More than half of men 50 years of age and older, and up to 90 percent of men over 80 are affected by symptoms of benign prostatic hyperplasia BPH, or enlarged prostate, which can significantly impact quality of life.
A new outpatient, in-office procedure for treating symptoms of BPH has proven to be safe and effective. The Rezūm System, approved by the Federal Drug Administration in 2015, uses minimally invasive water vapor therapy to reduce the symptoms of BPH, which can include slow or interrupted stream, getting up at night, having to void more frequently or urgently, hesitancy in initiating a stream, incomplete emptying, and dribbling urine at the end of a void. Traditional surgical treatment involves removal of the obstructing tissue with either a resection (TURP) or an open incision (suprapubic prostatectomy).
"Rezūm is unique in that it is a treatment that falls between medicine and surgery. It is something we can do in the office without full anesthesia and may be a good option for a lot of patients," says Mark DeGuenther, MD, a urologist with Urology Centers of Alabama.
The system uses sterile steam to treat BPH by delivering targeted, controlled doses of steam directly to the transition zone of the prostate gland. A narrow sheath, similar to a cystoscope, is inserted into the urethra and positioned within the prostate. A thin needle is deployed through the urethra into the prostate tissue, and a nine-second treatment of water vapor is delivered directly into the hyperplastic tissue which immediately disperses through the tissue interstices. Upon contact with the tissue, the vapor condenses into its liquid state and releases the stored thermal energy contained in the vapor directly against the walls of the tissue cells within the treatment zone. This immediately denatures the cell membranes and causes instantaneous death to the cells.
In addition, the energy release collapses the vasculature and causes denervation of the alpha adrenergic nerves and receptors in the treatment zone, effectively eliminating the contractile capability of the treated tissue. Over time, the denatured tissue will be absorbed by the body's immune system response and the reduction in the hyperplastic tissue volume reduces the compression of the urethra, enabling improved urine flow.
The Rezūm procedure minimizes the potential of side effects and complications that are seen with medications and other more invasive procedures. "The success rate for Rezūm is 80 to 85 percent for relieving or significantly improving symptoms," DeGuenther says. "That's less successful than invasive surgical procedures but better than the 65 to 70 percent success of medications."
Following the procedure, patients may return to regular activities within a few days, and symptoms should improve in as little as two weeks. The therapy is covered by most insurances companies.
DeGuenther says the biggest drawback to Rezūm is the trauma that it induces to the prostate which causes swelling. After the procedure, most men will need to wear a catheter at home for three to seven days or until the swelling goes down. "That's longer than a patient would wear a catheter following an invasive surgical procedure, but it seems to be a good trade-off if you can have a procedure that's less invasive," he says.
The procedure works best on men with small to medium-sized prostates. Men with very large prostates typically are not good candidates. DeGuenther says the two patient populations for the procedure are men who want to stop taking medications for the BPH and those whose medications no longer work for their condition. "If their medicines are not working and these men are not willing to have a surgical procedure, Rezūm may be a good option," he says. "The greatest risk with the therapy is swelling of the prostate that causes urinary retention. It can cause some bleeding into the bladder which may be problematic in a minority of patients. The procedure works in the majority of patients, but it may not be for everybody."
Urology Centers of Alabama has just recently started using Rezūm and is satisfied with the results to date. "This is a new technology to Birmingham and to the field of urology in general, but we see it as a good opportunity for our patients," DeGuenther says. "We want to remain on the cutting edge, so we try to be early adopters of technology that shows good promise."