In the US, around 14 million men reportedly have symptoms indicating BPH (Benign Prostatic Hyperplasia). This is one of the most common conditions among males worldwide, with 90 percent of males expected to have the condition by the time the age of 85 is attained. This age related condition has impact on the quality of life and refers to the non-cancerous enlargement of the prostate gland which results in difficulty during urination. The treatment options for BPH include medications, and surgical procedures that are intended to shrink/reduce the size of the prostate. Among the treatment options, the minimally invasive water vapor therapy Rezum is regarded as effective and popular. This is a different treatment methodology that relies on thermal energy for outcomes. We will look at the pros and cons of rezum and the surrounding facts, evidence to assess its efficacy in treating BPH.

What is Rezum, and what are the pros and cons of rezum of the method?

Rezum refers to water vapor therapy for the treatment of BPH. The procedure is minimally invasive and is termed as a transurethral method as it involves the insertion of a catheter in the urethra. To look at the pros and cons of rezum, it is necessary to understand a little more about the procedure. The method uses thermal energy from the water vapor to treat the condition. The procedure is performed using a local anesthetic and dispenses with the need for incisions in the body. Water vapor is used to bring about a deterioration and eventual death of extra prostate tissue that is specifically targeted through steam. The dead tissue slowly leaves the system, as it is flushed down along with urine. The removal of the extra prostate tissue helps to bring about a reduction of pressure on the urethra and consequently, urine flow is restored to flow smoothly.

Is the procedure suitable for all? How is its suitability established?

As we look deeper into the various aspects of the water vapor therapy and the pros and cons of rezum it is necessary to look at the suitability of the therapy and the manner in which suitability is assessed.

The procedure is suitable for certain categories of individuals with specific characteristics of BPH. The assessment is typically carried out in the following manner. A flow rate bladder is used for the purpose of ascertaining the manner in which the patient is emptying his bladder. During this period, the patient is typically asked to monitor the amount of fluid intake and the amount that is flushed out. This helps understand if the patient is the right candidate for the procedure. Following this, a prostate ultrasound is performed by the specialist for a proper telescopic view of the condition. This basically an imaging test that relies on sound waves for imaging. This involves the insertion of a transducer (a small probe) which transmits sound waves, which bounce back to help visualize the condition through advanced imaging. The use of a Doppler helps the specialist to actually hear the flow inside the organ, which will give help understand the extent of blockage. The assessment could also include a cystoscopy that will be used to determine the shape and the size of the prostate. This is important to assess if the patient is a suitable candidate for the procedure. Ideally, men who are more than 50 years of age with prostate volume that is between 30 cubic cms and 80 cubic cms are suitable for the procedure. It is also important to note that the procedure is most suitable for patients with BPH of the central zone or in a median lobe.

Distinct advantages of the procedure include the following.

As part of the pros and cons of rezum, the following standout advantages make the procedure popular and convenient for patients.

· It is minimally invasive, and does not require elaborate preparations or hospital admission for a long duration to undergo the procedure. Effectively, the actual procedure lasts around eight minutes.

· Dispenses with the need for anesthesia. The procedure is performed in an outpatient setting and does not require the administration of general anesthesia.

· It preserves sexual function. This is a huge advantage over other procedures that impair sexual function of individuals who undergo other procedures for treatment of BPH.

· The procedure has short term as well as long term outcomes. The short term outcomes include a gradual improvement in urine flow immediately after the treatment, while the long term outcome includes complete improvement after a period of time.

Disadvantages of the procedure include the following

As part of the pros and cons of rezum, the following disadvantages restrict the use of the procedure to a certain category of patients, in addition to minor discomfort experienced by patients who undergo the procedure.

· It is typically used for treating patients with small prostate sizes, and those who experience lesser obstruction in terms of flow of urine.

· It involves wearing a catheter for five or six days, during which time some kind of discomfort may be experienced.

· Full improvement in urinary flow is experienced after a month, while blood in urine will continue for around two months.

· Cannot be performed on individuals with a penile prosthesis or a urinary implant.

How to manage short term side effects?

From the list of pros and cons of rezum, it is necessary to understand that some of the disadvantages/side effects are short term in nature. This includes – pain while passing urine, presence of blood in urine, traces of blood in semen, the urge to frequently pass urine, and difficulty in emptying the bladder fully. These short term side effects can be managed easily at home without the need for medical intervention. Under recommendation of a physician, patients can take mild pain relief medications to control the pain and discomfort. Abstaining from alcohol, caffeine and chocolate during the period after the procedure will greatly help to bring down some of the side effects. Another method that reportedly has good results is to take a warm water bath to alleviate the discomfort. As mentioned earlier, these side effects are temporary in nature and will resolve naturally in a few weeks.

What are the pre-procedure steps usually performed?

As the pros and cons of rezum have been established, it is time to look at the steps that are typically performed as part of pre-procedure. Patients are usually start off on a course of antibiotics before the procedure. Depending on the condition of the patient and the response to the briefing about the procedure, it is possible that some patients may be prescribed anti-anxiety medication. Additionally, anti-inflammatory medications are prescribed, which are expected to be taken before the procedure as well as after the procedure. Finally, prescriptions include alpha-blockers that are intended to bring about an improvement in the urination flow.

Overview of procedure

With the pros and cons of rezum listed out in detail, here is a look at the actual procedure. The patient is expected to consume a light meal with plenty of fluid intake on the day of the procedure. In the event that the patient has not fully flushed out urine, the bladder is emptied. A local anesthetic is used on the prostate and the penis. Following which a portion of the Rezum device is inserted. The deployed needle injects thermal energy into the prostate, which then disperses among cells, intended to target the extra prostate tissue. The device used for the procedure is a compact, hand held device. One of the functions of the device is to generate high temperature in sterile water. The other function is to direct the thermal energy (the water vapor) at the targeted area of the prostate. This involves the activation of short (nine second) bursts of steam into the targeted area of the prostate. The number of times that the steam is activated and targeted depends entirely on the size of the prostate, the structure and the desired outcome. During the procedure, a catheter is inserted into the urethra, which will be removed after five days. In some cases, the catheter is removed after two or three days, though in most cases, it is kept in place for five days. A bag is connected to the catheter, which will help to empty/drain the contents.

What happens after the procedure is performed?

One of the advantages listed in the pros and cons of rezum is the phase after the procedure. Patients who undergo the procedure typically remain in the clinic only for a duration of time required to ensure that the patient can urinate. Effectively, this means that the patient leaves the center in a few hours after the procedure. The whole procedure is based on the concept of killing the surplus tissue, following which the dead cells are flushed out through urination. This cycle can take a few weeks to complete and most individuals typically experience full relief and outcomes in about six weeks after the procedure. This includes smooth flow of steady stream of urine, without any discomfort or pain and absence of blood in the urine. In a large number of cases, the relief is very fast, and these short term outcomes are also one of the reasons for the popularity of the procedure.

Studies that have been conducted on patients who have undergone the procedure indicate that presently, there are no reports of patients experiencing urinary incontinence of impaired sexual functions. Patients are known to get back to routine activities in a few days after the procedure, and this counts as one among the clear advantages in the pros and cons of rezum transurethral water vapor therapy.

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