The Rezum procedure and BPH

It really depends on the individual as well as size of the median lobe and the underlying bladder function.

We have had success, but it can take a little extra time (over a month) for symptoms to improve if the median lobe is enlarged. 

are there any negatives then, if you do rezum and have a medium lobe.

do you have  better options than rezum when median lobe is involved.

I wouldn’t say there is a “better” option for a median lobe that is minimally invasive, no.

TURP (or aquablation) would still be the gold standard, but I have few issues trying a rezum on these folks 

MRI guided focal laser ablation is minimally invasive and can specifically target an enlarged median lobe. I had a very enlarged median lobe and it worked wonderfully well for me. It is performed by an interventional radiologist and therefore will not be recommended by a urologist. You can PM me for more details. 

@Jersey: TURP (or aquablation) would still be the gold standard, but I have few issues trying a rezum on these folks 

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Not to pin you down, but would you recommend starting less invasive (Rezum) and then more aggressive (TURP/Aquablation) if Rezum doesn't work. Or, do you just go for the one more likely to produce results (TURP/Aqua) when presented with a difficult case (median lobe/full retention)? Also have you starting doing aquablation yet and if so how is it going?

We are just starting with aquablation.

A lot of it depends on the patient- the rezum is minimally invasive, and you often lose very little by trying it first

Most interventional radiologists don’t know about this (let alone urologists.)

It’s also not covered by insurance, and will cost someone tens of thousands of dollars, which isn’t practical for 99% of the population.

There are also no academic papers discussing results.

When you saw “i have few issues  trying rezum first” what would be those issues?

What are the negatives or risks for both the rezum and the turp?

Thank you

Few issues meaning it is generally safer with a lower side effect profile than most other procedures .

Most men will have some irritation and urinary frequency and urgency for the first few weeks, and will need a catheter (or do cic) for at least a few days, but most are happy postoperatively.

Ross73654,  Who did your FLA, and when ?

Thank you. 

Since a large median lobe is causing my issue, what other procedures do you preform that are effective for that.

Hi Thomas,

It'll be a year ago May 18th. It was performed by Dr Karamanian in Houston - the most amazing Dr and human being. Due to an oversized median lobe, I had gone into acute urinary retention a couple of weeks prior and arrived in Houston wearing a foley. He has transformed the quality of my life. I am eternally grateful.

Ross,  

I called Dr K's office today they told me the FLA procedure was 2 to 4 hours long.  How long was yours, and were you sedated the whole time ?  What kind of sedation did he use ?   Did you feel any pain during the procedure and did it seem long ?

Thomas

Rezum works well for a lot of men

Aquablation works well as well, as does TURP for the right candidates

2-4 hours is a long time to give sedation. There are risks with sedation, and they increase the longer it lasts.

As a reference, rezum takes 5-10 minutes and aquablation is around 30 minutes.

What type of sedation do you use for Rezum and Aquablation? Also do you know someone who performs Rezum in the Chicago area? Thanks again for all your valuable help here.

Jim

We have an anesthesiologist who gives propofol in the office generally.

It is a general anesthetic of some type for aquablation (in the hospital OR.)

In Chicago, Dr. Kevin McVary is a very well known men's health expert and I believe he does these.

Hi Thomas,

My procedure was around 3 1/2 hours start to finish. I was sedated but not that deeply - enough to sleep for the most part but I do remember waking up a few times and talking to Dr K. about how things were going. I felt some warmth but that was about the extent of it - no pain. It didn't feel that long tbh. I don't remember what kind of sedation he used but as you are in touch with him, I am certain he will tell you. I know of at least one of his patients that were not sedated and had no issues. 

Dr K is a very very fine Dr and I am quite certain that he is quite aware of what amount of sedation is safe for his patients. The anonymous Dr? promoting his office's urological solutions on this thread seems to be insinuating that Dr K might be putting his patients at serious risk and violating his hippocratic oath by administering sedation for an unsafe period of time. I'll be sure to relay to Dr K our learned friend's concerns. 

All Jersey Doc said (in answer to someone's question) was that the risks of anesthesia increases with the amount of time under. This is commonly accepted and does not suggest Dr. K. is putting patients at serious risks however it could be a consideration for anyone concerned about the subject. Curious, does Dr. K. administer the anathesia himself or with office staff or do they use an outside anesthesiologist?

Jim

Jim, I had an anesthesiologist.

With the greatest of respect, the question was asked of me and it was:

"I called Dr K's office today they told me the FLA procedure was 2 to 4 hours long.  How long was yours, and were you sedated the whole time ?  What kind of sedation did he use ?   Did you feel any pain during the procedure and did it seem long ?"

Aren't all procedures risky? Is general anesthesia fully understood? Why the anonymous JU felt it necessary to introduce some FUD is beyond me. 

This Ross seems to have an agenda here, pushing a very expensive procedure which apparently one doctor in the country performs, with no published results.

I would be very careful about this.

Just re-read and you are correct. I don't hold JerseyDoc as an information source about FLA as I don't hold any MD as an information source about a procedure he doesn't do and therefore probably isn't familiar with. That said anesthesia is an interesting subject, especially as we get older, so mentioning this fact is not that inconsistent with the way that we pick apart every procedure here. It may be FUD to some but to others just another bit of information to consider. I am dealing with the anesthesia issue right now with an older relative. Ideally none of us would ever go to a doctor, take a drug, or have a procedure, but of course that isn't the way it goes

Jim

I have no agenda. Just a genuine BPH patient.  But I have caught you in the past spreading misinformation about this procedure.

"apparently one doctor in the country performs" 

Here you are doing it again! So I wonder what *your* agenda is. We don't even know that you are a real doctor. 

My urologist has always had an open mind and is thrilled that patients like us (large median lobe) have more options.

jim-

absolutely; you need to be careful. Longer anesthesia times are associated with a lot of issues, especially as we age. This is one of the reasons why there is such a push towards minimally invasive procedures with minimal procedure time.

Ross, I can attest with very reasonable certainty that JerseyDoc is a real doc who does what he

says he does.

Jim

Jersey, I think that was my point to Ross but thanks for fleshing it out. Some studies re anesthesia and an increased dementia risk are troubling.

Jim

I was using the word sedation to mean whatever type of numbing is used.  I was think the FLA procedure probably uses a local anesthetic and it would have to be updated one or more times in a 2 to 4 hour procedure.

Thomas, This is my understanding after a very quick read on Dr. Sperling's site, however Ross did say he had an anesthesiologist with Dr. K. which seems to suggest otherwise. In any event, the anathesia issue is an important one for all these procedures.

Jim

Yes absolutely. I do remember feeling some discomfort during one pass of the laser and informed Dr K. He gave me more local. I never felt any pain during or after the FLA. This seems to be the experience of the 20 or so men that have had FLA and posted on this site. The post-op discomfort was only when I sat down and lasted less than a week. If you are interested, I also have some MRI slides showing how my median lobe was targeted and successfully ablated. i will gladly share them with you.

I would also highly recommend that you search YouTube for the following video by Dr Karamanian

"Prostate mpMRI and MRI Guided Focal Laser Ablation (FLA): Preserving Quality of Life"

Perhaps the anonymous urologist can watch the video too and educate himself instead of spreading misinformation and FUD about other Drs and important (not so) new procedures helping men like us.

Ross 

thomas- sedation implies some sort of general medication is used to relax you (vs. a local medication to numb an area.)

Prolonged sedation has potential risks. Being in one spot, not moving for an extended period of time also has risks. Be very careful taking advice from (any) strangers, and make sure you speak with your doctor in person about what your risks are for any procedure.

What I get from Dr. K.  He is very well trained in what he does and he cares about his patients.  He does the mapping in his head with the MRI and shows it to the patient of what he is getting rid of.  He will be up dating his site by the end of the year with some results from the BPH treatments.That is what he told me the last time I talk with him . I have read a few of the reports from some of his patients that he did for cancer.  The best one was a 75 year old man that his doctor wanted to do a Turp on him and told him that was the only way to go.  He asked the doctor about his sex life and retro.  This doctor told him that he may have a problem and he said at 75 he should be taking it easy.  That is when he looked up Dr K.  Went and talked with him and after another MRI from Dr. K he had it done.  Dr K. also found another spot that was not on the first MRI.  After 3 weeks he was ready to go  He felt fine and he did not get retro.  The last thing he said was.  Watch out lady's .  I hope I will be like that at 75.    Take care Ross  Ken

All procedures are risky. All drugs are toxic! Many risks can be mitigated by being treated by an excellent Dr.

No strangers are "advising" Thomas here other than you. I am merely sharing my experience as a patient - the core purpose of this forum. Thomas has told us that he is speaking directly with Dr Karamanian, not a stranger. Dr K and Dr Sperling from NY - another FLA practitioner - have posted here in person using their real names. You on the other hand, remain anonymous - while making demonstrably false statements about a procedure you know nothing about.

I am out of this conversation. Thomas if you want any more information, I'll be more than happy to share but not here. You are welcome to PM me but I would also advise you to continue to speak with Dr K. Also speak with Dr. Eric Walser in Galveston TX and Dr Sperling in NY. There are others in LA, Chicago and Florida. Good luck and I wish you well.

Jersey urology, Dr Mc vary is not in Chicago. He is in Southern Il 4 hour  drive.Do you know of another well versed Dr that does Rezum in Chicago area?

Thanks ,

frank,