A new, minimally invasive procedure for treating symptomatic prostate enlargement has been tested in clinical trials and has been shown to be safe and effective. I was informed about it at a recent urology meeting in Prague and was intrigued because of its simplicity. The prostate steaming procedure–called “Rezum”–takes less than 15 minutes and uses convective heat energy in the form of steam to open up the obstructed prostate gland.
Convection Versus Conduction
Convection is the transfer of thermal energy by heating up a liquid, resulting in currents of thermal energy traveling away from the heating source. This type of energy is used for the Rezum prostate steaming procedure.
This is as opposed to conduction, which is heat transfer via molecular agitation. Thermal energy that is directly applied to tissues heats up molecules and is transferred through tissues as higher-speed molecules collide with slower speed molecules. Conduction energy is commonly used in surgery to cut or coagulate tissues.
Benign Prostate Enlargement (BPH)
BPH is a common condition in men above the age of 50. Based upon aging, genetics and testosterone, the prostate gland enlarges to a variable extent. As it does so, it often compresses the urinary channel (like a hand around a garden hose), causing urinary obstructive and irritative symptoms that can be quite annoying. Obstructive symptoms include: a weak, prolonged stream that is slow to start and tends to stop and start (to quote my patient: “peeing in chapters”) and incomplete emptying. Irritative symptoms include: strong urges to urinate, frequent urinating, nighttime urinating and possibly urinary leakage before arrival at the bathroom.
BPH (note the tissue compressing the urinary channel)
Medications or surgical procedures are often used to alleviate the symptoms of BPH. One class of medication relaxes the muscle tone of the prostate (Flomax, Uroxatral, Rapaflo, etc.); another class shrinks the prostate (Proscar, Avodart). The erectile dysfunction medication Cialis has also been used (daily dosing) to help manage symptomatic BPH. Commonly performed procedures to improve the symptoms of BPH include Greenlight laser photovaporization of the prostate, Urolift procedure and TURP (transurethral resection of the prostate). The Rezum prostate steam procedure is a new addition to the BPH armamentarium.
Rezum Prostate Steaming
The prostate is a compartmentalized organ with discrete anatomical zones (compartments). The transition zone is the area responsible for benign enlargement. In the Rezum procedure, radio-frequency energy is used to convert a small volume of water to steam, which is injected within the transition zone of the prostate via a retractable needle under direct visual guidance (cystoscopy). The steam adheres to the anatomy of the prostate zones, its spread limited by the zonal anatomy. Each steam (convective water vapor thermal energy) injection takes less than 10 seconds and utilizes no more than a few drops of water. The number of injections necessary is based upon the size of the prostate gland, but it generally requires only a few.
Steam being injected into prostate tissue via a retractable needle
Convection uniformly disperses the steam, causing targeted cell death of prostate cells. This slowly and gradually will un-obstruct the prostate and alleviate the symptoms of BPH.
It is unusual for the actual procedure to take much longer than a few minutes, although the patient will need preparation time before and recovery time after the procedure. After the Rezum is completed, a catheter is placed for a few days. Common temporary side effects include inability to urinate (the reason for the catheter), discomfort with urination, urinary urgency, frequency, and blood in the urine or semen. Symptomatic improvement may be noted as early as two weeks after the procedure, but it may take up to 3 months before maximal benefits are derived.
Prostate anatomy 3-months following Rezum procedure
A multi-center, randomized, controlled study was recently reported in the Journal of Urology. 200 men were randomized to active treatment with Rezum versus control. The study concluded that convective water vapor energy provides durable improvements in the symptoms of BPH, preserving erectile and ejaculatory function.
Bottom Line: This quick outpatient procedure for BPH is safe and effective, can be performed in an office setting using sedation and can treat certain anatomical variations (e.g. middle lobe prostate enlargement) that cannot be treated by some of the alternative methods. Erectile and ejaculatory functions are preserved in most patients, which is often not the case with the BPH medications, Greenlight laser and TURP. A disadvantage is that the Rezum is not immediately effective, requiring a catheter for several days and a period of several weeks before symptomatic improvement is evident. Our urology practice is now offering this procedure to patients.