Rezum Water Vapour Treatment

For Benign Prostatic Hyperplasia (BPH)

What is BPH?

Benign prostatic hyperplasia (BPH) with associated lower urinary tract symptoms (LUTS) is a common medical condition in the aging male. The incidence has been estimated to increase from 50% among men between the ages of 50 and 60 years, to 90% for men older than 80 years of age. In 2016, it is estimated that up to 3 million men in the UK have lower urinary tract symptoms suggestive of BPH.

Symptoms of BPH include frequent urination and getting up at night as well

as a deterioration in the flow of urine often with hesitancy and sometimes with a feeling of incomplete emptying. Traditionally treatment options have included making life-style changes for mild symptoms as well as medication. Surgical procedures such as TURP or laser prostatectomy are available for men with more severe symptoms or complications of prostate enlargement such as urinary infections or a complete stoppage (urinary retention).

Some new minimally invasive surgical treatments are being offered to men with moderate symptoms, a reluctance to take/continue medication, and a desire to return to normal activities quickly.

  • "The treatment I received at Bristol Urology was outstanding. From the initial consultation through to my procedure I always felt that I was in safe hands."

    Mr D. Smith
  • Excellent as always!

    Mr Lewis

What other treatment options are available?

For men with concerns about BPH and mild symptoms, reassurance and advice regarding food and drinks is usually all that is required. This “watch and wait” approach is employed for many men diagnosed with BPH. Treatment usually occurs once the symptoms of bladder outlet obstruction and bladder irritability interfere significantly with quality of life.

Traditionally, the primary objective of treatment has been to alleviate bothersome LUTS that result from prostatic enlargement.

For many men, medications such as alpha blockers are the first line approach to control mild-to-moderate symptoms of BPH. Choosing the correct medical treatment for BPH symptoms is often complex and ever changing.

Issues:

Many men begin medical therapy but have:

  • Inadequate or short-lived improvement in their symptoms and quality of life.
  • Undesirable side-effects that lead to discontinuation such as light headedness and sexual problems.
  • Challenges remembering to take the tablets.

Increasingly, men do not want to commit to lifetime pharmaceutical treatment, particularly because they are often taking other medication and there can be concerns about interactions between tablets.

The most economical way of treating troublesome symptoms due to BPH is still not entirely clear but many men take medication for several years before going on to have surgery. Some new minimally invasive surgical treatments are being offered to men with moderate symptoms, a reluctance to take/continue medication, and a desire to return to normal activities quickly.

The use of Implants to retract enlarged prostate tissue (UroLift™) is gaining popularity but not all prostates are suitable for this procedure, which depends on the size and shape of the prostate gland.

The removal of prostate tissue is called a prostatectomy and when there is benign (non-cancerous) prostate tissue causing a blockage the central component of the prostate is removed in one of the ways described below, in order to allow urine to flow more easily from the bladder.

For men with severe BPH symptoms including retention of urine, Transurethral resection of the prostate (TURP) has been the gold standard for a long time. However, men are increasingly looking at the alternatives, such as laser enucleation (Holmium laser) or vaporization (PVP using the 180 W greenlight laser). These laser technologies remove prostate tissue by different means.

The other recognized side effects are listed below:

  • Retrograde ejaculation (dry ejaculation)
  • Erectile dysfunction (impotence)
  • Urethral strictures or scarring
  • Bleeding (occasionally requiring a transfusion)
  • Urinary infection (UTI)

It is often 6 weeks before patients can return to normal activities and regular exercise.

Return to work as you feel comfortable depending on your job. If in doubt, please check with your surgeon and obtain a certificate before you are discharged.

What is Rezūm?

Rezūm uses steam energy to ablate (or remove) the particular part of the prostate that enlarges and causes symptoms due to BPH. Specific technical information is explained below.

This system consists of a portable radiofrequency (RF) generator and delivery device that is introduced into the body via the urethra and guided using a telescopic lens in the device.

RF energy from the generator is applied to the delivery device to heat up a controlled amount of water outside of the body, converting the water into vapour or steam. The thermal energy created outside the body is delivered into the prostate tissue through a tiny needle with emitter holes to ablate the targeted obstructive prostate tissue that causes BPH. The procedure takes approximately 3-7 minutes and can be performed in a Day Surgery setting. No RF energy is delivered into the body.

Throughout the insertion of the device and during the treatment, saline (salty water) is running to help ensure better views and to keep the urethra cool

The generator has a number of safety features to ensure proper heating and thermal ablation of the targeted prostate tissue, while protecting the urethra during treatment. Thermocouples in the delivery device monitor temperatures to ensure consistent delivery of thermal energy into the ablation region. The length of the vapour needle is fixed and the operator controls all functions of the device. Placement of the vapour needle within the prostate is done under direct visualization through the telescopic lens, which is in the urethra inside the prostate.

The Rezūm System is intended to relieve the symptoms of obstruction and prostate tissue associated with BPH and is suitable for men with prostatic urethra lengths >2.0 cm and prostate volumes >20 cm3. The Rezūm System also is indicated for treatment of prostates with a median lobe or elevated central zone tissue.

Before

before

During

during

After

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Symptoms of BPH include frequent urination and getting up at night as well as a deterioration in the flow of urine often with hesitancy and sometimes with a feeling of incomplete emptying.

Treatment information

FAQ’s

You will have been given a time to attend the hospital. Even though the procedure only takes a few minutes, you will probably be at the hospital some time before and after the procedure, again depending on the anesthetic used. It is very likely that you will be discharged home the same day.

About an hour before the treatment, you will be given some strong painkillers as well as some antibiotics which you will continue at home. You will then be accompanied to theatre where the procedure will take place. If you are having a general anesthetic you will be sent to sleep. The majority of men will be awake for the procedure.

Antibiotics will be given directly into your vein.

Local anesthetic will then be administered around the prostate gland with the use of an ultrasound probe via the back passage. This may feel a bit uncomfortable, but the more relaxed you are the easier it will be.

The Rezūm equipment is then passed through the urethra using plenty of anesthetic gel, which may momentarily sting. After a quick inspection of the bladder, the treatment will begin.

On completion a catheter will be left within your bladder for a few days prior to voiding as the prostate readjusts to the treatment and the swelling goes down. An antibiotic and pain killing suppository will be inserted into your rectum at the end.

After your procedure, you will be reviewed by a member of the urology team who will discuss the operation, any specific requirements for you at home and a plan for your aftercare.

A date will be given to you as when to return for the catheter removal as well as the care required whilst at home.

It is normal to have some pain or discomfort after operations, and we advise you remain on painkillers to help keep it under control.

Return to work as you feel comfortable depending on your job. If in doubt, please check with your surgeon and obtain a certificate before you are discharged.

When you return for your catheter removal, please try to have a few extra drinks prior to arriving so that your stay will be as short as possible. The tube will be removed and then when you are ready you will be asked to empty your bladder into the flow machine; the bladder scanner will detect any remaining volume of urine. If the nurse is happy with the results you will be discharged. If there are any problems you may require a further period of catheterisation (or be taught intermittent self-catheterisation).

Within a few days you will be able to resume normal activities and should notice improvements within 2 weeks, although it may be 3 months before the full benefit is evident. Blood may be visible in the urine and ejaculation fluid while your urethra heals for a couple of days.

We recommend you try an avoid ejaculation for 6-8 weeks.

The Rezūm System has received CE Mark and FDA clearance for use in the USA. Rezūm does not currently have UK NICE approval. When a procedure is not approved (and, therefore, there is no formal NICE guidance available), NICE recommends that:

“In all cases, while NICE develops guidance on a procedure, where no guidance exists, clinicians using the procedure should do so with special arrangements for clinical governance, consent and audit.”

Rezūm is registered with NICE as “IP1555 Rezūm Procedure” which means that it is currently being considered, evaluated and discussed by NICE. The data collected will be presented to NICE and should receive its formal notice in summer 2018.

There have been several clinical studies undertaken on the benefits of the Rezūm System. Advantages of Rezum

  • Fast, effective and, precise BPH treatment
  • Ablates targeted tissue, which is then resorbed
  • Treats enlarged central zones and/or median lobes
  • Clinically proven, safe and effective
  • Preserves sexual and urinary functions
  • Rapid return to normal activities
  • Men who have elected to discontinue or who have chosen not to take BPH medications
  • Men who are not receptive to other minimally invasive or surgical BPH procedures
  • Men who have indicated they aren’t bothered enough by their symptoms to elect an invasive surgical procedure

Your BUA Consultant will consult with you to determine if Rezūm water vapour therapy is a good treatment option for you based on your symptoms and personal treatment goals. The Rezūm System is indicated for men 50 years and older with a prostate volume of ≥ 30cm3 and ≤80cm3.

The Rezūm System is also indicated for treatment of prostate with hyperplasia of the central zone and/or a median lobe. The use of the Rezūm System is not suitable for patients with a urinary implant or who have a penile prosthesis.

You will be offered a date for the procedure and also for a pre-operative assessment if a general anesthetic is going to be used. If you have not already done a flow test, this will be performed as well as completing the questionnaires. If you are on blood thinners you may be asked to stop taking them for a period prior to your treatment.

Within a few days you will be able to resume normal activities and should notice improvements within 2 weeks, although it may be 3 months before the full benefit is evident.