Steam Treatment for Benign Prostatic Hyperplasia

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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I had the Rezum procedure 5 months ago and all has not returned to pre-BPH times, but blood in my urine tapered to zero in a week. Get a different Urologist or at least a second opinion.

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It has been nine months since my Rezum, and I still get up every every two hours to pee usually resulting in six hours of sleep for the night. Nocturia was the primary purpose of using the REZUM procedure. A cystoscope a few weeks ago showed a regrowth of the prostate. The urologist recommended (1) Repeating the Rezum, (2) TURP, (3) Live with it. I am considering a procedures to totally remove the prostate - Green light. HoLEP, robot, anything. Any thoughts, recommendations, or experience, on repeat procedures to address BPH?

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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!

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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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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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Dr. Kohler,

Sounds like REZUM does not work if 10% redo the procedure and the rest either go back on meds or opt for a different procedure.

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For what it is worth.

I have BPH. On meds for a while.. I began taking 400mg of ibuprofen at night before bedtime while avoiding alcohol and caffeine at night and found that it gets me anywhere from 5 to 7 hours of uninterrupted sleep .

My theory is that it reduces inflammation and thus provides more space within the bladder to hold urine. Works for me.

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