Rezum treatment for BPH
(Benign prostatic hyperplasia)
Information for patients, relatives and carers
This booklet has been provided to help answer some of the quesons
you may have about your enlarged prostate and the Rezum procedure
we are oering you. It explains what Rezum is, what other treatment
opons are available, as well as what to expect before, during and aer
the Rezum procedure.
What is BPH?
Benign prostac hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland.
BPH with associated lower urinary tract symptoms (LUTS) is increasingly common as men
get older. It is esmated to increase from 50% among men between 50 and 60 years old,
to 70% for men older than 70.
Treatment opons usually include making lifestyle changes for mild symptoms, as well as
medicaon and surgical procedures such as TURP (transurethral resecon of the prostate)
or laser prostatectomy for men with more severe symptoms or complicaons of prostate
enlargement, such as urinary infecons or an inability to pass urine (urinary retenon).
What is Rezum?
Rezum is a surgical treatment which involves a special machine using steam to ablate
(remove) the parcular part of the prostate that enlarges (this is called the transion
zone) and causes symptoms due to BPH.
The machine consists of a portable radiofrequency (RF) generator and delivery device
that is passed into the body via your urethra (water pipe). A telescopic lens within the
device allows us to guide the treatment to where it is needed. The number of treatments
delivered at the me of the procedure depends on how large your prostate is.
RF energy from the generator is applied to an inducve coil in the delivery device to heat
up a measured amount of water outside of the body, which then converts the water into
vapour or steam. This is then passed into the prostate ssue via a ny needle with emier
holes to ablate the area which causes BPH. Please note that no RF energy is delivered into
the body.
The procedure takes approximately three to seven minutes to complete and paents are
normally able to go home the same day. Rezum is oen done under a local anaesthec
(you will be awake but the urethra and prostate will be numbed) but it can be done
while you sleep under a general anaesthec. The procedure takes in total between 20-25
minutes.
In comparison with other treatments, which have a longer recovery period, you should
be able to resume normal acvies within a few days. You should noce improvements
within three weeks, although it may take up to six months to obtain the full eect.
Is it safe?
The generator has a number of safety features to ensure proper heang and thermal
ablaon of the targeted prostate ssue, while protecng the urethra during treatment.
The temperature of the vapour/steam is monitored throughout and the person operang
the device is in full control of delivering the treatment to the targeted area.
Throughout the procedure, saline (salty water) is running to help the surgeon obtain a
beer view inside of your body.
Rezum does now have NICE (Naonal Instute for Health and Clinical Excellence) approval
as an intervenon (granted in August 2018). It is connuing to be assessed as part of
the normal NICE process, in order that
recommendaons can be made as to
who are the paents most likely to
benet, as well as the cost implicaons.
Basingstoke is one of several centres
in the UK that were oered the
opportunity to start using this
technology before the NICE approval
and we have now performed over 400
cases since March 2017.
There have been several clinical studies on the benets of the Rezum system and we can
give you details of them on request.
Are there any risks associated with having Rezum?
There are of course risks with all procedures on the prostate gland including Rezum.
These include the risks associated with the anaesthec as well as the procedure. Bleeding
and urinary tract infecons aer the procedure are not uncommon, as well as discomfort
passing urine. It does take up to 3 months to noce an improvement in symptoms. This
is not the case with some of the other opons where the improvement is oen noced
within the rst few days aer catheter removal.
It is important to be aware that a catheter will be required for a few days aer the
operaon. The duraon will depend on the size of your prostate gland but it can
commonly be le in for 3-10 days and somemes longer. It is possible that the rst me
the catheter is removed it may not be possible to pass urine inially. We recommend that
any prostate medicaon be connued for the rst month aer the treatment in order to
reduce the likelihood of dicules in the rst few weeks. It can take over 4 weeks for the
majority of the swelling to sele. We would also recommend abstaining from ejaculang
for 4-6 weeks aer the procedure, to reduce the risk of bleeding.
The aracon of Rezum is that it can be performed under local anaesthec (LA) or with
sedaon and the procedure takes 20 minutes to perform. Furthermore, it is very unlikely
to upset the sexual funcon or ejaculatory funcon. Our early feedback has suggested
that 5% (1 in 20) men will have drier ejaculaon aer the procedure but problems with
the erecons are rare. We don’t know how long the benets of the procedure will last in
the long term as this treatment has only been available for 5 years in the US and 2 years
in the UK. We suspect that the likelihood of further prostate surgery being required in the
long term to be higher than for TURP or laser treatments. Inconnence is very rare but
will also need to be discussed as part of the consent process. A small proporon of men
will require a second procedure in the rst year (2%), in order to obtain the maximum
benet. The overall re-treatment rate from the US data is 4.4% at 4 years.
What other treatment options are available?
Lifestyle changes and reassurance
For men with concerns about prostate cancer and mild symptoms, reassurance and
advice on diet is usually all that is required. This is known as a ‘watch and wait’ approach
and is used with many men diagnosed with BPH. Treatment usually occurs once bladder
symptoms interfere signicantly with quality of life. A small proporon of men will require
a second procedure in the rst year (2%), in order to obtain the maximum benet. The
overall re-treatment rate from the US data is 4.4% at 4 years.
Medication
For many men, medicaons such as alpha blockers are used to control mild to moderate
symptoms of BPH. These symptoms include frequent urinaon and geng up at night,
as well as deterioraon in the ow of urine oen with hesitancy and somemes with a
feeling of incomplete emptying. Choosing the correct medicaon for BPH is oen complex.
Tablets that shrink the prostate are also an opon (eg. Finasteride), but these can upset
sexual funcon in a minority.
Disadvantages of treatment with medication
• Inadequate or short-lived improvement in symptoms and quality of life
• Undesirable side eects, such as light-headedness or sexual problems.
You may not want to commit to lifeme treatment with drugs, parcularly if you are
already taking other medicaon. Remembering to take the tablets can also be an issue.
Minimally invasive procedures
There are opons other than Rezum and these include
• Prostate Artery Embolizaon (PAE) which is performed by a radiologist (not a urologist).
It tends only to be reserved for those with extremely large prostates, or who are too
frail to be considered for other opons.
• Uroli, a procedure that uses implants to retract (li) parts of the enlarged prostate out
of the way and thereby prevent it from blocking the urethra. However, not all prostates
are suitable for this procedure as it depends on the size and shape of the prostate
gland.
These and other even newer minimally invasive opons are currently under evaluaon.
There are now therefore several opons for men looking for an alternave to medicaon,
or wishing to avoid the side-eects of bigger procedures such as TURP.
Laser treatments
Paents are increasingly considering treatments using lasers to remove excess prostate
ssue, which include procedures known as enucleaon (usually Holmium laser) or
vaporizaon (PVP using Greenlight laser). Again the risks and side-eects include infecon
and bleeding, although this is less likely with the Greenlight laser as the laser seals
blood vessels during the procedure. Generally this is a day case procedure although
some paents require an overnight stay in hospital. The chances of a deterioraon in
sexual funcon aer the procedure are less than for a TURP (1-3%), but retrograde (dry)
ejaculaon is sll common (up to 50%). Inconnence is again unusual (1%). A man with a
large gland over 100 mls in volume would very likely be beer suited to a laser procedure,
as the symptoms are slow to improve aer Rezum if the gland is large.
TURP (transurethral resection of the prostate)
This is a type of endoscopic (keyhole) surgery can be used when there is benign
(non-cancerous) prostate ssue causing a blockage. The central part of the prostate is
removed, which will allow urine to ow more easily from the bladder. For men with
severe BPH symptoms, including retenon of urine, TURP has been commonly used for
a long me. This uses electricity and a wire to scoop out prostate ssue and is the most
common procedure oered to men in the UK. Increasingly men are put o having this
procedure as there is a small risk of major complicaons (1%) as well as a risk of requiring
a blood transfusion (1-2%). It can also upset the sexual (erecle) funcon in 5-10% and
will cause a drier ejaculaon in over 75%. Scarring of the urethra aerwards is also more
common aer this procedure. Inconnence is uncommon. This hospital stay is usually 2-3
days and so is seldom possible as a day case procedure. It is oen six weeks before men
can return to normal acvies and undertake regular exercise aer having TURP. A bipolar
TURP we believe is beer than a monopolar TURP because of the reduced likelihood of
bleeding.
What happens if I decide
to have Rezum?
We will oer you a date for the
procedure, and an appointment for the
pre-assessment clinic. If you have not
already had a urine ow test, we will
arrange this. If you are currently taking
blood-thinning medicaon (such as
warfarin), we may ask you to stop
taking it for a few days before your
treatment.
On the day of surgery
We will ask you to come in on the day of your operaon. Although the procedure only
takes a few minutes, you should expect to be at the hospital for a few hours, longer if
you are having a general anaesthec. It is very likely that you will be able to go home the
same day. We will discuss the procedure with you in detail and ask you to sign a consent
form. In theatre before the operaon, we will give you some strong painkillers as well
as anbiocs which you will need to connue at home. You will then be given a general
anaesthec if you are having one. We recommend to keep the bowel moons so aer
the procedure for 3-5 days.
The prostrate is measured with the use of an ultrasound probe via your back passage. This
may feel a bit uncomfortable, but the more relaxed you are, the easier it will be.
We will then pass the Rezum equipment through your urethra (water pipe) using plenty of
anaesthec gel, which may momentarily sng. Aer a quick inspecon of the bladder, we
will start the Rezum treatment.
At the end of the procedure, we will insert anbiocs and pain killers (this may include
a pain killing suppository into your rectum). You will have a catheter le within your
bladder for a few days to drain the urine away without the need for you to pass urine
yourself and also allow the prostate to adjust to the treatment and for any swelling to go
down. You may be given a tap or valve to aach to the catheter.
When can I go home?
Aer the procedure, a member of the urology team will discuss the operaon with you.
They will give you a date to return to hospital for removal of your urinary catheter, as well
as advise you on how to look aer yourself at home. You are usually in the hospital for
less than 6 hours.
You should be discharged home with at least 5 days of anbiocs as well as some
painkillers. You are unlikely to have any pain once the catheter has been removed.
Is there anything I need to watch for at home?
It is normal to have some pain and discomfort aer surgery, and we will advise you on the
most appropriate pain killers to use.
If you have a temperature aer the procedure with shivers and shakes you may require
anbiocs and so we would advise you to contact the hospital where you had the
procedure. If there is bleeding and blood clots we would also ask you to seek help.
When can I get back to normal?
You can return to work as soon as you feel comfortable to do. If you need a sick cercate
or have any queries about this, please speak to your surgeon before we discharge you
home. Some paents have returned to work within a few days. Most will take 1 week o,
some longer.
You should be able to resume most of your usual acvies within a few days. It is normal
to see a small amount of blood in the urine aer this procedure for 4-6 weeks. Burning
when passing urine can come and go. This responds well to an-inammatory painkillers.
You can resume sexual acvity 4 weeks aer the catheter has been removed and you feel
comfortable to do so. Please do not worry if you see blood in your semen which may also
be visible for a long as 3 months.
Will I need to return to hospital?
Yes, we will ask you to return to have your catheter removed. This appointment will be
arranged when you come in for your procedure. Please try to have a full bladder when
you come for this appointment, so that your stay will be as short as possible.
Once we have removed the catheter, we will ask you to empty your bladder. We monitor
how much you void and then do a bladder scan to detect any urine remaining in your
bladder. If the nurse is happy with the results, we will discharge you from the ward.
However, if there are any problems, we may need to recatheterize you for a further
period.
We will be asking you to complete some quesonnaires before and aer the procedure.
What to expect following the catheter removal
(Trial WithOut Catheter - TWOC)
After catheter removal once you have been discharged home it is
important to be aware of the following;
• For 24-48 hours the ow may deteriorate before it starts to
improve
• Blood in the urine is normal parcularly for the rst few days
• Increasing uid intake can help the urine to clear
• Avoiding heavy liing or straining is sensible
• Burning when passing urine is not uncommon and this can
occur at any me in the rst 6 weeks – this responds well to
an-inammatory painkillers and avoiding drinks which irritate
the bladder such as fruit juices and caeine containing drinks
• Please try not to get conspated – straining to open the bowels
can trigger bleeding and the passage of blood clots
Blood at the start of the urinary stream is normal parcularly in the rst few weeks. This
can last as long as 6 weeks. If the urine becomes a dark rose colour or red with clots it is
important to rest and take uids, and if this doesn’t sele within 24 hours please contact
the ward.
It is normal to pass some debris in the rst few weeks –
1
/
3
of men will pass small bits of
prostate ssue in the urine. This is more common if the median lobe has been treated
(not all men have a median prostate lobe).
It is possible that pads may be required to absorb any potenally embarrassing leakage
parcularly in the rst 2-3 weeks. This is something that will sele over me.
Continue to look out for the following;
• If you get a fever (high temperature) in the rst few
weeks – please consult the ward or contact your local
GP. Further anbiocs may be required to treat a
urinary tract infecon.
• If you are unable to pass urine and it becomes painful
at any me in the rst week you may need another
catheter for a few days. This doesn’t happen very
oen.
• If there is dark blood passing from the urethra with
clots and it is uncomfortable you may require urgent
review if it is not seling.
After 4 weeks
You no longer need to avoid heavy liing or sexual intercourse.
It is normal for the improvement in the urinary symptoms to be quite slow but usually
some improvement in the ow has occurred by this stage. ¼ of men will sll be having
some dicules with increased urinary urgency and frequency at 6 weeks.
To get the full benet of Rezum can take as long as 6 months.
Frequently asked questions
When should I stop my prostate medication?
It is sensible to stop the medicaon 4 weeks aer the procedure. If the prostate is very
large then this may be extended to up to 3 months.
Is it normal to have blood in the ejaculation uid?
Yes this is normal and can take several weeks for ejaculaons to sele.
Is it likely to be a slower recovery if my prostate was large
before the procedure?
The bigger the prostate the longer it can take to see an improvement and it can be a bit
more uncomfortable in the rst week or two. As addional injecons of steam are required
for a bigger gland it will be more swollen to start with.
What happens if my symptoms initially improve and then
deteriorate within the rst 3-6 months?
Occasionally this can happen in the rst few months following the Rezum procedure. This
can be due to the healing process and somemes a piece of dead prostate ssue can
cause a paral blockage. This is not dicult to deal with but it is important to nofy your
Urologist if this occurs.
Is there a limit to the size of gland treated?
We would recommend gland volumes are less than 100mls in size ideally. The data would
suggest that the best results are for those with a gland volume of less than 80 mls. This will
be assessed before your procedure. We can treat larger glands but there are usually other
opons which may be superior for very large prostates.
How much time will I need off work?
This does depend on the type of work. If there is quite a lot of travelling and exercise we
would recommend 2 weeks from the me of surgery. Some men are able to return to a
desk job within 2-3 days of the procedure whilst others will prefer to wait unl aer the
catheter has been removed.
Your feedback is important to us
Comments, concerns, compliments and complaints
If you have any comments, concerns, compliments or complaints about your care, please
let us know as soon as possible. Please speak to the urology specialist nurse so that we
can help to resolve your concerns quickly.
