The Rezum procedure and BPH

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Hello;

I represent a large Urology practice in New Jersey.

I have been notified that there has been a lot of interest in new procedures for the treatment of symptoms caused by an enlarged procedure.

My group has substantial experienced with many procedures for this condition, including the "Rezum" procedure (we have done over 100 cases at this point and are one of the most experienced groups in the world at this point.) I wanted to offer any information and answer any questions anyone here might have about this (or any other) procedure for BPH (Benign Prostatic Hypertrophy.)

 

Thank you.

 

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  • Posted

    Do you know the difference between a procedure and a prostate?
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    • Posted

      This site does not have a spellchecker now or auto correct. I often use Word to write my comments or questions to avoid appearing too stupid.

      The Moderator said that the spellchecker could mot cope with names of medical conditions or drugs.

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    • Posted

      @derek: The Moderator said that the spellchecker could mot cope... 

      ----------------------------

      What's the name of your spell checker. I'm looking for a good one smile

      Jim

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    • Posted

      Jim and Derek.  I don't think there is a spell check on here I wish there was I could use bigger words.  Most of the time all the procedure go together in some way so we are on the same subject.  Been out of school for a long time.  Spelling was never my thing.  Take care you guys and have a great day  Ken   

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  • Posted

    What do you feel are the greatest factors that have an effect on the outcome in different patients? Does the skill of the practitioner play a major role or is it such a simple procedure that almost any urologist should have the skills to be successful?

    What is the rate of success at your NJ practice as a whole?

    Thanks

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    • Posted

      While it is a relatively simple procedure for experienced urologists, I believe that number of cases never hurts; the Rezum procedure is new, but fairly similar to a procedure that urologists have performed for well over a decade (Prostiva.)

      The vast majority of our patients have been delighted by month 6 after the procedure; most of those who aren't have underlying bladder dysfunction (which is why I generally recommend bladder testing prior to the procedure.)

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  • Posted

    I've already had a PAE procedure and it was unsuccessful because my large median lobe is still blocking the neck of the bladder. As a result I'm self cathing 4-5 times a day. 

    Does the Nezum shrink the median lobe?

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    • Posted

      This sounds interesting. I have some other questions:

      1. Can the median lobe always be reached and treated?

      2. What are the potential side effects and percentages of those side effects?

      3. Out of the 100 patients that your practice has treated, how many reported what they themselves defined as success?

      Thanks.

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    • Posted

      1- I will never say "always"; technically, Rezum is generally recommended for glands less than 80 g; we have had some success treating as large as 130g so far. However, If you can "see" tissue, you can technically "treat it".

      2- Virtually all men will have some irritation with voiding for the first few weeks; some will continue for 2-3 months. I cannot give exact percentages, but somewhat fewer than 1/4 will likely have retrograde ejaculation; erectile dysfunction is a risk, but we have not seen this yet; urethral stricture would be another risk that we have not seen yet.

      3- Most will be defined as "success" that their AUA symptoms score will improve by at least 5, and their flow will increase by at least 5 cc/sec. I don't think that we are unique in this aspect compared to other high volume Rezum practices.

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    • Posted

      There is currently a "large gland" trial for glands larger than 80g.

      That being said, if a urologist feels comfortable, he is free to treat a larger (or smaller) gland. We have had good success, but I would not consider that the "gold standard" at this time; as my professors always used to tell me, "the plural of anecdotes is not "clinical guideline", (meaning, just because a few people have had success, doesn't mean it's the definitive treatment for you.)

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    • Posted

      unckle, I also investigated Rezum last year and my uro said the same. He measured my prostate by ultrasound at 125g (3T MRI measured me at 98) with a large median lobe. After a (quite bloody) cystoscopy, he said my propensity to bleed would impair his ability to see during the procedure, particularly since I would require a large number of 'sticks'. The company itself recommended 5mg finasteride for a month to reduce the bleeding. But after reading some forum accounts on some of the Rezum failures and experiencing the horrendous sexual side effects of finasteride, I went back into watchful waiting mode with a keen interest in MRI guided FLA. 

       

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    • Posted

      The largest we treated (I believe) was 125 g. The procedure took 12 minutes (the average for a Rezum is usually closer to 5 minutes) and the patient had a catheter for about a week; He was readily voiding after the first week. After 1 month, his flow rate was normal (15 mL/second) and his AUA symptoms score was under 7.

      We will obviously need to perform this on more larger glands, but early results seem promising thus far.

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