What is Rezūm water vapour therapy?

When the prostate becomes enlarged, men can experience a number of urinary problems. Fortunately, there are a number of solutions, and one that is growing in popularity is Rezūm water vapour therapy. Professor Hashim Ahmed, leading urological surgeon, explains more.

Rezūm water vapour therapy, also called prostate steam therapy, is a minimally invasive procedure that can treat enlarged prostates causing urinary symptoms in men. It does not involve any incisions.

The procedure involves using a telescope to locate the prostate and then injecting steam at 104°C throughout the prostate. Each injection takes nine seconds and the procedure in total only takes about 10 minutes. Most men have the procedure under sedation (being drowsy) or general anaesthetic. Some men opt for only local anaesthetic. It has a number of advantages over traditional treatment, with quicker recovery and fewer side-effects.

What prostate conditions can Rezūm be used to treat?

Rezūm therapy is used to treat prostates that are causing urinary symptoms. This is often due to an enlarged prostate, but is often in combination with a ‘tight’ prostate due to over-sensitive muscle fibres inside the prostate. This causes men to pass urine with poor flow, having to go again soon after passing urine, as well as have a sensation of incomplete emptying and having to sometimes strain to get the urine out. Many men have to get up at night and have urgency and frequency of urination during the day because their bladder is over-sensitive and not fully emptying.

Why is Rezūm a good choice for treating benign prostate hyperplasia (BPH)?

Urinary symptoms from an enlarged prostate are very common and can affect one-third of men over the age of 50. If they are affecting the patient’s quality of life, they can be treated with medication. These are tablets like tamsulosin or alfuzosin, which relax the prostate, or finasteride and dutasteride, which shrink the prostate. In the past, if the medication stopped working or caused side-effects, there were few options available apart from a transurethral resection of the prostate (TURP). Men who didn’t want to undergo this procedure often suffered in silence.

Rezūm therapy for the prostate is a good alternative for those men in whom medication has stopped working, is causing side-effects, or for men who simply don’t want to take medication for life. Rezūm has virtually zero risk of stress urinary leakage and virtually no erectile dysfunction in those men with good function before the procedure. About 1 in 20 men will get dry orgasms. Compared to TURP, these are much lower risks of side-effects.

Rezūm is effective in about 90 to 95 per cent of men at three to four years, and because it doesn’t involve implanting foreign material into the body, it has some advantages over the other newer procedures like Urolift and prostate artery embolisation. Rezūm is not for everyone though, and a thorough assessment is needed. For instance, a large prostate above 80-90ml or grams is better treated with a laser TURP like Greenlight or HoLEP.

Are there any side effects?

The risk of urine leakage when coughing/sneezing or lifting things is virtually zero. The risk of erection problems in men with no previous history of such issues is virtually zero, although 1 in 20 will get dry orgasms (no fluid when having sexual activity). Infection can occur in five per cent and, in rare cases, sepsis requiring admission to hospital (something that can occur with many prostate procedures). Bleeding risk is extremely rare.

A catheter is fitted due to swelling of the prostate initially, and this catheter stays in for seven days in prostates less than 60ml or grams and for 10-14 days in larger glands. Without it, there would be a high chance of seizing up. Whilst this is not nice, it is necessary. Once the catheter is out, most men don’t see any improvement for a few weeks as the body absorbs the prostate tissue destroyed by the steam. This is a slow process and some men can see improvements up to three to six months after. A few men do get worsening urinary symptoms for a few weeks, but this eventually settles and can be controlled with anti-inflammatories. Most prostate procedures have this impact early on due to the healing effect.

How can I find a specialist offering Rezūm water vapour therapy in the UK?

There are a number of urologists offering this procedure now. There is a requirement for urologists to have done lots of these cases, and so experience definitely matters. Professor Ahmed was one of two surgeons in the UK and the first in London to do this procedure. He is one of the highest volume practices for Rezūm steam therapy in Europe.

Visit Professor Ahmed’s Top Doctors profile to book an appointment.