Posted , 16 users are following.
Hello- I am 54 yrs old with enlarged median lobe, use Flomax but want to stop taking medication and do a procedure. My urologist is proposing either TURP or Resum. I am trying to weigh benefit vs side effects.
Seems like TURP is more effective but with more side effects vs Resum which is possibly less effective long term (not enough data) but better side effects. Any thoughts or experiences?
0 likes, 27 replies
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dennis47445 maurice86282
Posted
Maurice, I am 70 years old. I've had three surgeries so far, over a span of around 15 years. The first one was a "greenlight laser" surgery, the second and third one were "turp's" If I could do it over again, I would choose to do what I am doing now, which is CIC. I've been doing CIC for 28 months, and it's the best way to empty the bladder for me.
My suggestion to you, is to try CIC first. If it works for you, then fine. If it doesn't, then you can try some kind of surgery. This way, it is the least invasive way on your body.
I forgot to mention, surgery, may not be the final answer, because as in my case, the prostate, continues to grow. That's why I had three surgeries.
Good luck!
tom86211 maurice86282
Posted
Maurice,
I am going through a similar decision process now. The current TURP procedure is called bipolar TURP and uses a loop to cut the tissue then a plasma button to cauterize, so there is much less bleeding and in most cases the patient can go home the same day. Also, the patient is not awake for the treatment, so no pain. With Rezum the patient is usually not "out" and there is a lot of pain. With TURP there may or may not be a Foley catheter for a day or a few days - no big deal. With the other procedures there is also a period of catheter use, prostate swelling and pain that can continue for a long time. The most commonly mentioned objection to TURP is retro, and that seems to steer many men into other procedures that don't cut away prostate tissue. The other procedures are less effective and retreatment may be required some years in the future, likely sooner than with TURP. It's a tough call. I am still not decided how to go. For every procedure there are men on this forum who say all went well, and some who had bad experiences with lots of pain and post treatment issues. This included not only REZUM but Urolift. There is one procedure that is fairly benign - PAE. I had it a year and a half ago, and it was painless and easy. No catheter. Some discomfort for a week after. Unfortunately, due to the size and shape of my prostate it was only partially successful. I was able to go off Flomax for a year, but am back on it now. Statistics show PAE is normally about as effective as TURP at relieving BPH symptoms, but in my case it wasn't. It's something you should look into, if you don't have a median lobe. The ML can still block urine flow even if a PAE shrinks the prostate, so most PAE failures noted here are due to median lobe issues.
Tom
oldbuzzard maurice86282
Posted
Some of what was said here is wrong. If you are considering a first procedure, without a massive prostate, but typical BPH, you should absolutely do Rezum and not TURP. For most men, it works as well as TURP. There is no anesthesia risk, no incontinence risk, no impotence risk and a very low likelihood (5-10%) of Retro Ejaculations.
The recovery for most men from TURP (even the newer techniques) is longer than Rezum and most docs will twilight you with Rezum so you don't feel any pain. Most men can pee passably after a week or two from Rezum. And there are no long term studies, but its holding up over 3-4 years - and if it came to that, I'd rather get Rezum every 5 years than TURP once. There is no reason to do a full blown surgery when a quick procedure will probably work as well. And BTW, most urologists define continence as no more than 2 pads per day. That doesn't sound anything like continence to me. And if for some reason, Rezum doesn't work, they can always do a TURP.
If you have an enlarged median lobe, Urolift isn't likely to work. Go with Rezum, but first get scoped and have a urodynamics test to confirm that the prostate is your problem and that you have enough bladder strength to do the job if the obstruction is removed.
The CIC that someone suggested is an option and can work, but many men would rather have a quick procedure and be done with it than carry caths wherever they go. Many are fine with it, also FWIW. But given the question you posed, I'd say Rezum hands down.
tom86211 oldbuzzard
Posted
"Some of what was said here is wrong." Please explain.
oldbuzzard tom86211
Posted
"With Rezum the patient is usually not "out" and there is a lot of pain. With TURP there may or may not be a Foley catheter for a day or a few days - no big deal. With the other procedures there is also a period of catheter use, prostate swelling and pain that can continue for a long time. The most commonly mentioned objection to TURP is retro, and that seems to steer many men into other procedures that don't cut away prostate tissue. The other procedures are less effective and retreatment may be required some years in the future, likely sooner than with TURP. "
This is pretty much all wrong.
tom86211 oldbuzzard
Posted
I have read numerous reports here of men who have gone through Rezum without being "twilighted" and experienced great pain during the procedure. You need to read reports about bipolar/plasma button TURP vs the old style monopolar. It's a very different experience. Because I have to make this decision soon I have been reading all I can about both procedures, here and elsewhere. We must be reading different things.
lew82832 maurice86282
Posted
I would like to have re sum done but I cannot find anyone who does it in the Portland, Oregon area. the closest is in Seattle.
DaveCanPee maurice86282
Posted
To All:
How much shrinkage can be expected from the Rezum procedure? Also, how are "shrinkage" and "removal" different, aside from literal?
Dave
ken19524 DaveCanPee
Posted
Dave, to get an accurate answer to your question, you would need to see a urologist and find out the current size and shape of your prostate.
My prostate was estimated (via TRUS) at 68 grams with an enlarged median lobe prior to the procedure. I received 10 shots of steam, 4 on each lateral lobe and 2 on my median lobe. I asked the urologist how large my prostate was several months after the procedure, and he said "about half" the size it was before.
Ken
DaveCanPee ken19524
Posted
Hi Ken:
My prostate has already been fixed via a simple robotic prostatectomy. Removing it was my solution over trying to shrink it. I get curious when I hear that a certain medication or non-invasive procedure will "shrink" your prostate by a certain percentage.
I realize through reviewing this forum that everyone's first choice is meds, followed by non-invasive procedures in an effort to shrink the enlarged prostate. I was fortunate to only have one choice - removal.
Dave
maurice86282 DaveCanPee
Posted
Gentlemen- Thank you so much for all your input and for sharing your experiences. Based on what I learned from this discussion, I am moving away from TURP. My Uro only does Resum & TURP (he doesn't do Urolift or anything else), he said he does not like the fact that Urolift wasn't originally approved for ML so he doesn't trust it for for the ML indication, which makes no sense to me. So, I am going to do a bit more research and interview Urologists that are abreast of more of the newer techniques to get to a decision.
timothy81571 maurice86282
Posted
I found this article that compares the two - do a search on PD64-01 - may help a little.
PD64-01 THE WATER STUDY CLINICAL RESULTS – A PHASE III BLINDED RANDOMIZED TRIAL OF AQUABLATION VS. TURP WITH BLINDED OUTCOME ASSESSMENT FOR MODERATE-TO-SEVERE LUTS IN MEN WITH BPH
I opted for Rezum over TURP - TURP being the last resort.
Dave - my Uro told me that the overall shrinkage is not what counts, it's the fact that it opens up the urethra on the inside where it counts. I think I read somewhere that it's like 14%, but I can't find where I read that.