Benign prostatic hyperplasia is considered one of the commonest urological conditions affecting the middle-aged and elderly male population. Prostatic enlargement may manifest in most patients with symptoms of urinary obstruction. BPH is also a major concern because of its effects on male sexual function.
Benign Prostatic Hyperplasia (BPH) Credit: BruceBlaus
Treatment options for benign prostatic hyperplasia include pharmacological and surgical therapy which aims at improving the urinary symptoms, preserving or restoring sexual function, and improving the quality of life of patients. These therapies come with their unique adverse effects which have proven to be a major challenge to urologists. Current research attempts to explore treatment options to minimize the adverse effects of these treatment options and alternative therapies with better safety profiles for patients.
Rezum is a novel treatment that attempts to rapidly ablate the prostatic tissue responsible for urinary obstruction by the use of water vapor thermal energy. It is a minimally invasive procedure that is becoming increasingly popular because of its unique advantage. The Rezum system has been reported to improve lower urinary tract symptoms while preserving sexual function and is expected to minimize the cost and complications involved in the management of benign prostatic hyperplasia (Winkler, Klot, Madersbacher, Kuczyk, et al, 2023).
Rezum uses Water Vapor Thermal Therapy to Treat Benign Prostatic Hyperplasia
Table of Contents
Rezum is a novel minimally invasive procedure developed with the aim of minimizing the complications of surgical treatments for Benign Prostatic Hyperplasia. The new therapy has continued to gain popularity since its discovery and has received approval for use in the United States. Rezum differs from other ablative surgical procedures in its use of convective heat transfer instead of the usual conductive heat transfer applied in procedures like Transurethral microwave therapy.
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The Rezum system offers an encouraging list of unique benefits that has promoted its preference by patients who desire a minimally invasive, cost-effective procedure without having to risk the side effects of BPH medications and other surgical alternatives. The Rezum system introduced by Boston Scientific Company Inc. in Marlborough, USA; ablates targeted prostate tissue by the use of water vapor thermal energy. It is made up of a single-use transurethral delivery device coupled with a standard cystoscopy lens and a radiofrequency generator. The transurethral device delivers sterile water vapor via a vapor needle to the transition zone of the prostate penetrating as deep as 10mm and triggers rapid cell necrosis by releasing concentrated energy into target cell membranes. The thermal energy released is contained within the transition zone of the prostate and does not extend to surrounding tissues thereby sparing surrounding structures like the rectum, urinary sphincter, and the bladder (Westwood, Geraghty, Jones, Rai, et al, 2018).
The Several Risks to Consider Before Rezum Procedure
Contrary to what popular published reports claim, the Rezum procedure is not without considerable risk to the patients. There have been reports of certain adverse effects noticed in patients who have undergone the procedure. While experts claim that these side effects are mild and will resolve over a short period, there have been reports of serious side effects. Some of the common adverse effects to expect include:
- Acute Urine Retention: Some patients have reported an inability to pass urine lasting from a few days to even weeks. Most facilities will ensure that patients have a catheter for a few days following the procedure but in some cases, the patients are unable to urinate without the catheter for at least a few weeks.
- Ejaculatory Dysfunction: Whilst current studies insist that this is not common, it is important to note that some patients have noticed some level of ejaculatory dysfunction following their procedure. There have been recorded cases of retrograde ejaculation and reduced ejaculatory volume following the Rezum procedure.
- Poor urine stream: Patients may suffer trauma of different degrees to the urethra during the procedure resulting in urinary symptoms like poor or splayed urine stream following the procedure. Depending on the severity of urethral injury, healing of the urethra may result in scarring and narrowing of the urethral canal consequently increasing the risk of urine retention, urinary tract infections, and other severe complications affecting the kidneys and urogenital system.
- Hematospermia: This refers to the presence of blood in the semen. This is a potential side effect to consider and expect before the procedure and occurs as a result of a traumatic injury inflicted during the procedure in some patients. This is expected to resolve after a few days but in severe cases may continue for several weeks or months.
- Painful urination: This side effect is very common following the procedure and may be caused by injury to the urethra or bladder. Most patients experience a burning or stinging sensation during urination for several weeks following the procedure.
- Hematuria: This is also a commonly reported side effect. For several weeks following the procedure, patients may notice blood in their urine.
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Other rare but reported side effects to watch out for include;:
- Bladder injury especially injury to the bladder neck
- Excessive bleeding
- Bladder stones
- Side effects of anesthesia, etc.
Benefits of Water Vapor Thermal Energy in the Treatment of BPH: Preservation of Sexual Function
The commonest benefits of Rezum reported in published literature include; an impressive safety profile, preservation of sexual function or significant reduction of sexual side effects, cost-effectiveness, reduced hospital stay, and minimal anesthesia. The procedure has gained popularity amongst patients, especially with the growing concern associated with the sexual side effects of surgical therapy in patients with Benign Prostatic Hyperplasia.
Several studies have been published to throw more light on the efficacy and safety of this procedure since its introduction and it is expected to replace several surgical interventions in the near future. An obvious advantage of the Rezum procedure is its simplicity. The procedure lasts about 10 minutes, can be done on an outpatient basis, and is currently being considered for use in patients with larger prostates.
A study that involved the collection of data over a 36-month period from patients who had undergone the procedure reported significant improvement in the IPSS scores, PVR, Qmax, and QoL with no impact on their erectile and ejaculatory function (Woo & Gonzalez, 2017). In a study that compared the efficacy of the Rezum procedure with common pharmacological interventions, patients who received the Rezum procedure were found to have better outcomes when compared with those who received Finasteride monotherapy (Gupta, Rogers, Holland, et al, 2018).
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There is abundant scientific evidence to support the efficacy of water vapor thermal therapy. In addition to its short-term benefits on sexual function, some studies report that unlike other surgical interventions or common BPH medications like alpha-blockers and the 5-alpha reductase inhibitors, water vapor thermal therapy is not associated with a significant negative impact on sexual function in the long term (McVary, Rogers, Mahon & Gupta, 2018). Finally, due to the simple nature of the procedure, choice of anesthesia, and the short hospital stay postoperatively, Rezum is expected to significantly reduce the cost of treatment for BPH patients.
Which Patient Qualifies for Rezum?
The use of Rezum as a treatment for BPH is not recommended for all cases of Benign Prostatic Hyperplasia. Patients with very large prostates, previous invasive surgery involving the prostate, a history of recurrent or current urinary tract infection, or a PSA score > 2.5ng/ml are not eligible for the procedure (Westwood, Geraghty, Jones, Rai, et al, 2018).
It is also important to note that unlike in procedures like TURP, prostate tissue cannot be obtained using the Rezum procedure. This means that cases of prostate cancer co-occurring with prostate enlargement could be missed especially in patients who have not developed obvious symptoms.
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Conclusion
The decision to choose Rezum ahead of other forms of BPH management must be made carefully. All aspects of the patient’s history and unique clinical condition should be taken into consideration. The patient should also be well aware of the possible side effects. Hopefully, with more study, the procedure will get even more refined leading to fewer side effects.
References
Gupta, Nikhil; Rogers, Tyson; Holland, Bradley; Helo, Sevann; Dynda, Danuta; McVary, Kevin T.† Three-Year Treatment Outcomes of Water Vapor Thermal Therapy Compared to Doxazosin, Finasteride and Combination Drug Therapy in Men with Benign Prostatic Hyperplasia: Cohort Data from the MTOPS Trial, Journal of Urology: August 2018 – Volume 200 – Issue 2 – p A1-A28, 215-466 https://doi.org/10.1016/j.juro.2018.02.3088
Kevin T. McVary, MD , Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?, The Journal of Sexual Medicine, Volume 15, Issue 12, December 2018, Pages 1728–1738, https://doi.org/10.1016/j.jsxm.2018.10.006
Westwood J, Geraghty R, Jones P, Rai BP, Somani BK. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Therapeutic Advances in Urology. 2018;10(11):327-333. doi:10.1177/1756287218793084
Winkler T, von Klot CAJ, Madersbacher S, Kuczyk MA, Wolters M (2023) Rezum water vapor thermal therapy for treatment of lower urinary tract symptoms: A retrospective single-centre analysis from a German high-volume centre. PLOS ONE 18(1): e0279883. https://doi.org/10.1371/journal.pone.0279883
Woo HH, Gonzalez RR. Perspective on the Rezūm® System: a minimally invasive treatment strategy for benign prostatic hyperplasia using convective radiofrequency water vapor thermal therapy. Med Devices (Auckl). 2017;10:71-80 https://doi.org/10.2147/MDER.S135378
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