Good Morning All I have not seen much on any of the procedure for BPH on the site. For a while we were seeing a lot. Over the last year we have seen many new ones and you still have some of the old stand buy hanging on. These are mostly done by doctors that are set in there way and do not want to learn anything new. A man has the right to have the best treatment he feel he need that will fix his problem but there have been men on the site that had to have more then one because the first one did not do the job. When a men is looking for a procedure he needs to find a doctor that care enough to listen about his concerns. Being we are all different we all have different concerns. I think it also has to do with age. BPH can hit a man of any age from 30 to 70. I have dealt with it at 55. I have a brother that is 77 and has had no problem. When picking a procedure a man in his 30's will have different concerns then a man in his 70's most of the time. Are you looking to just pee better do you have concerns about your sex life and are you willing to give up your ejaculation. All this has to be taking into any decision on what procedure you pick. A good doctor will tell you to start looking at less evasive procedure these are the ones that will cause less side effects. Procedures that cause the less amount of side effects are Urolift.....MidLift.....PAE.....Rezum. These procedures do that by not cutting away at the prostate. Procedures that cause more side effects are any Turps done with a Loop or a Laser. You also have Holep and then you go into Simple Robotic Prostatectomy and a Prostatectomy which remove the prostate when you have cancer. There are also some others that are new that I will not go into but they cause the same side effects has a Turp. These procedures are just a Turp done in different ways. When picking a doctor you need to look at all the procedures that he does If there is something that you want and he does not do you need to move on and not be talked into something you are not ready for. Just get all the information you can. Another thing talk with any of the patients that have had the procedure and see how they came out. I'm only going to say a few things on the Rezum procedure because that is the last procedure that the site has been talking about. A lot of the men have had a long healing time and the procedure was very painful. I get video's and information on procedure every week this week it was on the Rezum The steam is giving in a injection at 70 Celsius which is 158 Fahrenheit. The doctor that was talking about this said that it cooks the prostate tissue. Did you also know that at 131 Fahrenheit causes second degree burns and at 162 Fahrenheit the human tissue is destroyed so they are just under that. The reason I'm telling you guys this is because maybe this is why it is so painful and the pain will continue for months sometime. Cooking the tissue. You guy's must know that if you have ever had a burn you know it hurts like you know what. In any of the booklets on Rezum it tell you nothing about this. I think this is enough for now. Just be aware of what you pick because you are the one that will have to deal with the side effects not the doctor he just moves on. With Christmas in the next 2 week I wish you all a happy holiday and try on that day not to think of your problems. Just for that day enjoy your family Merry Christmas & Happy New Years...........................................Ken
I didn't have any pain from the REZUM treatment at all, except for when it was being performed. After that, the catheter was the most inconvenient but NO PAIN. I would say though that two months out from the treatment and I am only a bit better than before. Still go pee quite a lot. Still wake up two to four times a night. Still start and stop urine flow. Still have week urine flow. If I had to do all over again, I would probably choose HoLEP or perhaps TULSA Pro or Aurolase.
Ken, I'm glad you started this thread and was thinking of doing the same as the Urolift thread was, at 70-something pages, a bit shall we say unwieldy. Now I don't have to!
Let the discussion commence.
Vernon, Thanks for sharing your experience with Rezum. Curious if it was covered by Medicare or your insurance?
Patrick
Hey Guy
It's no problem. Men need to know everything about the procedure that they are looking at.The few that I found out I have never heard before when any of the men have talked about it.
We can talk also about the Urolift also and the new procedure that the company came up with is the Med Lift which they came up with to take care of the median lobe.
Like any procedure you will not know if it works for you until it is done but then it's do late. I had my Urolift done almost 5 years ago and I am still wide open
Life goes on and so do we....Ken
Patrick: The REZUM billing code was added to Medicare's list this year and I have a CIGNA supplement so the REZUM didn't cost me anything out of pocket. I'm glad because it didn't do much for me anyway. I am afraid of the Urolift because I heard stories about the bladder being punctured with the stents and I'm not okay with that. I'm beginning to think my issue is with my bladder and not my prostate at all, although my Uro did say the median lobe is my issue. I don't know. I need to get over the trauma of the REZUM before I think about having any other procedures performed.
Vernon,
Thanks for your reply and I feel your pain. I KNOW my problem is my bladder after 5 liters were drained from my "massively distended bladder" during my visit to the ER after my bike spill 3 months ago. Although my uro says my BPH caused the urinary retention, he says no use in expanding the pipe until my pump is working as I am not able to void at all without a catheter. My urodynamics test showed my muscles are not squeezing the urine out as they should and I likely have nerve damage from the overstretched bladder.
I will be patient with the CIC in hopes of rehabbing my bladder so I can reduce or eliminate the need for CIC one day. Meanwhile, I'll keep reading posts like yours to keep up with the latest treatments and learn from the experience of others. I'm in no hurry to rush into a surgical procedure with little chance of success as it sounds like all have risks of not only failure but living with irreversible negative side effects.
Thanks again for sharing your experience and best to you going forward!
Patrick
Ken,
Fair enough, I just think Aquablation now belongs on the list since it was FDA approved this year and insurers are starting to pay for it, and the comparative studies praise it.
Before doing any laser, heat or Urolift procedure, consider robot implemented, cool water based Aquablation. There are discussions about it on this forum. Personally, PAE is first on my list, Aquablation 2nd.
Marty
Hey Marty
Aquablation is just another way of doing a Turp.
About 2 years ago I talked with the doctor that did the trial in the UK a Mr. Barber. He was the one that brought it to New York.We had a talk about it because I did not like the fact that they do the mapping of the prostate while you are asleep and it can't be adjusted. It's the whole prostate or nothing.
It carries the same side effect as the Turp. I have also talk with a few of the men that were in the trails. They were told that side effects rarely happens. After the procedure both men were able to have sex and they did not get retro at the time but about 6 months they went dry. They were not happy.
Talking with Mr Barber he said no procedure is guaranteed to save your sexual function. He said that if you want to have 100% guaranteed have a Urolift. So I told him that is what I had. It's going on 5 years and I am still wide open.
I would place them at Urolift, Medlift, PAE . Rezum for me would be a last resort because I'm not having any tissue cooked in my body. The others I will not even bother with because they will not be cutting any prostate tissue out of me
It not up to me what men have that is there choice. I don't have to live with there side effect they do.
All the best to everyone. Ken
Ken,
I suggest you google Neil Barber regarding Aquablation. There are YouTubes of him and studies he has authored regarding this procedure. He is a big fan of Aquablation as is NICE in their study of Aquablation last year.
For example, you may wish to read one study Barber co-authored in June, 2019 entitled "Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained." The title sums up the findings.
Furthermore, the study states “Aquablation’s symptom score improvements appeared to be larger than those reported for non-resective techniques, such as the convective water vapor energy (rezum®, 3.3 points higher) [16] and UroLift® procedure (3.7 points higher) [17].”
The final sentence of the above mentioned Barber co-authored study states “The lower rate of anejaculation after Aquablation is consistent with the procedure’s overall design, which avoids damage to tissues involved in ejaculation through precise, image-based targeting and robotic execution.”
Your understanding about how the mapping is done is not accurate. It is very flexible and can remove as much or as little of the prostate as the surgeon wants, with unparalleled precision.
With all due respect, the conclusions you stated about this procedure are just not consistent with the information currently available, although they may have been correct when the procedure first came out, that I don’t know. They are certainly not reflective of what Neil Barber is saying today.
When experts say Aquablation is a “TURP like” procedure today, they are saying it provides all the benefits of TURP without most of the TURP side effects.
in short, this is a procedure that men with BPH need to take a serious look at. It’s a game changer. I fear many men reading this forum are not getting enough accurate information about this very exciting option that is increasingly available throughout the world. HOPEFULLY, it will soon be paid for by your NHS, if it isnt already.
Be well and Merry Christmas,
Marty
Ken,
Regarding Urolift. This is an option that, as you state, confers the lowest risk of RE. However, no procedure is without downsides. And, when compared to Aquablation or Turp, flow improvements have a more consistent and better outcome.
Urolift does not remove any tissue, so the prostate is more inclined to grow back. We will see in coming years what follow up procedures are viable and not viable with the hardware that is left behind in the prostate tissue. I’m just not a big fan of leaving anything up there.
Because it does remove tissue, a “TURP like” procedure like Aquablation is expected to have a lower likelihood of recurrence of BPH symptoms for about ten years.
None of the available BPH procedures work every time. Also, none are without significant possible downsides, perhaps with the exception of PAE. That’s why it’s my first choice. It apparently has the least side effects.
Marty
Clarification:: According to studies (such as the study I quoted above) flow improvements with TURP and Aquablation tend to be more consistent and better than Urolift. My wording was a little off.
Ken, Thank you for starting this new thread and your well-written post, it is a good general overview that would certainly have been helpful for me when I started getting myself educated on BPH and treatment options. I agree with many of your comments and will just add my a perspective on Rezum and your comments on pain. I had Rezum under general anesthesia and except for burning & discomfort associated with the foley catheter I really didn't experience much pain at all. I also had a smaller prostate size and fewer injections than most so that may explain less pain. I am now five months out and doing much better. The positives are that I sleep through the night 75% of the time if I am careful about fluid intake in the evening. I no longer have the urgency, burning and dribbling and can go longer between voids. I am no longer taking tamsulosin and cialis . I do still have a fairly weak stream and wish it was better than it is, still takes me a longer time than it should to void, think I likely have bladder damage from letting the BPH go too long before seeing a urologist and deciding to do Rezum.This site has been great and so helpful. Each one of our experiences is different but we can all learn from each other. Thanks again Ken and everyone for sharing your perspective and experience with the various BPH treatments as the science and procedures continue to advance.
Good morning Marty
What you say may be true to a point but I have all of my email from Mr Neil Barber and what he told me about Aquablation in August of 2018. I'm sorry but it still has the side effects of a Turp. The data that they said on the trails really do not make cents. They said 7 % for Aquablation you will get retro and the Turp is at 35 % that right there is a lie because the first thing for a Turp is that you will loose your ejaculation.
Men have had it done and they have lose there ejaculation after 6 month's. Some men do not want to lose that. Peeing better is good but I don't need to pee like a 16 year old A 40 year old is just fine. I should not have to lose anything.
To me it is odd that in the UK where the trail were done that it is not approved by there insurance. I know when Barber brought it to the US FDA did not approve the new way he was helping to stop the bleeding. They still had to put in a catheter and blow it up in the cavity to stop the bleeding.
Every man has a right to any procedure that he feel that will be good for him. I will never have a procedure that will remove any part of my prostate. At 64 I like it just the way it is. I may not be having anymore kids but I will not give up any of my sexual function.
I will take a look to see if anything has change and I may send a email to Mr. Barber to see if he has been doing any here.
Good morning Boethius
It's no problem I try to give men all the information that I can find. With the Rezum I have never heard any of that. I watch a video and this is what they said. I have never seen it in any of the booklets talk about these things
How hot the steam is and what it does. I still can't get it through my head when this doctor told everyone the the steam cooks the prostate Tissue. Any procedure you should be out after you find out what the doctor is going to do.
When I had my Urolift I also had a general. So I felt nothing. That is true each man is different so we never know what will work.
Glad your off all the meds and I hope you see more improvement as time goes by.
All the best...Ken
Ken,
I am primarily concerned with your statement above, based on your conversation two years ago with just two patients: “Men have had it done and they have lose there ejaculation after 6 month's.” I’ve just listed in one of my prior responses quotes from a scientific study published June 2019 that says the positive results (including no dry ejaculation) lasted throughout the two year period of the study. Everyone can decide for themselves which is more useful information. Perhaps both are useful.
I take no issue with your preference for any procedure, Urolift or otherwise. As you say, you don’t want to remove any tissue. That certainly is the beauty of Urolift and PAE. But I’m sure you agree that there are plenty of nightmare stories with Urolift. Just read Urolift discussions in this forum if you haven’t heard of any.
That’s why I feel studies are so important. We each have to make a decision based on our personal objectives and accurate data. Yes, statistics vary from study to study (as you alluded), but when the winner in all the studies is clearly always procedure a over b, it’s worth paying attention to.
In response to your comment, FDA approved Aquablation in May. We’ll see what happens with NHS. Neither of these institutions move quickly, however, relative to other approvals, the FDA moved with lightening speed on this one. It is a much safer version of TURP that takes surgeon skill out of the equation.
Thank you for sparking the discussion. I hope our difference of opinion, and the points raised, proves useful to all BPH sufferers.
Marty
Good points. I have posted my experience on Rezum from 3 years ago. The Rezum is temporary but has still been well worth the cost, time and pain. I had posted my original experience because I felt like there was lots of negative perceptions and doubts. Anyway, if anyone wants to learn more, please see these two post.
My original story: https://patient.info/forums/discuss/rezum-treatment-details-553352
The story I am on now: https://patient.info/forums/discuss/rezum-treatment-details-part-2-722110?page=0&order=Oldest
Marty and Ken - your exchange is interesting and, equally importantly, polite. Which is often a rare commodity here on the interwebs!
Marty, I'd never heard of Aquablation before and I'm glad you brought it to our attention. I suppose I could say that I wish I'd known of it before I had the Urolift in October, but when I read the FAQs on their website get the impression that it works best for prostates that are far larger than mine. I also looked at the video; at one point a disclaimer comes on "not for sale in the US". Hmm.
Ken, I've of course read and commented on your fine posts on the other Urolift thread. I'm so glad it worked well for you. Unfortunately it doesn't seem to be doing that for me, although I am continuing to be patient. Next week it will have been 2 months and I would estimate my improvement at maybe 10%.
If by the first of the year that hasn't ticked up I guess I'll know. Will be having a chat with my uro in a couple of weeks and trust that he'll enlighten me. My situation is a bit more complicated as I'm also blessed with PCa, though thankfully only 2 low-volume cores Gleason 6. So no treatment in my immediate future.
But of course the urinary situation is a huge drag. I'll bring up both PAE and Aquablation with him.
Thanks, guys. Very informative stuff! David
David,
Finding a Urologist who truly knows PAE and Aquablation was difficult for me. Especially with PAE, since that is an Interventional Radiology procedure that cuts into the bread and butter of a urology practice. Aquablation requires a AquaBeam robot that many hospitals still don’t have. I was told all kinds of crap about PAE and Aquablation by doctors that just was not true.
I had my PAE done five years ago and then had my Aquablation done November 5, 2019. My prostate size was about 60.
It appears thus far that I stopped the majority of blood in urine after 4 days and I was fully recovered after my 15th day. I was able to function sans Foley the day after surgery with just some tolerable burning when I peed which stopped by day 4. I now completely empty. No RE thus far. I have only some occasional annoying sensation in my urethra after urinating that will go away in time, I am told.
I know that the four other patients my surgeon did prior to me are experiencing similar results. This is all anecdotal to you and you should keep it in context. Do your homework! I did not have PC. Good luck!
Marty
Marty
Remember what we say on here is just our opinion. Being we are all different that is what happens. If we had the same opinion this site would be very boring.
The 2 men that I talk about were on this site about a year ago and that is what they said.
I went on line and looked at some of the new reports and there was only one that said that retro has a lower rate. I also look at a trail of 21 men that had it done. They only mention 11 that were still into sex. All that was said that they had no problem with ED but retro was not even mentions.
I have been on here for over 4 years and most of the men that have had any procedure there doctor was only concerned with getting them to pee better they are not concerned with there sex life.
As for the Urolift most of the men that it did not work had other problem either it was not the prostate or the doctor did not take care of the median lobe. That is why the company came up with the MedLift
But a long story short. Men have to pick what they feel is right for them. A Turp is a Turp no matter if it is done with a coil, laser or with water. I would not deal with any Turp. This is my opinion.
But if that is what they want it is on them and if any side effect come up it is on him not the doctor.
All the best. I did find a clinic in Georgia that are doing Aquablation. 2 doctor are train to do them a Dr. Sharpe and a Dr. Kriteman. They have done 10 so far. I sent a email to them to see what there results are for that 10. I asked to see if it worked and how many in the 10 ended up with retro. Also with not having the prostate what was there orgasm like. Did it stay the same or is it different.
Be safe....Ken
We should do as much research as we can to pick what we feel is right for us but we should not be anyone test subject.