Minimally Invasive Surgery for Benign Prostatic Obstruction

New Insights and Future Technical Standards

Enrique Rijo; Richard Hindley; Shahin Tabatabaei; Thorsten Bach


Curr Opin Urol. 2021;31(5):461-467. 

In This Article


Rezum (Rezum System, Boston Scientific, Marlborough, MA, USA) is a treatment for benign prostatic obstruction (BPO), using radiofrequency energy to convert sterile water into steam, which is transurethrally injected under direct vision into the prostatic tissue with a small needle. The heat transfer mechanism is convection and the energy is precisely targeted and contained within prostate anatomy, avoiding damage to surrounding structures.

Rezum might seem similar to TUNA, when actually they are completely different procedures, the main difference is the mechanism of heat transfer (Table 2).

The objective is to create contiguous overlapping thermal lesions between the bladder neck and proximal to the verumontanum. Each treatment last 9 s and the average total procedure time is 2–4 min.

The procedure is done under local anesthesia with oral pain medication, prostatic block or under IV sedation.

The Rezum procedure is capable of treating not only the lateral lobes but also the central zone without any morphological restrictions (intravesical median lobe is not a limitation).[7]

Catheterization after the procedure is normally 2–7 days (according to the size of the prostate).

The prostate size limit is 80gr, however, some authors have reported promising results with larger glands, but requiring longer catheterization time.[8–11]

A multicenter randomized controlled trial (RCT) of Rezum with a follow-up period of 5 years including 197 subjects with symptomatic BPH, randomized to treatment and sham control (rigid cystoscopy) in a 2:1 ratio with prostate volume of 30–80 cm3 without morphological restrictions. Qmax increase was 49%. IPSS, QoL and BPH impact index improvements were 48%, 46% and 49%, respectively.[12]

Most common related adverse events included: dysuria (18.1%), hematuria (11.7%), hematospermia (6.4%), urinary frequency (5.9%), retention (5.9%) and urgency (4.8%).

The 5-year surgical retreatment is 4.4% and the medical retreatment rate is 11.1%.[12]