Hello- I am 54 yrs old with enlarged median lobe, use Flomax but want to stop taking medication and do a procedure. My urologist is proposing either TURP or Resum. I am trying to weigh benefit vs side effects. Seems like TURP is more effective but with more side effects vs Resum which is possibly less effective long term (not enough data) but better side effects. Any thoughts or experiences?
If it were I, I’d try Rezum first. If results are not good, then Turp is still an option.
I went through the same decision process. Finally joined a clinical trial study for iTind. The other latest and greatest was water ablation. I chose iTind and it worked great. The key was that I took the one with the least likelihood of a bad outcome. I was 61 and did not want to deal with incontinence for the next 25 years.
The iTind procedure was very very mild. If I had to repeat it in 10 years I would gladly do so instead of going through TURP. A week of discomfort compares to 25 years of incontinence was my decision point. Not yet approved by FDA yet but I heard that water ablation has been and the outcomes are very good.
I kept hearing that TURP was the gold standard. Does that mean the medical community makes the most gold with it?
In the end you are trading off risk with benefits. Benefit of TURP is that you won’t likely have to have it repeated because it is so aggressive. Risks are many.
Best of luck.
Hello Maurice:
Only two choices seems very limited. Are these the only two your doctor does? If so, perhaps a 2nd opinion would provide other alternatives.
Dave
Maurice, I am 70 years old. I’ve had three surgeries so far, over a span of around 15 years. The first one was a “greenlight laser” surgery, the second and third one were “turp’s” If I could do it over again, I would choose to do what I am doing now, which is CIC. I’ve been doing CIC for 28 months, and it’s the best way to empty the bladder for me.
My suggestion to you, is to try CIC first. If it works for you, then fine. If it doesn’t, then you can try some kind of surgery. This way, it is the least invasive way on your body.
I forgot to mention, surgery, may not be the final answer, because as in my case, the prostate, continues to grow. That’s why I had three surgeries.
Good luck!
Maurice,
I am going through a similar decision process now. The current TURP procedure is called bipolar TURP and uses a loop to cut the tissue then a plasma button to cauterize, so there is much less bleeding and in most cases the patient can go home the same day. Also, the patient is not awake for the treatment, so no pain. With Rezum the patient is usually not “out” and there is a lot of pain. With TURP there may or may not be a Foley catheter for a day or a few days - no big deal. With the other procedures there is also a period of catheter use, prostate swelling and pain that can continue for a long time. The most commonly mentioned objection to TURP is retro, and that seems to steer many men into other procedures that don’t cut away prostate tissue. The other procedures are less effective and retreatment may be required some years in the future, likely sooner than with TURP. It’s a tough call. I am still not decided how to go. For every procedure there are men on this forum who say all went well, and some who had bad experiences with lots of pain and post treatment issues. This included not only REZUM but Urolift. There is one procedure that is fairly benign - PAE. I had it a year and a half ago, and it was painless and easy. No catheter. Some discomfort for a week after. Unfortunately, due to the size and shape of my prostate it was only partially successful. I was able to go off Flomax for a year, but am back on it now. Statistics show PAE is normally about as effective as TURP at relieving BPH symptoms, but in my case it wasn’t. It’s something you should look into, if you don’t have a median lobe. The ML can still block urine flow even if a PAE shrinks the prostate, so most PAE failures noted here are due to median lobe issues.
Tom
Bobby,
My uro says the risk of permanent incontinence with bipolar TURP is about 1%. I have seen similar stats elsewhere. However, incontinence is not well defined. It can mean anything from total inability to control urination to just a slight dribble here and there. I have had this for decades and wear a pad of toilet tissue in my underwear - absolutely no inconvenience at all, don’t even think about it. I have been on this forum for a long time and the risks of any procedure are real - and many here have gone through months and even years of issues with any of the procedures - except PAE (which I had). The only problem with PAE, for me and others, is that it doesn’t work well if one has a median lobe that can continue to block the bladder even after the prostate has been reduced in size. I have to point out that old TURP and the newest bipolar version with plasma button cauterization are very different. The old monopolar TURP reqired several days of hospitalization to control the bleeding, but the newer version usually sends the patient home the same day with far less post op bleeding and discomfort. The pure plasma button TURP without the cutting loop is even better at reducing bleeding and from what I have read post op side effects.
Tom
Some of what was said here is wrong. If you are considering a first procedure, without a massive prostate, but typical BPH, you should absolutely do Rezum and not TURP. For most men, it works as well as TURP. There is no anesthesia risk, no incontinence risk, no impotence risk and a very low likelihood (5-10%) of Retro Ejaculations.
The recovery for most men from TURP (even the newer techniques) is longer than Rezum and most docs will twilight you with Rezum so you don’t feel any pain. Most men can pee passably after a week or two from Rezum. And there are no long term studies, but its holding up over 3-4 years - and if it came to that, I’d rather get Rezum every 5 years than TURP once. There is no reason to do a full blown surgery when a quick procedure will probably work as well. And BTW, most urologists define continence as no more than 2 pads per day. That doesn’t sound anything like continence to me. And if for some reason, Rezum doesn’t work, they can always do a TURP.
If you have an enlarged median lobe, Urolift isn’t likely to work. Go with Rezum, but first get scoped and have a urodynamics test to confirm that the prostate is your problem and that you have enough bladder strength to do the job if the obstruction is removed.
The CIC that someone suggested is an option and can work, but many men would rather have a quick procedure and be done with it than carry caths wherever they go. Many are fine with it, also FWIW. But given the question you posed, I’d say Rezum hands down.
Bobby,
That is the best comment that I’ve seen about TURP EVER!
I kept hearing that TURP was the gold standard. Does that mean the medical community makes the most gold with it?
I would like to have re sum done but I cannot find anyone who does it in the Portland, Oregon area. the closest is in Seattle.
“Some of what was said here is wrong.” Please explain.
To All:
How much shrinkage can be expected from the Rezum procedure? Also, how are “shrinkage” and “removal” different, aside from literal?
Dave
Dave, to get an accurate answer to your question, you would need to see a urologist and find out the current size and shape of your prostate.
My prostate was estimated (via TRUS) at 68 grams with an enlarged median lobe prior to the procedure. I received 10 shots of steam, 4 on each lateral lobe and 2 on my median lobe. I asked the urologist how large my prostate was several months after the procedure, and he said “about half” the size it was before.
Ken
I found this article that compares the two - do a search on PD64-01 - may help a little.
PD64-01 THE WATER STUDY CLINICAL RESULTS – A PHASE III BLINDED RANDOMIZED TRIAL OF AQUABLATION VS. TURP WITH BLINDED OUTCOME ASSESSMENT FOR MODERATE-TO-SEVERE LUTS IN MEN WITH BPH
I opted for Rezum over TURP - TURP being the last resort.
Dave - my Uro told me that the overall shrinkage is not what counts, it’s the fact that it opens up the urethra on the inside where it counts. I think I read somewhere that it’s like 14%, but I can’t find where I read that.
Hi Ken:
My prostate has already been fixed via a simple robotic prostatectomy. Removing it was my solution over trying to shrink it. I get curious when I hear that a certain medication or non-invasive procedure will “shrink” your prostate by a certain percentage.
I realize through reviewing this forum that everyone’s first choice is meds, followed by non-invasive procedures in an effort to shrink the enlarged prostate. I was fortunate to only have one choice - removal.
Dave
Gentlemen- Thank you so much for all your input and for sharing your experiences. Based on what I learned from this discussion, I am moving away from TURP. My Uro only does Resum & TURP (he doesn’t do Urolift or anything else), he said he does not like the fact that Urolift wasn’t originally approved for ML so he doesn’t trust it for for the ML indication, which makes no sense to me. So, I am going to do a bit more research and interview Urologists that are abreast of more of the newer techniques to get to a decision.
Tom,
Yes, I had heard 1-2% for incontinence, but then there is ED and RE too. At 61 I did not want to be one of the 1-2% who suffers for the rest of his life. For the 98% who had a good outcome I say “Thank God”. They were blessed.
I chose the path that had a history of 0% negative side effects. The only downside known at that time was that it worked for 85% of men and that the results were only known for 5 years since that is how long the procedure has been in use. Now it has been 7 years and from what I have read still no downside and nobody had had to have it repeated yet. I am hearing that water ablation is also almost as gentle.
All that being said whatever happens I know that I will cope. Human beings can adapt to almost anything. I met with a cancer survivor’s support group to discuss how their surgeries have impacted their personal lives. This included women who have had double mastectomies and men who had a radical prostatectomy. The man who had his prostate removed became impotent yet with support from the group he said his sex life improved. Instead of 10-15 minutes ending in ejaculation sexual intimacy now extends for as much time as they wish. He focuses more on his wife’s desires and gets pleasure from pleasing her … sometimes several times a session which elicited smiles an d a few giggles from the group. Then over about a year or so he found that while he did not climax with an ejaculation, he was getting the same release of endorphines, dopamines, oxytocin, etc. in his brain from having his other erogenous zones stimulated for an extended period of time. The result was a much deeper sexual intimacy than they had ever achieved from before. His wife pointed out that all this occurred with a lot of frank communication and a lot of patience. The effort was worth it because she said her husband had become a much more generous lover.
So it all depends upon each of us making the best of our situation no matter our choices.
Bobby,
A few years ago I had radiation for prostate cancer, so my sex life went from fantastic to nothing. So, my present concern is eliminating the frequency/ugency/nocturia issue. I have to pee about every hour to hour and a half, day and night. I never, ever get a good night’s sleep. I am up 5-8 times per night, sometimes more. My uro offers three procedures - bipolar TURP, Greenlight Laser, and Urolift. For Rezum I would have to drive to another city and pay out of pocket - not covered by my current insurance.
One of my concerns about the Rezum procedure, aside from pain during the treatment, is the prostate swelling after. I can barely pee now and am retaining about 200ml, so if there is further swelling I might be completely blocked for possibly weeks. I would need a Foley catheter and after that CIC. At some point, the prostate would shrink and I would be able to pee again. I went through this for five weeks after my prostate radiation - had 6 Foley’s in and out, and eventually the swelling went down and I was able to pee again.
After my PAE I had swelling, and the urine flow was reduced, but I was able to handle it with 2 Flomax per day and Tylenol for a week. No UTIs because nothing is passed up the urethra. The procedure itself was completely painless and actually pleasant.
Back to Rezum - add a UTI to the swelling and I can imaging running to the bathroom every 15 to 30 minutes all night long.
I really need to hear from anyone here who has had the Rezum procedure to find out two things: how was the pain and what about the next couple of weeks?
We are all in the same boat trying to make the right decisions. My rule of treatment has always been to go with the treatment that is the most effective with the fewest side effects first (for me that was PAE), then if that didn’t work, move to the next procedure. Many here believe that to be either Rezum or Urolift. There are so many ways to go it can make your head spin.
Tom
Tom, I think that you’re doing the right thing by starting with the least invasive and going from there. I only have experience with Rezum, so I’ll offer my suggestions for that procedure. And really there are only three:
- try to find out beforehand if you have the type of blockage that the Rezum will eliminate. By that I mean make sure that the urologist has a good image of the anatomy in that area. My urologist used a TRUS (Trans Rectal UltraSound) and was able to see the enlarged median lobe that was causing most of my problem.
- ask for general twilight anesthesia. Rezum can be painful without it. On the other hand, it does only last for a few minutes. It must be rather memorable though, since it gets its share of attention from those who have not had a general anesthesia.
- learn to self cath before the procedure and don’t let them insert a Foley after the procedure. If you self cath, you have control over when you urinate. I self-cathed at least three times after the procedure later that day. I expected some pain because of the procedure but I didn’t really feel any.
Yes, there will be swelling of the prostate for several weeks after the procedure, and so you need to take steps to counter the swelling. A Foley catheter is normally used, but CIC makes the recovery so much more pleasant and less stressful.
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