THE JURY IS STILL OUT

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My name is Vern and my initial dilemma was a choice between the HoLEP method of BPH treatment and REZUM. The doctor that would have performed the HoLEP moved from one medical facility to the Mayo Clinic and unfortunately, the Mayo Clinic would not accept Medicare. I suppose I could have searched for another doctor that performed the HoLEP treatment but I was in a hurry to get some relief, plus, the REZUM treatment seemed less invasive and tissue traumatic. Therefore, I went with the REZUM.

I had the REZUM performed on 10/15/2019. Contrary to the advertisements, the procedure itself was not exactly a walk in the park. Besides being very uncomfortable (to be expected) the pain of the needle and injection of water vapor into the prostate through the urethra was quite painful. I did not enjoy it at all and afterward thought I would not choose to go through that again. I honestly think that the level of pain one experiences from the procedure justifies at least a twilight sleep, if not general anesthesia. The procedure lasts only about five to ten minutes so putting someone under for that period of time would not be that harmful, in my opinion. After the procedure, my urologist put a catheter in place. I was instructed to remove it the third day post surgery and revisit the urology office for a flow test.

On the third day post surgery, I removed the catheter at home and drove to the urologist who was about an hour and a half away. On the way, I developed an urge to urinate that was so strong that I pulled off to the side of the road but could not urinate even a drop. I got back in my car and continued my journey to the urologist. I felt like I was going to explode. I was torn between getting off the road again but the thought of loosing more time and not being able to urinate anyway kept me moving forward. When I arrived at the office of my urologist, I skipped the check in procedure and walked into the back room without being called. They took me right in but unfortunately, the doctor was in surgery and I had to wait in what turned from significant urgency to significant pelvic pain. Luckily, the doctor was not too far away and he eventually arrived to reinsert the catheter. What a relief. For that reason, I would not advise anyone to remove the catheter themselves after RESUM, unless you are very close to the office of your urologist and very close to your appointment time.

My doctor said the lack of ability to urinate was normal and that I should not be worried or lose patience. We set yet another appointment for a flow test in another four days but this time, I waited to remove the catheter until I was at the office of the urologist. I wasn't about to go through the discomfort I went through the last time I removed it myself at home. It was now a full week post REZUM surgery and I was again at the office of my urologist. I removed the catheter in the waiting room lavatory and waited for my appointment time, which was in about an hour. During that wait, I drank a sixteen ounce of bottled water and by the time I was called in, I was in distress again because I could still not expel urine from my bladder. Once again, my urologist inserted a catheter and once again I left the office disappointed that I could not urinate on my own.

This time, I made another appointment a week out, which will be exactly two weeks from the date of my REZUM surgery. I am crossing my fingers that I will be able to urinate on my own by then. My urologist is hopeful and encouraging that this will be the case. He continues to say that my inability to urinate on my own, at this point, is normal. That's not what all the REZUM advertisements said.

Having a catheter is quite uncomfortable to say the least. I experience a constant urge to urinate and I have bladder spasms that are very painful, lasting anywhere from 30 to 45 seconds. When the spasms occur, urine pushes past the catheter and out the penis so I have to hold a paper towel over the tip to catch the urine, unless I happen to be at a toilet when the spasms happen. Additionally, urethral itching ensues, after the spasms and lasts for sometimes hours afterward. A heat pack gives me some relief. In the mean time, more spasms and continued itching can occur. I asked my urologist about self catheterization but my urologist did not want me to do that at this juncture. It would have made it so much easier than having a catheter in place but what's a little bit more inconvenience and discomfort, right?

I will be returning to have the catheter removed in another week (two weeks post REZUM treatment). After that, I will report on whether or not I can urinate on my own, two weeks post treatment. Until then I will suck up the discomfort, pain and inconvenience of the constant urge to urinate, the urethral itching, the bladder spasms and the leaking past the catheter. I will keep you posted on the long term outcome but for now I can say that I probably should have found someone who could do the HoLEP and left the REZUM treatment to the guinea pigs. The saving grace is that the REZUM treatment is so benign that it still allows for other treatments like TURP and HoLEP to be performed. Therefore I am hopeful that one day, I will be able to urinate on my own again.

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  • Posted

    You should be fine - this is yet another example of why self cathing after Rezum is generally a better option. You can live normally and slowly regain function, rather than having to live with a Foley for potentially weeks at a time.

    Once you can pee on your own, you'll be out of the woods.

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    • Posted

      I agree - Vern, you may want to look into CIC - it wasn't an issue for me, though we are all different. Personally, I feel better now knowing how to do it and should the need arise, I will be able to get immediate relief vs going to the emergency room.. (which I've done twice - the pocket catheters are a LOT cheaper and easier).

      Good luck.

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    • Posted

      Tim-B Thanks for your input. I think I am going to ask my urologist to send me home with some catheters so I can start using this method instead of relying on the Foley. With each response I read to my initial post, I am reassured that I will get past this rough spot in the road and arrive at beneficial results. Thanks for your input. Be well.

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    • Posted

      Oldbuzzard Yours, among other responses to my original post has been helpful and reassuring. I appreciate all the responses I received and I thank you personally for your input. Be well Oldbuzzard.

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  • Posted

    Hello, Vern:

    Sorry to hear your troubles. I can't speak to your procedure, but I can add some suggestions to the spasms and catheter discomfort:

    1. Spasms. After experiencing multiple sessions of acute retention, and runs to the ER for relief because my bladder was about to bust, a young ER nurse told me that bladder spasms can occur when the overly stretched bladder is emptied too fast once the catheter is inserted. She said the nurse/doctor needs to relieve the pressure with a stop/go approach. Let a little out, then clamp the catheter hose, then let out some more, etc. The slower release will help the expanded bladder re-adjust after being overly stretched. She tried it on me and I had no bladder spasms, for which I had before when someone else emptied me too fast. Those spasms are terrible!
    2. Catheter Discomfort. I lived on a foley bag most of the 2018 summer. The first thing I did was yank off the hose clamp that they stick on the inside of your leg to hold the catheter hose. We are all built differently and that device limited my mobility and was constantly gigging my penis every time I moved. Instead, I used painters blue tape and ran a piece around the hose to capture/secure it to the tape (away from the end of my penis), then stuck the remainder sticky part of the tape on my upper hip. This way I could move. Plus the painter's tape stays on real good in showers, etc., and then you can redo the tape when needed. Next, I used sport headbands to secure the foley hose around my leg. This way the hose is not flopping around. Lastly, I went and got some KY Gel (not liquid) and kept the end of my penis and catheter hose coming in plenty lubricated so things could slide without chaffing and rubbing you raw until you bleed. If you are a boxer shorts wearer (like I am), I folded a pair of cotton briefs and set them inside my shorts for added comfort. Everyday when showering, I washed it good and then reapplied more KY gel.

    This all helped me. Perhaps others have different suggestions.

    Dave

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    • Posted

      Dave: The time you took to explain you method of handling the Foley is greatly appreciated. I will try your methods to see if this helps. As you said, everyone is different and experiences different results so all we can do is our best to make ourselves as comfortable as possible. Much thanks to you for your response. I hope you are doing well.

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  • Posted

    Ok hang in there sir:

    I also had Rezum on Aug 15 th.I had a cath in for 5 days after the procedure and then removed. I was urinating ok until i also started having problems,dribbling urine, blood and urgency.I almost went to the ER but then pushed some tissue out and started to urinate again with blood and tissue still coming out. Then in another 4-5 days i was stopped up again and could not urinate at all.I ran to my urogolist office and he showed my how to self cath which blew my mind since i never seen a cath before and the 14 inch tube i had to insert up my penis.This lasted for about 4 days when i tried to urinate before self cathing and the amount of tissue that came out of my penis looked like i blew my brains out. Lots of blood and tissue.Since then it has fingers crossed no more problems except maybe my bladder is not use to emptying and have a little urgency when about to urinate. I am sleeping through the night or at least 5-6 hrs sometimes more even after a night of playing pool and 5-6 beers.It's been 2 and 1/2 months and i also in the beginning was regretful for doing the procedure and had the same experience with the pain of the procedure,but for now going forward satisfied with the results as i said fingers crossed. Sex is still good which is the main reason why i chose this rezum procedure.

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    • Posted

      Frankieyes I can't tell you how much the responses I have been receiving to my initial post have eased my concerns and yours is no exception. Thank you so much for the input. I am more reassured than ever that I will eventually get past this and that the procedure will prove to be a success. My doctor said he is satisfied that the procedure went very well and he expects me to benefit greatly and says I made the right decision to have it done. Again, thank you for taking the time to respond. Be well.

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  • Posted

    Vern,

    Not to worry. It is very early yet. REZUM is a good procedure when done by a skilled, experienced doc on an appropriate prostate. Too bad your doc will not teach you CIC; the Foleys are very uncomfortable on a long term basis. I took mine out after two days and then did CIC the rest of the time. It took about 2-3 weeks before I could pee at all and then it was just a little bit ---- I still had to cath to empty completely. As time went on, I peed more and cathed less and this went on for about 6 weeks. I had the bladder spasms too. They went away after a couple of weeks.

    Fortunately, my doctor (Kevin McVary, Loyola Chicago) advised me against having the procedure with local. I had twilight, so was spared the pain of the procedure itself.

    Don't be surprised if you start to pass blood and/or clots after 6 or 8 or even 10 weeks. Maybe on several different occasions. That will be the old, dead tissue sloughing off. Check with your doctor though.

    At this point, it's too early to decide that the procedure didn't work. Hang in there; chances are everything will be fine. Let us know.

    Best of luck,

    Fred

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  • Posted

    Light1 I can't tell you how welcome and reassuring your comment was to me. I am encouraged to hear what you had to say. I am a type A personality and patience is not one of my few virtues. To hear you explain that you have essentially gone through what I am now going through and made it to the other side is music to my ears. Thank you for responding with such encouraging information. If I ever have this done again, I will most certainly request (and if I have to, demand) twilight sleep for the procedure. Again, thank you for your response.

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  • Posted

    Hi Vern,

    My comment is made in hindsight as you've already had a treatment.

    The Medicare website shows the Mayo Clinic as a participating hospital.

    I speculate that you have a Medicare Advantage plan which Mayo would not accept.

    Once a year during the open enrollment period one can move between Medicare original and

    Medicare Advantage.

    Anyways, wishing you a speedy recovery.

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    • Posted

      T800 Thanks for your input about Mayo Clinic. I think I just got one of those typical individuals that didn't feel like doing her job the day I called. Recently, I just couldn't accept the fact that the Mayo Clinic wouldn't accept Medicare so I called again and spoke to yet another woman who was very helpful. She confirmed that yes, the Mayo DOES accept Medicare and my CIGNA plan G supplement but that I might end up being billed a few dollars. When I asked if she really meant a few hundred dollars, she told me that she meant literally a few dollars. That, I can handle. It pays to call back and speak with someone else sometimes, when you don't get the answer you are looking for from the first person you contact.

      Vern

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  • Posted

    Vernon,

    .

    As I tell anyone who plans to have a Rezum, you should know how to self-cath before you have the procedure. Your urologist should have gone over this with you when you decided to have a Rezum. Many do not do this though.

    .

    I had a successful Rezum at the end of November 2018 so I am going on 11 months post-Rezum now. I had 10 injections (4 per lateral lobe and 2 median lobe). My Rezum was easily tolerated and I went out to lunch afterwards.

    .

    My Rezum recovery followed the common schedule. At 2 weeks, my Foley was removed but I could not pee so I self-cathed. At 4 weeks, I started to open up and by 6 weeks I was peeing OK. By 3 months, I was completely opened.

    .

    Because of bladder damage, at 3 months my PVR's were 150 ml. Now 11 months later they are below 100 ml which is OK for my age. My IPSS went from 28 or 29 to 8 or 9. The way Rezum works, you need to give it time.

    .

    Report back here at 4 weeks to 6 weeks so we how you are doing. It is still too early.

    .

    Steve

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    • Posted

      It will be four weeks this coming Tuesday that I had my REZUM treatment. I am peeing on my own now, although the stream is still a bit weak. Sometimes, especially at night, the stream starts and stops about three times before I feel I am done peeing. I still get up four to five times a night but at least I can actually pee until relieved. Before REZUM, it was at the point where I wondered if I would have to go to ER to get relief. Luckily, I started peeing after about three minutes. During the day, I don't have to go as often now. I think I am getting better. I still expel blood on initial stream but the spotting in my underwear is lessoning. I will report again after another month. I'm looking forward to the three month point, which is where I am told I should experience the most benefit from the procedure.

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    • Posted

      Vernon,

      .

      Report back at 6 weeks as a lot may happen soon.

      .

      I 1st opened up at 4 weeks and it was similar to you with a series of starts and stops before I felt like I was done peeing. Over the next 2 weeks, my streams got stronger between the stops.

      .

      I was only peeing 1 time overnight, but I was self-cathing to completely empty before going to bed. Supra-public tapping over my bladder with my fingers, help to stimulate and prolong the streams.

      .

      Also at about 4 weeks my bleeding stopped.

      .

      Good luck to you,

      .

      Steve

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