BPH problems NEW treatment

GENTLEMEN; my name is Phil and I live just outside of Denver CO. in Centennial. I am 68 years old and have been having BPH problems for about 3 years. I started to take Super Beta and tried several natural pills but found they had no results, just a bunch of advertising crap.  I went to my PCP doctor and he put me on Finasteride, then Avodart, and then Flomax. I took them over a 9 month period and found they caused all sorts of problems from dizziness, to E.D. and dry ejaculations. All of them are bad stuff, please stay away from them. My issues were getting worse. Having to get up at night 4 or 5 times, stopping and starting, weak stream, have to push or strain to start, etc.

I decided to go to a prostrate doctor and did much research on the internet and found one locally who was advertising the newest treatment being the “Green Light Laser” I was excited. I made an appointment with him. I had to do several tests with him including a Cystoscope (small camera down the urethra) which was not fu at all. I would ask your doctor for a local. He found no cancer and that my bladder was working fine. He found a very small amount of scar tissue which he removed with the scope. He said many people get these form when they have other operations and get a catheter during the operation and the doctors sometimes are not very easy and cause it. I have had several operations including a hernia just 1 year back. He indicated he wanted to wait for about 3 months to see if everything would heal up and them we could go for the Laser treatment.

After waiting 3 months and then going back in to see him he indicated that there was this new procedure out called “UROLIFT” and he felt it was much better and less invasive.   He also indicated to me that he had found that the Laser treatment was very underpowered and he many times had to finish up with using the button TURP method to get it done. He gave me all the information on it. I did some more research on it including this webpage. After seeing that there was some people reporting poor results in this “UROLIFT” procedure I decided to go see another proctologist to get a second opinion. Was I ever glad I did.

The new Doctor told me he had been part of the original studies done on the “UROLIFT” and found it very disappointing. That many of the patients saw very little or no improvement after having it.  The brochures show that you get 2 of the stainless steel implants but in all of his patients had at least 4 or more put in. He also said the tool they use to do the implants is had to use and if the Doctor is not very good there can be other problems with them not being placed in straight. He said that the other big problem is that the prostate continues to grow and at some point the implants may begin to cut into the gland and cause more problems. At this point if you want to have the “Green Light Laser” treatment done they have to go in and remove all the stainless steel implants which is not easy and takes up more healing time.  He also indicated he has done over 1,000 of the Laser treatment and had no power problem and it is the best way to go if you have to go that far. The main problem is about 30% of his patients have Dry Ejaculation after this procedure.

Then he tells me that there has been a breakthrough and it is the best thing out there so far. It is called “REZUM”. It is a water vapor therpy. It is a minimally invasive BPH treatment that delivers with just a few drops of water a targeted, controlled dose of stored thermal energy in a water vapor directly to the region of the prostate gland with the obstructive tissue. The procedure can be performed in a physician’s office and may minimize the procedural discomfort, post procedure complications and side effects associated with other BPH treatments.

It eliminates the Hyperplastic tissue from inside the prostate which then allows the urethra to open up normally again. It provides patients with significant improvement in BPH symtoms, including frequency, intermittence, urgency, weak stream, straining to urinate and nocturia while preserving erectile function and urinary continence.

I will be getting back with my new proctologist in the next few weeks to set up tests so I can proceed with this treatment and I will get back on this after going through with it. I guess there is about 6 or 7 places in the US that are now offering this treatment which is still going through more testing but he says he has done 50  or so and it is really looking like this will be the new  way to treat BPH. Here is a web page with more information. Have a great day. Phil

https://bphnews.com/2015/12/02/nxthera-publishes-1-year-results-of-rezum-ii-clinical-study-evaluating-the-efficacy-of-the-rezum-system-in-treating-bph-symptoms/

Hi Phil,

We have had people here with good results from Urolift (see relevant threads) but also with not so good results. A lot depends on a person's individual situation and the doctor performing the operation. An operation or procedure that is good for one person may not be the best for another.

There is also a relaitve new bph treatment called PAE. You may not have heard about it from your urologist because they don't perform it. It's performed by an interventional radiologist. 

The REZUM treatment you mention is quite new but sounds very promising. Another promising treatment, at least on paper, is something called MRI Guided Focal Laser Ablation. As far as I know, it's only performed by one doctor currently, a Dr. Sperling. 

Personally, I don't want to be the first kid on the block for any of these new and promising treatments. I have chosen a different path called Clean Self Catherization (CIC). It allows me to empty my bladder completely any time I want and has virtually eliminated all my bph symptons. Meanwhile I will follow the newer procedures such as PAE, REZUM and Focused Laser Ablation. Sometimes these things pan out, sometimes not. 

Wish you the best moving forward. 

Jim

Hi jim.. I would suggest to you to research the HOLEP procedure. I got mine done in December of 2015,approximately 19 weeks ago.It was not a "walk in the park" for the first 10-12 weeks of recovery but my results have been very positive. The key to this procedure is finding the right Doctor as there are not many who have the training to perform this ...I was also getting up 4 or 5 times a night and suffered from Prosticitis on a weekly basis... While none of these procedures are perfect,the HOLEP procedure has worked very well for me and many others..Check out the HOLEP blog on this site...Sam

I had Ruzum done 6 weeks ago. I am apparently an outlier, but I still can't pee as well as the day before I had it done. My doc says that other than me, his results have been universally good. Most people can pee without a cath within 7 days and he says he has one guy he did on the same day as me who hadn't peed without help in over 4 years who is now funtioning normally.

For me, this has been one big sh*tshow - but for most others its ideal. Sexually - I'm fine, no RE. The PAE seems to do the same thing as Rezum, but its even less invasive, but takes longer to work. I might try that first as there is no catheter involved and apparently virtually no side effects or down time, even short term. Good Luck!

Phil,

After considerable research on my bph treatment options and my increasingly diminished ability to pee, combined with every side-effect ever reported with FloMax, I finally selected UroLift (UL), and I am so happy I did. I did give strong consideration to PAE but went with UL because it does not destroy prostate tissue at all. I will delve into that concern in another post if pressed to do so. Why did I select UL? Very simple: it works and it works fast. I know it may only be a stop gap solution but so are TURP, PAE, and many other procedures. Moreover my enlarged prostate was nevertheless functional and I did not want to have it ablated and lose sexual function and or face urinary incontinence issues. Before UL I could pee only dribbles and that was with the maximum dose of FloMax. I could have sex but was so obstructed, I could not ejaculate. Two weeks post UL I could pee as I did when I was a teenager and I was now able to ejaculate easily. If I find that my renewed abilities fade with time I can again have another UL implant installed and if that should also fail I can do PAE or any other procedure now available. Moreover, UL is covered by Medicare. If you are eligible for UL I strongly advise you do it. As for alleged UL failures, find a physician you have faith in to perform the procedure. I was the first UL patient my urologist had done but because I was his first patient I had the benefit of having a UL rep, also a urologist, advising and guiding my urologist and the entire procedure lasted only 20 minutes. I also should add I had the dreaded 3rd lobe and that was dispensed with by merely pinning it back so it could not obstruct my urethra as it passed through the prostate. And I should add my 3rd lobe was relatively small. To conclude, UL is fantastic, the odds are it will probably work for you if your prostate is not overly enlarged and you do not have a large 3rd lobe, and your bladder has not been overly stretched by years of urinary obstruction. And if UL eventually fails you can stil have other and perhaps newer treatment options when those become available.

Hi Sam,

I decided to pass on the more invasive procedures  such as HOLEP because of the incidence of sexual side effects such as retro ejacuation. I'm actually quite happy at the current time with managing my ocndition with self catherization. I'm glad yours has worked out. You wee smart to pick a doc with lots of experience. That seems to be key.

Jim

Hi Oldbuzzard,

Where did you have the Rezum done? Was it part of a trial? Did you ask your doctor how many he has done? While I have no reason to doubt the veracity of your doctor, I always give pause when a doc tells me "you're the only one I've had a problem with". Good luck with PAE if you go ahead with it. 

Jim

I went in yesterday for my 2 week check-up after having the Rezum procedure.  Doc says everything is going normally(based on all his other patients).  He said mine was the first one he did with just a local.  Next time he needs to maybe wait a little longer for the deadening to take or give a little bit more juice or maybe both.  I'll be able to forget the pain if all ends well.  Right now after 16 days, I'm able to easily go, but not a lot yet.  Interestingly though, I get thru the night with 2 trips and sometimes and only one to the bathroom.  Right now, there is a little blood at the beginning and this is probably part of the healing process.  Hope to report good results in the near future.  I'm going to try it again.  Digital monitors and wireless communication have been around a long time.  I'm reminded of that every time I pray for a healthy prostate exam(finger=digital monitor, prayer=wireless communication),

I had it done at the Cleveland Clinic and it wasn't part of a trial. He's done over 60 of them and I researched it thoroughly, including talking to the parent company that makes the unit. In the clinical trial, of 82 people, the longest anyone went needing a cath was 10 days (only 3 needed more than a week) and I broke that record by 10 days. It's unlikely that I would have the PAE done because it does the same thing Rezum does (kills tissue) via constricting blood flow instead of steam.

I'm glad you're doing better than I was at 2 weeks - I think your experience is much more typical. I'm not sure that they can numb you well enough to make doing this with a local a good idea. Knowing what I know now, I would have asked to be twilighted like they do for something like a colonoscopy. My life was not at all enriched by being awake for the procedure.

Phil,

I am checking in to having the Prostate Artery Embolization (PAE) done with Dr. Charles Nutting with RIA Endovasular, located in the Denver Tech Center. This procedure is done by interventional radiologists, not urologists. If you ask a urologist about PAE expect them to throw some shade on this procedure. Most urologists promote the procedure they've trained in. There is a thread on this forum about PAE. It's worth a read before you make a decision.

Stebrunner

I talked with my Doctor on the PAE treatment and he said that is also really not a good way to go. Lots of issues with it. I guess it is a way of zapping the capilaries around in the prostate which kills the blood supply so it stops growing. too many things can go wrong there. JMO.

Best of luck with whatever path you choose, but after doing a lot of research, and having the HoLEP done 4 months ago, I'm a very happy camper.  Had it done at Mayo in Phoenix by Dr. Humphreys whos done hundreds of these, and is probably among the top docs on this in the nation, to say nothing of Mayo being rated the #1 hospital in the nation by US News & World Report (check the stats on your hospital).  HoLEP reasons: 1) less bleeding/blood loss, 2) shorter time in hospital/on cath (less than 24 hrs), 3) they remove the tissue (not incinerate it) and test for cancer, and 4) much less chance of needing a repeat op.  Humphreys has also published several papers on this (see his bio on the Mayo website), and won't consider doing TURP anymore.  Spend the money; not all mine was covered by insurance, but I'd do it again in a heartbeat, especially after following this blog for several months.  There's a hotel right on the Mayo campus so you could stay a week and get preops, etc., all done.  I'm traveling in Europe right now, and it's great to not worry one bit about where the next bathroom is.

Thats good to hear. I'll do some more research on PAE. like you said they all want to do it their way. Thanks for info.

I have heard the cost is about $10,000 or more to go there and my insurance will not cover that so I will have to go another way, thanks

Hello Phil.  First let me tell you I feel the same way about dry orgasm and not giving up one for another.  That is why I had the Uro-lift.  I had it done a year ago and have no problem.  Had the surgery on Monday and by saturday was peeing great no pill or getting up at night.  Had 4 implants put in.  If there is a problem they can be taking out with no problem.  The outer schell of the prostate is very hard that is why they can do it.  If it was soft tissue would go through.  My doctor has done over 200 urolifts in the last 3 years when it was approved by the FDA. I have talk to about 10 guys that have had it done.  No problem.  I sent a few to see him.  To me it sounds like your doctor is pushing the green light which he has done alot.  Is that the one he does best Some dooctor will do that.   That has been around for many years and does the same as a Turp and the other that core out the prostate and distroy the bladder neck.  You get retro.  Your doctor said 30% it more like 95% A doctor will down play any side effect to sell the procedure.  I am glad that he offered You the other procedure. There as been a few men on here that have had it.  Try to get a hold of them and see if they had retro or not.  I know when we were looking into to it some said yes and some said no on retro.  It is up to you what procedure you have but be aware of the side effect and the down time.  PS  I would rather have somthing less invasive done first and see if it work before I have something done I will not be happy with.  When they start cutting away you never get that back.  Please look at everything  with a fine tooth comb  Take care and good luck  Ken

I am glad your doing good.  How are you dealing with the retro?  and was that a factor that you had it done.  Some men don't want to give it up..Take care and have a good time..Ken

I'm 68 and have all the family I want (3 sons, 7 grandkids), so retro no problem.  Acutally, had full retro under the drugs prior to the surgery, now only partial, but, machs nichts.

No problem has long as you can handle it.  Some men say it's no problem and when they get it they what it back.  Once the bladder neck is cut you will never have it again.  Take care my friend and have a good weekend  Ken

Phil, you should also check on PAE surgery. Lots of us here have used it for your symptoms, and it has very few side effects, if any, and gets awesome results, 90% success rate. Works really well for very large prostates.  take a look at some of the research links you will see posted.   I had mine a couple months ago, after I wasnt able to pee at all!  and it has fixed me right up..

Greg