Rezum for Benign Prostatic Hyperplasia (BPH) at Warwickshire Hospital

What is Rezum?

Rezum is a treatment for an enlarged prostate that uses steam to shrink away the tissue blocking your flow of urine. It's a quick, minimally invasive procedure carried out through your urethra (the tube you urinate through), so there are no cuts or stitches involved.

What conditions does it treat?

Rezum treats benign prostatic hyperplasia (BPH), commonly called an enlarged prostate. BPH causes your prostate to grow, which can press on your urethra and cause problems peeing, such as a weak stream, needing to go often, or getting up at night.

This treatment is generally considered if you're aged over 45 and your symptoms and urine flow meet certain thresholds your urologist will check. It may not be suitable if you have kidney function problems, a urethral implant, a very large prostate, previous invasive prostate treatment, or a current or recurrent urine infection. Sources differ slightly on the prostate size limit: Cleveland Clinic advises against Rezum for prostates over 80 grams, while a UK clinical review notes some studies used a cut-off of 120cc. Your urologist will confirm whether your prostate size is suitable.

What are the benefits of Rezum?

Many people notice their symptoms improve within a few weeks, though it can take up to three months to feel the full benefit. On average, studies show urine flow rate improves by around 50%, alongside better quality of life scores, with benefits shown to last for at least four to five years.

Compared with more invasive prostate surgery, Rezum is generally linked to:

• preserved sexual function, with no new cases of erectile or ejaculatory problems reported as being caused by the treatment
• a day-case procedure, so you shouldn't need to stay in hospital overnight
• the option of local anaesthetic and sedation, rather than always needing a general anaesthetic
• the possibility of repeating the procedure if your symptoms return in future
• in some studies, fewer than 5% of people needed further prostate procedures or surgery within five years.

Are there different types or approaches?

Rezum is delivered in one way, using steam applied directly to the prostate through a telescope passed via your urethra, but a few things can vary:

• how many individual steam treatments you have, up to about 15, depending on the size of your prostate
• your anaesthetic: some people have sedation or a local anaesthetic injected around the prostate, while others have a general anaesthetic. In the UK, this is often planned around a rigid cystoscopy (telescope examination), which is typically carried out under general anaesthetic.

Rezum also differs from other prostate treatments such as TURP (transurethral resection of the prostate) or Aquablation, which remove prostate tissue straight away using an electric current, laser or water jet. With Rezum, steam damages the tissue, which your body then absorbs gradually over weeks to months. TURP and Aquablation tend to bring faster, more noticeable improvements to your urine flow, though generally with more risk.

What happens before the procedure?

• your urologist will usually have already checked your prostate with a flexible telescope (cystoscopy) and possibly an ultrasound scan, to see where it's enlarged and confirm the treatment suits you
• on the day, you'll change into a hospital gown and go to the toilet before the procedure
• your urologist will talk you through the procedure and ask you to sign a consent form if you're happy to go ahead
• you'll be given antibiotics through a vein to help prevent infection
• your urethra and prostate will be numbed with local anaesthetic, or you may be given sedation or a general anaesthetic, depending on what's been arranged for you.

What happens during the procedure?

1. Your urologist passes a thin telescope with a needle attachment through your urethra, using anaesthetic gel to ease it in.
2. They take a quick look inside your bladder first.
3. A generator heats a small amount of water into steam, delivered through a tiny needle directly into the enlarged part of your prostate, in bursts of about 9 seconds each.
4. This is repeated at different points in your prostate, up to around 15 times in total, depending on its size.
5. Salty water (saline) flows through the telescope throughout, to protect your urethra from the heat and help your urologist see clearly.
6. A catheter (a thin tube to drain urine) is left in your bladder for a few days afterwards, while any swelling settles.

What does recovery look like?

Because Rezum is usually a day-case procedure, you'll normally go home the same day.

Before you leave:

• a member of your urology team will talk you through how the procedure went and what to expect at home
• you'll be given a date to come back to have your catheter removed
• you'll be advised on pain relief, and told when you can return to work, depending on your job.

At home:

• rest for at least a day, and avoid strenuous activity for a few weeks, including running, heavy lifting or cycling
• avoid sexual activity, including ejaculation, for around 6 to 8 weeks to let the area heal
• drink plenty of water, and try to avoid things that can irritate your bladder, such as caffeine, fizzy drinks and citrus juices
• expect some blood in your urine or semen for a few weeks, and some pain or discomfort, which pain medication should help
• your symptoms may feel worse before they get better over the first few weeks. Most people notice an improvement within two weeks, though it can take up to three months to feel the full benefit.

You'll have a follow-up appointment, usually two to three weeks after your procedure. This is when your catheter is removed and it's checked that you can pass urine normally. If not, you may need the catheter a little longer or be shown how to pass a temporary catheter yourself.

What are the risks and complications?

Some side effects are common in the first few weeks and usually settle on their own:

• pain or discomfort when peeing or ejaculating
• peeing more often, or feeling a more urgent need to go
• blood in your urine or semen
• urinary tract infection (UTI).

More than half of people need a urinary catheter for a few days afterwards while any swelling settles. Less commonly, people experience:

• dry ejaculation, meaning little or no semen is released at climax
• narrowing of the urethra, known as a stricture
• bladder stones.

Serious complications are uncommon, but can include a urine infection that spreads more widely (urosepsis), a blockage that stops you passing urine, needing further catheterisation or, occasionally, a different procedure such as TURP, and reactions to sedation medication.