Rezum

Men's health
1

I am scheduled for Rezum 5/21. My prostate is about 30-35 cc. The doctor wants to do 4 injections. He said that was the minimum number of injections in the clinical trials for the procedure and if he does any less it may compromise the results. I spoke to another doctor who has done about 270 Rezums from Texas and he said he has deployed less than 4 injections depending on the anatomy. My doctor says sometimes the anatomy one sees during cystoscopy may not correspond to the physiology of obstruction. I have no median lobe. My current doctor has done more that 100 and he is a professor of urology. I am concerned because my prostate is not that large and 4 injections may cook too much of the the prostate leading to more complications like RE/ED. I cannot tolerate meds. I am 62 and wake up about 3 times a night. Stream is slow but no residual. I have urgency during the day. Any input will be appreciated.

2

I’m curious, how was your prostate measured?

3

I also must add that I have a slight high bladder neck.

4

Hi NBCP,

I’m looking at Rezum too. I have a 93 gram prostate with a median lobe. Can you give me the name of the doc in Texas who has done 270 procedures? You may have to PM me .
Thanks in advance,
Fred

5

I am surprised that LUTS is present with a prostate that seems small at 30 to 35 cc. But unclefester brings up a good question. If the prostate measurement was done as an estimate from a DRE, then it could be way off. My uro told me for several years that my prostate was 40 cc based on a DRE, leading me to think, rightly or wrongly, that my LUTS problems were due to prostatitis (also because I had blood in semen on and off). A TRUS showed a prostate volume of 100 cc. I now have a new uro.

6

I should have said LUTS is due to a prostate that seems small at 30 to 35 cc. There could be other issues such as the bladder.

7

I have problems with an even smaller prostate, 28g as measured by trans-rectal ultrasound. I also have a raised bladder neck caused by the prostate median lobe pushing up into it.
I had urolift done for it which has helped the original symtoms some but not greatly; but since I’ve had a lot of pain so not sure it was worth it.

How will rezum help a raised bladder neck?

8

i did pm u

9

NBCP,
My uro estimated my prostrate at 30 with a DRE. The CT scan showed it to be 38. I have been suffering very significant LUTS for about 2 years, no known median lobe, stricters, or other “issues”. My retention varies between about 25-100 , but I CIC at least once (sometimes twice) a week to prevent any higher retention volumes; because I strongly believe the larger the PVR volume, the less I can void. I can NOT get much sleep; my eyes are sunken / black circles and I llok like I have been punched in both eyes. I am very concerned that I not experience AUR. I would prefer to try PAE, and have made numerous efforts towards that (including going to Stanford and being examined by IR Dr. Picel), however I may have to go for REZUM or Auqablation due to Costs, Insurance refusal, and… my prostrate “not being considered large enough” for PAE to have a high likelihood of success.
NBCP, please keep us updated on your REZUM procedure results sir. Thank you,
Chuck

10

rectal ultrasound

11

my bladder neck is slightly raised but if it is indeed causing my symptoms then I assume Rezum will not help.

12

IMHO, you don’t have enough problems to really benefit from a procedure. Your risk/reward ratio is therefore high.

13

IMHO, you don’t have enough problems to really benefit from a procedure. Your risk/reward ratio is therefore high.

14

I had blood in my urine a couple of times due to burst blood vessels in my prostate. When you look at your overgrown prostate during a cystoscopy the vessels do look quite big.

15

I’ve been looking at PAE lately, and it never occurred to me to ask the question: what happens if a blood vessel that has been embolized bursts?

16

Following on with what hank is suggesting, are you sure you can’t make some lifestyle changes to manage your symptoms? Taking care with regards to how much you drink after dinner or wearing compression socks during the daytime or even considering desmopressin to have your body produce less urine at night (but it will produce more then during the daytime). I’m not saying that your issues aren’t with the prostate, but you really should consider if your issues are simply life-style related and/or issues with the bladder. My suggestion would be to rule these out before you undertake a procedure. You need to do your own research, but it seems like a lot of the failed PAE and urolift outcomes are due to an enlarged median lobe (which it sounds like you have). Researchers are trying to come up with fixes to this, but…

Can I ask how old you are?

17

I am 62 , there is no median when Cysto was done. My flow are is about 9.8 which is slow. My bladder pressure was very high during uro-dynamic studies. There were also minor trabeculations in my bladder seen during Cystscopy. The issue here is watchful waiting may worsen the problem and it would be more difficult to correct especially if there is some bladder damage. It is not a good idea to go into retention with very big residual and develop hypotonic bladder.

18

i am 62. there was no madian lobe on cystoscopy. My flow rate is about 9.8 with high bladder pressure with some tabeculations observed during cystoscopy. It may be a good idea to be proactive before developing hypotonic bladder and high residuals due to baldder damage. But unfortunately it is hard to pinpoint a procedure with the besr risk/reward ratio and finding the right doctor to do the right procedure.

19

Hi, I had my REZUM done in January, My urologist said I had a short prostate. I had all the usual symptoms, for many years. He told me of the possibility of RE but the risk was low so i took the chance. The doctor did 5 injections. Now 4 months later, I do have RE, and as time goes on I feel many of the symptoms come back, The only difference now is when I stand in front of the toilet I go. I may not always feel I completely emptied but I go, where as before the procedure I would sometimes stand there for minutes wondering if I would be able to go. My biggest disappointment is the RE. I am 59. Good luck with whatever u do.

20

Thank you John for the input. That is my concern. I thought if I were to get 4 injections it maybe too much for a small prostate. Did it cause problems with erection or the sensation during sex ?