The Rezum procedure and BPH

Currently, the Rezum procedure is not technically reimbursed by most Medicare plans  (although some urologists will bill using the Unlisted code successfully.)

The role of stricture after Rezum has not been extensively tested as far as I know; I wouldn't think the rate would be significantly high. Urolift would have a minimal if any increased risk of stricture.

Everyone's prostate is different; In your case, without a median lobe, a Urolift may be a less invasive first line approach, although I would still recommend a cystoscopy and possibly urodynamics evaluation first.

That's a great question, and not something I have off the top of my head.

I can tell you that our incidence after Urolift is effectively zero- which makes sense given how the procedure works.

The Rezum procedure will have less of this than a standard TURP procedure, as the ducts are not typically treated directly. However, as the steam may extend around the capsule, I would never assure anyone a 0 risk of retrograde ejaculation (or anejaculation).

I generally recommend that my patients not have interest in continued reproduction prior to doing this procedure (even though that, even in the worst case scenario, sperm could be harvested for IVF afterwards.)

Thank you for your candid and frank answer.

Outside of the reproductive issue, I always advise men to do a trial by Tamsulosin (or similar) to experience retro first hand so they know exactly what it is.

Many men here report that either their uro's didn't mention retro at all as a side effect of prostate reduction surgery, or they assured them that their orgasm function will remain intact, which while technically accurate can be very misleading, as can be evidenced by the surprise (and sometime anger) when these men shoot unexpected blanks after the surgery.

I don't think it's up to the doctor, or any of us here, to either minimize or scare men about retro, but I do think men have a right to experience it beforehand so they can draw their own conclusions. That, and to be offered alternative procedures like you do, should they not tolerate retro very well. 

Jim

I believe tamsulosin should be tried in just about every case; it is cheap (generic) and usually has some level of efficacy. It also allows one to guage for potential side effects. For anyone who is not happy with the retrograde ejaculation, I would recommend against most procedures (except Urolift.) I would also recommend switching to alfuzosin (another generic medication) if they would prefer not to have a procedure, as the incidence of this problem is less with that medication.

JerseyUro,

I was specifically refering to a "trial by Tamsulosin" to preview retro for a prospective candidate for bph surgery so a more informed decision could be made. Outside of Urolift, do you ever offer men the option of self catherization (CIC) either as a solution or to extend their watchful waiting period. That was my choice three years ago when there weren't really any ejaculation preserving procedures being offered. 

Jim

CIC is always an option.

It is great for

1- Men who have limited bladder function (and, hence, prostate surgery likely won't work completely)

2- Men who are in retention and are waiting for procedure

3- Men who may go into retention after a prostate procedure

4- men who are not well enough for treatment, or don't want treatment for some other reason.

JerseyUro,

Glad to see you understand and support CIC. I probably fell into "#4" when I started CIC three years ago when my doc recommended TURP.  

Then, as they say, a funny thing happened, and I was able to rehab my bladder to the extent that I went from near acute retention (PVR of 1.5 liters when I started) to where I now rarely have to CIC with acceptable PVRs, often below 50ml. 

I don't claim that my bladder rehab is typical, or that anyone can do it. But I did, and my situation is not unique. 

So I would add to that list, 5. Men who are motivated to attempt bladder rehabilitation in lieu of surgery. 

#6 might be: " Men with retention who want to extend the watchful waiting period for a number of reasons including waiting for better and newer surgeries and procedures".

Jim

So in a way your saying that we don't need it because we are older and not having kids.  But what if we still what it..Ken

Well I certainly wouldn't go that far.

I would say that pretty much ANY procedure performed on the prostate has at least a small risk of ejaculation issues; the conventional TURP certainly has a higher risk than most of the minimally invasive procedures, but I would hesitate to say that anyone would claim "100% normal ejaculation" after any sort of procedure.

The challenge is deciding what level of risk of this is acceptable to you.

Some are bothered by this and do not want to accept this risk, regardless of how small it is. Some don't mind the risk. It is an individual decision that everyone should discuss with his physician when making an informed choice

Thank you for the queck answer.  Yes every man has the right to have any procedure he want but I feel it should be ajusted to that person.   There are so many doctor that do not consider the ejaculation a sexual function.  They all ways tell you everything will be the same but the male ejaculation is not tallked about  We have had men on here that have been talk into turps and GL and when they come up with retro and tell the doctor Some have them well your not have kids and there less to clean up and then laugh.  To me that is not funny.  That orgasm your having goes with that ejaculation.  If you lucky anough to feel the orgasm you still feel the pumping and it feel incomplete.  Some men take this very hard. Last year I went into retention and all that was coming out was blood ended up having bladder spasms that hurt like hell  I could not move because they would start.  I had to have emergency surgery  It was not my doctor and I would not sign the paper until he sign a paper that my prostate was not to be cut for any reason.  Turned out to be 3 blood clogs on my prostate.  He burned them an I was in the hospital for 3 day with a 3 way catheter for a flush of the blood.  I will fight for my prostate no doctor is going to tell me that cutting some of it out is going to make be pee better.  I will force myself first.  My doctor knows how I feel and he will do anything to help me.  Thank you for your time.  I sent a e-mail to you about the 2 men that had only the one side done ( right side only )  I think if the men can still get relief from that.  They both pee better and no retro  Thanks again  Ken

And it also avoids 'floppy iris symdrome' for patients whe later need cataract surgery.

Doc, First of all, thanks for enlightening all of us.  You mentioned the Urolift procedure.  I'm making some basic assumptions about it that may not be accurate.  For example, even though it's an oversimplification, the procedure itself is analogous to pinning-back-the-drapes. I get it.  However, we're led to believe that we can stop taking 5-AR inhibitors.  While the urethra is widened, isn't there a potential for further prostate growth, given the fact that the medications that initially controlled for this hyperplasia are no longer being used?   To my (erroneous?) thinking, does this procedure create more longt-term problems than it solves? And does your group do Urolifts as well as Rezums?  Please advise and thanks again.

Hi Alan;

you are largely correct in the analogy. It shouldn't create more problems, as theoretically, even if the prostate grows, it is still "tacked" out of the way. However, we do not have long-term data beyond 3-4 years or so, as it is a new procedure; how it fares in 10 years is difficult to predict. My group does Urolift as well, and has done several hundred at this point.

Alan  I had it done and its over 2 1/2 years and it great.  It does the same thing any of the cutting procedure do Make a tunnel. Which the urolift does with no cutting  I would have it again  Ken

Appreciate your input, kenneth1955.  I'm giving serious consideration to having it done, and I'm definnitely going to investigate further into the Jersey Urology Group. 

Alan,  get Kenneth to tell you about the problems he's had with urolift, like when the pin came loose and floated around his body, putting him in agony.  

Alan  What JJJJ is refuring to is a year after I had it done my doctor was checking my stricture.  That was fine but one of the implants came lose  I did not even know  I did not feel a thing until my doctor tryed to hook it back to my prostates he had to stop it hurt to bad.  Had a new one put in 2 weeks later  My prostate got smaller and the other 3 had to be tighting All has been fine and I would do it again.  If you have any questions feel free  Ken     PS  To me that was not a problem  He told the company that do the urolift and it was put into the research papers

Kenneths version today is very different from the horror story he told a few months ago.  By the time he got to the hospital he was in dire condition.   Go back and see for yourself.  

@jjj..."Kenneths version today is very different from the horror story he told a few months ago...

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So which version is most helpful? I can think back to when I started self cathing. Had I posted at week 1, probably would have scared a lot of people away. But looking back, it was a minor, short termed glitch, and I can say with certainty that it was one of the best medical decisions I made. But thanks for point that out, because sometimes the real time take is also useful. 

Jim

 

Thankfully, the vast majority of men who have had the procedure are quite pleased; if they weren't, there would be an investigation/removal of FDA approval!

If you go back that emergency surgery I had was not caused from the urolift it was going back on my blood thinners to soon after surgery.  Ken 

Your comment attracted my attention because I am dealing with a recently discovered stricture.   Doc recommends urethrotomy and simultaneously doing urolift since no median lobe and prostate is 60 grams.  Comments appreciated.

I am also going to see a surgeon on Friday who specializes in urethrography. Not interested in THAT, at this point, but think some imaging would be right before I do anything.  Alternatives for my stricture seem to be urethethrotomy and subequent use of catheters if necessary, or urethreograhy.  My situation is by means acute and at this point, I could do nothing for awhile.  My primary complaint is the need to get up every 1.5-2 hours every night.  Daytime is manageable, although need to urinate almost immediately if there is a surge, to prevent leaking. 

Stricture disease often confounds this; it really depends to what extent and size your stricture is; was it merely a narrowing, or, say, a 3 cm long pinpoint stricture with scar tissue? The treatments vary considerably; a retrograde urethrogram (a radiological test) can usually give some good indications regarding this.

We have performed Urolift with men with minimal stricture disease with good results; The nocturia (waking up to void) may not be related to either issue (stricture or prostate), however.

Richard where is your stricture.  That surgery is hell you have to watch  which one is he tell you that you need.  End to end or graft  Let me know.  Ken

Please elaborate on your last statement---nocturia may not be related to either stricture or prostate---thank you.

Also, a doctor I recently spoke with claimed I HAD to have stricture problem dealt with befoe tackling BPH problem. Your comment sugests this is not true.

There could be underlying bladder dysfunction- this often occurs after having prolonged bladder outlet obstruction (the bladder function changes to compensate for having to work harder).

It could also be due to undiagnosed sleep apnea, cardiac disease, or diabetes (including borderline cases.)

There are many different types of strictures.

A long, dense stricture would likely have a very different type of treatment vs a 2 mm 16 french "narrowing". 

Jim, how did you rehabilitate your bladder?

Dear Jerseyurology, for a 25grm gland with mod to severe IPSS, which  would you recommend out of the gate? Urolift or Rezum? thank you.