The Rezum procedure and BPH

I, like many men on this forum, have BPH and LUTS. In my case, I have almost total obstruction and have been doing CIC for about 21 months. 91 gram prostate. Current PSA around 8. History of PCA with Gleason 6, 10 years ago, with no specific treatment other than macrobiotic diet and lifestyle. 3T MRI in October with pi-rad 3. And a couple of PCA3 tests and an MDX that showed low risk. Not that interested in treating the PCA right now, but very interested in treating the AUR/BPH. Looking for a less invasive treatment that will not cause impotence, incontinence, or retro and also does not destroy the prostatic urethra. Have looked into FLA, Rezum, HIFU, TUNA, TUMT. What kinds of options do you have in your practice that might be of interest? Thanks in advance for any information. 

Thanks for your reply. My urologist here in CA is offering plasma TURP, HOLEP, and, more recently, REZUM, of which they have only done about a dozen since starting in January of this year, and with mixed results. I'm not interested in TURP or HOLEP, but could be interested in REZUM or Aquablation with someone who has had more experience with those procedures and is getting good results. I would be grateful to hear your opinion on those two procedures and how they are working for your patients. Thanks in advance for any help.

I'm 66 and had BPH for 11 years with what I thought was mild urinary retention until my Doc checked my blood pressure and sent me to a urologist when she found it was way too high (~200/90!). The Uro found my prostate was 134cc, my bladder was 1.2 litres and I had signs of hydronephrosis later proven to be acute with an eGFR of only 32mls/min (Creatinine of 185 umol/L). Note that other than a little tiredness I had no other symptoms. Frightened off by TURP's reputation I had an urgent REZUM procedure which required 5 lesions to each side. I have no median lobe. 5 months post-procedure I'm still self-catheterizing twice a day with residual urine of around 400-450mls each time. Each urination is about 100-250mls every 3-4 hours.

I have some weeks where the urine is normal color (pale yellow) and every now and then I have what appears to be a blood clot pop out and then a day or two of brown colored urine before it clears again. Strange how it comes and goes. Urologist tells me that my bladder is desensitized hence the continuing requirement to protect my kidneys by self-catheterization but he doesn't seem concerned about the intermittent brown colored urine. Is this brown color the result of the kidney's damaged cells being excreted? I hope you can answer this from me.

For the information of others contemplating REZUM I should also mention that full sexual function returned within about 3 weeks with no retrograde ejaculation and normal erections.

https://patient.info/forums/discuss/rezum-is-terrible-680166

What?