Rezum Therapy in Turkey

What is Rezum (Water Vapor Therapy)?

Rezum therapy is a new technological treatment developed in the United States by the company Boston Scientific for patients experiencing difficulty urinating due to benign prostatic hyperplasia (BPH). It involves delivering 103°C water vapor into the prostate tissue, causing damage to cell membranes and reducing the size of the prostate. After extensive research and testing, this method was approved by the FDA in 2015 for use in patients with prostate-related complaints.

How is Rezum Therapy Different from Other Heat-Based Treatments?

Approximately 20 years ago, heat-based methods such as TUNA (transurethral needle ablation) and TUMT (transurethral microwave thermotherapy) were used for prostate patients. These methods rely on conductive heat transfer, where heat is gradually transmitted into the prostate tissue.

In contrast, Rezum uses a completely different mechanism. The water vapor is at 103°C and raises the tissue temperature to about 70°C upon contact. More importantly, since the vapor transitions from a gas to a liquid phase—known as convective heat transfer—a large amount of energy is released. This results in greater tissue damage and more significant reduction of the prostate size.

How is Rezum Therapy Performed?

As recommended by the manufacturer, Rezum therapy is performed endoscopically in patients whose prostate size does not exceed 80 grams, after thoroughly evaluating the patient and ruling out the possibility of prostate cancer.

The procedure begins with a cystourethroscopy to ensure there are no accompanying conditions such as urethral strictures or bladder stones/tumors. Then, a single-use application kit is opened for each patient. The applicator, which is 18 French in size and equipped with a needle at the tip, is connected to the Rezum generator for treatment.

The applicator is advanced through the tip of the penis until it reaches the bladder. During this process, the length of the prostatic urethra is measured. Water vapor is then delivered for 9 seconds into the left and right prostate adenoma tissue at 1 cm intervals, starting 1 cm away from the bladder neck, by inserting the needle at a 90-degree angle into the lateral lobes of the prostate. If there is a median lobe extending into the bladder, additional applications are performed from the right and left sides at a 45-degree angle, also for 9 seconds each. After the procedure is completed, a catheter is inserted into the urethra.

Who is Eligible for Rezum Therapy?

This treatment can be applied to all patients with moderate to severe urinary symptoms caused by benign prostatic hyperplasia (BPH). Although the manufacturer defines ideal candidates as those with a prostate size up to 80 grams, the literature shows successful use of this method in prostates sized between 120-150 grams as well.

Rezum therapy is also an important option for patients using medication who experience side effects. The medications typically used include alpha-blockers, which relax the bladder neck, and 5-alpha reductase inhibitors, which reduce the prostate size by about 30% within three months. Alpha-blockers may cause side effects such as retrograde ejaculation (semen flowing backward into the bladder after intercourse) and dizziness due to blood pressure drops when standing up. The 5-alpha reductase inhibitors reduce dihydrotestosterone—a form of testosterone that is ten times more potent—leading to decreased libido and erectile dysfunction in some men.

• Rezum treatment can be applied to all patients with BPH who have moderate to severe urinary symptoms.
• Ideal candidates are defined as patients with prostate size up to 80 grams.
• However, literature shows that this method has also been successfully used in patients with prostate sizes between 120 and 150 grams.
• It is an important alternative treatment option for patients who use medication and experience side effects.

What Are the Advantages of Rezum Therapy?

The most significant advantage is the very short duration of the procedure, which takes approximately 10-15 minutes. Other alternative methods often require anesthesia lasting 1 to 1.5 hours or even longer. Rezum eliminates the risks associated with general anesthesia, making it especially suitable for patients with anesthesia-related concerns.

Rezum therapy can be easily performed under sedation without the need for intubation. It can also be done under local anesthesia, although most patients prefer not to remember entering the operating room at all.

Another advantage of Rezum is the very short hospital stay. Although it can be done as an outpatient procedure, most patients prefer to stay one night in the hospital. Patients are discharged comfortably once the urine color from the catheter is observed to be clear.

The applicator used during Rezum is much thinner compared to endoscopic instruments used in other methods, and since the operation time is shorter, the risk of urethral stricture (narrowing of the urinary tract) is significantly lower.

Because the treatment is performed while keeping a 1 cm distance from the bladder neck, the risk of retrograde ejaculation (semen entering the bladder rather than exiting through the penis after intercourse) is very low compared to other methods. While this risk is between 80-100% in procedures like TURP, HOLEP, or open prostatectomy, it is less than 10% with Rezum therapy.

In particular, patients using blood thinners have a high risk of bleeding with other methods, but this risk is very low with Rezum treatment.

Is Rezum Therapy an Effective Method?

Yes, it is an effective method, as demonstrated by numerous studies in the literature. It has been successfully used in thousands of patients. However, it would be incorrect to say it is superior in effectiveness to other alternative methods.

Currently, TURP remains the gold standard for prostates under 80 grams. For larger prostates, open prostatectomy and HOLEP are options to be discussed with the patient. Rezum is not the preferred method when a very rapid response is needed, especially in patients presenting with urinary retention.

We have 6-7 years of follow-up data on Rezum therapy, showing very good results. The rate of reoperation within 5 years has been found to be 4.4%.

Who Are Not Good Candidates for Rezum Therapy?

Patients with very large prostates and those who can tolerate long anesthesia sessions may be better suited for alternative treatments. Since the effectiveness of Rezum therapy begins after about one month and reaches maximum effect by the third month, patients who have a catheter due to inability to urinate may need to keep the catheter in place for a longer time after Rezum treatment.

The manufacturer recommends keeping the catheter for 1 day per 10 grams of prostate size. However, if preoperative urinary flow rates are not severely impaired, the catheter may be removed earlier to check if the patient can urinate.

If the patient is taking prostate medications, these are continued for 2-3 months after Rezum surgery. The medications are stopped once the effect of Rezum therapy is established.

Additionally, patients with a rigid penile prosthesis cannot undergo this treatment.

What Are the Side Effects of Rezum Therapy?

There are no major side effects. Compared to alternative methods, the catheterization period may be longer in patients with large prostates, which can cause some discomfort. Some patients may experience bladder spasms related to overactive bladder along with prostate enlargement. In such cases, supportive treatments such as anticholinergic medications may be required. After catheter removal, some patients may notice small blood clots in their urine for 1-2 months. These clots have no clinical significance and indicate that the prostate tissue is shrinking.

How Long Does the Rezum Procedure Take?

Rezum surgery is generally a very short procedure, usually completed in about 10 to 15 minutes. Local anesthesia or mild sedation may be used during the procedure.

The water vapor energy targets and reduces the prostate tissue that compresses the urinary channel, allowing the obstructing tissue to be naturally expelled by the body over time. The quick recovery and the lack of need for hospital stay make this method especially preferred.

What Kind of Anesthesia Is Used in Rezum Therapy?

Patients do not need to be intubated. Sedation medications are usually sufficient. If the patient prefers and there are no contraindications, the procedure can also be performed under spinal anesthesia. It can even be done under local anesthesia alone.

How Much Does Rezum Therapy Reduce the Prostate Size?

The goal of Rezum therapy is to necrotize the transitional zone around the urethra, which presses on the urinary channel and causes difficulty urinating, thereby widening the passage. MRI studies have demonstrated significant widening of the urinary channel following Rezum therapy.