Steam Treatment for Benign Prostatic Hyperplasia

Mar 21, 2019 | Tiffany Rindels | @tiffanyrindels | Comments (65)

BPH

 

It is the genetic destiny of men, as they get older, to start to experience problems with their prostate. Half of men who have prostate problems, or benign prostatic hyperplasia (BPH), will experience bothersome symptoms.

Active surveillance, oral medication, lasers or an electric loop that burn the prostate tissue from the inside out  have been historic treatments for BPH. However, steam treatment has shown great promise and is changing the way BPH is treated.

Steam treatment is a convective water therapy that shrinks the prostate. The procedure can be performed in the doctor's office and has a low risk for complications and side effects.

Dr. Tobias Kohler, a urologist at Mayo Clinic, discusses steam treatment for benign prostatic hyperplasia.

Helpful Links

More helpful discussion may be found at the Men’s Health Group

Learn more about benign prostatic hyperplasia.

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@jakedduck1

@peeman
I don’t know how long it takes to recover from this procedure or if you’re having complications or not.
However, doctors aren't Gods. They are capable of mistakes even Harvard-educated ones.
Sounds like you'll stick with him even though you're having doubts.
Second opinions are welcomed are encouraged by good doctors. Why don't you ask him if you should get one? Don't use his recommendation though.
Good luck,
Jake

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Thanks for all the replies. It's been 9 weeks since I had the Rezum procedure. The bleeding and pain stopped after 6 weeks. I've had 3 urinary tract infections that have been resolved with antibiotics. I now have a good flow when I urinate with no problem during the day or night. BUT, I am now incontinent and have lost all my libido and ability to get an erection at all. I was never incontinent in my life. So, the trade-off is I couldn't pee at night (even with large doses of Flowmax or Alfuzosin) while now I pee on myself all the time (day and night) and have 100% ED. I wouldn't do this procedure in hindsight or recommend it to ANYONE.

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I am still waiting to hear from a patient that has actually had the REZUM therapy. Are there any on this forum?

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@peeman

Thanks for all the replies. It's been 9 weeks since I had the Rezum procedure. The bleeding and pain stopped after 6 weeks. I've had 3 urinary tract infections that have been resolved with antibiotics. I now have a good flow when I urinate with no problem during the day or night. BUT, I am now incontinent and have lost all my libido and ability to get an erection at all. I was never incontinent in my life. So, the trade-off is I couldn't pee at night (even with large doses of Flowmax or Alfuzosin) while now I pee on myself all the time (day and night) and have 100% ED. I wouldn't do this procedure in hindsight or recommend it to ANYONE.

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Thank you for the insight. Can you share your story from the beginning? I am considering REZUM but finding it difficult to get accurate real information. I am 81 and on Tamsulosin for about 5 years. Information keeps changing. I fear exactly the things you are experiencing. Thanks again for sharing.

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@tkohler

I looked back at other comments and would also like to comment on picking the "right" BPH procedure. There are many choices and they can be quite overwhelming. The menu of appropriate BPH options differs for each man based on prostate size, degree of symptoms, bladder strength/weakness and risk tolerance for sexual sides effects or urinary leakage. The earlier a man chooses to treat his BPH, the more likely he will qualify for all options. The most effective and durable BPH option involves enucleation of the prostate. If one imagines a prostate as an orange, enucleation removes everything except the rind creating a verly large channel to urinate through (surgical treatment for prostate cancer on the other hand removes everything including the rind which causes more side effects affecting stuff stuck to the rind). A patient with a very weak bladder (which can be assessed with tests) or a very large prostate (typically > 100-130 grams) should undergo enucleation. Enucleation can be done through an incision or an operating urethral scope. Because enucleation is so effective at removing tissue - most men will experience some sexual side effects. Thus, men who opt for rezum or other approaches opt to sacrifice potential efficacy and durability of the procedure for decreased risk of unwanted side effects.

Best

Dr Kohler

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Dr. Kohler,
I had been given numerous different measurements when I ask "what is the size of my prostate". I have been told 50 grams, then 57 CC, then 71CC and last time 81CC.

Can you share what the proper measurement is" Is it grams, CC or ML? I am very confused.

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@peeman

I want to share my information in the hopes that it will help others with similar problems; plus I have one question (at the end). I am 75 now and started having difficulty urinating about 6 years ago. My urologist at the time prescribed Alfuzosin 10mg once a day. That helped a lot, but after 2-3 years I started to have difficulty again. My urologist did a cystoscopy and said my bladder had lost some flexibility and prescribed Oxybutin 5mg once a day. This worked until early last year when I started having problem again. My urologist retired so I had a new one that did another cystoscopy and said my prostate had grown and I should take the Alfuzosin twice a day along with the Oxybutin. This worked until the end of 2022 and then I started to have problems again. In addition I started to have chest pains and saw a cardiologist that did x-ray, EKG and stress test. His conclusion was that my heart was fine but that the Alfuzosin was probably causing the chest pain. So my urologist recommended the Rezum procedure. I had the procedure done on 1/26/23. It was extremely painful. More than I expected. I was on a catheter for 5 days which was also extremely uncomfortable especially at night. I bled from my penis around the catheter the entire 5 days. The catheter was removed on 1/31/23. The nurse told me to drink a lot of fluids to keep the urine flowing to prevent a clot which might cause me to have be re-catheterized. It has been 5 days and I can hardly urinate at all. My urologist prescribed the double dose of Alfuzosin for another 30 days, but it is not helping. All I urinate is a teaspoon or two at a time every 45 minutes. This is a manageable problem during the day but a bigger problem at night. It's impossible to get a good nights sleep, and last night I was awake for 3hours trying to urinate a little to relieve the pressure. Finally a lot of blood came out and I was able to urinate a little. I am still bleeding and still can't urinate more than a teaspoonful at a time and it stings each time. Plus, my urologist had me Cipro 1000mg/day for 7 days. My hemorrhoids acted up and I thought the Cipro was making me constipated, but after stopping the Cipro my problem continued and I realized that my perineum was swollen and irritated probably from the swollen prostate. So, I was bleeding from both ends. This is where I am today. My question is this: I can live with the bleeding and pain and discomfort for the 6-12 weeks that they say it will take to recover, but how long will it take before I can empty my bladder. This is my biggest problem. At this point I can't say that I would recommend the Rezum procedure to my worst enemy.

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Thank you for sharing. I am 81 years old and just cancelled my REZUM appointment. I am reconsidering whether to have any procedure and focus more on managing my symptoms. I have been told that as we age the growth of prostate slows in many men. I am on Tamsulosin and it does still work. I have added Vitamin D, Turmeric and beta sitosterol. I will focus more on understanding size and growth. Hopefully it will slow before symptoms grow. Thank you again very much for sharing. I hope things improve quickly for you.

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@peeman

Thanks for all the replies. It's been 9 weeks since I had the Rezum procedure. The bleeding and pain stopped after 6 weeks. I've had 3 urinary tract infections that have been resolved with antibiotics. I now have a good flow when I urinate with no problem during the day or night. BUT, I am now incontinent and have lost all my libido and ability to get an erection at all. I was never incontinent in my life. So, the trade-off is I couldn't pee at night (even with large doses of Flowmax or Alfuzosin) while now I pee on myself all the time (day and night) and have 100% ED. I wouldn't do this procedure in hindsight or recommend it to ANYONE.

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Thank you for sharing. I hope the incontinence goes away with time and exercises.

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@kayak461

Hello Pablo81! The reason the VA recommended Prostate Surgery is because the median lobe of the prostate was growing up and into my bladder. One of the Urologists that I visited, who performs the Rezume’ procedure, told me that Rezume’ would not work in my case because the lobe growing up into my bladder couldn’t be “steamed” for risk of damaging the bladder. It also bothered me that the steamed and decaying Prostate was left in my body, thus the risk for sepsis. I am looking forward to hearing from you after surgery on how it all comes out! Good luck friend!

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Interesting. My current Urologist tells me that REZUM works for large median lobe. Frankly I am confused and am beginning to have little confidence in what I am reading and hearing from the some of the medical professionals. A lot of the info is put out by the company that sells the machine. I am looking in to PAE as an alternative and remaining on current regimen of Tamsulosin.

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@kayak461

Hello Pablo81! If you have access to YouTube, you can see and listen to answers to your question. I’m not a doctor and can only tell you about my condition before and after having HOLEP. I had BPH for years, was in the VA System for healthcare, and was taking Finasteride and Tamsulosin for 7 years. I had two colon surgeries and bilateral hernia surgeries under my belt, all of which were performed laparoscopically. After the VA looked up into my bladder and saw that my prostate median lobe was growing up into the bladder, they recommended I have my prostate removed. I began the search for a solution…..it can be somewhat overwhelming. I’m 70 years old and to answer your question on side affects from the HOLEP procedure, I will tell you that I am extremely pleased. I had to have the Foley catheter in for the first night following surgery, I didn’t like that at all. It was removed the following morning after surgery. I have no incontenence! I had minor leaking immediately after the procedure, but that was gone in just the few weeks following. My wife and I still enjoy an active sex life! There is a change though…..I no longer ejaculate semen, but I have the orgasm! The sensation is as it always was previous to surgery, just slightly different because I don’t ejaculate. The nerve endings are there, but the pathway for ejaculation has been disrupted. I’m thrilled with this! Being 70 and no longer capable of producing children doesn’t bother me, but being able to experience the same or near the same feelings during intimacy….I am delighted! My flow during urination is now excellent! After years of slow urination, I now urinate like I did when I was 20 years old. It’s amazing. I’m thrilled with the HOLEP procedure performed by a Urologist at the Mayo Clinic is Jacksonville, FL. If I can answer any other question for you, don’t hesitate to ask. I hope you find the procedure that is right for you….and the right Urologist for the procedure!

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I just yesterday cancelled my appointment for REZUM due to other medical issue that cropped up. Thanks for insights on HOLEP. I am currently on Tamsulosin and it does work so perhaps I should take a step back.

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@tkohler

Thanks for the questions. Rezum has good longer term data now showing retreatment required in about 10% of patients after 4 years (half restart medications, the other half undergo an additional procedure). This is very comparable to other technologies or approaches including TURP and laser therapy etc. Rezum can be done in the office for some patients and has the benefit of having low risk of causing sexual side effects. In my practice, all patients keep a catheter for at least 3 days after Rezum with that duration increasing based on prostate size, number of steam treatments required and baseline bladder strength. The reason why is that the procedure causes some inflammation in the area but the treatments do not immediately remove tissue like traditional laser or TURP procedures. Peak treatment effect typically occurs 4-6 weeks after treatment. Based on our experience over the last 5 years in Rochester, the vast majority would opt to undergo the procedure again (97%). It is very important to be proactive with prostate and bladder health - 1 in 7 men come to the Urologist with a bladder (the urine pump) that is already very weak - this limits your surgical options and sometimes forces men to catheterize to empty their bladders. With lower risks of new prostate procedures such as Rezum, I believe healthcare needs to shift patients away from long term prostate medications which may not prevent the bladder from getting weaker.

Keep the questions coming,

Dr Kohler

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Dr. Kohler,

You described Holep procedure and used example of an orange and rind.

Question I have is:

Does using the laser remove all or portions of the uretha and what are the implications of this short and long term? I am considering laser.

Thank you

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Thanks for the question - the anatomy of the prostatic urethra is a bit confusing. There are 4 distinct parts of the urethra - the first 2 are distinct tubes, the 3rd portion traverses the sphincter muscle and finally there is the prostatic urethra. The prostatic urethra is not really a tube per se here, rather it is the potential space that occupies the donut hole of the prostate - thus it can be a circular, slit like or any shaped opening. When surgeons remove prostate tissue they are not disrupting a confined tube, rather they are simply expanding that opening typically into a big circle. In case of a holep that circle is very large as it is takes the prostate to the maximum outer limit (the prostate capsule = rind of orange). Because so much more tissue is removed with Holep it is a more durable case as regrowing tissue to cause more blockage takes longer. On the downside the chance of problems with ejaculation is definitely higher. Some think risk of ED is also higher compared to other less invasive/max tissue removing approaches.

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