Steam Treatment for Benign Prostatic Hyperplasia

Hello Pablo81! It can be overwhelming when trying to figure out what to do. I’m a believer in multiple opinions as my BPH experience ultimately led me to have the HOLEP procedure to reduce the size of my prostate, performed at the Mayo Clinic. I had a Urologist tell me that Rezum was right for me…when it wasn’t. When I found a Urologist that performed nearly all of the procedures out there, he ruled out all procedures and said “there’s only one procedure for you and I can’t perform it”…. it was a load off my mind. He referred me to the Mayo Clinic. Because you’ve had Radiation, your oncologist should weigh in and offer some guidance to help. Find the best Doctors, get their opinion! Best of luck friend!

Kayak461's experience with doctors is similar to my own. Why choose one doctor who is performing all Rezum procedures (for example) unless you've already been to a medical institution (such as the Mayo Clinic) with hundreds of doctors with many who specialize in your particular medical problem and who work as teams of doctors first deciding how to treat your particular case? However I can understand not living close to lots of renowned hospitals etc as I do and not being able to travel to one.

Has anyone out there had REZUM? What is your experience with it? Thanks.

Dr. Kohler,

Can you talk about post treatment (REZUM). How long until improvement? Catheter and for how long? What has been you experience i.e. number performed versus outcomes? Thank you.

Thank you. I have looked in to available therapies and have landed on REZUM because it seems to be an elegant procedure with very low risk and few if any side effects. Can be done in office in minutes and leaves prostate sack intact. Trying to confirm with patients who have done it. Not surprised to hear they are looking into using it for cancer.

Thank.s

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

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

Thanks Doc. Is enucleation the same has the holep procedure?

Hello Dr Kohler. Thank you for a doctor's experience with many patients performing the Rezum procedure. However, what might also be as valuable information to new patients contemplating having the procedure done are reputable websites with patient reviews of their own personal experience with Rezum both short and long term after having it done.
Of course you need hundreds of patients recounting their experiences to begin to get a sense of the best to the worst outcomes and everything in between. (Bobweb, retired engineer)

Hi Gerryp….I’m not the doctor you asked the question of…..I was a Mayo Patient and I had HOLEP in May of this year! The “E” in HOLEP stands for enucleation!