Hello all, First let me say thank you to everyone that shares their story and knowledge on this site. Been doing allot of reading and it's been scary and helpful. I am 54 years old with a prostate size of 90cc. Been on flowmax for about 2 years and over the past few months been having drips of incontinence from time to time. After much research and talking to two urologist I have made the choice to try Rezum to help with my nightly bathroom visits and get off the meds. I have had biopsy and MRI on prostate and no sign of Cancer at this stage. I will be having my procedure on Sept 10th in Toronto Canada by Dr. Dean S. Elterman.. Rezum is new to Canada but he has done about 50 procedures at this time. Next week I have a few pre op test.. Blood work, EKG and Urinalysis/Culture test. My goals after the procedure.. 1. Don't be worse off than I am now 2. No sexual side affects 3. Fix incontinence 4. Lower PSA by reducing prostate size 5. Better voiding of bladder so I don't get up 2-3 times a night. Any advise the experts want to offer would be appreciated and i will update everyone on my experience.
The best first step for you is to try a PAE. Your prostate size is best indicated to use the PAE procedure. Rezum is good but for smaller prostates. Also rezum has longer healing time and possible use of a cath for a week or so. If you go the PAE direction I recommend Dr. Isaacson at UNC Chapell Hill.
Hi Roderick,
The success of the Rezum procedureI, in my opinion, is dependent on the skill and experience of the Dr. operating the equipment. 50 is not very many procedures. There are a lot of docs around who have done over 100. I had Rezum on June 28 with Dr. Kevin McVary at Loyola University in Chicago. As far as I know, he has done several hundred of the procedures. He was on the team that helped develop the technology and he is Principal Investigator of the clinical trials. So far, my results are good. My prostate was 93g with a median lobe. It was not a "minor" procedure. I had 13 steam injections and it was done under anesthesia, not local. Recovery has been steady but slow. I used catheters for the 1st 4 weeks. Now I use them intermittently (CIC). I can urinate, which is a blessing after 3 years of total retention and countless years before that of barely being able to pee and spending inordinate amounts of time in the bathroom and then having to go again in half an hour. At one point before I started using catheters, I was getting up 4 to 5 times per night. Now it is 1 or 2. I would recommend looking around for a urologist who has more experience with this procedure. A couple I ran into in my search were Tobias Kohler at Mayo Clinic and Scott Eggener at University of Chicago. I also visited and consulted with about 4 other urologists who did Rezum before settling on Dr. McVary. You cannot undo surgery and it's not an emergency, so take your time and do your homework. Don't go to a guy who is still learning. Wishing you the best, Fred
roderick58376, . I had a successful Rezum in November 2018. I recommend the following before your Rezum: . 1. Research your urologist carefully for one who has done enough Rezums with 50 being a minimum number. Absolutely do not go with a urologist who has only done a few Rezums. This could be a big mistake! 2. Have all of the pre-Rezum procedures done, urodynamics test, cystoscopy, and TRUS/MRI. I did not have the last done as the cystoscopy gave the urologist the necessary information on a median lobe. 3. That you are having drips of incontinence from time to time, suggests retention so also have a bladder ultra sound to determine your post void residual (PVR) and overall bladder size. 4. Know how to self-cath before you have your Rezum just in case you need to do it after you have your Rezum. Many of us have required self-cathing for a period of time after our Rezums.
Good luck! . Steve
Roderick,
Take the information you receive and process it based upon Your Personal situation. Then move forward based on the Best information and Choice(s) you can.
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I know, based upon my research, that there are a lot of choices to be made. And I wish I could, but I can not, afford some of the Best Choices. That's just the way the Universe works. We don't get Everything we want. * Example: After having my Primary Care Physician refuse me anything but drugs for years, I was FINALLY lucky enough to get a referral from her to a Urologist. Then after All the visits, and Cystoscopy and DRE's, etc... He states "You have 2 choices either Urolift, or TURP." but I didn't want Urolift or TURP, I wanted PAE, or FLA, or some Specialist with tons of Experience and Expertise to fix me.... (just $$$$ is not there).
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So I jumped through tons of hoops for months, completed an unimaginable "Run-A-Round" course with my Insurance and finances, and even made a couple of round trips visits 400+ miles each way, to get a PAE at UCSD in San Diego. With Dr. Picel (excellent reviews, and seems to be an Excellent Doctor). Then.... Dr. Picel suddenly went to Stanford University * about 400 miles the other direction for me to travel back and forth. LOL .
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So I did the same Flipping mess All over again, many more months. Got and paid "out of pocket" for a CT Scan (I could NOT afford an MRI 3T which is the Best, and I wanted). Only to be subsequently told that "You are not an excellent Candidate for PAE..." because although they believe it is my enlarged Prostrate (38 grams verses the normal size 14 grams) which is causing my years worth of LUTS issues, the "Best" size for optimum success is 50 - 95 grams for PAE procedures.And in my Humble opinion... having just started at Stanford University, Dr. Picel wants a "Home Run" and so he decided (in my opinion... not based upon anything he said) now he is referring me to another Urologist at Stanford (appointment in September).
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Sorry for the long, whining story.... Point being, if you did your best researching, and have made what you believe is your Best choice; You should have Faith, go into this with a very Positive attitude, and Pray for the Best outcome. All these Procedures have Positive and Negative possibilities. When you are tired of living with this curse (BPH and its Wonderful side issues) , then at some point you need to go for what you think will be your Best Choice, based of course on Your own Personal situation. That is what I am trying to do.
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Good Luck Brother. I sincerely wish the Best for you, and myself,
Chuck
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PS - I hope someone with Rezum experience Actually gives you some Good Advice on Pre-Op Rezum recommendations. Verses me and the last couple of guys, just confusing the request.
I had GL PVP on my 75grm prostate in 2004. They did a bladder neck sparing version and I was fortunate that my lateral lobes were the problem and the median lobe was not too bad. Catheter out in the morning Recovery hardly took any time at all and I was out and about to normal life on day three. My prostate regrew over the years to 135 grms and I then had Thulium/Holmium laser (Similar HolEp) in 2012. Again no problems. To my mid they re the easiest on the patient with quick recover and few later problems.Does you hospital not do them ?
I am in Bermuda and will fly up to Canada for the Rezum.. the green light laser is available here in Bermuda but one of the high probabilities is sexual side affects. I'm too young to take on that too.
38 grms is still quite small. Though when mine was first discovered in 1995 it was 35 grms and I was told that I needed a TURP as a matter of some urgency. There was not much else around im the UK then but I said no I'll wait for one of the laser treatments that are being researched. It was a long wait for GL in 2004 but in the end it was the right choice despite what my local Uro's said.
No sexual side effects with me or with friends who have had it. My hospital in Newcastle and others were doing a bladder neck sparing version. A friend anxious about the outcome had sex on day five. I was more conservative and waited fifteen days :-) Actually the day after my GL I woke up with an erection. Strange going from Bermuda to Canada for it as many Canadians complain about their health facilities and Uro's. My cousins husband in Toronto had his prostate and his heart bypass done in Florida during their winter vacations.
Some good and bad advice here.
Good: Get a urodynamics test done before any procedure. Often bladder damage is a result of long term BPH and that can limit the success potential. Incontinence isn't usually a BPH side effect so there might be something else going on. Find someone who has done a lot of these. 50 is kind of the floor. If you're going to travel anyway, it makes sense to find someone who has done hundreds - and potentially closer to Bermuda than Toronto. Atlanta/Charlotte/Raleigh seem like good choices. Learn to self cath prior to the procedure and make sure your doc will write you a script that you can get filled beforehand. Foley's SUCK and self cathing is a minor inconvenience that allow you a completely normal life. Bad: Prostate size and PSA are not that important.How its growing (in or out) means more. I had a 30 gm prostate and had a miserable case of BPH. Some guys are over 100 and pee just fine. PAE as a first choice. Results are not good with an enlarged median lobe and anecdotally on this forum there are a lot of failures. Greenlight has a 50/50 chance of RE and in the wrong hands can create big, permanent problems, while Rezum rarely does. Better to start with a non surgical, less risky procedure with little chance of RE that usually works well. You can always do Greenlight if Rezum doesn't work.
Most important thing is make sure your prostate is impeding your flow, get a urodynamics test and make sure you have enough bladder function that you'll get results. It doesn't have to be perfect, just adequate without an obstruction and it usually rehabs some over time.
Good luck!
I have family there in Canada and my wife is from there. The Uro I'm using is Dr. Dean S. Elterman he is highly respected in Canada. But you are all right and i am doing my own research. As many for as I find that aren't. :)
My doc told me 50/50 on RE with Greenlight. Higher than Rezum, but much lower than TURP/Holep.
The problem now it that there is so much choice that patients are confused. I had my GL when they were doing trials of it in England. They were possibly being selective in the patients they took. The team had only done 38 procedures and I was the sixth patient of the most junior Uro but I had utmost faith in him. They kept me for a second night as I was not voiding completely and I had a long train journey home . Day three I went to the races and friends asked if my operation had been cancelled as I was out and about as normal and looking so well. I usually went straight to a toilet when I got off the bus but not that day. I did go later and had several coffees and had to remind my self to go again before leaving. They later did a 92 year old patient with a very large prostate as they said it is a very gentle procedure. It will be even better now that they re on the third generation machine. When my prostate regrew I had moved and the original hospital was too far to go to... Distance though is evidently not a consideration for you. The first person to have GL used to post to an old news group and flew to Japan from LA on day three. I did have an appointment later when my prostate regrew with one of the two urologists who pioneered GL in England. He said that many of them had thought that GL was a very easy procedure but later realised that it needed more care.
Everything has its price. ER worries some more than others.
Roderick,
Do you know if you have an enlarged obstructing median lobe ? This can be determined by a cystoscopy or by MRI which you have already had. You may need someone to read your MRI and tell you if you have enlarged median lobe. Before any procedure you should have a cystoscopy and ask for a video CD of it and a written report. Discuss before hand that you want them to tell whether you have a enlarged median lobe or not. How was it determined that your prostate size is 90cc ? The most accurate way is by 3T MRI, followed by 1,5T MRI, followed by TRUS, followed by Trans Abdominal Ultrasound, followed by DRE. The size of your prostate and the median lobe are the two main charateristics to determine which procedure is best for you. Since you are only 54 you should probably be concerned about sexual function, in which case PAE is the least likely to cause Rertrograde Ejaculation, RE. However PAE does not work well with enlarged median lobe, so you need to determine that first. Some doctors say they can now target the median lobe arteries. Dr Bagla, Dr Issacson, and Dr Picel say they can target the median lobe but you would need to contact them to ask for results data. The next procedure least likely to cause RE is Urolift but some Urolift procedures have gone bad, very important to find an experienced doctor. Urolift has not worked with an enlarged median lobe in the past, but a new version of the procedure claims to deal with it, again ask for the results data. The long term results of Urolift are not well known, and the devices they put in stay there for the rest of your life, The next least likely procedure to cause RE is Rezum, which I think has better results than Urolift, but longer recovery, and a 5 - 10% chance of RE. So there you have it, if you don't have an enlarged obstructing median lobe, PAE is the best procedure to start with. You can try any of the other procedures after that,
Good luck, Thomas
Why are you advising a GL laser? If frys the prostate and almost always leads to RE so sex life is crap. Everyone with a prostate larger than 80cc should first try PAE. Urologists dont' like it because they don't do it. Beware the medieval procedures done by urologists.
The IR's are figuring out how to deal with a large median lobe. Talk to one about a PAE before looking at other options.
RE was a dealbreaker for the guy who opened this thread - so maybe GL isn't the best first option for him. It was for me too so I waited for Rezum. I agree that many men don't care .
Hi Fred Your report is interesting. I went to DrMcVary also,however he said my prostate was to large for rezum 116 gr.I am in total retention,have been for 3 years. I was very disappointed when Dr Mc Vary said Rezume would not work for me ,he then suggested Turp. Maybe my age had something to do with his decision. I'm 90 years young. How are old are you Fred? Did you have a cystoscopy done before Rezum.How long has it been since you had Rezum done? Thanks for this info? Sincerely frank,.to
I talk from the experience of having had it. It most certainly does not fry it. The laser accurately removes tissue and does not burn deep into it as frying would indicate to do that. Google for how the procedure is performed accurately leaving a smooth inner shell and is blood free as the laser seals as it goes. Were it as you suggest would Uro's still be using it as their procedure of choice after fifteen years. It's only possible drawback is that it does not save tissue for histology as Holep or newer procedures do.