Rezum water vapour therapy for an enlarged prostate: a guide

1What is Rezum water vapour therapy?

Rezum water vapour therapy is a minimally invasive procedure used to ease lower urinary tract symptoms caused by a benign enlarged prostate (benign prostatic hyperplasia, BPH). Sterile water vapour (steam) is injected into the enlarged prostate tissue. The heat released by the steam destroys some of the cells, which the body then gradually absorbs, so the prostate shrinks and puts less pressure on the urethra. NICE describes Rezum as minimally invasive, meaning open surgery is not needed.

2Who is it suitable for?

According to NICE, Rezum should be considered for men with moderate to severe urinary symptoms (an IPSS score typically 13 or over) and a moderately enlarged prostate, typically between 30 cm3 and 80 cm3. The American Urological Association (AUA) 2023 treatment algorithm also lists water vapour thermal therapy for prostates of 30 to 80 cc.

It may be discussed with men whose enlarged prostate medicines no longer help enough, who prefer not to stay on long-term tablets, or who want to protect sexual function. Very large prostates may be better suited to other options. Your urologist decides whether it fits, based on the size and shape of your prostate and your general health.

🔬How is an enlarged prostate diagnosed?

According to the NHS, assessment starts with questions about your symptoms and an examination of the abdomen and genitals, which may include a rectal examination of the prostate. You may be asked to keep a bladder diary. Common tests include:

• A urine test to check for infection or blood.
• A PSA (prostate-specific antigen) blood test.
• A urine flow test.
• An ultrasound scan of the bladder, which also helps estimate prostate size.
• Cystoscopy, a look inside the bladder with a thin camera, when needed.

These results help your doctor compare the available options, including the different types of prostate surgery.

4How is the procedure done?

According to the British Association of Urological Surgeons (BAUS) patient leaflet:

1. You have a general or spinal anaesthetic, sedation or a local anaesthetic, depending on your circumstances.
2. A thin telescope is passed through the urethra into the prostate and bladder, with no cuts to the skin.
3. Steam is injected under direct vision into the enlarged lobes of the prostate using a special applicator.
4. A urinary catheter is placed at the end.

BAUS states that the procedure itself usually takes 10 to 15 minutes.

🩺Catheter, recovery and when symptoms improve

According to NICE, a urinary catheter is usually left in for 5 to 7 days so the treated tissue can drain away, and the NHS England decision support tool gives the same range. It is normal for urinary symptoms to get a little worse in the first weeks before they improve, because the prostate shrinks gradually rather than straight away.

According to BAUS, maximum improvement takes on average 8 to 12 weeks and can take up to 6 months in some men. BAUS lists common temporary effects:

• Burning or stinging when passing urine (about 1 in 3 men).
• Blood in the urine (about 1 in 4).
• Pelvic pain or discomfort (about 1 in 5 to 1 in 6).
• A urine infection needing antibiotics (about 1 in 15).
• Blood in the semen, which can last up to 3 months.

💊Effect on ejaculation, erections and retreatment

According to NICE, erectile dysfunction is rare after Rezum, although ejaculatory problems have been reported. BAUS describes erectile dysfunction as very rare and retrograde (dry) ejaculation as very uncommon. The AUA algorithm lists water vapour therapy among the options that may be offered to men who are concerned about preserving erectile and ejaculatory function.

Retreatment is possible. According to NICE, the Rezum II study reported that 4.4% of men had further surgery within 4 years of follow-up. BAUS estimates that about 1 in 25 men need further treatment within 4 years.

7Rezum compared with TURP and laser surgery

This is a simplified, general comparison; the final choice is made with your doctor after assessment.

According to NICE, clinical experts consider TURP the standard of care for urinary symptoms caused by BPH.

⏰When to seek urgent medical help

According to the NHS, get an urgent appointment or medical help if you cannot pee at all, have blood in your urine, or have pain when peeing. After Rezum, contact your care team straight away if:

• Your catheter blocks or stops draining, or there is pain or leakage around it.
• You cannot pass urine after the catheter is removed.
• You develop a fever or signs of infection.
• Bleeding increases or you pass blood clots.

The NHS England decision tool advises telling your team if blood in the urine or semen continues for longer than 6 weeks.

❓Frequently asked questions

10Sources

1. Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia (MTG49) – 1 Recommendations | NICE
2. Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia (MTG49) – 4 Committee discussion | NICE
3. Rezum (steam ablation) – Information about your procedure from The British Association of Urological Surgeons (BAUS)
4. Making a decision about enlarged prostate (BPE) – NHS England decision support tool
5. American Urological Association – BPH Algorithms (2023)
6. EAU Guidelines on Management of Non-neurogenic Male LUTS – Disease Management
7. Enlarged prostate – NHS