REZUM procedure update

Men's health
1

Hello All:

I found this website strictly by accident.  In an earlier discussion from June of this year I detailed my rezum procedure.  To recap:  I had the rezum procedure on June 10.  The procedure itself was extremely painful by the way.   I wore a catheter bag for 3 days and it was removed on June 13.  I was able to urinate on my own that morning but by the evening was unable to do so.

So, on to the emergency clinic where a catheter bag was reinstalled and I wore it for 5 days.  My doctor removed it and for the next week I had to self catheter several times.  This was not painful but uncomfortable and I was able to stop the self catheter on June 23.

I should mention that I passed blood clots several times when doing the self catheter but once I was able to urinate on my own the clots stopped.

Sexual function?  Well no other way to put it but to be a little blunt.  After 6 weeks, I decided to pleasure myself and a mixture of semen and blood was ejaculated.  This was very painful and the pain lasted for about a day.  I tried it again about 2 weeks later and same thing except less blood.

Then a week later and nothing but a small blob of semen and that was that.

Now some 5 months later absolutely nothing is ejaculated.  I am sad to say but my urologist neutered me.  I visited him for a regular routine and I have an appointment to see him again early 2017.  He noted that I was the first patient to have this problem but then again I was about the 24th patient he had performed the rezum procedure on.

Hope this helps anyone who is thinking of this.  By the way I am 55 years of age and before this had an enlarged prostate that kept me up at night having to use the restroom at least 3 times.  Now it is down to 1 time usually.   I live in the USA  here in south Texas, San Antonio.

Jerry 

 

2

Sorry to hear things didn't go as planned. Apparently you are not alone per this thread here where you might want to relate your experience.

https://patient.info/forums/discuss/retro-or-no-retro-after-surgery--545770

Jim

3

Hey Jerry,

According to most of whom that contribute to this site, there are many procedures out there and They all come with there own set of problems,    That is why we are here,  to finally find the silver bullet that works.   But before you get too worried keep some basics in mind.

1).  A lot of the meds we take'. Like flowmax and the sort can cause low sperm production, or actually none at all.

2).  They also cause a lowered libido,  or no sex drive.

3).  It's all temporary,    However you have to find that balance by lowering your drug intake and letting your body get back to having a strong sex drive and your ejaculations will improve dramatically.

4).   How do you do that and not have to worry about keeping your bladder empty?    Self Cath!  It's easy and simple.   Technically it's called CIC.   Clean intermittent cathing.  If you don't do it,    Then you need to start,    Until that silver bullet is found!

Good luck and welcome to the group!

4

 

 

I’ve been following this blog for about 11 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  I used tamsulosin (Flomax) and dutasteride which did help, but eventually as the prostate continued to grow, the effect was lessened. Plus I realized later the drugs zapped my sex drive.

 Some procedures seem to work for some but not all.  Worse yet, some have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

The best answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it back out.

 Yes, you have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

I have heard varied reports on PAE which is done by interventional radiologists.  It is an outpatient procedure and far less invasive.  However, I don’t believe it’s covered by most insurance, and because of the iffy results, don’t think I’d try it.

 Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

5

Jerry,

Thanks for your description of your REZUM. Doesn't sound too promising. Had a Urolift with surprisingly no improvement. The sexaul thing is almost the same as before but not quite. My doc also said I was the first patient he had (over 150 proceedures) that the proceedure didn't work and caused other issues. Could that be??? After reading the blog and my own experience I suggest that one holds out as long as possible with medication. My doc said 3 times  up at night is normal for a male in his 60's. Seems none of these proceedures is a cure all.

6

Thanks Jerry for sharing. I had the rezum procedure August 23.  It not only did not help it made things worst.  I'm know having the self cath up to 3 times per day whereas before the rezum procedure I never had to self cath.  My situation does seem to slowly improving and I may be able to drop back to self cath twice a day, but still - Rezum did not work for me.  It is interesting to note the pain that you experienced with the rezum procedure; pain level seems to vary from person to person - I had zero pain while others report pain.  As an aside, I was concerned about self cathing myself but it turned out to be pretty easy.  The part about self cathing that I don't like is that it takes a bit longer than the natural way and you've got to fuss with the catheters.  Other than that is self cathing, for me, is mostly a non event.  Medicare supplies up to 6 per day and a 3 month supply; I now seem to have boxes of cather's stacked up everywhere all over my home office, ha!!  Take care - John.

7

Lately a lot of new procedures have sprung up and more will be coming. Before jumping into something you know little about you should consult at least 3 urologists. It's your life.

8

Hi John,

Hi John,

Glad the self cathing  is going well even though you were forced into it because of the Rezum. How would you rate your overall BPH symptons now compared to before the Rezum and self cathing?

I agree, everything being equal, it's better (and quicker) not to self cath. That said, I have it down to just under 60 seconds total -- including opening the package, doing the prep, cathing, and disposing the catheter. This is down from probably three or more minutes when I started out. Part is practice and technique (just 5 seconds for the actual cath process) and I probably cut a few corners with prep, but no increase in UTI's. 

Jim

 

9

BPH symptoms score is 21, about the same as it was before the Rezum procedure apart from the fact that I now need to self cath because I can now never empty my bladder.  Before Rezum I could sometimes empty my bladder but not always .  I still have frequency and urgency issues.  I see my Uro tomorrow; he will be doing a hydro test on my bladder and then later this week we will discuss other procedures that he might be able to do that would improve my condition ...turp??

Anyway, I don't want to sound like a cry baby.  In general, I'm really pretty happy in life. If I've got to self cath the rest of my life I can do that (I'm 65 yo).....but I just thought I would share my experience after Jerry posted his.

 

As far as self cathing, I'm not a quick as you (60 sec is pretty quick!!!).  For me, the critical path step is running the tap water until it warms up to the point that I can wash my hands.  That step takes about 2 minutes .. eeerrr!!   So, the self cath procedure is probably 4 minutes total for me.

Take care, John

10

Hi John,

As long as you're cathing anway, do you think increasing your cath frequency would help your frequency and urgency issues as well as your overall sympton score? 

As to technique, I usually skip the handwashing part altogether because I only touch the plastic funnel and never touch the part of the catheter that enters the urethra. When I do wash my hands, I generally used one of the alcohol based hand cleaners. Just squirt it on the hands, rub, and you're done. I also don't use wipes, but instead just squirt an antibacterial spray on open meatus and penis head. That only takes a couple of seconds. The most time consuming part of the 60 seconds is opening the package and orienting the catheter (and coude tip) in the proper position for insertion.

Jim

11

Just wanted to add that the 60 seconds is total time, including urinating through the catheter, which takes around 30 seconds. So the actual catheter time is only around 30 seconds. That said, I almost always cath at home and I'm sure it would take a little longer if I had to pack the materials with me. 

Jim

12

I fgiured that 60 sec was your total time.  That is really very good.   I'm not there yet but maybe someday I will be; it's now on my wish list!   I never throught the being able to self cath in 60 sec would be on my wish lisyt,  Ha! Ha!  What  hoot!  Life can be funny.

We should have self cath races

13

Jim, Yes, more frequent cathing would reduce frequency and urgerncy issues.  I might do that

Thanks for the tips on cathing.  That is really very helpul to me.  Thanks for sharing that!

 

14

Hi John,

In a sense you’re back to square one in your decision making progress, the difference being that the Rezum procedure has adversely affected things to a certain degree.

Rather than rushing into another procedure like a TURP, you should seriously consider trying self cathing as a longer term solution. You’re already ahead of the game as you know how to do it, and seem to tolerate it well.

Be prepared that your doc may try and talk you out of it, as they are hard wired into promoting whatever surgery they are trained on, and can sound very convincing sitting across the desk in their starched white jacket. And also, we as Westerners, are suckers for the quick fix, the magic bullet; but as you have found out, the magic bullet doesn’t always work as promised!

I was also offered the TURP option several years ago but told the doc I would pass and ended up self cathing instead. Today, my prostate symptom score is as good, if not better, than the results for a successful TURP, and with none of the negative side effects.

If I were in your shoes I’d dump any drugs you may be taking and give the self cathing at least six more months before making any decisions re a surgery, and then reevaluate things. But if you’re gong to self cath, you have to increase the frequency so that you won’t have any frequency/urgency issues.

One rule of thumb is to keep your total bladder volume under 400ml. Total volume would be the total of your natural void and your catharized void. Consider starting at six time a day and only work down if your symptons and total bladder volumes stay the same at a lower frequency.

I know six times a day may sound like a lot and maybe you could get by with 4 or 5, but in the beginning of the bladder rehab process, more is really better in that your bladder rests more. Later on, you can start to decrease frequency.

Personally, at one point after some initial progress, I wanted to see how few times a day I could self cath, and got down to once a day or even skipped days. What I found was that even though I could do it, my bladder condition stopped improving. So I then increased frequency back to six times a day for some time. Today, I hardly have to cath at all, but I really believe my progress began when I went back to the more aggressive cath frequency schedule.

Jim

 

15

Thanks Jim, You provide me lots to think about.  I appreciate the time that you have taken to post on the subject.  Your posts on this subject are always welcomed by myself.  Take care.

16

I'm sorry that you can no longer ejaculate normally.  However, that hardly amounts to being neutered -- you still have functional testicles and still produce sperm, and can orgasm, even though you can't ejaculate normally.

Being "neutered" for many others, though, is a reality.

It's so common for women to have ovaries removed along with a hysterectomy that it is considered more or less a normal procedure in the US.

Quite a number of men  on this board have personal experience of having both testicles removed.

And when it comes to dealing with prostate problems, hormone treatment is, in effect, a chemical castration with side effects much more dramatic than retrograde ejaculation.

Now, it's possible to get used to just about anything, but nothing can really prepare one fully in advance for the penile shrinkage and lack of erectile capability (or even the desire for it).  For some men, too, the development of significant breast growth can come as an embarrassing shock.

However, if it's a choice between neutering and not living, then a very different life that one can still enjoy, though not with the same sort of pleasures as hitherto, is still very much worth having.