Sorry for the delay in answering. I partially tore my Achilles tendon in the mean time and have been dealing with that also. A median lobe... or sometimes called middle lobe is also a BPH condition. My understanding is that the central or middle part of the prostate is the part that grows too large constricting our urethras and making it difficult to pee. A median lobe is when that same portion of the prostate grows vertically up into the bladder. Not sure if this normally occurs near the neck of the bladder outlet or if I am just lucky, but mine is right next to the bladder outlet and is essentially acting as a ball valve restricting urine flow from my bladder. A median lobe is readily visible on a cystoscopy. After pushing through my prostate, the doctor continued up into my bladder. He is then able to bend the cystoscope and look back at the opening of the bladder. I was able to watch all of this in real time and was shocked to see the blockage as the doctor pointed it out on the screen. As the saying goes, one picture paints a thousand words. It served to make me realize that it is time for a surgical procedure to fix this problem. The urologist who did the cystoscopy only does traditional TURP surgery, so I got a referral to the University of Washington urology department hoping they would be able to perform HoLEP or Rezum. I have had bladder retention issues for the past few months, and maybe longer. On my first visit to the UW, I was in extreme bladder retention and ended up on a foley catheter. Unfortunately I also learned that UW does not have the equipment to do either HoLEP or Rezum and the doctor I was dealing with did not know of anyone in the Seattle area who does. I am on his schedule for robotic simple prostatectomy in the next few weeks. I asked if I could continue to search for another urologist who does HoLEP or Rezum and he said "of course". I have since found a doctor who does HoLEP, but his earliest appointment for a first visit was in February 2022 with surgeries scheduled out 6 weeks later, which puts me out to late March approaching April. I also found a doctor through Boston Scientific's Rezum doctor finder website. Still waiting for the referral paperwork to process before they will even talk to me. I feel like I am running out of time. My GP doctor does not recommend being on a foley catheter long term while I wait to see those other urologists. Has anyone in this forum had HoLEP or Rezum done anywhere near Seattle? Washington state or Oregon? I would love to have this done at the Mayo Clinic, but traveling to Rochester, MN would be challenging.