I am 61 with 35 cc prostate. I have a small median lobe and high bladder neck. I could not tolerate meds. My post residual is less than 15 cc. Uro-dynamics is consistent with obstruction. I wake up about 4 times a night and it messes my sleep as I am still working. 1st urologist was recommending TURP, but I thought it was a drastic measure. PAE is not the best for a small prostate with high bladder neck. I looked into FLA but I asked two physicians from reputable medical centers who use the technology to treat prostate cancer and they say it is not as accurate as claimed by the doctors who use it and there is the risk of perforation. My urologist , who is a professor of urology, is now is recommending Rezum and he has done more that 100 of those. He has also experience with HOLEP, Urolift, TURP. I am scheduled Nov 20th but I am hesitating because messing with bladder neck can have risk of RE and incontinence and the fact that my prostate is small and most of it would be cooked considering that only a small portion of it is causing the problem, but I don't know if there are other options. Any response will be greatly appreciated. Ken have been very helpful in these posts.
It's a study that you can find (it was mentioned on this site) that any thermal treatment of prostate(that will include TURP and RESUM ) will impair nerve bundles on both sides of the prostate, most likely making some neural cells to die. Why no to try Urolift. It works great on smaller prostates (35 g sounds like normal size to mine 140 g before PAE) and seemingly helps 95% of patients. Given a small size of your prostate, you might have a bladder neck anomaly ("lazy bladder" in your youth?). Then Resum is not an answer. Double check.
I went through that last year. For many years I denied having a problem until i had an acute retention after a marathon race. Months followed until I found the urologist in Houston in whom I trusted, because previous options like TURP didn't comvince or were not feasible like Urolift, due to the median lobe. The doctor I chose did a combination of Rezum and PAE. Post surgery I steadily improved, my bladder capacity improved, I had a short period of incontinence when it became urgent, but overcame that, FE is working, i go up once a night if i sleep longer than 6 hours. i am very pleased with the outcome. if you trust the doctor, go for it!
Do you have any issues with urinating, like slow flow, frequency during the day as well ? Hank
My problem seems simiar to yours , small prostate but bladder obstruction, confirmed by urodynamic study , made worse recently due to a nasty UtI. I was recommended a bladder neck incision which I was told was far less invasive than other options (UROlift was not offered for some reason ) . It has a quick recovery time but likely to result in RE. Meds worked well for me for 6 months . I have not had it yet but im now regretting not having it when offered . I know Nick on this forum has had this option done. All the best Darren
My situation was very similar to yours, I had Rezum done and I'm very glad I did. It was a life changer and sometimes I can't believe how my life used to revolve around the bathroom. If your doc has done 100 or more, go for it. If he/she offers a twilight option go for that too
If your post residual is less than 15 cc do you need to do anything right now? My Urologist told me anything less than 40 or 50 is normal. Maybe think about CIC before you go to bed as an option.
When there is long standing obstruction it will lead to a hypotonic (lazy) bladder. That is what I am afraid of because I do not want to end up with atonic bladder with high residual. Also Urodynamic did demonstrate very high bladder pressure due to obstruction, so it is not lazy bladder.
yes slow flow and I go about every 90 minutes and I have urgency and some discomfort and fullness in the area in the perineum where the prostate is.
yes he does, he will put me out
I can void okay, do you mean to leave the catheter in all night, I don't understand. My main concern is to preserve the bladder before it becomes lazy and to get up less at night.
can't you have it done now ?
did you have any incontinence or RE? did they inject the bladder neck? how many injections / steams did you have
No incontinence. Not as much volume on ejeaculations as before, but not full RE either. Well worth it to me for sure.
5 sprays. 2 on each side and one on the dreaded median
Are you retaining urine ? How much ? Hank
I just reread your post. You don't have retention. With small prostate like that, I don't see how you can feel its fullness. It could be some kind of inflammation! I might not even be the prostate. Hank
Is your only issue that you get up 4 times a night? Do you keep a urination/defecation journal? I recommend that you do. You might find that the volume of urine you void at night is well over 30% of the total you urinate in a 24 hour period. If so, that might be contributing to the 4 times per night. With some lifestyle changes, you might be able to cut down the number of trips at night.
No as i was formally using private health care in the Uk but am now on the NhS , which is a very slow meandering beast and they are insisting on their own tests which take forever . im now hoping somehow i can have a Urolift rather than a BnI
I would recommend checking w/ interventional radiologists (Isaacson at UNC, Spies at Georgetown or Bagla in northern Virginia) rather than urologists regarding the PAE and the FLA (Karamanian in Houston). There seems to be a reluctance for urologists to recommend any procedures performed by radiologists.
Keep in mind that if you have an enlarged median lobe then the PAE has a much lower succes rate (if any).
Best of luck!