1. Community
  2. Men's health
  3. Prostate Problems

The Rezum procedure and BPH

Posted , 28 users are following.

JerseyUrology
JerseyUrology

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.

 

4 likes, 305 replies

305 Replies

Prev Next
  • richard_39772
    richard_39772 JerseyUrology

    Posted

    Thought I had a stricture problem that had been diagnosed when cystoscope did not pass through.  This AM  a stricture specialist found I JUST had an enlarged prostate  ( She did a retrograde urethrogram, passed an "8" catheter into bladder, pumped in contrast fluid, etc. and did a cystoscopy,) Had a green light laser 12-15  years ago. No clear answer to "best" procedure to do now ( green light again or TURP, or ????.   What do you think?

    My symptoms are bothersome but not severe.  Frequent need to urinate at night is probably my major problem.  Second issue is daytime urgency with  sudden need to urinate or I will leak.

     

    • JerseyUrology
      JerseyUrology richard_39772

      Posted

      I recommend urodynamics to better study the bladder function.

      Is there obstruction?

      If so, then a procedure on your prostate may be warranted.

      Is there a different irregularity in the bladder function?

      If so, then an anticholinergic medication or percutaneous nerve evaluation of the sacral nerves may be warranted.

    • jimjames
      jimjames richard_39772

      Posted

      Hi Richard,

      What are your natural void volumes? Do you know your PVR (post void residual)? What did the cystoscopy report say? Have you ever done a void log to see what per cent of your voids are daytime versus night time? 

      What the JerseyDoc says makes sense regarding urodynamics. You want to get a proper diagnosis before moving forward.

      Jim

  • brian34488
    brian34488 JerseyUrology

    Posted

    Thank you, I have a median lobe pushing into my bladder, TURP will remove much of the bladder neck resulting in sperm going into my bladder and render the upper sphincter valve useless leaving only the lower sphincter valve as a backstop against incontinence but with no gurantees and leave my prostate full of urine 24/7.Is there no way of removing the urine blockage without the above?. I just turned 61 with a young wife and otherwise healthy and hope to live another 20 years but hate to risk incontinence either presently or in the future!. I want to prevent further prosate growth and want everything working as it should what are my options in 2017? than you.
    • JerseyUrology
      JerseyUrology brian34488

      Posted

      While nothing is ever a 100% guarantee, we have had a lot of success with the Rezum procedure for these cases. Side effects are generally a lot better than a TURP, and it is almost always covered by insurance.
  • brian34488
    brian34488 JerseyUrology

    Posted

    Hello...I notice you mentioned aquablation in a favorable light which is very encouraging...I read the article you mentioned by Peter Gilling etc but do not understand how it indicates  aquablation does not seem to have retro ejaculation results like turp often does, the article indicates the aquablation method takes care to save the exterior sphincter valve which inturn reduces retro ejaculation, but isnt the exterior sphincter valve the lower valve? I could understand if it saved the upper internal sphincter valve which is in the bladder neck area which would reduce retro ejac.

    But if aquablation renders the upper internal sphincter valve useless then how can it prevent retroejac? and would it not at the same time leave only the lower external sphncter valve as the only prevention against incontinence just like turp?

    Look I am just a beginner at pretending to understand but I will appreciate if you would grant me understanding on this please as I wish to resolve my median lobe growth into my bladder but save both my upper and lower sphincter valves by the least invasive method-any suggestions please? 

    • jimjames
      jimjames brian34488

      Posted

      You probably read the smaller Phase I and Phase II studies which showed no retro. Take a look at the Phase III trial results and you will see that the incidence of retro is 25% of the TURP control. So if you then compare it to the 40-60% incidence of retro in TURP, you come up with 10-15% retro with Aquablation. The Phase III study, however, came up with a lower number because their TURP control I believe only had a 25% rate of retro. 25% retro from TURP seems very low, based on larger, prior studies, so my guess is that their study underestimated retro both with the Aquablation and the Control group, for a number of possible reasons.

      In any event, the takeaway is that unfortunately Aquablation is not the retro free procedure many of us were hoping for. 

      Jim

    • kenneth1955
      kenneth1955 brian34488

      Posted

      Brain read what jim is telling you alot of retro in both.  Try the urolift.  no side effect.  THey have had good results with it.  THey can pin the lobe to the one side.  You just have to fine a doctor while to do it.  Stand firm and tell them this is what you want to try.    GOOD luck  Ken
    • jimjames
      jimjames

      Posted

      See if you can find the video of the "Water Study" on the Aquablation manufacturer's web site. Let me know if you can't find it and I'll send you a link. 

      Unlike the Phase I and I studies where they call out the fact that there is no retro, they kind of bury it in the Phase III study which is unfortnate. But if you stop the video at the 1:49 mark, you will read that "anejaculation (retro or none at all) is 6.9%. But again, I would not take this number to heart since they only had 25% retro in the control. I'm guessing some sort of reporting issue and that the actual retro rate is closer to 10-15%.

      Jim

      . 

    • brian34488
      brian34488 jimjames

      Posted

      Thank you for your kind reply I guess sadly your logic is true that aquablation does not save us from retro/ejac but has better odds than turp. I suppose the same is true with saving the upper internal sphincter valve which holds the urine in!

      It seems all it does is cut less away than turp and hopefully not too much, enough to save both the bladder neck which stops retro/ejac and the upper internal sphincter valve which holds the urine in the bladder.No doubt a turp sugeon will argue it will grow back and block up again.A turp surgeon told me a second turp opp can lead to incontinence, but we know it could also happen in the first opp.So whats the truth?I have yet to research e p turp meaning ejaculation preserving turp but I imagine its once again just cutting less away with no guarantees of preventing retro/ejac or incontinence or of it growing back and blocking up again.

      Im still lost as to the real truth and just what to do.

    • brian34488
      brian34488 kenneth1955

      Posted

      Thank you for your kind reply, I wonder how it effects the upper internal sphincter valve which holds the urine in? while it will be wonderfull to pee easily I dont want to damage that valve because if the only other valve(the lower exterior sphincter valve) fails to hold urine that means incontience.In my case I have a large median lobe growing into my bladder, what was your case?
    • kenneth1955
      kenneth1955 brian34488

      Posted

      My doctor found it when he was checking my stricture it was the size of a lemon.  He could not get into my bladder.  It was tight.  After trying some pill that gave me retro I told him no.  So he offered me the Urolift which he did. 4 weeks later.  It's great and it worked  Ken 

    • kenneth1955
      kenneth1955

      Posted

      Brain....Tell them this is what you want to try.  My doctor have done it you just have to pull it to one side to make the opening......very good result ken..
    • jimjames
      jimjames brian34488

      Posted

      Brian,

      I sent you a private message with more information on ejaculation preserving (ep) TURP.

      Jim

  • frank74205
    frank74205 JerseyUrology

    Posted

    Jersey Urology. Do you think  Uro-Lift could work ? i was told  i have a median lobe,and diverticula. Uro Lift  will not work.  My second cystoscopy with another URO said this. My first URO tells me  i do not have a diverticula ,i only have a median lobe. If i send you the report of test results  would you tell me what i have?I'm confused?

    Thank you very much,

    frank,

Back to top
Prev Next

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.