Rezum

What is Rezum?

Rezum is a new technology that uses heated sterile water vapour (steam) reduce the size of enlarged prostates to help men with urinary symptoms (LUTS). It uses steam to heat up the prostate and kill some of the excess prostate tissue. The device has a number of safety features to make sure the correct amount of steam and heat energy is applied so that the heat energy is contained within the prostate. Initially there is some swelling of the prostate but over time your body removes the dead cells and the prostate shrinks.

The steam is injected under direct vision using a camera. The surgeon will plan the number of injections based on the size and shape of your prostate.

Is Rezum safe?

Rezum received NICE approval in June 2020 [MTG49] and was approved in the USA by the FDA in August 2015. This approval was given because Rezum has been studied in clinical trials showed that Rezum improves LUTS and is safe. However there are some possible side effects:

• Discomfort or burning on passing urine, this usually resolves after 7-10 days. Over the counter pain relief can be used (e.g. paracetamol and ibuprofen)
• Bladder irritation – the need to pass urine frequently, this usually resolves after 7-10 days and may be improved by avoiding caffeine
• Blood in the urine and ejaculate may be seen on and off for a few weeks, heavy bleeding is rare
• Inability to pass urine (retention). Most patients have a catheter for 3-5 days after the procedure, if you have a very large prostate you may need a catheter for longer. Rarely patients may not be able to pass urine after this time and need a catheter for a few weeks.
• Urine infections – you will be given antibiotics at the time of the operation but occasionally patients develop infection requiring a full course of antibiotics.
• Some men may notice a change in their ejaculation or erections, but this is rare.

How well does Rezum work?

Rezum is proven to work in men with LUTS caused by medium sized prostates (30cc-80cc). For these men Rezum is more effective than medication (such as alpha-blockers, 5-alpha reductase inhibitors) and has fewer potential side effects than other surgical procedures such as a TURP or a laser prostate enucleation (HoLEP).

However, although Rezum has few potential side effects it is less good at improving symptoms compared with a TURP or HoLEP. Rezum has not yet been shown to work in men with retention of urine, very poor bladder emptying (chronic retention) or very large prostates (>80cc) so your urologist would only recommend Rezum in these cases if there were exceptional circumstances.

How long will my Rezum treatment last?

Less than 5% of patients (1 in 20 patients) require further prostate treatments within 5 years of having Rezum. As Rezum is a new technology we do not know the long-term results as so far studies have only followed up patients for 5 years.

What happens on the day of treatment?

You will attend the hospital a few hours before the procedure so we can get you ready. If the Rezum treatment is being done under local anaesthetic (with sedation) we will give you painkillers an hour before the procedure. Some procedures are done with men awake under local anaesthetic and some men are put to sleep (general anaesthetic)

If you have the procedure when you are awake (with sedation) when you arrive in theatre local anaesthetic will be injected around the prostate using an ultrasound probe in the back passage (trans-rectal ultrasound). This may feel a bit uncomfortable but the more relaxed you are the easier it will be.

Some anaesthetic jelly is put into the water pipe (urethra) then the Rezum equipment is passed though the water pipe (urethra) into the bladder. The urethra and bladder are inspected then the steam treatment given.

A catheter is left in the water pipe to drain the bladder while the prostate swelling subsides; this is usually left in for 3-5 days but this may need to be longer for men with larger prostates.

What happens when I go home?

You will go home with a catheter in the bladder for 3-5 days. We will let you know a date for the catheter removal before you leave hospital.

You will be given a course of antibiotics and some painkillers to take as needed. It is normal to have some discomfort after surgery but the painkillers should control it.

How fast is the recovery?

Within a few weeks of having the catheter removed you will start to notice an improvement in your LUTS, but it can take 3 months until the full benefit of the treatment is felt. For the first month after surgery try to avoid drinking fluids that may irritate your bladder such as caffeinated drinks (tea, coffee, cola) and stay well hydrated.

Some patients find the first 6 weeks after surgery difficult as their urinary symptoms may temporarily worsen until the prostate heals and starts to shrink. Symptoms will gradually improve.

You should be able to perform normal activities within a few days, but you should avoid sexual activity for 4 weeks. It is common to see small amounts of blood in the urine or ejaculate for a few weeks, but this will stop as the prostate heals. Heavy bleeding is rare. Some men may notice discomfort/burning when passing urine, but this will improve gradually over a few weeks. A small number of men (2-4%) may need a minor second operation to remove residual prostate tissue.

Will I see anyone after my operation?

Yes - we see you after your procedure before you go home. We will also arrange a follow up appointment for you in 3-4 months to see how well the treatment has worked; this may be a telephone appointment. If you have problems, please let us know and we will see you sooner.

Further information

Details of the clinical studies looking at Rezum and videos of the procedure are available on the manufactures website (Boston Scientific).