Urolift vs Rezum
Posted , 10 users are following.
For those interested in discussing controlled study data (please note, the outcomes of individual cases are not relevant to this question):
Background
I'm 60 years old, have a 40g prostate (no median lobe) with an IPSS in the low 20s and a fair amount of retention. Two urologists have encouraged me to have Urolift rather than Rezum.
However, when I review the controlled study data, it favors Rezum. If you've read the study data (4 year data is available for Rezum and 5 year for Urolift), know how to interpret it and can tell me if there is something I'm missing in relations to Rezum--there are many considerations here--I'd appreciate it.
Study data summary
The short-term data favor Urolift: Average length of catheterization is 4.1 days for Rezum vs 0.9 days for Urolift. More Rezum patients have symptoms of urgency, dysuria and acute retention. Recovery from Urolift is faster than Rezum
But the long-term data appear to strongly favor Rezum: At 4 years, less than 10% of Rezum patients required retreatment. In contrast, with Urolift at 5 years, 33% of patients required retreatment (issues arising with the implants added to the total, see below). Additionally, I'm concerned about interference of the implants with detection of prostate cancer by MRI (I have no history of prostate cancer but it is common)(see footnotes 1 and 2)
Note: Both urologists suggested Rezum can cause retrograde ejaculation, something I've experienced from medication and would like to avoid, but I don't find that reported in the Rezum study data ?
In summary, Urolift is more appealing for someone facing surgery, but Rezum seems the better long-term option.
Retreatment data for Rezum and Urolift
Rezum retreatment at 4 years (N=135):
Surgery: 4.4%
Restart medication: 5.2%
TOTAL: 9.6%
Source: McVary, Rogers & Roehrborn (2019)
Urolift retreatment at 5 years (N=140):
Surgery: 13.6%
Restart medication: 10.7%
Remove encrusted implants: 7.1%
Remove implants from bladder: 2.1%
TOTAL: 33.5%
Source: Roehrborn et al. (2017)
Footnotes
1 - A case report of MRI interference by Urolift implants
2 - A Mayo Clinic urologist comments in Grand Rounds: Urolift is “…supposedly MRI compatible. The only person I know that has those protocols that work well is Claus Roehrborn at Texas, because he was one of the investigators. When I put these through my MRI, my radiologist comes back and says “Well, there’s too much scatter in this area, I can’t tell you if that’s a PI-RADS region or not”
0 likes, 17 replies
russ_777 mark06334
Posted
Mark, the data and conclusions you posted are pretty much what I've seen after reading a lot of medical literature on Rezum. I haven't read as much on UroLift because I had the procedure done in 2016 without researching it much.
The only thing about the data you presented I'd question is whether the percentages of patients who experienced the various side effects you listed are additive. In other words, some patients may have experienced more than one of the side effects, in which case they would not be mutually exclusive. The number I'd want to know (in addition to the ones you showed) would be the percentage of patients who experienced any of the side effects. So the ones who experienced more than one of them would only be counted once in the numerator meaning the numbers would be smaller than 9.6% and 33.5%.
Also, I want to say I've read some papers that were likely not one of the sponsored trials that indicated a small percentage of patients did develop RE with Rezum. There have certainly been several who've posted here who've developed RE after Rezum so it does happen. One theory I came up with considering some have posted here that they only developed RE months after having the Rezum procedure is that because the tissue ablation is a slow process, unlike with any type of TURP or HolEP which happen instantly, anatomical changes that occur over time as that tissue is absorbed by the body cause a delayed side effect of RE. I suppose the same thing could happen with PAE since it doesn't remove the tissue immediately either. One urologist I consulted with said among other potential causes of RE, having too large of a chamber created from ablation could cause RE even if the bladder neck, ejaculatory ducts, veru or relevant musculature are not damaged as the prostate muscles can't contract enough to force the ejaculate out. So given that Rezum can create a 1 cm deep defect from point of injection, some prostates could end up with an axial void of between 2 and 3 cm in diameter.
As far as urolift goes, my experience was very good but I started having symptoms again after about 18 months. None of the 5 urethral end pieces were visible in the past two two cystoscopies I've had. My lateral lobes are grown back out and my median lobe, which was not treated, is pushing up into my bladder. The procedure itself was painless as I was under anesthesia and the recovery was quick and uneventful. The Foley was out an hour after I woke up and I went home in the early PM. Maybe a week of minor pain and blood/clots coming out while urinating, but no trouble at all emptying my bladder. I do suffer from some chronic pain in my lower right abdomen which I wonder if it could be due to a misplaced implant. It could just as easily be some form of prostatitis.
I am going to have an aquablation if I can ever get it scheduled. I would probably go with Rezum if the doc could give me confidence there would be no RE, but he was unable to do that.