My Clinical Experience with Rezum
Rezum occupies an important niche in the BPH treatment spectrum: it is suitable for men with prostates 30–80 mL who wish to avoid both the recovery of surgical procedures (TURiS, HoLEP) and the mechanical implants of UroLift, while prioritising ejaculatory function preservation.
At my practice in Rhodes, I offer Rezum for appropriately selected patients as an outpatient procedure under local anesthesia, returning home the same day.
- Performed under local anesthesia — no general or spinal anesthesia.
- Same-day discharge; catheter 3–7 days.
- Ejaculation preserved in >90% (ReZUM II 5-year trial).
- Median lobe treatable — unlike UroLift.
What Is Rezum Water Vapor Therapy
Rezum (NxStage Medical / Boston Scientific) is a convective water vapor thermal therapy for benign prostatic hyperplasia (BPH). A specialized cystoscope is passed transurethrally. A retractable needle deploys into the prostatic adenoma and delivers 9-second pulses of steam at 103°C. Each pulse generates a cloud of vapor that disperses through the tissue, converting kinetic energy to heat and causing cell death (necrosis) throughout the treated zone.
Over 4–6 weeks, the body’s immune system resorbs the necrotic adenoma tissue. The prostate shrinks, reducing urethral obstruction and improving urinary flow.
Prostate Cancer Must Be Excluded Before Rezum
Rezum is a treatment for BPH only. Before scheduling Rezum, PSA, DRE, and where indicated mpMRI must be performed to exclude prostate cancer.
Indications & Patient Selection
BPH with Moderate–Severe LUTS
IPSS ≥8, prostate volume 30–80 mL, failure or intolerance of medical therapy (alpha-blockers, 5-ARIs). Rezum is EAU-listed as a treatment option for this population.
Sexually Active Men Who Wish to Preserve Ejaculation
The strongest indication. Men who wish to avoid retrograde ejaculation associated with TURiS (>60–90%) or HoLEP (70–90%). Rezum preserves ejaculation in >90% of patients.
Patients Preferring Avoidance of General/Spinal Anesthesia
Performed under local anesthesia. Suitable for patients with significant comorbidities that increase anaesthetic risk.
Median Lobe Hypertrophy
Unlike UroLift, Rezum can treat the median lobe. This is a practical advantage for patients with intravesical median lobe protrusion causing outlet obstruction.
Pre-procedure Preparation
Prostate Evaluation
PSA, DRE. TRUS or suprapubic ultrasound for volume measurement. Uroflowmetry + post-void residual. mpMRI if cancer exclusion is required.
Urine Culture
Urine culture within 4 weeks. Active UTI must be treated before Rezum.
Anticoagulant Management
Stop antiplatelet agents 5–7 days before. Anticoagulants: discuss with prescribing physician.
Antibiotic Prophylaxis
Single-dose prophylaxis before the procedure. Continued oral antibiotics for 3–5 days post-procedure in most protocols.
How Rezum Works — 3 Steps
Anesthesia & Cystoscope Introduction
Patient in dorsal lithotomy. Urethral local anesthetic gel applied. Periprostatic nerve block given. Mild IV sedation offered. Rezum cystoscope passed through the urethra to the level of the prostatic adenoma.
Steam Injections into the Adenoma
The retractable needle is deployed at 90° into the adenoma tissue. Each injection delivers a 9-second burst of water vapor at 103°C. The steam disperses through the tissue creating a 1–2 cm diameter treatment zone. 2–5 injections per procedure targeting lateral lobes and median lobe as needed.
Catheter Placement & Discharge
A urinary catheter placed at the end of the procedure to manage edema-related retention during the healing phase. Patient discharged same day. Catheter removed after 3–7 days at follow-up. Gradual symptom improvement expected over 4–6 weeks.
Duration, Anesthesia & Setting
Recovery & Outcomes
Weeks 1–4 (Sloughing Phase)
Necrotic tissue begins to slough. Urinary urgency, frequency, and mild dysuria are expected during this phase. Hematuria may persist for 1–2 weeks. Oral antibiotics and alpha-blockers prescribed. Catheter removed after 3–7 days.
Months 1–3 (Absorption Phase)
Body absorbs necrotic adenoma. Urinary symptoms gradually improve. Most patients notice significant improvement in flow rate and IPSS by weeks 4–8. Full effect achieved by 3 months.
5-Year Data (ReZUM II Trial)
McVary et al. J Urol 2021: IPSS improved by mean 11.4 points, Qmax improved by 6.4 mL/s, quality of life improved durably. Surgical retreatment rate: 4.4% at 5 years. Ejaculation preserved in >90% of sexually active men.
Advantages & Comparison
Ejaculation Preservation (>90%)
The most compelling advantage of Rezum. In the ReZUM II trial, >90% of sexually active men preserved antegrade ejaculation — far superior to TURiS (retrograde ejaculation >60%) or HoLEP (70–90%).
Local Anesthesia / No Hospitalization
Unlike TURiS (1–2 days), HoLEP (1–2 days), or laparoscopic adenomectomy (2–4 days), Rezum is performed as an outpatient under local anesthesia with same-day discharge.
Treats Median Lobe (vs UroLift)
UroLift cannot be used when median lobe hypertrophy is the primary obstructive mechanism. Rezum treats all obstructive lobes including the median lobe.
Durable 5-Year Results
Retreatment rate of approximately 4% at 5 years is comparable to TURP for appropriately selected patients (30–80 mL, no very large adenoma).
Possible Side Effects
Urinary urgency / dysuria (Expected, temporary)
Most common: urgency, frequency, and mild burning lasting 2–4 weeks during the sloughing/healing phase. Managed with alpha-blockers and antibiotics.
Hematuria (Expected)
Mild to moderate blood in urine for 1–2 weeks. Significant bleeding is uncommon.
Urinary retention (5–15%)
Some patients need catheter for longer than 7 days due to edema. Self-catheterization taught if needed.
UTI (3–5%)
Managed with targeted antibiotics. Urine culture before and after procedure minimizes risk.
Retrograde ejaculation (<5%)
Rare with Rezum. Far less common than with TURiS or HoLEP.
Frequently Asked Questions (FAQ)
What is Rezum therapy and how does it work?
Rezum is a minimally invasive treatment for benign prostatic hyperplasia (BPH). A small needle is passed through the urethra into the prostatic adenoma and delivers 9-second bursts of water vapor (steam) at 103°C. The convective thermal energy destroys adenoma cells. Over the next 4–6 weeks the body absorbs the necrotic tissue, shrinking the prostate and relieving obstruction.
Can Rezum treat a median lobe of the prostate?
Yes — this is a key advantage of Rezum over UroLift. Rezum can treat both lateral lobes and the median lobe. The needle is directed into each obstructive lobe including the median lobe if present. Patients with significant median lobe hypertrophy are not excluded from Rezum.
How long will I need a catheter after Rezum?
Most patients require an indwelling catheter for 3–7 days post-procedure while the necrotic tissue begins to slough and inflammation subsides. Some patients require catheter drainage for up to 2 weeks. This is longer than TURiS (1–2 days) but Rezum is performed as a day procedure under local anesthesia — no general/spinal anesthesia required.
Does Rezum preserve ejaculation?
Yes — preservation of ejaculatory function is one of the most important advantages of Rezum. In the ReZUM II 5-year trial, >90% of sexually active men preserved antegrade ejaculation — significantly better than TURiS (retrograde ejaculation 60–90%) or HoLEP (70–90%). This makes Rezum the preferred option for sexually active men with BPH who wish to preserve ejaculation.
How long do Rezum results last?
The ReZUM II trial (McVary J Urol 2021) published 5-year results: IPSS score improved by an average of 11 points, Qmax increased significantly, and quality of life improved durably. Surgical retreatment rate was approximately 4% at 5 years — equivalent to TURP at 5 years for appropriate patient selection (prostate 30–80 mL).
What is the difference between Rezum and UroLift?
Both are office-based BPH procedures preserving ejaculation. Key differences: Rezum destroys and resorbs adenoma tissue; UroLift mechanically retracts lateral lobes with implants (no tissue removal). Rezum treats the median lobe; UroLift does not. Rezum requires catheter 3–7 days; UroLift requires no catheter. Rezum prostate size range 30–80 mL; UroLift typically <80 mL without median lobe. Symptom improvement with Rezum is generally comparable or superior to UroLift.
How many steam injections are given during Rezum?
Typically 2–5 injections depending on prostate size, anatomy, and presence of median lobe. Each injection delivers one 9-second burst of steam. The total procedure time (including preparation) is 15–20 minutes.
Can Rezum be repeated if symptoms return?
Yes. If BPH symptoms recur after several years, Rezum can be repeated. Additionally, if Rezum is insufficient, patients can subsequently undergo TURiS, HoLEP, or other surgical treatments without compromising outcomes. Rezum does not close off future surgical options.
Related Topics
Book an Appointment in Rhodes
BPH symptoms affecting quality of life? Find out if Rezum is the right minimally invasive option for you — consultation and full evaluation at our urology practice in Rhodes.
References & Sources
- EAU Guidelines on Non-neurogenic Male LUTS 2024 — uroweb.org
- McVary KT, et al. Rezum Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology 2019;126:171–179.
- McVary KT, et al. Long-term Outcomes Following Convective Water Vapor Ablation Therapy for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia With or Without an Obstructing Median Lobe. J Urol 2021;206:686–694.
- Darson MF, et al. Convective Water Vapor Energy Ablation for Surgical Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Curr Urol Rep 2017;18:61.
Medical Review
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Marinos Vasilas offers Rezum Water Vapor Therapy for appropriate BPH patients according to EAU 2024 guidelines, with particular experience in selecting patients who will most benefit from ejaculation-preserving minimally invasive treatments.
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