Rezum Procedure Cover-up Re: Ejaculations

Men's health
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I had the Rezum procedure 10 weeks ago. While it indeed makes urination far easier, one of the major side effects has been dry ejaculations and a loss of satisfying orgasms, probably FOR LIFE. While the Rezum literature states a 1-2% probability of retrograde ejaculation, other sources say this is more like 4-6%. In addition, it appears that my condition is not retrograde, but instead caused by the destruction of the semen glands from the procedure.

The manner in which Rezum avoids taking responsibility for these issues is by implying that these permanent side effects are temporary. They do this by listing this issue in a list of side effects to expect just after the procedure, thus making it appear that these side effects are relegated only for that few-week period. This is dishonest. Moreover, when searching the internet for “complaints about Rezum” or any other search critical of the procedure, invariably you get knocked over to the Rezum site or other positive articles.

If you have had a similar experience with Rezum, please chime in on this thread.

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I did not have Rezum therapy but looked into it extensively prior to choosing Aquablation. My concern with it, in addition to what are typically very modest improvements in flow rate, was that it appeared the risk of damaging the ejaculatory ducts if the urologist treats a median lobe aggressively would be high. This is because they run through the central zone to reach the verumontanum where they emerge into the urethra. They carry ~70% of the volume of semen (originating from the seminal vesicles on either side of the prostate) with the remaining 30% coming from a network of glands within the prostate originating mostly from within the peripheral zone but also the central zone. It’s easy to see how the latter glands could be affected by Rezum or any other procedure that produces large cavities in the prostate. But again that’s only ~30% of the overall semen volume.

The main argument in favor of Rezum with respect to avoiding ejaculatory dysfunction is that the heat release by the change of phase of the injected steam will be confined to the transition zone tissue IF that’s where it is injected. Since the transition zone is only 5% of the prostate volume in a non-enlarged prostate it does not have a significant role in producing semen or causing it to be ejected. However, if you have an enlarged median lobe (in central zone) and your urologist injects it along the floor of the prostatic urethra between ~ 5 & 7 o’clock, depending on how far it propagates, the heat it releases it could damage one or both ejaculatory ducts. That would mean either 35% or 70% (if one or both ducts are obstructed) of the total semen volume would never make it to the urethra. The urologist I consulted with who offers Rezum therapy stated he could not guaruntee that my ejaculatory ducts would not be affected if he injected the median lobe. He proposed 2 injections in the median lobe given the size of mine.

One other failure mode that could case ejaculatory dysfunction with cavitating procedures like Rezum (and most others) is if the cavity is too large, even if semen does make it into the urethra, the volume of the void is so large that there is not enough tissue to “squeeze out” the semen. I’ve seen some Rezum patients reporting developing RE months after their procedure. Given that the necrosis and removal of treated tissue occurs over an extended period of time with Rezum, this failure mode could explain those scenarios.

Bottom line with me was that I did not have the confidence that the urologist would have a sufficient degree of control over the extent of the effects of the steam with Rezum. I’m sure there are patients/cases where it’s a great option, just not mine.

How many injections did you get, and where?

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russ, where did you have your aquablation procedure done? cant find anyone locally or even within Colorado.
thanks

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Georgia Urology in the Atlanta area.

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The risk of RE is higher with Rezum than they claim - probably in the 5-10% range, which still makes it the procedure routinely covered by insurance with the lowest incidence of RE. Its also otherwise non invasive and generally quite effective.

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Try using duckduckgo for search instead of Google. you might get better results

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I might have tried it if I hadn’t needed to have my median lobe treated.

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Hello Russ Im going to GA Urology on 1/18/2022 for initial visit with Dr Kriteman about aquablation. Who was your dr.?

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Bob, sorry I didn’t see your question here. I did just see your more recent post while in recovery at Northside and sent you a PM. Brent Sharpe did my Aquablation, also at Northside Forsyth. He has offices in Braselton and Gainesville. Excellent physician and even better person. Let me know how your recovery goes.

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im 7 weeks out from my rezum procedure. while my frequency, urgency and flow are improving my climaxing diring sex has very little to zero feeling at all and no ejaculation. my doctor is suggesting cialis to improve feeling. erection is not a problem and i am wondering if cialis will help at all. they can seem to give me any answer as to if this is temporary or permanent. so far, very frustrating and scary for myself and my wife

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i had the rezum procedure 2 to 3 years ago… i’ve had RE ever since. i bet everyone gets it with rezum. this is bull… the pleasure is almost gone. do you know of anything that helps? mike

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i had Rezum procedure about 4 years ago and had no problems. My prostate tissue grew back and I decided to repeat the procedure..
I am 6 weeks post op and thus time was a whole different story. I bled for one month post op and I still have to urge to urinate often and wake up 5 times a night which is worse then before my procedure. Now I have discovered i may have retrograde ejaculation as my orgasms are dry. I feel like i should say I’m young 50’s and non diabetic and in decent shape. Ejaculation was fine before my procedure. Will it get better? Anyone have a similar experience? I chose Rezum solely on the fact that RE chance was 1-2%..

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My doctor during my 8 month post op visit stated RE has a 10 to 15% possibility, not the low percentages stated here. My only negative from Rezum is the RE, allelseis good.

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I had Rezum almost six years ago when I was 61. 54 cm3 prostate size with small median lobe. Had 3 injections on left, 3 on right, 1 in center. I am 5’8", 145 lbs.

Orgasm returned to normal at 60 days out from the procedure and has remained constant. IPSS score is currently 9. (It was 21 when I had my Rezum.)

If and when things slow up again, I was planning on having another Rezum. After your experience, though, maybe I was lucky the first time - like you. I’d have to talk in-depth to my doctor (Richard Levin, Baltimore area) before a second round. I do trust him; he was involved in the first Rezum trials and has copious data about his Rezum procedures.

Just a thought: A lot of Rezum success may be doctor experience/skill dependent.

Best wishes, John.

Bill

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Hi John, Yes, I"m almost 6 weeks after Rezum and have had no feeling or sensation during ejaculation since. No contractions or Kegel muscles. After a few seconds a little semen spatters out. Like having an orgasm during an epidural. This hasn’t changed in the last 4 weeks and I fear it may be permanent. I don’t have ER or ED and because there is some semen, I don’t think the ducts from my prostate were damaged, although I had two needles in the central lobe. My prostate was big, 98ml and I’m old, 83, but satisfaction level before Rezum was 70/80%. I would not have had it done, had I ever heard of the outcome. I have contacted the surgeon and will let you know what he says. I’ m sorry John, hang in, I know exactly how dissapointed you are. Steve.

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I spoke to my GP today about lack of feeling during orgasm and he said not to give up on it, that it was probably just some nerve damage due to the ablation. They do grow back but it’s slow. I see that in the UK where they have been doing Rezum a lot longer than we have, they say it takes 6 months for full recovery not 4. So let’s hang in and hope for the best. Cheers, Steve.

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I’m now 3 1/2 months post procedure, have not yet had a follow up with the neurologist to perform the procedure other than a phone consultation. I experienced some improvement in urinary flow, however, I received five total zaps as he called them with two in one lobe and three in the other. My prostate was approximately 50 g and I have had dry climax since the procedure as well as shall we say diminished satisfaction at orgasm. I can’t seem to get my urologist to give me a straight answer or even really talk to me about whether or not what I’m experienced is permanent. I don’t know if anyone else has experienced this but I find climax to be considerably less intense, and practically unsatisfying.

I wish I had known about this particular risk and that it was far more likely an outcome. The only thing that the clinic that treated me has told me is they don’t even really want to discuss it until I’m six months post procedure. Does anyone know if there will be any improvement at all or am I going to just have to learn to get used to this?

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I had the Rezum procedure in Sept. 2019. I was previously scheduled to do the Urolift procedure but decided on the Rezum after some negative feedback about that from a Urologist who didn’t think highly of it. He thought the Rezum was a better choice.

On the day of the procedure, after taking the prescribed valium, I was asked on the way in if I would be okay if a representative from Rezum observed the procedure. Without thinking much about it, I agreed. Anxiety about the procedure and not knowing how it would actually happen was more in my mind.
I am taken in and put in a similar position as a woman in stirrups giving birth, and a younger woman (with Rezum) comes in with the male nurse and doctor. At this point I wasn’t comfortable with the idea, but didn’t voice my concerns.
With wide open crotch, and with this woman, not a medical professional, standing in the “front row” the procedure proceeded…

The blasts of steam lasted about 9seconds each and towards the end of each blast the pain level was 12 on a scale of 1-10. I nearly couldn’t take it, and I thought I had a high tolerance for pain!
I went home with a catheter and bag, and feeling a bit like the sexual abuse survivors I treated for 35 years as a LCSW. Adjustment to the catheter was painful and wearing a bag to work for several days wasn’t fun. After 5 days I took the catheter out, as directed, and soon found myself unable to urinate. I went back in and had the catheter put in again, and again went through the very painful adjustment of having it in.

I think the catheter was in for another 5 days when again I took it out. This time, although painful and difficult, I could eventually start peeing again. It took some time but eventually I started feeling more normal and experiencing decreasing BPH symptoms, ie increased flow and decreasing urgency and frequency.
After some time, and resuming sexual activity I discovered I had no ejaculation, ie I had retrograde ejaculation. I didn’t know that was a thing, but I now had it. At first I went through some feelings of being abnormal but found I could adjust to that, and unlike some men, my wife didn’t mind. At the time I was involved in an online support chat/group with many other men who had had mostly adverse reactions to the Rezum procedure and found that support very useful. I heard many stories that were worse than mine, and was able to vent my frustrations about my experience with other men who were feeling like me. Btw, my urologist seemed surprised when I told him about my online support group and the fact that so many men were having very negative experiences with Rezum.
So why do I write about this now after almost 7 years? After this procedure I soon discovered an irrational fear of going to see physicians, even my own personal doctor, who I respected. As such I found myself avoiding self-medical care, with an irrational fear of going to any physicians. I realized I had medical ptsd, but still avoided most treatment for about 5 years, when I slowly began “risking” to just go see a physician. I never went back to the urologist that performed the Rezum and as predicted I now have moderate BPH symptoms agai–, almost as bad as before the procedure. I’ve tried tamulosin, finasteride, and Cialis to treat the BPH symptoms but none of them have helped at all. I also frequently wake up with almost obsessive feelings of having been traumatized/exploited by this situation and wanting to warn others about the potentially negative experience they may be getting themselves into. When these night-terrors happen, I also relive the feelings of violation from my urologist’s insensitivity to my personal privacy. Had he asked me prior to being drugged and heading into the procedure room, I would never have consented to some non-medical woman coming if for front row seats to my wide-open crotch witnessing my medical trauma.

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