Rezum resection on a very large prostate

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.        

0 likes, 18 replies