BPH Treatment after Penile Implant with Rezum Water Vapor Procedure for Enlarged Prostate
by Dr. Alex Shteynshlyuger, a board-certified urologist, and specialist in the treatment of enlarged prostate and complex urinary problems using minimally invasive approaches. He is one of the first urologists in the US and NYC to offer Urolift as a treatment for enlarged prostate.
Rezum Procedure in Men with Inflatable Penile Implants
Rezum is an in-office treatment for benign prostatic hyperplasia (BPH), which is a non-cancerous increase in the size of the prostate gland in men. BPH is often associated with a number of urinary symptoms including frequent urination and sudden urge to pee during the day as well as at night. Men may also experience trouble starting urination and may need to push to empty the bladder. A weak or fluctuating urinary stream is common in men with enlarged prostate. It may also cause incomplete bladder emptying and loss of bladder control.
Rezum is a minimally invasive procedure that utilizes the thermal energy stored in water vapor to treat prostatic tissue and improve BPH symptoms. This article discusses the challenges of treating enlarged prostate symptoms with Rezum procedure in men with penile implants.
Treatment of BPH in Men with Penile Implants
Over time, men with penile implants may develop symptoms of enlarged prostate, as do many men with advancing age. Medications such as Flomax and Uroxatral are often used to treat these symptoms. However, in some men with inflatable implants in the penis, these medications may not work or they may cause unpleasant side effects, such as dizziness, or lack of ejaculation. For men who experience side effects to medications or do not experience sufficient benefit from taking medications for enlarged prostate, other treatments for BPH symptoms are necessary.
Surgical treatment in patients with penile implants is challenging, given that the device compresses the urethra. Surgery is associated with a small risk of urethral stricture and difficulty accessing the prostate and the bladder. There is also a small risk of mechanical injury to the implant in the penis if it is not completely deflated or if excessive pressure or torque is applied with the surgical instruments.
Our Experience in Treating Enlarged Prostate in Men with Penis Implants
At New York Urology Specialists, we have extensive experience in the insertion of penile implants, such as AMS-700 and Titan-OTR, as well as in the treatment of men with symptoms of enlarged prostate who have penile implants.
Some men who have coexisting erectile dysfunction (ED) and urinary symptoms caused by BPH may need a penile implant for treatment of the ED. In such patients, we typically recommend that symptoms of an enlarged prostate are treated first, typically with medications. If the patient is able to tolerate the medications and they work well, we can proceed to implant placement.
If the patient does not improve with medications such as Flomax (tamsulosin), finasteride (Proscar), or they cause significant side effects, we can perform the appropriate procedure based on patient preferences and eligibility. Common treatment options include minimally-invasive office procedures such as UroLift and Rezum treatment for BPH. We also offer prostate enucleation, bipolar TURP, Holmium laser ablation and Holmium laser enucleation of the prostate (HoLEP) using MOSES technology.
Treatment of BPH After Prior Penile Implant
Patients who have had prior penile implant surgery and present with new symptoms of an enlarged prostate are usually offered medications as a first option. Pharmacologic treatment of BPH symptoms includes drugs such as Flomax, Rapaflo, Uroxatral, and finasteride (Proscar). If these medications do not work or they cause intolerable side effects such as dizziness, lack of ejaculation or the patient develops urinary retention, other options need to be considered.
New minimally-invasive treatments that have no sexual side effects are particularly appealing to patients with an implant in the penis and coexisting BPH symptoms. These options include UroLift and Rezum procedures.
Rezum Procedure for Men in New York City
At New York Urology Specialists, Dr. Alex Shteynshlyuger has extensive experience in treating men with enlarged prostate using UroLift and Rezum. We are able to perform these procedures in the office under local anesthesia, even in patients with a preexisting inflatable penile implant such as AMS 700 or Coloplast Titan.
Special Considerations in Men with Penile Implants Undergoing Treatment for BPH
Infection is a significant concern in men with foreign devices such as inflatable implants in the penis. Urinary tract procedures, such as treatments for BPH, are associated with a small but definite risk of infection. Sometimes, a more severe infection may occur. The risk of infection ranges from 2% to 20% depending on the individual patient’s risk factors.
At New York Urology Specialists, we are particularly attuned and experienced in treating high-risk patients with penile implants in need of treatment for BPH symptoms. Usually, we advise waiting at least six months after placement of the implant before undertaking surgical treatment of the enlarged prostate. This helps to minimize the risk of penile implant infection.
Antibiotic Prophylaxis for Rezum Procedure
It is extremely important that patients do not have an infection prior to the Rezum prostate procedure. This is especially important in patients who have a foreign device in place, such as an inflatable penile implant, where infection can cause severe complications. In patients with recurrent or persistent urinary tract infections, the infection must be treated before Rezum is performed. Antibiotics may need to be continued to suppress bacterial colonies prior to the treatment. At our offices, broad-spectrum antibiotics are administered 20-30 minutes prior to the procedure. The antibiotics are tailored to cover the appropriate organisms and account for resistance patterns.
Rezum Anesthesia in Patients with Prior Penile Implant
After intramuscular or intravenous administration of appropriate antibiotics, local periprostatic anesthesia is administered in the region of the prostate gland. This is done under direct ultrasound guidance. Anatomically, the penile implant is far removed from the needle. Nonetheless, our surgeons take extra care to avoid advancing the needle beyond the area of the prostate or seminal vesicles. This ensures that no damage occurs to the components of the implant in the penis during the Rezum treatment.
Preparation for Rezum Procedure in Men with Penis Implants
The penile implant is fully deflated prior to the procedure. The patient is prepped and draped according to CDC recommended guidelines. We use a chlorhexidine-based solution to disinfect the area. Careful cystoscopy is performed with care to avoid tension or torque on the penile shaft.
What to Expect with Rezum Treatment?
Rezum therapy (water vapor treatment) is delivered directly into the enlarged prostate gland. The procedure takes less than 10 minutes to perform. A Foley catheter is gently inserted into the bladder and left draining into a Foley bag. The patient is able to go home shortly afterwards.
Results and Recovery from Rezum Procedure for Patients with Penile Implant
Catheter removal typically occurs 5 days after the Rezum prostate procedure in patients with penile implants. Most men experience some degree of urinary urgency or frequency, which tends to disappear within a few weeks. Small amounts of blood may be present intermittently in the urine during the recovery period.
Usually starting 2-3 months after the procedure, patients will experience a significant improvement in their urinary stream and a gradual decrease in the frequency of daytime and nighttime urination.
At New York Urology Specialists, our experience shows that Rezum procedure is as effective in men with penile implants as it is in men who do not have a foreign device present in the penis.
Why Choose New York Urology Specialists for Treatment of Enlarged Prostate (BPH) after Penile Implant?
- All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers, and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of BPH.
- We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
- Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).
When it comes to experience and innovation – New York Urology Specialists are a step ahead. Better Science Means Better Care. We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.
Medicare and major insurances accepted. We offer affordable rates and financing options.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men. He uses modern effective and proven treatment methods including Urolift for BPH. He is highly recommended by top primary care physicians in the New York area.
He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.
BPH Symptoms are Treatable in Nearly Every Man
At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of urinary dysfunction. We understand the challenges that urinary problems create for our patients, their relationships and their self-esteem. We are also aware of how urinary problems can affect sexual function. We help you find a treatment for symptoms of enlarged prostate and erectile dysfunction that fit your needs, your lifestyle and your preferences.
Urologists are doctors specializing in the treatment of men with urinary problems and erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for BPH and ED. We offer medical and surgical treatment for BPH and erectile dysfunction.
We treat some of the most complex urinary problems including:
- erectile dysfunction in men with prostate cancer after radical prostatectomy
- urinary retention after TURP
- Frequent urination and urge incontinence at night
- impotence in men with diabetes.
- Erectile dysfunction in men with Peyronie’s disease
- Erectile dysfunction in men for whom Viagra and Cialis do not work.
- Erection problems in men with low testosterone.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.