Rezum for BPH: Water Vapor Therapy – Complete Guide

What is Rezum?

Rezum is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses water vapor (steam) to destroy excess prostate tissue. It is an office-based procedure that takes about 5-10 minutes and does not require general anaesthesia or a hospital stay.

The Rezum system was FDA-approved in 2015 and has been performed on over 100,000 men worldwide. It is one of the most popular minimally invasive surgical treatments (MISTs) for BPH.

How does Rezum work?

Rezum works by injecting sterile water vapor (steam) directly into the prostate tissue through a small scope inserted into the urethra.

The science:

• Water vapor at ~103°C (217°F) is injected into the prostate via a small needle
• The steam releases thermal energy, causing immediate cell death (necrosis) in the targeted tissue
• The body's immune system absorbs the dead tissue over 1-3 months
• The prostate shrinks by 20-30%, relieving urethral obstruction
• The cooling action of the steam prevents damage to the urethra (unlike TUMT or TURP)

Number of injections:

• Typically 4-10 injections depending on prostate size
• Each injection treats about 1-2 mL of prostate tissue
• Injections are placed in the lateral lobes and median lobe (if present)

Who is a good candidate for Rezum?

Ideal candidates for Rezum meet the following criteria:

• Prostate size: 30-80 mL (small to moderately enlarged)
• Symptoms: Moderate to severe BPH symptoms (IPSS ≥12)
• Medication failure: Poor response or intolerance to BPH medications
• Wants to avoid daily pills but not ready for major surgery
• Acceptable risk of retrograde ejaculation (20-30% rate)

Who is NOT a good candidate?

• Very large prostates >80 mL (less effective; consider Aquablation or TURP)
• Active urinary tract infection
• Bladder stones or large bladder diverticula
• Urethral stricture (narrowing) that prevents scope passage
• Known prostate cancer (requires different treatment)

The Rezum procedure – what to expect

Before the procedure:

• Stop blood thinners (if possible – Rezum can sometimes be done without stopping)
• Antibiotics may be prescribed to prevent infection
• No special bowel preparation or fasting required

Day of procedure:

• Performed in a urology office or outpatient centre
• Anaesthesia: Local anaesthesia (lidocaine gel in urethra) plus oral sedation (valium or similar). General anaesthesia is not required.
• Position: Lying on your back with legs in stirrups
• Duration: 5-10 minutes

Step-by-step:

1. A small scope (cystoscope) is inserted into the urethra
2. The Rezum delivery needle is advanced into the prostate tissue
3. Water vapor is injected for 9 seconds per site
4. The needle is repositioned and the process repeated (4-10 times)
5. The scope is removed – no incisions or stitches

Recovery and downtime

Immediate post-procedure (first 24-48 hours):

• Catheter: 10-15% of men need a temporary catheter for 1-3 days (most do not)
• Burning with urination (dysuria): Very common – lasts 1-2 weeks
• Blood in urine (hematuria): Common – lasts 1-2 weeks
• Increased frequency/urgency: Temporary, improves over 2-4 weeks

Return to activities:

• Desk work: 1-3 days
• Physical labour: 1-2 weeks
• Exercise (light): 1 week
• Sexual activity: 2-3 weeks (after discomfort resolves)

Symptom improvement timeline:

• 1-3 days: Temporary worsening due to swelling (normal)
• 2-4 weeks: Initial symptom improvement begins
• 1-3 months: Progressive improvement as tissue is absorbed
• 3-6 months: Maximum benefit achieved

Effectiveness – symptom improvement and durability

Clinical studies demonstrate excellent outcomes with Rezum:

5-year clinical trial results (Rezum II study):

• IPSS reduction: 50-60% (e.g., 22 → 10)
• Peak flow rate (Qmax) increase: 50-100% (e.g., 9 → 14-15 mL/s)
• Prostate size reduction: 20-30% at 3 months
• Quality of life improvement: Significant (QoL score improved by 50%)
• Durability: 5-year data shows sustained improvement with low re-treatment rates (4-5% needed repeat procedure)

Patient satisfaction:

• 85-90% of men report being satisfied or very satisfied at 5 years
• 80% would recommend Rezum to a friend

Side effects – retrograde ejaculation, dysuria, hematuria

Rezum is generally safe, but side effects occur:

Common side effects (occur in >10%):

• Dysuria (painful urination): 60-70% – usually mild, lasts 1-2 weeks
• Hematuria (blood in urine): 50-60% – resolves in 1-2 weeks
• Urinary frequency/urgency: 30-40% – temporary
• Retrograde ejaculation: 20-30% (semen goes into bladder instead of out) – harmless but affects fertility

Less common side effects (occur in 2-10%):

• Urinary retention requiring catheter: 10-15% – usually resolves in 1-3 days
• Urinary tract infection: 5-10% – treated with antibiotics
• Pelvic pain: 2-5% – resolves with time

Rare side effects (<2%):

• Erectile dysfunction (rare – <1-2%)
• Urinary incontinence (very rare – <1%)
• Urethral stricture (rare – <1%)

Rezum vs. TURP vs. UroLift

Feature	Rezum	UroLift	TURP
Anaesthesia	Local + sedation	Local	General or spinal
Procedure time	5-10 min	15-30 min	30-60 min
Hospital stay	None	None	1-2 days
Catheter required	10-15% (1-3 days)	Rare	1-2 days
Return to work	1-3 days	2-5 days	2-4 weeks
IPSS reduction	50-60%	40-50%	60-70%
Prostate size range	30-80 mL	30-80 mL	30-100+ mL
Retrograde ejaculation	20-30%	<2%	70-80%
Erectile dysfunction risk	<2%	<1%	5-10%

Cost and insurance coverage

• Medicare: Covers Rezum for eligible patients (must meet criteria)
• Private insurance: Most major insurers cover Rezum (coverage varies – check with your plan)
• Out-of-pocket cost: $2,000-$5,000 depending on insurance, deductibles, and facility fees
• Compared to TURP: Rezum is generally less expensive than TURP when factoring in hospital stay and anaesthesia costs

Interactive FAQ – Rezum for BPH

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Disclaimer: This information is for educational purposes. Rezum is a medical procedure with risks and benefits. Discuss with a urologist at Vivekananda Hospital to determine if Rezum is right for you.