What Is Rezum (Water Vapour) Therapy and Who Is It Suitable For?

Benign prostatic hyperplasia (BPH) is a common condition in men as they get older and can noticeably affect quality of life through urinary symptoms. The first step in treatment is usually lifestyle advice and medication; however, interventional options come into consideration for patients whose symptoms do not improve sufficiently with medication or who cannot tolerate its side effects.

At this point, minimally invasive methods positioned between medication and conventional prostate surgery become relevant. Rezum belongs to this group and is applied by delivering water vapour energy into the prostate tissue. This article covers what Rezum therapy is, how it is performed, who it may be suitable for and how it differs from the other options.

What is Rezum therapy?

Rezum is a minimally invasive method based on delivering water vapour into enlarged prostate tissue through a fine needle. The vapour spreads within the tissue and causes the cells in the targeted area to shrink over time. As a result of this reduction, pressure on the urinary channel decreases and urine flow becomes easier.

What distinguishes the method is that no incision is made and tissue is not removed on a large scale. The procedure is carried out through the urethra; the whole prostate is not removed, and only the areas narrowing the urinary flow are targeted. The effect is not immediate; because the targeted tissue regresses over a period of weeks, the relief in symptoms is also gradual.

Rezum is not a method used to treat prostate cancer; it addresses urinary symptoms caused by benign prostate enlargement.

How is the procedure performed?

The procedure is carried out using a dedicated device advanced through the urethra. The fine needle at the tip of the device is placed into the targeted area of the prostate and short vapour applications lasting a few seconds are delivered. Depending on the size of the prostate and the distribution of the tissue, these applications are repeated at more than one point.

The procedure is generally short, and the choice of anaesthesia is determined according to the patient's condition. A urinary catheter may be needed for a period afterwards; this varies between patients and relates to the subsiding of tissue swelling. Patients can usually return to daily life the same day or shortly afterwards, although they are asked to wait for the period specified by the surgeon before heavy physical activity.

In the first weeks after the procedure, burning on passing urine, a sense of urgency and mild blood in the urine may occur. These findings are usually temporary; persistent or increasing symptoms warrant medical review.

Who may be suitable for Rezum?

Rezum is not a method applied to every patient with urinary symptoms due to prostate enlargement. Suitability is determined by assessing the size of the prostate, the structure of the tissue, the severity of symptoms and the patient's general condition. It may generally be considered in the following situations:

• Those not benefiting sufficiently from medication: Patients whose symptoms do not improve enough with drug treatment.
• Those unable to tolerate side effects: Patients who cannot continue medication, particularly because of effects on sexual function.
• Those who prefer not to take long-term medication: Patients who would rather not remain on continuous treatment.
• Those prioritising preservation of sexual function: Patients for whom preserving ejaculatory function is a prominent expectation.
• Those whose general condition is not suited to major surgery: Patients in whom a more extensive operation is considered risky because of other illnesses.

By contrast, more extensive methods may come to the fore in patients with a very large prostate, additional problems such as bladder stones or a high volume of residual urine, or recurrent urinary retention. This distinction becomes clear after assessment with examination and investigations such as ultrasound and urine flow testing.

How does Rezum differ from conventional prostate surgery?

Rezum is not a procedure of the same scope as methods such as HoLEP, where tissue is removed. The main differences can be summarised as follows:

• How it is applied: In Rezum no tissue is removed; the aim is regression of the targeted area over time using vapour energy. In HoLEP the tissue causing obstruction is removed.
• Onset of effect: With Rezum, relief develops gradually over weeks; with tissue-removing methods the effect becomes apparent earlier.
• Prostate size: In very large prostates, tissue-removing methods are generally considered more appropriate.
• Recovery: Return to daily life is usually faster with minimally invasive methods.
• Long-term course: The need for a repeat procedure is expected to be lower with tissue-removing methods, while additional treatment may be required over time with minimally invasive ones.

These differences do not make one method superior to another; each suits a different group of patients. The choice in treating prostate enlargement is made by considering prostate volume, symptom severity, other illnesses and the patient's expectations together.

What is the effect on sexual function?

One of the topics patients most want to know about in the treatment of prostate enlargement is how the chosen method will affect sexual function. After conventional prostate surgery, retrograde ejaculation, meaning semen passing towards the bladder rather than forwards, is common and is a significant concern for some patients.

One of the reasons minimally invasive methods such as Rezum are preferred is the expectation of preserving ejaculatory function. That said, it cannot be stated for any method that sexual function will be entirely unaffected; the outcome can vary with the patient's anatomy, the extent of the application and the existing state of sexual function.

Discussing the patient's expectations about their sexual life openly before the procedure can therefore be decisive in choosing a method. Because medication for prostate enlargement can also affect sexual function, this assessment applies not only to surgical options but to treatment as a whole.

How does the period after the procedure progress?

Recovery after Rezum progresses as the targeted tissue regresses over time. Relief in symptoms therefore becomes apparent not in the first days but generally over a period of weeks. Knowing this timing in advance prevents disappointment in the early period.

Patients are asked to pay attention to the following points in the early period:

• Drinking plenty of fluids and taking the prescribed medication regularly
• Avoiding heavy lifting and strenuous physical activity for the period specified
• Monitoring changes in urinary symptoms and attending follow-up appointments regularly
• Seeking review without delay in case of fever, inability to pass urine or increasing bleeding

At follow-up, urine flow, the volume of urine remaining in the bladder and the severity of symptoms are assessed. This assessment shows whether treatment is progressing as expected.

How long does the effect last, and might a further procedure be needed?

Prostate enlargement is a progressive condition; no method means the prostate tissue will never change again over time. After minimally invasive procedures, symptoms may increase again over the years and additional treatment may be required.

Discussing this possibility beforehand matters, because choosing a method covers not only short-term relief but also the long-term plan. In patients treated at a younger age, the likelihood of further treatment in the long term may be higher; for a patient prioritising preservation of sexual function, however, this may be an acceptable balance.

Rezum is a method applied without removing tissue, positioned between medication and conventional surgery in the treatment of urinary symptoms due to prostate enlargement. The decision on suitability is made by assessing prostate volume, symptom severity, other illnesses and the patient's expectations regarding sexual life together. Assoc. Prof. Dr. Zülfü Sertkaya practises in urology and andrology in Istanbul; assessment of method selection in prostate enlargement is carried out with individual planning and confidentiality.

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