Is a prostate size of 36 ml indicated for Rezum treatment for Benign Prostatic Hyperplasia (BPH)?

Rezum Therapy for a 36 ml Prostate Size in BPH Treatment

A prostate size of 36 ml is well within the indicated range for Rezum therapy for benign prostatic hyperplasia (BPH), as this minimally invasive procedure is typically recommended for prostate volumes between 30-80 ml.

Prostate Size Considerations for Rezum Therapy

Rezum therapy is a minimally invasive water vapor thermal therapy that has emerged as an effective treatment option for BPH. When considering prostate size:

• The typical recommended range for Rezum is for prostates up to 80 cc, though some centers have reported successful outcomes with larger prostates 1
• A 36 ml prostate falls well within this recommended size range
• Median prostate volume in successful Rezum treatment cohorts has been reported around 58 cc (IQR 44-82) 2

Efficacy and Outcomes

For prostates in the 36 ml range, Rezum therapy has demonstrated:

• Significant improvement in urinary symptoms with IPSS score reductions of approximately 55.3% at 2-year follow-up 3
• Quality of life improvements of approximately 50% 3
• Maximum urinary flow rate (Qmax) improvements of 62.5% 3
• Reduction in post-void residual urine by approximately 50% 3

Advantages of Rezum for Moderate-Sized Prostates

For a 36 ml prostate, Rezum offers several advantages:

• Preservation of sexual function, including lower rates of ejaculatory dysfunction compared to TURP 2, 3
• Outpatient procedure with shorter hospital stays compared to traditional surgical options 3
• Shorter catheterization time compared to TURP 3
• Fewer overall complications compared to more invasive procedures 3

Treatment Algorithm for BPH with 36 ml Prostate

1. Confirm symptomatic BPH: Ensure the patient has moderate-to-severe LUTS (AUA Symptom Score >8) that are bothersome 4

2. Evaluate for Rezum candidacy:

   • Prostate size (36 ml is well within range)
   • Rule out other causes of LUTS
   • Consider optional diagnostic tests like uroflowmetry and PVR measurement 4

3. Discuss treatment options:

   • Rezum as a minimally invasive option
   • Medical therapy (alpha blockers, 5-alpha reductase inhibitors)
   • More invasive surgical options (TURP)

4. Proceed with Rezum if:

   • Patient prefers minimally invasive approach
   • Sexual function preservation is important
   • Quicker recovery is desired

Potential Limitations and Considerations

• While effective, Rezum may not provide as dramatic improvement as TURP for some outcome measures 3
• Retreatment may be necessary in some cases, though Rezum can also be used as a retreatment option for recurrent LUTS after other procedures 5
• The presence of a middle lobe should be evaluated, as this may affect treatment approach 4

Conclusion

For a patient with a 36 ml prostate with bothersome LUTS due to BPH, Rezum therapy represents an appropriate and effective minimally invasive treatment option with good outcomes for symptom relief, quality of life improvement, and preservation of sexual function.