Enlarged prostate, also called benign prostatic hyperplasia (BPH), is a common age-related urological condition that mostly affects 40% of men in their 50s and 90% of men over their 90s. BPH may result in bladder outlet obstruction, which can also cause lower urinary tract symptoms such as poor stream, difficulty urinating, dribbling and frequency, besides other sexual side effects. It can also have a significant negative impact on patients’ quality of life.
The management algorithm consists of conservative approaches including lifestyle modifications, pharmacotherapy with common drugs, like alpha-blockers that allow urine to flow more easily or other drugs that might shrink the prostate, and surgical interventions as well.
However, prostate medications can produce unsatisfactory symptom relief and have adverse effects like postural hypotension, asthenia and reduced sexual functions. Despite new and selective drugs, surgical intervention remains a mainstay treatment.
There are many surgical interventions and options available to treat prostate enlargement, for example holmium laser enucleation of the prostate, treatment with the UroLift® system, prostate artery embolization and transurethral resection of the prostate (TURP) that is still considered the gold standard intervention for BPH.
A new wave of BPH treatment, called Rezum, has been recently adopted after being approved by the Food and Drug Administration (FDA) in 2015. The Department of Urology at Hôtel-Dieu de France has introduced this novel technology, on January 21, 2020, for the first series of cases in the Middle East, thus delivering state-of-the-art patient care and affirming its status as a leading medical destination.
Rezum is a minimally invasive innovative technology that uses water vapor to treat BPH. Water vapor is delivered through a retractable vapor needle via special emitter holes. Every treatment cycle requires a nine-second burst that will diffuse evenly throughout the target tissue of the prostate. Upon contact with body temperature, the vapor will condense and this shift to a liquid state will dispense concentrated energy to the surrounding cells causing prostate cells to shrink. The average number of cycles is six, which makes this new technique a fast and efficient procedure compared to lengthy other classical surgical approaches.
Since the FDA approval in 2015, Rezum has been a potential alternative for treating patients with prostatic disease with minimal side effects.
In the last few months, many patients complaining of symptoms related to their enlarged prostate were treated at Hôtel-Dieu de France and reported great improvement in their symptoms and successful outcomes, owing to the expertise of the hospital’s highly specialized medical team.
The Rezum procedure provides a number of advantages. It is a day case procedure that could be done in an outpatient setting. It can also be performed under very light sedation and has a strong short-term safety profile. By resorting to Rezum, physicians are noticeably avoiding the risk of retrograde ejaculation in 65% of patients treated with other modalities, especially TURP. Other complications seen with TURP like urethral strictures, urinary tract infections, bleeding requiring transfusion, and urinary incontinence have not been reported after the REZUM procedure. There are no reports of de novo sexual dysfunctions with the REZUM technique, as erectile dysfunction affects 10% of men undergoing TURP. In addition, it is a short-time procedure suitable for patients with median lobe (a case in which the prostate grows inside the bladder).
The treatment showed good improvement in quality of life, in urinary stream and a notably reduced post-void residual. It represents an exciting technique with limited drawbacks for younger men who suffer from BPH and prostatic symptoms and who were very reluctant previously to undergo surgery with older techniques.
Nevertheless, patient selection is very important in treating men with the Rezum water vapor system as very large prostate size (120 g) and patients with acute urinary retention are not suitable candidates for this procedure. It is with no doubt necessary for men to consult their urologist as soon as they suffer from urological symptoms in order to benefit from these minimally invasive procedures without affecting their erectile and ejaculatory function typically associated with other treatment modalities.
The Department of Urology at Hôtel-Dieu de France is highly specialized and equipped to provide efficient and safe treatment for men suffering from urological conditions, as their highly qualified medical and surgical team remains at the forefront of innovation hence offering patients the best quality of care.