Rezum then Urolift - what I've learned (it's plenty)

Big picture after my own experience and reading others and perhaps this is an oversimplification but hopefully useful.

If your procedure of choice did not go well, then:

1. 1/3 of the time you were not a good candidate for the procedure - this could be for a variety of reasons - size and shape of your prostate, issues with your bladder, etc
2. 2/3 of the time the procedure did not go well. This could be as simple as you moved a little, or the surgeon was ineffective. Unfortunately its very difficult to find out if a surgeon is any good at their job here in the US. Many will perform just about any prostate procedure offered. TURP - lets roll. Rezum absolutely. Urolift why not. Green light lets give it a shot.

My experience:

1. I was seeing a urologist for about 5 years went through a few types of medicine then settled on alfusozin because of its effectiveness reducing symptoms and tolerable side effects. I used Flomax but it gave me retrograde ejaculation. Any one tells you its no big deal never had a proper orgasm. When it was time to move past drugs and discuss surgical options he went straight to TURP and wasn't happy when I was asking questions. When I asked him about retrograde he said he wasn't a big deal. I asked him if he ever experienced it and he said no, I told him I had and its a huge difference. I'm 60, otherwise very healthy and not ready to give up that just yet. So on for a search for another urologist. I'll spare you the details but one guy was arrested for solicitation of a prostitute and was charged by The State Attorney General of very shady business practices, And he was still practicing at the time!!! Google my friends, Google.
2. After researching Rezum and UROLIFT I decided on Rezum. The recovery was going to be longer but I was trying to avoid having implants. Both seem close in effectiveness when you look at the literature, with no unwanted sexual side effects. My prostate is about 60 grams and was a candidate for both. I settled on a urologist who was doing Rezum and went forward. Big mistake. The place is a mill. No follow up, and I needed it. I was hospitalized from what I guess was the antibiotic but could have been the anesthesia too. Evidently I was twitching during the procedure and have no idea what they did (if anything) to get me to stop doing so. I asked for the records but no one would return my calls. When I called the after hours number before I went to the emergency room I left a message. After abut 30 minutes someone called back and asked me if I could"tough it out" for a few days. At the time my GI system basically shutdown, I was vomiting and had the worst headache of my life. The ER put me on morphine and a bunch of other medicine then admitted me right away. I also had two bouts of Prostatitis and couldn't get an appointment. There is plenty more detail , but I'll never likely do an outpatient procedure for anything that requires anesthesia again. After what I experienced next go ahead I'm surprised they didn't give me an infection too. More on that later. Bottom line, after 6 weeks of bleeding, two nights in the hospital, pretty severe pain, no symptom relief , and a physician who seemed to think he did his bit it was time to move on. Oh yeah, they sprung an anesthesiologist who didn't accept any insurance right before the procedure. Classy.
3. Finally what appears to be success. Went urologist shopping again. This time settled with a Director of Urology at a major teaching hospital in Philadelphia. He showed me via the Cystoscopy that my prostate was still blocking my urine stream and also showed my the issues with my bladder. BTW have the urologist show you realtime when they are looking at your prostate. Its a great education about what is going on. My bladder isn't too far gone but its not pretty. Make sure your urologist does Urodynamic testing too in order to see what shape your bladder is in. I did have this at Dr. #1. If they aren't doing this and want to jump right into a procedure its time to find another Dr. because all they want is to give a procedure. After discussing HOLEP, TURP and Urolift I opted for Urolift. He was very upfront about the pros and cons of all of them. Talked about retreatment likelihoods, side effects, likely impacts to continuing medicine and recovery timetables Didn't rush me at all and openly discussed his experience with each. He also added myrbetriq along with the alfuzosin. It did help a fair amount. I'd never heard of it. On to procedure day which was yesterday. The procedure was done in the hospital. They had me get a MSRA test first and had me use a wash to kill bacteria on my genitals three days before the procedure. I had three calls prior to the procedure; 1) making sure I was getting my blood work, 2) outlining my out of pocket (including the anesthesia), 3) what to expect that day and for the recovery, and medicines and foods to avoid. On procedure day they had me wipe off my body to kill bacteria and used a nasal swab to kill MSRA. This way there was no need for an prophylactic antibiotic. I had a team of people explaining to me what was going to happen in great detail. There was even one person whose role was to basically make certain the surgeon performed the service he was supposed to. Three implants were placed on one side and two on the other. I went home with a catheter with instructions to remove it the next day. He added Pyridium to help with the pain as well as instructions to take Tylenol as needed. When they removed my catheter from the rezum therapy it was pretty painful, so I was prepared for the same. This time it practically came out itself after I deflated the balloon. Not sure how that can be? There was blood in the bag that abated about 8 hours post procedure. I'm urinating just fine albeit with a sense of urgency, relative frequency, and some minor pain (way less than my experience with Rezum). This is be expected. He said three weeks I should be pretty good and may need a week or two more before I really feel the impacts. He also said it will take about a year for my bladder to regulate so should he is hopeful that I should expect continuing improvement throughout the year.

Hope this helps you with your journey. There isn't a one size fits all approach and some outpatient facilities could be incredible. That just wasn't my experience. Be educated, research the physicians, ask questions and check to see who will be doing the anesthesia then ask to speak with them before the day of the procedure. Find out if they are in network and asked everyone for an estimate of your out of pocket. Also check your plan if they require preauthorization (they probably do. Urologist #2 wasn't going to get the pre-auth until I hounded them). 50% of bankruptcies in the US are because of unpaid medical bills (those reading this from other countries may be shocked by that - Americans too). Its your body and your money. Do what's right for you.

Best of luck. Stay well.

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