By David M. Hartke, MD
Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms affects approximately 50 percent of men between the ages of 51 and 65 and over 90 percent of men over 80 years old. Not all of these men seek treatment: either because they have adapted and will simply live with the symptoms or because they are afraid of the side effects of prostate therapies. Fortunately, many different therapies are now available. We can meet the needs of patients depending on the severity of their symptoms.
Often, we can customize patient treatments to a potential side effect profile that is most congruent with what they will accept. Medications such as alpha-blockers and 5-a reductase inhibitors are often the front line therapy and carry side effects such as orthostatic hypotension, erectile dysfunction, and retrograde ejaculation, among others. Surgical options of transurethral resection of the prostate (TURP), greenlight laser vaporization of the prostate (PVP) and open or robotic simple prostatectomy are widely deemed the most successful approaches at relieving urinary symptoms, but they produce the most sexual side effects and require a potentially more prolonged operative time under general anesthesia.
Rezum water vapor therapy is a relatively novel treatment that allows for a minimally invasive approach offering better symptom relief than medications (but potentially not quite as good as TURP and PVP) with the fewest sexual side effects and it can be done in a matter of minutes.
Rezum therapy is performed cystoscopically under local anesthesia or mild sedation in the urology office or operating room. A small needle is passed within the cystoscope and used to penetrate the prostatic urethra – releasing steam into the transition zone of the prostate. This results in cell lysis and eventual reabsorption of the dead cells, shrinking the prostate and opening the urethra.
Patients feel well immediately. However, symptoms begin to improve after two weeks, and the maximum benefit is reached after approximately three months. Patients achieve significantly higher urinary flow rates and improved International Prostate Symptom Scores compared to BPH medications. This treatment is safe, as the extent of the spread of steam is limited to the prostatic capsule. Furthermore, there is only an approximately four percent risk of retrograde ejaculation, resulting in an improved quality of life for sexually active males compared to other treatments.
In summary, Rezum is a safe and effective minimally invasive treatment to relieve BPH symptoms. It is successfully employed as a more effective alternative for patients who are not doing well on medication, cannot tolerate BPH medications, or simply don’t want to take medications. Unlike Urolift, another minimally invasive prostate procedure, Rezum can be utilized for any size prostate and for prostates with middle lobe hypertrophy, resulting in strikingly similar flow rates without the need for a persistent foreign body and fewer future procedures being necessary. While not every patient is ideal for Rezum, it is a growing treatment in my approach to BPH.
David M. Hartke, MD, is a Board certified urologist and fellowship trained in Urology, Laparoscopy, and Oncology. He sees patients at TPMG Urology – Newport News. Mytpmg.com