Benign prostatic hyperplasia (BPH) Surgery Options

Thanks Ferris! If I have the procedure it will be at Mayo Clinic Rochester. Thanks for the additional info...great questions to ask.

I had a TUNA way back in 2000. My Uro said it would last about 15 years, it has now been 21 years and I am having no problems with it at all. Last prostate exam was done in Sept. Results were " prostate feels smooth, no lumps, still a little large but no reason to do more surgery". "Come back to see me in one year".
The only issue I have had in the last 21 years is Peyronies disease. Cause of this disease is unknown but I do suspect it may have been caused in part by the bladder exams ( I had two exams in less than 5 months) and I think the tube they used may have caused some damage.

@sirref , Ferris, thanks for this insight into Rezum. I see the importance to talk to the doctor about pain before the procedure. There are other similar procedures and I will be sure to bring up the subject whatever I do.

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.

@jetjock , I am being a good boy and following all my PCP's steps prior to admitting that surgery is the next step. So I am using the time to see what surgical methods are available out there, including pros and cons. A friend of mine had water ablation therapy and is happy with it. I don't have an organized approach and have not talked to knowledgeable professionals. You might want to look at it and talk to someone.

Or have you considered it already?

After all the research, I was unable to come up with a "best procedure," so I took my Urologist's recommendation. He was experienced and had good successes with REZUM so that was my choice. I had my procedure done on September 12, 2022. It hurt. No lie. It was worse than the biopsy. He injected steam at eight points. The Valium that I took a couple of hours earlier was my friend. Soon after completion, the pain lessened. Not a lot, but still. Learning how to navigate a catheter didn't take long and improved with practice. Now, two days later, the pain from the procedure is essentially gone. The only pain now is where the catheter enters the tip of the penis. Movement into and out of a chair is done slowly to avoid movement of the catheter at the penis tip. The clinic people remove the catheter tomorrow.
My advice: Try to avoid all of the hype - you'll know hype when you read it.
https://www.rezum.com/home.html
is an example of what I am talking about.
Get your information from contact.mayo.com or other people who have had a BPH treatment. I didn't ask my Urologist for references, but HIPPA probably would have gotten in the way. There are many videos on youtube, both pro and com, but the best video I have seen is
https://youtu.be/TvTjREdHO0I
It is a 30 minute video is presented by a urologist experienced in REZUM who does not have a financial interest in the product. You could ask urologists in your neighborhood and get an opinion that will lean towards their preference. Ask your friends who have had one of the many procedures performed and have them describe the pros and cons. If your like me, your decision is going to depend heavily on what your Urologist is qualified and experienced in. At day 2, REZUM gets a thumbs up from me.

@rfherald Good luck on your continued recovery. I like you have been undecided but leaning towards AquaAblation. I found a urologist in the area that has done about 20 of them, being a relatively new procedure. I have spoken to someone who had Rezum and he was happy he had it done but it took about 6 months for it work as hoped, he's good to go now. I have been OK with the condition for now, in fact the last question on the IPSS (someone had a sense of humor when naming this), where it asks how you would feel if you spent the rest of your life at the current stage of BPH and I was fine for the most part, so I do have some time, but a procedure is definitely in my future.
Rf, if you could keep us updated on your progress that would be very appreciated and thank you for the video and links, very helpful.
Bill

I am looking at the UROLIFT procedure. Going to have to do something...I think the REZUM might be a good option. Just can't take another day of this foley catheter, been in for 60 days, and tip of penis with ANY movement is beyond painful. Thanks for your input. Good luck.

Will do. The procedure was painful even with Valium. But the pain subsided quickly and completely gone in two days. The catheter caused great pain until I was able to limit tubing movement by taping it to my leg. On the third night after, I slept eight hours! It's been years since I've had eight hours sleep! I almost asked for a permanent catheter - the two liter bladder let me sleep through the night. The procedure bothered the prostate so it grew making urinating slow, frequent and painful. The pain was caused by the catheter. The urine remaining in the bladder was 260 ml, 60 ml over the limit. So I have to recathiterize, self-catheterize, or hope I'm below 200ml this morning. More next time.

Bilal Chugtai of Weill-Cornell Medical Center in NYC does REZUM.
.