REZUM Water Vapor BPH Therapy

Dr. Engel has been and continues to be a big proponent of heat-based, minimally invasive in-office BPH therapies. Many of these procedures have come and gone over the years, and Dr. Engel has trialed most of them – some very effective and some with mixed results. While microwave-based therapies and TUNA or transurethral needle ablation (that uses RF waves to heat and destroy prostatic tissue) were once the standard for in-office BPH treatment, very few urologists use them anymore, and they are no longer included in the latest AUA guidelines. Even insurance companies have begun to question coverage because they often don’t consider these procedures mainstream treatments.

You may have also seen the heavily marketed procedure known as Urolift on the internet, radio, or via TV commercials. This uses implanted permanent sutures to pull back prostatic tissue and eliminate some narrowing of the urethra, thus reducing lower urinary tract symptoms. However, this procedure has drawbacks that make it less palatable to Dr. Engel than Rezum or Tuna/Prostiva. Urolift is designed as an office procedure and can be performed very simply. However, serious risks such as bleeding and pelvic hematoma formation raise the specter of subsequent hospitalization, which should not be part of an office-based procedure. Just as important is the idea that permanent foreign bodies that can cause irritation, infection, and distort subsequent imaging like prostate MRI are considerations. Lastly, Urolift is not well applied to all anatomies, such as Rezumor Tuna/Prostiva can be, so it is not as versatile a procedure.

Rezum water vapor therapy is an evolution of prior heat-based therapies, using heated water vapor therapy instead of microwave or RF waves to destroy the overgrowth of prostatic tissue. This water vapor application retains the precision and flexibility that was the hallmark of previous heat-based office BPH procedures but dramatically reduces treatment time.


Dr. Engel’s Evolving Thinking on Rezum

In the past, Dr. Engel exclusively used the TUNA procedure for in-office therapy because it was a tried-and-true option with few risks while being comfortable for the patient. Dr. Engel has performed over 1,000 of these procedures over the years.  Dr. Engel delayed his move to REZUM because of a few crucial considerations. Early REZUM protocols made the patient far more uncomfortable than the TUNA procedure he was already using. There was also some concern about results superiority and the longer catheterization time recommended with REZUM. To make the minimally invasive procedure as comfortable as possible for our patients, we opted not to use REZUM after an initial trial.

The New Rezum

To address some of these concerns, Boston Scientific, the manufacturer of the REZUM device, has implemented new protocols, including a better nerve block that Dr. Engel has further modified to make the procedure far less painful. Dr. Engel has further modified this nerve block, and with this new protocol, patient discomfort seems to be similar or perhaps even superior to a TUNA/Prostiva – very low. Additionally, while TUNA requires 15 minutes of active time, Dr. Engel often completes the REZUM in as little as one minute.

Another concern with REZUM was the length of catheterization needed. After a TUNA with Dr. Engel, patients required catheterization for two days typically, but the REZUM carried a standard recommendation of 5-7 days. However, with the right counseling and explanation of symptoms, as well as the implementation of self-catheterization taught to some patients, Dr. Engel has noticed that a two-day catheterization is sufficient for nearly all  REZUM patients. That said,   Dr. Engel has gained extensive experience with REZUM, and this has allowed for far better informed patient education and giving patients the information they need to understand what is expected and what is concerning, requiring further intervention.

The Bottom Line

As a result of the thoughtful improvements implemented by the device manufacturer and protocols developed by Dr. Engel to improve the comfort and convenience of the procedure, we wholeheartedly believe that REZUM is a viable option for virtually any patient that qualifies. Of course, patients with larger prostates, those greater than 80g, or those with other complicating factors may best benefit from a surgical procedure in a robotic simple prostatectomy or HoLEP laser therapy.

Related Information on Minimally Invasive BPH Procedures:

Related Information on Operating Room BPH Procedures:

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