Rezūm Water Vapor Thermal Therapy for BPH
Rezūm therapy is an effective minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) that uses convective water vapor energy to ablate prostate tissue, with significant improvements in urinary symptoms and flow rates while preserving sexual function.
What is Rezūm Therapy?
Rezūm is a minimally invasive surgical treatment that uses convective water vapor thermal energy (steam) to treat BPH. The procedure involves:
- Injection of sterile water vapor directly into the prostate tissue
- The steam disperses between cells and releases stored thermal energy
- This causes cell death in the targeted prostate tissue
- Over time, the body's natural healing response removes the dead tissue, reducing prostate volume and opening the urethra
Clinical Effectiveness
Rezūm therapy demonstrates significant clinical improvements:
- 50% reduction in International Prostate Symptom Score (IPSS) 1
- 53% reduction in quality of life scores 1
- Significant improvement in peak urinary flow rate (Qmax) from 10.6 ml/s to 17.9 ml/s 1
- Reduction in post-void residual volume by 136 ml 1
- Decrease in prostate volume by approximately 40% 1
Indications and Patient Selection
Rezūm is indicated for:
- Men with moderate to severe LUTS due to BPH
- Prostate sizes between 30-80 cc (though it has been used successfully in larger prostates) 2
- Patients with urinary retention (with 87.8% success rate in catheter removal) 2
- Patients with median lobe enlargement 2
- Patients seeking to preserve sexual function 3
Benefits Over Traditional Therapies
- Outpatient procedure with minimal anesthesia requirements
- Preservation of sexual function (no retrograde ejaculation)
- Effective for various prostate morphologies, including median lobe 2
- Reduced medication dependence (significant discontinuation of alpha-blockers and 5ARIs post-procedure) 2
- Durable results with benefits maintained at 4-year follow-up 3, 4
- Cost-effective compared to traditional surgical options 5
Sexual Function Outcomes
One of the key advantages of Rezūm therapy is its impact on sexual function:
- Preserves sexual function in men without baseline erectile dysfunction 3
- May improve sexual function in men with baseline erectile dysfunction at 4-year follow-up 3
- No cases of de novo erectile dysfunction at 4-year follow-up 3
- Temporary decreases in sexual function may occur at 12 months in men with baseline ED, but improve by 48 months 3
Effectiveness Across Age Groups
Rezūm demonstrates comparable effectiveness in both younger (<65 years) and elderly (≥65 years) patients:
- No significant differences in symptom improvement (IPSS, QoL) between age groups 4
- Similar adverse event profiles regardless of age 4
- Low surgical retreatment rates at 4 years (approximately 4%) in both age groups 4
Procedure Details
The Rezūm procedure typically involves:
- Outpatient setting
- Local anesthesia with sedation
- Cystoscopic approach
- Strategic injections of water vapor into the prostate (typically 4-8 injections)
- Procedure time of approximately 10-15 minutes
- Short recovery period
Common Pitfalls and Considerations
- Patient Selection: While effective for most prostate sizes, extremely large prostates (>80cc) may have variable outcomes
- Temporary Catheterization: Some patients require temporary catheterization due to post-procedure edema
- Delayed Results: Maximum symptom improvement may take 1-3 months as the body resorbs treated tissue
- Retreatment: A small percentage (approximately 4%) may require retreatment within 4 years 4
- Temporary Symptom Worsening: Patients should be counseled that symptoms may temporarily worsen before improving
Conclusion
Rezūm water vapor thermal therapy represents an effective minimally invasive option for treating BPH-related LUTS with durable outcomes and preservation of sexual function. It is particularly valuable for patients seeking alternatives to long-term medication or more invasive surgical procedures.