The Rezum procedure and BPH

Men's health
1

Hello;

I represent a large Urology practice in New Jersey.

I have been notified that there has been a lot of interest in new procedures for the treatment of symptoms caused by an enlarged procedure.

My group has substantial experienced with many procedures for this condition, including the "Rezum" procedure (we have done over 100 cases at this point and are one of the most experienced groups in the world at this point.) I wanted to offer any information and answer any questions anyone here might have about this (or any other) procedure for BPH (Benign Prostatic Hypertrophy.)

 

Thank you.

 

2

Thank you  And you well Ken Orlando Fl

3

Do you know the difference between a procedure and a prostate?

4

I did read about the difference in a book somewhere once. Unfortunately, it appears that autocorrect didn't

5

What do you feel are the greatest factors that have an effect on the outcome in different patients? Does the skill of the practitioner play a major role or is it such a simple procedure that almost any urologist should have the skills to be successful?

What is the rate of success at your NJ practice as a whole?

Thanks

6

I forgot to mention- I'm referring to Rezum.

7

I've already had a PAE procedure and it was unsuccessful because my large median lobe is still blocking the neck of the bladder. As a result I'm self cathing 4-5 times a day. 

Does the Nezum shrink the median lobe?

8

Had green light 12 yrs ago.  Increasing symptoms today and just discovered a urethral stricture.  Assuming stricture is "fixed" and  BPH still is a problem,  which approach is "best"  or better I do evaluate all the possible treatment methods out there? 

So far I have spoken with 2 urologists. One says he likes TUNA.  The second recommends UROLiFT, since I have a 60 gram prostate and no median lobe.  Both are office procedures with significantly higher reimbursement rates from Medicare.

Seems to me that urologists and intervention radiologists become wedded to a particular therapy.

9

Hi,

I posted this question in another thread, but it seems to better belong here. 

Out of your over 100 cases, what was your incidence, if any, of retro ejaculation? 

I ask because we have had several cases of retro from Rezum reported on this forum, far more than would be expected from the data reported by the manufacturer. 

And thanks again for coming here to answer questions.

Jim

10

While it is a relatively simple procedure for experienced urologists, I believe that number of cases never hurts; the Rezum procedure is new, but fairly similar to a procedure that urologists have performed for well over a decade (Prostiva.)

The vast majority of our patients have been delighted by month 6 after the procedure; most of those who aren't have underlying bladder dysfunction (which is why I generally recommend bladder testing prior to the procedure.)

11

If the median lobe is treated, it will shrink as well after the Rezum procedure.

We have had success in using this treatment for very large (>100 gram) prostates

12

Currently, the Rezum procedure is not technically reimbursed by most Medicare plans  (although some urologists will bill using the Unlisted code successfully.)

The role of stricture after Rezum has not been extensively tested as far as I know; I wouldn't think the rate would be significantly high. Urolift would have a minimal if any increased risk of stricture.

Everyone's prostate is different; In your case, without a median lobe, a Urolift may be a less invasive first line approach, although I would still recommend a cystoscopy and possibly urodynamics evaluation first.

13

That's a great question, and not something I have off the top of my head.

I can tell you that our incidence after Urolift is effectively zero- which makes sense given how the procedure works.

The Rezum procedure will have less of this than a standard TURP procedure, as the ducts are not typically treated directly. However, as the steam may extend around the capsule, I would never assure anyone a 0 risk of retrograde ejaculation (or anejaculation).

I generally recommend that my patients not have interest in continued reproduction prior to doing this procedure (even though that, even in the worst case scenario, sperm could be harvested for IVF afterwards.)

14

This sounds interesting. I have some other questions:

1. Can the median lobe always be reached and treated?

2. What are the potential side effects and percentages of those side effects?

3. Out of the 100 patients that your practice has treated, how many reported what they themselves defined as success?

Thanks.

15

Thank you for your candid and frank answer.

Outside of the reproductive issue, I always advise men to do a trial by Tamsulosin (or similar) to experience retro first hand so they know exactly what it is.

Many men here report that either their uro's didn't mention retro at all as a side effect of prostate reduction surgery, or they assured them that their orgasm function will remain intact, which while technically accurate can be very misleading, as can be evidenced by the surprise (and sometime anger) when these men shoot unexpected blanks after the surgery.

I don't think it's up to the doctor, or any of us here, to either minimize or scare men about retro, but I do think men have a right to experience it beforehand so they can draw their own conclusions. That, and to be offered alternative procedures like you do, should they not tolerate retro very well. 

Jim

16

I believe tamsulosin should be tried in just about every case; it is cheap (generic) and usually has some level of efficacy. It also allows one to guage for potential side effects. For anyone who is not happy with the retrograde ejaculation, I would recommend against most procedures (except Urolift.) I would also recommend switching to alfuzosin (another generic medication) if they would prefer not to have a procedure, as the incidence of this problem is less with that medication.

17

1- I will never say "always"; technically, Rezum is generally recommended for glands less than 80 g; we have had some success treating as large as 130g so far. However, If you can "see" tissue, you can technically "treat it".

2- Virtually all men will have some irritation with voiding for the first few weeks; some will continue for 2-3 months. I cannot give exact percentages, but somewhat fewer than 1/4 will likely have retrograde ejaculation; erectile dysfunction is a risk, but we have not seen this yet; urethral stricture would be another risk that we have not seen yet.

3- Most will be defined as "success" that their AUA symptoms score will improve by at least 5, and their flow will increase by at least 5 cc/sec. I don't think that we are unique in this aspect compared to other high volume Rezum practices.

18

JerseyUro,

I was specifically refering to a "trial by Tamsulosin" to preview retro for a prospective candidate for bph surgery so a more informed decision could be made. Outside of Urolift, do you ever offer men the option of self catherization (CIC) either as a solution or to extend their watchful waiting period. That was my choice three years ago when there weren't really any ejaculation preserving procedures being offered. 

Jim

19

CIC is always an option.

It is great for

1- Men who have limited bladder function (and, hence, prostate surgery likely won't work completely)

2- Men who are in retention and are waiting for procedure

3- Men who may go into retention after a prostate procedure

4- men who are not well enough for treatment, or don't want treatment for some other reason.

20

JerseyUro,

Glad to see you understand and support CIC. I probably fell into "#4" when I started CIC three years ago when my doc recommended TURP.  

Then, as they say, a funny thing happened, and I was able to rehab my bladder to the extent that I went from near acute retention (PVR of 1.5 liters when I started) to where I now rarely have to CIC with acceptable PVRs, often below 50ml. 

I don't claim that my bladder rehab is typical, or that anyone can do it. But I did, and my situation is not unique. 

So I would add to that list, 5. Men who are motivated to attempt bladder rehabilitation in lieu of surgery. 

#6 might be: " Men with retention who want to extend the watchful waiting period for a number of reasons including waiting for better and newer surgeries and procedures".

Jim