Rezum Experience

[BuddyPish]

I had the Rezum vapor therapy at BNH Hospital on 27th September and I thought I'd share my experience in case someone needs insight into the experience in Thailand.

I'd been having issues with urination for years but things got serious around December last year. I was waking up 6 times a night to urinate and clearly, the situation was unsustainable over the long term.

I went to see Dr. Viroj at Bumrungrad.

I was diagnosed with urinary retention caused by bladder outlet obstruction, namely an enlarged median lobe.

I asked the doctor about surgical options and he ruled out Rezum and pretty much everything else because of my urinary retention of around 600ml and said that needed to be brought under control first.
He didn't suggest a cystoscopy or urodynamics even though the ultrasound clearly showed the median lobe protruding into my bladder.
To my horror he prescribed CIC (Clean Intermittent Catheterization). I was gutted.

I lived with that for 4 months doing it 4-7 times a day and having to wake up at night to do it too as my kidneys were producing too much urine (I'd already been diagnosed with hydronephrosis and diabetes insipidus after undergoing a water deprivation test at Samitivej.

Eventually, it got to be too much to bear with my entire life being arranged around my proximity to my bathroom so I arranged to get a 2nd opinion.
I contacted Dr Suntchai at BNH hospital and went to see him.

I brought all my records from Bumrungrad and Samitivej and he said that Dr. Viroj is a very experienced urologist and there had to be a reason for his refusal to sanction any surgical procedure.
He checked to make sure that 4 months of self catheterization had resolved my moderate hydronephrosis in both kidneys which it had.

 

I wanted to book the Rezum procedure right there and then but he told me to slow down.
He wanted to do a cystoscopy to see if there was a reason besides the median lobe obstruction as to why I couldn't urinate. 
Sure enough, the cystoscopy revealed the full extent to which the median lobe blocked the bladder. Really cool to see it on the big screen. He also showed me the mild to moderate thickening of the bladder wall but said it wasn't anywhere near bad enough to compromise my ability to urinate if/when the obstruction was removed.

He also did a TRUS (trans-rectal ultrasound) which showed that my prostate wasn't that large - 54 cc

We discussed options - including TURP - which I flat out refused.
I reasoned that minimally-invasive was the route to go since, if it didn't work or last, I could always go for more invasive surgery.
To be honest, I don't think I'd ever go for a TURP - if I need another operation, it'll almost certainly be acquablation.

 

Anyway, I had the Rezum done under IV sedation so I was asleep and I woke up with a catheter installed.

Dr. Suntchai said I needed to keep it in for 2 weeks because the median lobe was the focal point of the treatment and it would bleed like crazy and potentially take longer to heal.

He ruled out CIC because the prostate tissue would be inflamed and it would be easy to create a false passage with the catheter if I had to do it 4-7 times a day as before.

He said I'd been given 7 injections, 5 of which were in the median lobe and 2 in the lateral lobes since there wasn't much enlargement in those.

Frankly, the catheter was the worst aspect of the entire journey - very uncomfortable and downright painful if you moved the wrong way . . . or got an erection in the middle of the night which I did on several occasions.

Anyway, I had the catheter removed 3 days ago. After drinking a liter of water, I was expecting having to make a considerable effort to void but to my delight, when the urge hit, urine (and a fair bit of blood) came gushing out of me with considerable force. I went back in to see the doctor after urinating and he did the ultrasound. There was very little retention - less than 100ml - and I was delighted.

I had been worried about retrograde ejaculation and wanted to find out if I would have to live with it forever since, from what I remember of the doctor's pre-operative briefing, the median lobe is where the ejaculatory ducts are.

My lady came round and I needn't have worried. All good there. ????

All in all, I'm very pleased so far but frequency and urgency are dogging me. I'm peeing every hour and it's playing havoc with sleep.
The doctor said I should expect that to resolve over time and suggested I take Harnal (tamsulosin) if flow gets a little worse in the coming days.


Hope this helps anyone looking for personal insight into this procedure in Thailand.  

[JimmyJ]

How painful were the catheter/cytoscopy/other aspects?

 

What was the purpose of the injections?

 

What was the price?

[BuddyPish]

11 minutes ago, JimmyJ said:

How painful were the catheter/cytoscopy/other aspects?

 

What was the purpose of the injections?

 

What was the price?

I don't know how painful inserting the catheter was because I was asleep when he did that.

Removal was fine - a little discomfort but couldn't describe it as pain.

The cystoscopy didn't hurt at all since the urethra was numbed although, to be fair, I'd been self-catheterizing for 4 months before so maybe I was used to it.

The price was 200k but my insurer covered that and the cost of the cystoscopy which is 40k

 

Edited October 14, 2022 by BuddyPish

[Adumbration]

Thanks for the detailed post.  I am also very interested in the cost for the Rezume and associated follow ups.

[Adumbration]

Also did you stay in hospital overnight or was it day surgery?

[BuddyPish]

Just now, Adumbration said:

Also did you stay in hospital overnight or was it day surgery?

Rezum is treated as an outpatient procedure.

I was out in 4 hours

[Adumbration]

Also, what is the doctor's view regarding the improvements....what is the expected shelf life and chances that you will have to go back for another treatment?

[BuddyPish]

Just now, Adumbration said:

Also, what is the doctor's view regarding the improvements....what is the expected shelf life and chances that you will have to go back for another treatment?

He was most pleased.
 
He showed me the ultrasound after my first voiding; the median lobe protrusion was dramatically reduced but I could still see what remained of it.

He said that would continue to shrink as the inflammation dies down and consequently, flow will improve significantly.

 

He said that indications are that a small percentage of men will need another procedure in 3-5 years but he said my prostate isn't too large. If my median lobe doesn't regrow, it could be a lot longer before I need another intervention.

[Adumbration]

Thanks very much for your detailed report.  I am currently using doxasozin and it is helping a little.  Did you try that drug previously?

 

Also did you try finasteride? And would that have any effect on the lobe as opposed to the prostate?

[xylophone]

3 hours ago, Adumbration said:

Thanks very much for your detailed report.  I am currently using doxasozin and it is helping a little.  Did you try that drug previously?

 

Also did you try finasteride? And would that have any effect on the lobe as opposed to the prostate?

You may also wish to view posts on Rezum by @GarryP as he underwent that treatment not too long ago.....may help with a different perspective.

[BuddyPish]

15 minutes ago, xylophone said:

You may also wish to view posts on Rezum by @GarryP as he underwent that treatment not too long ago.....may help with a different perspective.

I read his posts avidly.

Edited October 14, 2022 by BuddyPish

[Sheryl]

3 hours ago, Adumbration said:

Thanks very much for your detailed report.  I am currently using doxasozin and it is helping a little.  Did you try that drug previously?

 

Also did you try finasteride? And would that have any effect on the lobe as opposed to the prostate?

The lobe referred to is a lobe of the prostate.

 

Finasteride and related drugs (dutasteride etc) help prevent further increase in prostate size and sometimes cause some shrinkage of an existing enlargement. Both these and drugs to improve urine flow by relaxing the neck of the bladder (e.g. doxasozin, tamsulosin etc) are the first line of treatment for BPH.

 

Other treatments, including Rezum, are usually considered only if medications alone are insufficient or the patient is unable to tolerate them.

 

Note that  Rezum is indicated only in BPH patients with  prostate volume less than  80 cubic centimeters, so nto suitable for really severe enlargement.

[BritManToo]

5 hours ago, Adumbration said:

Thanks very much for your detailed report.  I am currently using doxasozin and it is helping a little.  Did you try that drug previously?

 

Also did you try finasteride? And would that have any effect on the lobe as opposed to the prostate?

I use both for 2 years.

Then I was seemingly cured by taking a 1/2 dose of NorfloxStar (200mg, twice a day for 5 days) once a month for 3 months.

 

I'm assuming I was originally misdiagnosed by the Thai hospital.

Edited October 14, 2022 by BritManToo

[BuddyPish]

5 hours ago, Adumbration said:

Thanks very much for your detailed report.  I am currently using doxasozin and it is helping a little.  Did you try that drug previously?

 

Also did you try finasteride? And would that have any effect on the lobe as opposed to the prostate?

I used Finasteride, tamsulosin, Urief, Saw Palmetto, Pygeum extract etc - none of them had any discernible effect on men with median lobe obstruction of the bladder. All (except Saw Palmetto and Pygeum extract) they did was lower my blood pressure and bring on retrograde ejaculation.

[Adumbration]

19 minutes ago, BritManToo said:

I use both for 2 years.

Then I was seemingly cured by taking a 1/2 dose of NorfloxStar (200mg, twice a day for 5 days) once a month for 3 months.

 

I'm assuming I was originally misdiagnosed by the Thai hospital.

So do you think that you had prostatitis as opposed to an enlarged prostate?

[Mark Nothing]

I resolved the frequent night time urinations by not drinking liquids 4 hours prior to bedtime which results in 8 hours of uninterrupted sleep.  If your mouth is dry swish with water, but don't swallow. 

[BritManToo]

41 minutes ago, Adumbration said:

So do you think that you had prostatitis as opposed to an enlarged prostate?

That appears to be the case. 

[Adumbration]

2 hours ago, BritManToo said:

That appears to be the case. 

Why did you not get a urine test for bacteria?

[BritManToo]

11 hours ago, Adumbration said:

Why did you not get a urine test for bacteria?

It often doesn't work for prostate infections.

But you would really need to ask the Thai doctor why he didn't.

[BuddyPish]

OK I'm coming up to the 4 week mark since my Rezum procedure and I thought I'd share an update.

I saw Dr. Suntchai and did the obligatory uroflow test and ultrasound.

Flow was strong straight away and the doctor said the chart was textbook for what they want to see.

The ultrasound showed a PVR of just 40cc which is excellent especially compared to the 560cc I had before I started self-cathing nearly 6 months ago.

I'm pleased.

 

Aside from that, urinary frequency seems to be settling down so, instead of having to relieve myself every hour or so during the 7-10 days after the much-hated Foley catheter was binned, I'm now going 2-3 hours between visits during the day. There is still blood and clots/tissue in my urine but it's not as bloody as it was two weeks ago.

Night time is even better. A couple of times in the last 5 days, I went 4-6 hours without having to wake up.

Urgency can be an issue when it comes because the burning sensation is quite intense and painful when I have to hold it but it's not as bad as it was after the catheter was removed.

 

So far, my quality of life has been much enhanced by this procedure.
I can go out without having to pay mind to where the facilities are and everything in the carnal department is just fine.

I used a great patient forum (www.patient.info) to get people's experiences with Rezum before choosing it but they are mostly from the USA and UK so I couldn't find any from patients in Thailand. There are patient experiences for all the BPH procedures including TURP, HoLEP, Acquablation, PAE etc 

I believe reading up on patient cases provided me with realistic expectations for the procedure so I went in eyes wide open.

There were several people who had prostate sizes and median lobe obstructions similar to mine and their experiences had been overwhelmingly positive so I made a reasonable assumption that I might be ok.
Key thing to remember is that this procedure is NOT going to be suitable for everyone.

There are guys on the forum who had this procedure with massive prostates over 100-150cc and who ended up feeling much worse and determined to rubbish the procedure when, to be honest, they shouldn't have had it in the first place.

 

I think I got lucky but I had a good feeling about Dr. Suntchai.

He seemed keen to reward faith and trust in his capabilities but he also insisted on making sure pre-operative qualifying tests indicated good candidacy.

He laid out all the potential side effects and complications that could result from the procedure.
BNH Hospital is not the plushest when compared to Bumrungrad or Samitivej but having seen the inside of two of their operating theaters, it's clear it spends money on the stuff that really matters like brand new equipment.

[msbkk]

Thanks for telling us your experience. Sounds positive, i might do the same in next year.

[vandeventer]

On 10/14/2022 at 4:43 PM, BritManToo said:

That appears to be the case. 

I have had prostate enlargement trouble for the last 25 years. I have been on 2 products for the last 10 years and they work very good for me. Firide 5 mg to make the prostate smaller in size and Urief 4mg to give better flow. These work great for me and that's all I can say.

[BritManToo]

1 hour ago, vandeventer said:

I have had prostate enlargement trouble for the last 25 years. I have been on 2 products for the last 10 years and they work very good for me. Firide 5 mg to make the prostate smaller in size and Urief 4mg to give better flow. These work great for me and that's all I can say.

If you've been using the Firide for 10 years, I' suggest it isn't working.

[vandeventer]

3 minutes ago, BritManToo said:

If you've been using the Firide for 10 years, I' suggest it isn't working.

Well my tits are getting bigger, only joking but I am feeling much better in that area.

[thefed]

I have similar problem. I tried Tamasulin (flomax), and alfuzosin. I tried to not during any fluids in the evening but this caused a reaction like hay fever/cold., but unbearable Now that I look back it was a bad idea not to stay hydrated. I was waking up to pee all night, I may as well stay hydrated. I went from 1 urologist to another as I thought Urolift may be good. The scoped me again which is quite traumatic, as no anesthetic. I found out I was not a good candidate so I researched Rezum therapy.

The problem here is this clinic does not have the machine to do it. ( outside Thailand).  Then a month later I developed a high fever and had extreme difficulty to pee. Called my primary doctor and said may be some Prostatitis and prescribed antibiotics. The next day I could not pee and ended up at ER.

Scans show a small piece of tissue blocking urethra . It may have been nicked or something. Catheter installed and I started super hydration . 
I was laid up but for the 1st time I can drink a ton of water and not have to worry where a toilet is.

 

Now I am thinking these doctors in my area may not be so good. Better and expensive good procedure than a botched free one!

I am considering BNH as I am heading over there soon. It is an expensive procedure at BNH as opposed just about free where I am now(Medicare) 

I will still give it a good think before deciding as there may be other doctors closer that I can used insurance. Also hate to be able to move around and travel freely when I visit. Long time visitor and also worked in Bangkok. 
Bunrumgrad has most of my medical record and are usually more expensive. No Thai insurance anymore
 

 

[xylophone]

16 minutes ago, thefed said:

I have similar problem. I tried Tamasulin (flomax), and alfuzosin. I tried to not during any fluids in the evening but this caused a reaction like hay fever/cold., but unbearable Now that I look back it was a bad idea not to stay hydrated. I was waking up to pee all night, I may as well stay hydrated. I went from 1 urologist to another as I thought Urolift may be good. The scoped me again which is quite traumatic, as no anesthetic. I found out I was not a good candidate so I researched Rezum therapy.

The problem here is this clinic does not have the machine to do it. ( outside Thailand).  Then a month later I developed a high fever and had extreme difficulty to pee. Called my primary doctor and said may be some Prostatitis and prescribed antibiotics. The next day I could not pee and ended up at ER.

Scans show a small piece of tissue blocking urethra . It may have been nicked or something. Catheter installed and I started super hydration . 
I was laid up but for the 1st time I can drink a ton of water and not have to worry where a toilet is.

 

Now I am thinking these doctors in my area may not be so good. Better and expensive good procedure than a botched free one!

I am considering BNH as I am heading over there soon. It is an expensive procedure at BNH as opposed just about free where I am now(Medicare) 

I will still give it a good think before deciding as there may be other doctors closer that I can used insurance. Also hate to be able to move around and travel freely when I visit. Long time visitor and also worked in Bangkok. 
Bunrumgrad has most of my medical record and are usually more expensive. No Thai insurance anymore
 

 

Sorry to hear about your troubles, although I can sympathise because I have been down a similar route over the years, and it's now got to the stage where I can't pass any water, so self catheterisation is both my saviour and my concern.

 

I did go to Bumrungrad hospital to see what they could do but despite the urologist being top-notch, and doing all of the tests he could, the outcome was that the nerves in my bladder had stopped working, and there appeared to be no solution to it (well there is one, but that's another story).

 

Whilst I was at Bumrungrad I did see that they were advertising the Rezum treatment and had all the equipment there to carry it out, so maybe that would be your first port of call, especially as they have your medical records there.

 

This would have been about three months ago or more, so perhaps worth giving it a try??
 

[Lacessit]

On 10/30/2022 at 4:07 PM, BritManToo said:

If you've been using the Firide for 10 years, I' suggest it isn't working.

What do you think would happen if he stopped using it?

My main beef with Firide is the effect on my libido.

I've been told I have a very large prostate, 1 mg of Cardura daily seems to keep me flowing OK.

[Pumpuynarak]

1 hour ago, Lacessit said:

What do you think would happen if he stopped using it?

My main beef with Firide is the effect on my libido.

I've been told I have a very large prostate, 1 mg of Cardura daily seems to keep me flowing OK.

I was prescribed Firide and Cardura XL when i first had urination problems but like you i suffered libido problems so my urologist suggested i stop the Firide which i did but carried on with the Cardura XL, my libido problems appeared to improve but my urination flow was still poor so he recommended i try just Alfuzosin on its own.

 

I've currently been taking it for 9 days so its too early to tell if its going to solve my problem, here's hoping.   

[GarryP]

4 hours ago, Pumpuynarak said:

I was prescribed Firide and Cardura XL when i first had urination problems but like you i suffered libido problems so my urologist suggested i stop the Firide which i did but carried on with the Cardura XL, my libido problems appeared to improve but my urination flow was still poor so he recommended i try just Alfuzosin on its own.

 

I've currently been taking it for 9 days so its too early to tell if its going to solve my problem, here's hoping.   

I've been through the meds and Rezum and while I urinate fine now, my libido has continued to decline. I will be having my annual health check in a couple of weeks and one of the added things I will have them check is my testosterone level.

[Pumpuynarak]

14 hours ago, GarryP said:

I've been through the meds and Rezum and while I urinate fine now, my libido has continued to decline. I will be having my annual health check in a couple of weeks and one of the added things I will have them check is my testosterone level.

So you had the Rezum treatment and that cured your urination flow, thats good to know as i may very well end up needing some operative procedure.

Like you i had my testosterone level checked a few months ago and all was fine, good luck with yours.