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Southern California Urology Institute
Gary Bellman, M.D., F.R.C.S.
Board Certified Urologist
Fellowship Trained, Certified in Robotic Surgery

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Rezūm Therapy: A Minimally Invasive Treatment for BPH

By: Dr. Gary Bellman on September 25, 2019


What is Rezum Therapy?
A unique technique called Rezum Therapy uses steam to treat enlarged prostate (aka, benign prostatic hyperplasia). Approved by the Food and Drug Administration in late 2015, Rezum therapy has demonstrated impressive results but currently is available at only a few sites throughout the United States.

What kind of anesthesia is required for Rezum therapy?
Rezum therapy can be done under local anesthesia in your doctor’s office. Pain medications can also be prescribed to help you feel more comfortable during the procedure.
What do I need to prepare before the procedure?
To best prepare for the procedure, follow your doctor’s instructions, including taking pain or calming medications and possible fleet enema to clear the stool from the rectum. You should arrange to have someone drive you home after the procedure due to the drowsy effects of pain medications.
Alternative treatment options for BPH

Alternative treatment options include observation, medical therapy with alpha blockers and 5-alpha reductase inhibitor medication, phosphodiesterase inhibitor medication, radiofrequency treatment, microwave treatment, laser vaporization or laser enucleation of the prostate, transurethral incision of the prostate, transurethral resection of the prostate, or open prostatectomy (open surgery to remove the prostate).
What are the advantages of Rezum therapy compared to the alternative treatments?
Rezum therapy should be considered over oral medication if the patient has not achieved the desired relief from the medications, or if the medications are causing side effects. Rezum therapy can also be individualized to the particular shape and figuration of the prostate, making it a good alternative to microwave therapy that does not. Compared to radiofrequency ablation (TUNA or transurethral needle ablation of the prostate), the Rezum treatment is shorter in duration, lasting just a few minutes, and can potentially cause less pain and discomfort. Unlike the Urolift procedure, the Rezum therapy can treat the median lobe of the prostate. Urolift also requires patients to permanently have a metal clip on the outside and inside of the prostate, causing potential interference if the patient needs magnetic resonance imaging (MRI) of the prostate. Compared to other surgical procedures of the prostate, such as laser treatment, transurethral incision of the prostate, TURP, or open surgery, Rezum therapy is less invasive and has shown not to have adverse effects on sexual function and ejaculation. Rezum therapy can cause less bleeding and can be done in the doctor’s office under local anesthesia without the need of general or spinal anesthesia. 
How long does it take?
Though the procedure itself takes several minutes, the preparation may take longer so you should prepare to spend 1 hour or longer in the office. 
What are the possible risks of Rezum therapy?
The possible risks of Rezum therapy may include but are not limited to minor bleeding, pain or discomfort during the procedure, and irritating voiding symptoms transiently after the procedure.
During the study prior FDA approval, Rezum therapy has been shown not to cause adverse effects on sexual function or ejaculation.

What happens during the procedure?
Your doctor may administer local anesthesia through the rectum to the barrier around the prostate. After that, the area in your lower abdomen and the genital area will be cleaned with an anti-septic solution. You will be given numbing medication or gel into the urethra inside the penis. Your doctor will then gently insert a small scope into the urethra inside the penis, going through the prostate to inspect the bladder and the prostate. Your doctor will identify the appropriate site for the Rezum therapy. Your doctor will insert a very small tube into the tissue of the prostate and heated water vapor (steam) will be released into that area of the prostate for 9 seconds. After that, your doctor will move to another area of the prostate and release the steam for another 9 seconds. Depending on the size and figuration of your prostate, your doctor will determine the appropriate number of treatments. For each treatment, steam is targeted onto the desired prostatic tissue for 9 seconds. Within one session/appointment, the average number treaments can be between 2-8 vapor treatments. After the treatment, your doctor will insert a small tube called a Foley catheter into your bladder. The Foley catheter is anchored to your bladder by an inflated balloon so you won’t have to worry about the catheter slipping out. The catheter can be connected to a small leg bag that can be strapped to your upper thigh. Your doctor may give you a larger bag if needed. Your doctor may recommend you to keep the catheter in for a few days to ease urination during healing.
You need to continue antibiotic pills for 3-5 days as instructed by your doctor. You need to follow your doctor’s instructions on how to empty the urine from the urine bag. You can take a shower as usual, but do not put soap in the tip of the penis – this may cause irritation. Avoid any activity that may cause irritation to your prostate area, including sexual activity or riding a bicycle for up to 4 weeks. If you experience pain or discomfort, you can take mild pain medications such as Tylenol, or pain medications prescribed by your doctor. You can also try sitting in a warm bath or on a hot water bottle, and avoid consuming caffeine, chocolates, and alcoholic beverages.
Within a few days, you will be able to resume normal activity and may experience an improvement of symptoms as soon as 2 weeks after the procedure. 
To learn more, call us to schedule your consultation 818-912-1899


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