hi guys dr charles schubert urologist and director of the prostate clinic
the following video is here to provide information for you if you are awaiting a resume or water
vapor treatment for the management of bph or in fact if you have some interest in
this particular procedure so to recap bph is the benign prostatic enlargement
it is one of the most common causes that we see for men who experience urinary symptoms
as a quicker side as we progress through life the prostate grows and it's the growth of the prostate
that compresses the outlet pipe of the bladder and causes urinary symptoms those symptoms can be
broadly broken down into two key categories they include obstruction which is when men notice that
their flow is slow it takes them a long time to pee and it can be a bit broken or intermittent in
nature then there are the irritative symptoms which are due to reciprocal thickening that
happens in the bladder as it works harder trying to force urine beyond the obstruction a thickened
bladder wall manifests as more frequency so the need to pee happens at a smaller capacity
and men go more frequently they might rush to the toilet or they might get up at night to pee
so water vapor or resume is a relatively new minimally invasive treatment that is performed
in the majority of people as a day case before we get to surgery every man has a urinary test
to make sure that there is no infection and then we would proceed on at a specific time to your
treatment the treatment itself is performed either in the main part of theaters at pindara private
hospital or alternatively in the day surgery when you arrive at either of those two centers
you'll go through the administration process and then you'll be taken through to a holding bay
prior to which we would then make arrangements for your your treatment the treatment itself is
done under a general anesthetic so you are asleep during the whole treatment uh if you are planning
to head home that day it's important to note that you cannot drive for 24 hours after the treatment
in light of the anesthetic so someone would need to collect you from hospital to take you home
and supervise you really for the subsequent 24 hours the treatment itself is performed through a
fine telescopic camera it's passed through the urethral or the outlet pipe of the bladder and a
very fine needle is passed through the telescopic camera and is used then to deliver steam into the
prostate now what happens is that that steam disperses through the connective tissue if you
like inside the prostate so that there is an even distribution of heat or energy to the treated area
on average i use a total of six injections inserting the steam injecting the steam into the
various areas within the prostate to ensure that we've got good coverage and good treatment of the
entire transition zone to ensure that we get a good durable outcome each injection is
around one cubic centimeter of steam which as you can imagine increases the volume of the
prostate and potentially causes obstruction the video that you're currently watching highlights
graphically on the left hand side the process of inserting the needle through into the prostate
in a transurethral fashion on the other side of the image you can see the real-time
intraoperative images and how they steamed therapy the water vapor therapy is deployed in real life
so as you can imagine we deliver that volume of fluid to the prostate it therefore swells
afterwards men then struggle they struggle more to pee than they were beforehand and as a result we
need to put a catheter in it's usually a very fine caster that we put in and that really ensures that
the bladder drains adequately after the procedure you are then given a leg bag which is a bag that
attaches onto the end of the caster and that attaches onto your thigh so urine that fills in
the bladder drains through the caster and collects on the thigh you are given some education about
how to manage that leg bag and also a night bag which is a larger bag that plugs into the leg bag
and you're given instructions and education on how to manage that for most people they go home
with the leg bag and this night bag and you would keep your caster for around three or four days
you then come back to hospital and we send off a urine test at that time we remove the catheter
and we perform what's called a trial avoid where we ensure that you're emptying your bladder okay
we get you to pee in a jug and we measure the volume of fluid that you pee
and we do a small bedside ultrasound to make sure that you're not retaining too much urine
as long as you pass out checks at that point you may go home expect to stay with us for the
better part certainly of the morning sometimes it can be two-thirds or three-quarters of a day that
men are with us while we wait for the for the bladder to begin to work properly and to empty
sometimes that can be a slow process as i will have explained previously in our pre-op consult
with resume treatment men will notice no improvement in the way that they pee to begin with
and in fact for the first two or three weeks after the treatment there can be some irritation related
to the treatment that makes you feel like you need to pee more urgently and more frequently
even get up through the night and pee a little bit more frequently than you were beforehand what we
tend to see though is by the three week men notice for the first time an improvement in the pressure
with which they pee and it's important to know that from around the three-week mark through to
the three-month mark there is a gradual steady improvement in an individual's urinary symptoms
certainly in my practice here at the prostate clinic every man has a specific questionnaire it's
called an international prostate symptoms school but that questionnaire it's a score out of 35
we do it before treatment we do it after treatment and the expectation if you have resume is that
we will see around a 50 improvement in that score that's the average improvement that we see
so we do not turn for example 70 year old men into 20 year old men but we can
get a 50 improvement in the way that we pay or in the way that they pee i should say so
a gradual slow steady improvement that begins with improvement in flow and then bladder
related symptoms slowly follow suit it's common to see small amounts of blood within the urine
it can sting and burn to begin with one of the aims of resume of other treatments other bph
treatments is that the risk of sexual dysfunction is at the lower end of the
spectrum sexual dysfunction is two things it's erectile dysfunction and it's ejaculatory function
and with resume there's next to zero risk of erectile dysfunction and i tell men that there
is around a five percent risk that they may notice a reduction in the volume of their ejaculate fluid
and in some circumstances they may ejaculate no fluid at all but the majority of men
following this procedure do retain normal ejaculatory function sometimes we can see
that men develop infections and this can be related to the catheterization process so if
you are in that post-operative period where the catheter is being removed and you notice either
a change in the smell of your urine more blood in your urine or
pain or stinging or burning when you pee please get in touch with the prostate clinic
we would make arrangements for a urine test and if appropriate we would commence you on antibiotics
i see every man following this procedure at the three month mark we fill out the questionnaires
again we get you to do another flow test and we confirm that there's been a big improvement in
the way that you pee and also answer any residual questions that you may have at that time moving
forward the plan is usually to continue on with an annual psa test which can be done either locally
here at the prostate clinic or alternatively through your local gp i hope this answers some of
your questions if you do have additional questions or comments please leave them in the comment box
below or if you're awaiting this procedure with me through the prostate clinic please
and you'd like a sooner answer contact my office and i will respond to you accordingly thanks again