Rezūm™ Water Vapor Therapy

The Rezūm Water Vapor Therapy

What is the Rezūm procedure?

The Rezūūm treatment is a minimally invasive approach to treating an enlarged prostate (BPH) that uses water vapor (steam) to heat the prostate tissue and eventually shrink the prostate gland.

The Rezūm Water Vapor Therapy is a minimally invasive procedure to treat the symptoms related to an enlarged prostate. It is a great alternative to medications or those not improving on medications. Rezūūm treatment uses injections of sterile steam (water) into the prostate to “cook” and shrink the prostate tissue that is obstructing the urinary flow. Patients tend to have improvement in their symptoms at about 1-3 months after the procedure as the prostate shrinks.

Who would be a good candidate for the Rezūm procedure?

Rezūūm is a good option for many patients with an enlarged prostate gland causing obstruction to the flow of urine. Patients who do not wish to be taking daily pills, cannot tolerate medications are great candidates for the procedure.

What are the Benefits of the Rezūm procedure?

You might receive the following benefits. The doctors cannot guarantee you will receive any of these benefits. Only you can decide if the benefits are worth the risk.

  • Relief of urinary obstruction
  • Reduced chance of bleeding from the prostate by destroying and shrinking prostate
  • blood vessels
  • Less bothersome urinary symptoms
  • Improved ability to urinate and empty the bladder
  • Decreased risk of infections
  • Decrease risk of bladder stone formation
  • Potential to stop all prostate / urinary related medications
  • In-office procedure
  • Does NOT require general anesthesia
  • NO reported erectile dysfunction or damage to the urinary sphincter

What are the Risks of the Rezūm procedure?

Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications. Most of these side effects are often mild and short-lasting (4-6 weeks).

Common Side Effects:
Mild to moderate bleeding in the urine
Burning sensation on passing urine for a short time after the procedure (usually resolves by 2 weeks)
Difficulty urinating the first 3-4 weeks requiring a catheter as the prostate may still be swollen right after procedure
Urinary urgency and frequency

Occasional
Urine infection requiring antibiotics
Pain during the procedure from injection of steam or placement of catheter
Failure to improve some are all of your urinary symptoms which may require an alternative or additional treatment with either medications or other procedures.

Rare
Heavy bleeding that requires removal of clots or further surgery
Scarring of the urethra channel
Reduction in the volume of ejaculate

How is the Rezūm Procedure Performed?

The procedure is done in the office under local anesthesia (injection to numb up the prostate). Within a few minutes, through a small probe inserted in the penis, several 9 second injections of steam are then delivered into the prostate destroying the tissue that has been obstructing the urinary flow.

Initially, the steam of the procedure swells the prostate up and makes it more difficult to urinate, thus, a catheter is placed immediately to help drain the bladder after the procedure and is kept for a few days. After the catheter is removed, mild burning and urgency is typically experienced. However, by a month from the procedure, patients start seeing a noticeable improvement in urinary urgency, frequency as well as stronger urinary stream. These improvements continue to become more pronounced at 3 to 6 months after Rezūm as more prostate tissue shrinks. The longest running study on the Rezūm procedure shows the benefits last at least 3 years with re-treatment rates of less than 5%.

What are the alternative options to the Rezūm procedure?

The Rezūm is a minimally invasive safe treatment for urinary symptoms caused by an enlarged prostate gland. However, it may not be suitable for every case. The alternative options include:

No treatments at all (aka observation) - Observation is a great option for patients with mild symptoms. If you are considering surgery, likely your symptoms are getting bad enough where you are seeking more drastic help. We are not inclined to force any patients to undergo any procedures that they are unwilling to do. Certainly, patients may elect to undergo absolutely no intervention. We do, however, want all patients to be aware of the possible risks of delaying intervention and the possible outcomes of letting the enlarged prostate problems get out of hand. Please click here to learn more.

Medications – medication are usually not as effective as surgery, can have side effects, and you will need to take them for the rest of your life.

GreenLight Laser Prostate Vaporization – a minimally invasive surgery that uses a laser beam to vaporize the obstructing inner part of the prostate gland that is causing your urinary symptoms. This allows for a clear and open passage of urine, improves bladder emptying and other associated symptoms of an enlarged prostate (BPH). It is considered to be the current gold standard BPH treatment.

Microwave of the Prostate – this is an office procedure that involves placing a small catheter tube in the penis that contains a microwave antenna and heats the prostate over a short period. The heating of the prostate will eventually make the prostate smaller and improve urinary symptoms.

UroLift® – either done in the surgery center or office, the procedure is done by placing a small rigid camera in the penis and prostate and deploying clips on either side of the prostate so as to compress the obstructing parts of the prostate and open up the urinary channel.

Transurethral Prostatectomy (TURP) – is the standard operation for prostate enlargement. Laser Prostatectomy has similar effectiveness to TURP in published studies. TURP has a higher risk of bleeding compared to laser prostatectomy so you may need to stay in hospital a day or two longer with a catheter.

Transurethral Incision of Prostate (TUIP) – also sometimes called Bladder Neck Incision. May be recommended for small prostates that are a bit too narrow.

Open or Robotic Suprapubic Prostatectomy – recommended in really giant prostate glands, that are too big to manage with minimally invasive surgery. This is not a common treatment and is usually only done when the prostate is extremely enlarged and involves either the open or robotic/laparoscopic methods to remove the prostate via an incision in the belly and bladder and core out the inner part of the prostate. This is not the same operation that we do for prostate cancer, but is similar in the approach.

Long-term catheter – recommended if you are not fit for any operation and unable to urinate at all or retaining very large volumes of urine in the bladder. May be a catheter through the penis or a tube that is placed below the belly button to drain the bladder.

Prostate Artery Embolization – done by special x-ray doctors (interventional radiologists), the procedure involves blocking the blood supply to the prostate, thus leading to the shrinking of the prostate gland and improving urinary symptoms.

Where Is the Rezūm procedure done?

The procedure is performed in the office.

Will I Be Asleep for This Surgery?

No. The Rezūm procedure is not done under general anesthesia but is done under local anesthetic that is injected via a small rectal probe just before the procedure. Some patients elect to take an anti-anxiety medication just prior to the procedure for relaxation during the surgery.

How Long Does the Procedure Take?

The amount of time the surgery takes depends on the size of the prostate but typically 15-30 minutes is required to complete the procedure.

Will I be staying in the hospital or going home?

This procedure is done strictly in the office, thus you will be going home after the procedure.

Getting Ready for Your Operation

If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and lung complications during and after the procedure if it is done under deep sedation or general anesthesia.

If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming. This will help both with anesthesia and with overall recovery.

You are required to visit your primary care doctor for “clearance” for the procedure. Typically, this is a general checkup that includes checking your heart, lungs, blood work, EKG, chest x-ray and any other necessary tests to ensure that you are fit and ready for surgery. Your primary doctor will notify you if you need to see any other specialists such as a cardiologist or pulmonologist to make sure that you are ready for the procedure.

Tell the doctor if you:
  1. Take medication to thin your blood thinners (anticoagulants), such as: aspirin, clopidogrel, plavix, dalteparin, fragmin, rivaroxaban, xarelto, heparin, lovenox, warfarin, coumadin, prasugrel, effient
  2. Take steroids such as prednisone or arthritis medications
  3. Take any other medications, such as herbs, vitamins, minerals, or natural or home remedies
  4. Have taken any antibiotics in the past 3 months
  5. Have any sort of heart condition, implanted devices such as knee or hip replacements
  6. Allergic to any medications or latex, especially local anesthetic like lidocaine, xylocaine, marcaine
  7. Urinary tract infection (uti) in the last month.had an infection or were hospitalized after a previous prostate biopsy
  8. Have a history of achilles tendon injuries or tendonitis
  9. Have difficulty hearing
  10. Work at a hospital or nursing home

5 to 7 Days Before Your Procedure

Stop taking blood thinners (anticoagulants), such as: aspirin, clopidogrel, plavix, dalteparin, fragmin, rivaroxaban, xarelto, heparin, lovenox, warfarin, coumadin, prasugrel, effient as directed by your primary doctor or cardiologist Stop taking Vitamin E.

3 Days Before Your Procedure

Stop taking pain medicines like: ibuprofen (Advil® or Motrin®) or naproxen (Aleve®).

Morning of Procedure

Please make sure you have a good meal and take all your blood pressure and diabetes medications if you take those. A good meal will reduce the risk of you getting weak after the procedure. Please don’t skip your meal and stay very well hydrated.

Day of the Rezūm Procedure

Morning of the procedure, we would like for you to do an enema with any over the counter product like a Fleets enema or a saline enema to clear out the rectum.

The typical course of the procedure is as follows:
  1. When you arrive to the office, you will check in at the front desk
  2. You will give us a urine specimen and be brought into one of our procedure rooms and sign the procedure consent form if it has not been done previously
  3. Then you will be given a chance to privately undress below the waist and cover up with a sheet
  4. The medical assistant will then administer a shot of antibiotics in the buttock area
  5. Then you will lay on your left side on the examination table and the doctor will gently place a lubricated ultrasound probe in the rectum to do a quick injection of a local anesthetic and remove the probe. That will take about 30 seconds to do. At this point, you will be asked to reposition on the examination table and lay on your back with your legs in stirrups. The penis and scrotum area will be cleaned with iodine soap and sterile drapes will be placed over your thighs and lower belly. Our nurse will then clean the penis and place a small catheter to fill the bladder with a mixture of numbing medications. The catheter will be removed and numbing jelly will be inserted into the penis as well
  6. The Rezūm procedure is then started and takes about 10 minutes to be completed
  7. After the procedure is complete, a final catheter is inserted to drain the bladder and attached to a small bag that collects all the urine.

What Should I Expect After The Operation?

If done in the office, once the procedure is complete you will be given a chance to urinate and may pass some blood with urination. This is expected. If you are unable to urinate, we may need to place a temporary catheter tube in the penis to allow the swelling to calm down and remove the catheter in a day or two.

If the procedure was done in the hospital or surgical center, then after your operation, you will be placed in the recovery area. You may start eating and drinking as soon as you recover from the anesthetic. The nurses will provide any pain medicines, will monitor your breathing and vital signs. You may not remember any conversations or your time in the recovery area. Once the nurses and anesthesia staff have cleared you to go home, you will be provided follow up information. You will be given a chance to urinate, but if having difficulty, a penis catheter may be placed by the nurse and kept for a day or two to allow the swelling to calm down and let you urinate better.

If you had deep sedation or general anesthesia, you MUST arrange for a ride home.

Discharge Information and Home Advice

Catheter
After the Rezuūm procedure patients require a catheter to drain the bladder temporarily. A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine in this way until the urine is clear. Your catheter is usually removed 5-7 days after your operation. Avoid pulling on the catheter as this may provoke bleeding. It is common for urine to occasionally squirt around the catheter at the tip of the penis. It is also very common to have a bit of blood dripping around the catheter at the tip of the penis.

We advise putting a small amount of antibiotic ointment such as Neosporin or Bacitracin or simply some Vaseline at the tip of the penis several times per day to allow the catheter to glide smoothly.

Call our office or stop by if all the urine is coming around the catheter and none is draining into the urinary drainage bag. You and your family/friends will be given instructions on the catheter care.

Bleeding
It is quite normal to see an occasional show of blood in your urine during the first month after surgery – this is due to the healing of the operation site. It is common to have more bleeding if you strain to have a bowel movement. If you see blood, simply increase your fluid intake. If you have prolonged heavy bleeding (>24 hours), significant pain or increasing difficulty passing urine, please contact our office.

Pain
Because there are no external cuts, this procedure is relatively pain free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers. Tylenol may be used for pain. However, we will provide you with a prescription for a stronger painkiller should you need one. Beware, stronger pain killers may cause constipation.

Diet
It is important that you do not get constipated. There are no dietary restrictions but you should try and eat plenty of high fiber food or anything that would get your bowels moving. You may use milk of magnesia or an enema if you get severely constipated. If you have chronic constipation, you may be provided with a stool softener as one of the prescriptions after the procedure to prevent constipation. The reason to avoid constipation is that straining to have a bowel movement tends to increase the risk of bleeding from the prostate.

Showers
There are no restrictions on taking showers even with the catheter in the penis. Staying and keeping yourself clean is always important. Please do NOT take baths, go into the pool or ocean with the catheter in place.

Exercise
You should take it easy for a month, although it is important to do some gentle exercise like walking, to reduce the risk of developing a blood clot in your legs. Try to avoid any activity that makes you strain as this will increase your chances of bleeding from the prostate.

You can resume normal sexual activity 2 weeks after your operation.

Work
Recovery may take several weeks. However, most patients feel well within a few days to a few weeks. We will be able to advise you when it will be safe to return to work as this depends on your occupation. Most patients with a sedentary office job require about a week of recovery, but those who do a lot of straining and lifting, may need several weeks before they are clear to go back to work. We can provide you with an excuse from work and any other paperwork for your job at our offices.

Driving
You may resume driving a motor vehicle if you feel well and do not have significant pain or discomfort. You are absolutely not allowed to drive or operate any other motorized device while on narcotic pain killers.

For Further Information

Visit the official Rezūm Website at: www.rezum.com/


DISCLAIMER

This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional. Not all potential benefits or complications are listed, and you must talk to your urologist about the best treatments specific to your situation.