For those interested in discussing controlled study data (please note, the outcomes of individual cases are not relevant to this question): **Background** I'm 60 years old, have a 40g prostate (no median lobe) with an IPSS in the low 20s and a fair amount of retention. Two urologists have encouraged me to have Urolift rather than Rezum. However, when I review the controlled study data, it favors Rezum. If you've read the study data (4 year data is available for Rezum and 5 year for Urolift), know how to interpret it and can tell me if there is something I'm missing in relations to Rezum--there are many considerations here--I'd appreciate it. **Study data summary** * The short-term data favor Urolift: Average length of catheterization is 4.1 days for Rezum vs 0.9 days for Urolift. More Rezum patients have symptoms of urgency, dysuria and acute retention. Recovery from Urolift is faster than Rezum * But the long-term data appear to strongly favor Rezum: At 4 years, less than 10% of Rezum patients required retreatment. In contrast, with Urolift at 5 years, 33% of patients required retreatment (issues arising with the implants added to the total, see below). Additionally, I'm concerned about interference of the implants with detection of prostate cancer by MRI (I have no history of prostate cancer but it is common)(see footnotes 1 and 2) * Note: Both urologists suggested Rezum can cause retrograde ejaculation, something I've experienced from medication and would like to avoid, but I don't find that reported in the Rezum study data ? In summary, Urolift is more appealing for someone facing surgery, but Rezum seems the better long-term option. **Retreatment data for Rezum and Urolift** **Rezum retreatment at 4 years (N=135)**: Surgery: 4.4% Restart medication: 5.2% **TOTAL: 9.6%** Source: [McVary, Rogers & Roehrborn (2019)](https://) **Urolift retreatment at 5 years (N=140)**: Surgery: 13.6% Restart medication: 10.7% Remove encrusted implants: 7.1% Remove implants from bladder: 2.1% **TOTAL: 33.5%** Source: [Roehrborn et al. (2017)](https://) **Footnotes** 1 - A [case report](https://) of MRI interference by Urolift implants 2 - A Mayo Clinic urologist comments in [Grand Rounds](https://): Urolift is “…supposedly MRI compatible. The only person I know that has those protocols that work well is Claus Roehrborn at Texas, because he was one of the investigators. When I put these through my MRI, my radiologist comes back and says “Well, there’s too much scatter in this area, I can’t tell you if that’s a PI-RADS region or not”
hi Mark,
every case is different. I had Rezum the end of October 2017 and it worked well for me. i had a large median lobe and Urolift was not an option. I could remove the catheter 24 hours after surgery and was able to pee. Urgency and incontinence in the beginning, but all went well after a few weeks. If you trust your urologist, go for it. Best wishes!
I had both a Rezum and Urolift procedure. My issue was primarily the median lobe where the Rezum failed terribly. Going into the procedure I could urinate, but I had a significant amount of retention. After the procedure, I could not urinate at all for almost 3 months. I then decided on the urolift procedure and things are now working well. I am 7 weeks post, so far so good. You are correct that there is no long term data with Urolift which is a concern. However, if you decide on Urolift, make sure that you find a physician at a center of excellence where the do a lot of procedures. My opinion is that your outcome with Urolift is much more dependent on the surgeon's skill than Rezum. Good luck!
interesting what Jeff says about Rezum and median lobe. It did nit work for him, but perfectly well for me with a large median lobe. What makes the difference? The surgeon, the individuality of each person, the tools? I really don't know, it's just so much mystery that the outcomes can be so varying. Based on my knowledge and all I read, I would still take the risk to get a procedure done.
interesting what Jeff says about Rezum and median lobe. It did nit work for him, but perfectly well for me with a large median lobe. What makes the difference? The surgeon, the individuality of each person, the tools? I really don't know, it's just so much mystery that the outcomes can be so varying. Based on my knowledge and all I read, I would still take the risk to get a procedure done.
I had Urolift with a median lobe. It didn't work and left me in pain. I have since had a TURP which has worked and one of the 5 urolift clips completely removed. Still have pain; not really sure why; no-one seems to know; just have to live with it. Since TURP I have retro which isn't great but at least I can pee.
Hi Emil,
Thanks for your reply. Inclusion/exclusion criteria are used to determine who can and cannot enter the studies. This ensures uniformity and allows you to compare across treatments. For example, in the first Urolift studies subjects with median lobe were excluded because that wasn't a target indication at the time. One thing though is that sample size for these surgical procedures is small relative to drug trials
Regards, Mark
Hi Jeff,
Not being able to urinate for 3 months is too much, I'm happy to know Urolift turned things around. I completely agree with that surgeon's skill is critical for Urolift--I was seeing a urologist initially who was not Center of Excellence trained and I switched. Hoping your good outcome continues!
Mark
Hi Emil,
Both Rezum and Urolift manufacturers designate urologists with higher level training as Center of Excellence--when possible I would use a urologist with this designation
Regards, Mark
Hi Andrew,
I'm glad to hear urination is better and sorry to hear you're still having pain, that's not good. I'm surprised 4 clips remained, I would have thought they would all be removed with TURP
Regards, Mark
Whatever Urolift say, I think it is very difficult to get the clips out, especially the 'other' end which is outside the prostatic capsule; generally only the end in the urethra is removed when they talk about removing clips. In my case the other 4 clips were helping but the lowest one through the median lobe had prostate growing all round it. The turp was on the median lobe and my uro said he took the entire clip out, managed to hook out the far end through a 'hole' in the prostatic capsule. I guess it must have taken a lot of digging which is why I probably still have pain. As I'm just 7 weeks after the TURP, there is no point complaining about pain yet; I'll have to see how it is after about 5 or 6 months.
With no median lobe, urolift is much more straightforward than what I had done. As I see it with Urolift your risks are: 1) prostate just growing around clips again 2) a clip firing off in a random place that causes an issue (the other end has been known to end up in the bladder).
With Rezum I think the recovery can be tougher and the results quite variable as the amount of tissue affected by the steam can go on dying for some weeks.
Do your urologists perform the Rezum procedure? How many Rezums have they done versus Urolifts? The answers to these questions could indicate why they are recommending Urolift.
I chose the Rezum procedure four years ago when I was 61 and had a 54 g prostate. My IPSS was also in the low 20's.
I had seven injections, one in the median lobe and three on each side. I was shown how to self-cath immediately after the procedure and then did it once myself before bed that night. This was the only catheterization needed and I really did it just to see if I could.
I could have gone to work (desk job) after the weekend (procedure was done on a Friday), but didn't since I was retired. ;) Current IPSS is 7. And no retrograde ejaculation.
I did not have the data that you presented when I made my decision since it didn't exist then. My selection of the Rezum procedure was due to it seeming to be the most forgiving procedure. I felt that having the Urolift hardware inside of me wouldn't be the best situation in case something went awry and a redo, or some other procedure, was needed.
Best wishes on your choice, Mark.
Bill
Hi Andrew,
Thanks a lot for your comments.
The Urolift implant is made up of a nitinol (nickel titanium) capsular cap, a PET suture and a stainless steel urethral end piece.
TURP only removes the inner part of the prostate, leaving the capsule.
Your TURP was median lobe only, but let's talk about the more general procedure:
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The stainless steel urethral end piece would be removed
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But what about the nitinol capsular cap? I'd like to know if TURP surgery normally removes the capsular caps or leaves them in place *
- If left in place, could the nitinol cap migrate to the bladder, cause pain (which could be severe) and requiring surgery for removal? (the 5yr Urolift data indicated 2% of subjects required surgery for removal from the bladder, you said this was the nitinol cap rather than the urethral end piece)
It seems likely that many men will undergo the sequence of Urolift followed some (hopefully many) years later by TURP. It's not clear whether or not there a good understanding of the general outcome and potential complications of TURP post-Urolift (although my urologist said it's not an issue).
One last thing, you mentioned the prostate growing around the stainless steel end pieces as a risk of Urolift. But my understanding is that it's intended and expected that the prostate will grow around clips
Regards, Mark
Bill,
Thanks for your comments.
I chose a urologist who is Center of Excellence (i.e., has completed higher level of training) for both Urolift and Rezum, and he recommends Urolift. When I asked why, he said to avoid retrograde ejaculation, which you happily haven't experienced, and which the Rezum 4-yr study data suggests not to be an issue. So I'm not clear why the recommendation of Urolift .
Two things that could influence that recommendation are:
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Urolift's fewer post-surgical complications (often going home without a catheter for Urolift vs 4.1 days on average from Rezum) result in higher patient satisfaction (short-term) and fewer headaches for the physician
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Urolift surgery costs twice as much as Rezum and the urologist stands to earn a lot more. Important note: I'm not accusing urologists of being greedy, but I am accusing them of being human. We humans have a way of putting a "halo" around things that benefit us and that can influence our judgment. For this reason, pharmaceutical companies are prohibited from giving physicians even the smallest of gifts that could influence their prescribing behavior
I absolutely agree with you that it's best to avoid leaving implants behind that can cause problems later on, and your positive experience is an incentive to me to look more into Urolift. You said you could have gone back to work on Monday after a Friday procedure. Could I ask how for many days post-procedure you were catheterized?
Thanks! Mark
I was not catheterized (Foley) at all. The doctor showed me how to self-catheterize right after the procedure because I wanted to avoid the Foley. I had a Foley about five months before the Rezum and didn't like it at all. Before bed that night, I self-cathed again. This was the last time that I needed to do this. I could pass enough urine naturally starting the next day to get by.
While I had my normal physical strength almost immediately, I didn't stray too far from a bathroom for a month or two. Urgency and frequency of urination were on and off issues. It took about four months to get to the steady-state condition that I'm at now. Not perfect, but I'm a lot better than I was before having the Rezum procedure.
Bill,
No Foley, that's how I'd like to do it. So now you've gone 4 years, no implants to worry about, and you'll ride it out for as long as possible, that sounds great. Before receiving your message, I was ready to move forward with the Urolift. But today I left a message for a urologist who is Center of excellence for Rezum , and I look forward to talking with him and then making an informed decision
Thanks, Mark
Yes, Mark, avoiding a Foley was a big thing for me. I only had it in for one day after the bladder stone removal, but it made it difficult to move at all. I can't understand how people can live with the Foley for days/weeks at a time.
If I went under for the Rezum, having a Foley was mandatory. So I opted for just the local anesthetic. Some of the Rezum injections were pretty painful, but the pain was short lived. I was disappointed that I failed the urination test right after my procedure - not a drop even after they filled my bladder with fluid. I resigned myself to getting a Foley, but the doctor surprised me by saying I could self-catheterize instead of the Foley. This was the first time that he mentioned this as an option. So I went the self-cath route and it was short.
If and when my prostate grows and I need to do something else, I would definitely consider having another Rezum. Unless of course one of the guys on this board alerts me to something better.
Best,
Bill
Mark, the data and conclusions you posted are pretty much what I've seen after reading a lot of medical literature on Rezum. I haven't read as much on UroLift because I had the procedure done in 2016 without researching it much.
The only thing about the data you presented I'd question is whether the percentages of patients who experienced the various side effects you listed are additive. In other words, some patients may have experienced more than one of the side effects, in which case they would not be mutually exclusive. The number I'd want to know (in addition to the ones you showed) would be the percentage of patients who experienced any of the side effects. So the ones who experienced more than one of them would only be counted once in the numerator meaning the numbers would be smaller than 9.6% and 33.5%.
Also, I want to say I've read some papers that were likely not one of the sponsored trials that indicated a small percentage of patients did develop RE with Rezum. There have certainly been several who've posted here who've developed RE after Rezum so it does happen. One theory I came up with considering some have posted here that they only developed RE months after having the Rezum procedure is that because the tissue ablation is a slow process, unlike with any type of TURP or HolEP which happen instantly, anatomical changes that occur over time as that tissue is absorbed by the body cause a delayed side effect of RE. I suppose the same thing could happen with PAE since it doesn't remove the tissue immediately either. One urologist I consulted with said among other potential causes of RE, having too large of a chamber created from ablation could cause RE even if the bladder neck, ejaculatory ducts, veru or relevant musculature are not damaged as the prostate muscles can't contract enough to force the ejaculate out. So given that Rezum can create a 1 cm deep defect from point of injection, some prostates could end up with an axial void of between 2 and 3 cm in diameter.
As far as urolift goes, my experience was very good but I started having symptoms again after about 18 months. None of the 5 urethral end pieces were visible in the past two two cystoscopies I've had. My lateral lobes are grown back out and my median lobe, which was not treated, is pushing up into my bladder. The procedure itself was painless as I was under anesthesia and the recovery was quick and uneventful. The Foley was out an hour after I woke up and I went home in the early PM. Maybe a week of minor pain and blood/clots coming out while urinating, but no trouble at all emptying my bladder. I do suffer from some chronic pain in my lower right abdomen which I wonder if it could be due to a misplaced implant. It could just as easily be some form of prostatitis.
I am going to have an aquablation if I can ever get it scheduled. I would probably go with Rezum if the doc could give me confidence there would be no RE, but he was unable to do that.