerest regrets for what you've gone through and my Thanks for sharing your experience.  It's obvious you aren't willing to share the name of your Uro Surgeon but I certainly wish you would share Your Country and probably State as Your Post read as if You are in America. If You happen to reside in my State, I can hopefully weed out this Surgeon!  Being in my 70's and dealing with an enlarged Prostate, I'm not looking forward to the day when I may have to have one of the current procedures.  Your Surgeon seemed to lack an "Empathy Gene" if his biggest concern was someone may elect to NOT have this specific Procedure.  (There ARE more than one!)  And TWO WEEKS before a Follow Up following this Procedure on such an enlarged Prostate and having had Problems for over 25 Years?  Is He insane in addition to appearing to be incompetent?  What age is this Surgeon?  And in my opinion, You are fortunate not to had suffered possible Kidney damage to the straining/blockage you were experiencing!  Hope you are on the road to a miraculous Recovery!  Ernie

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  • Posted

    I live in San Bernardino, California and the doctor is a personable man of middle age.
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  • Posted

    It sounds as though he may have just flat out botched it. Large prostates can respond well to Rezum, but you had a ton of bleeding and that kind of bleeding for that long isn't normal. You might want to find another URO and see if there is anything short of another Rezum that might help. Holep might be a good option, particularly since RE is the least of your concerns and not currently relevant. Take note that the recovery from Holep can be long, but the results (when in good hands) are usually quite good.

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    • Posted

      A lot of negative talk on REZUM but not much mention lately of FLA.  I'm still considering FLA.  Have there been any disaster results described on this blog from FLA?

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    • Posted

      Good morning Jerry.  The only thing I know is Dr. K. is doing trials and he will be publishing the results by the end of the year.  It's been about 2 month's that anyone went for FLA.  I hope they come back and tell us how they are doing  Take care  Ken.  

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    • Posted

      Jerry like I said before there has been no one on for about 2 months. For awhile it seam like every day there was something.  If I remember we had about 22 men in the last year good result only one it did not work and he had to go for another.  Only 1 men had retro. But i could be wrong.  I hope the men that have had the FLA keep coming on.  It is good to know what is going on with all the procedures.   
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