Introduction
Benign prostatic hyperplasia is one of the major causes of urinary tract problems in men. Day-to-day life is affected as this may cause difficulty in urinating, urine frequency, nocturia, and incomplete emptying of the urine. Rezum is a minimally invasive approach in which steam injections thermally ablate the tissues in the transpositional prostatic zone through transurethral access. Prostatic benign hyperplasia is commonly seen in older men, usually in their fifties and nineties.
What Is Benign Prostatic Hyperplasia?
As the name suggests, benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. A prostate gland comprises glandular and muscular tissue that enlarges in size. It is located in front of the rectum and below the bladder. The urethra is the tube that carries the urine and sperm out of the body, and the prostate gland surrounds this tube. When there is an enlargement of the prostate gland, it disrupts the flow of urine and semen through the urethra. The prostate gland helps in producing fluid which helps in the motility of the sperm and grows in size during puberty which is stimulated by the hormone testosterone.
What Are the Symptoms of Benign Prostatic Hyperplasia?
Because there is an enlargement of the prostate gland, the tube that carries the urine is affected, presenting the following symptoms:
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Difficulty in passing urine.
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A slow stream of urine.
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Dripping of urine.
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Frequent urination.
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Nocturia (increased frequency of passing urine at night).
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Urgency in passing urine.
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Pain during ejaculation.
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Pain while passing urine.
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Urine with a foul odor.
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Bladder stones.
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Hematuria (blood in urine).
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Infection of the bladder
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Infection in the kidneys due to the backward flow of retained urine.
Symptoms that require immediate medical attention:
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Not able to pass urine at all.
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Pain in the lower abdomen.
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Fever and chills.
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Blood in the urine.
Rezum Therapy:
Bladder flow obstruction is the main cause of lower urinary tract symptoms in individuals with benign prostatic hyperplasia. Management of benign prostatic hyperplasia includes conservative approaches like lifestyle modifications, pharmacotherapy, and surgical modalities. Pharmacotherapy has disadvantages which include postural hypotension, asthenia, and reduced sexual activity. Advancements in surgical treatments involve holmium laser enucleation, prostate artery embolization, urolift, and transurethral resection of the prostate. However, these procedures have compilations like erectile dysfunction, retrograde ejaculation, urinary tract infection, urethral stricture, urinary incontinence, and bleeding, which may require transfusion. To overcome these drawbacks, alternative procedures are being used, like rezum therapy.
What Does the Procedure Involve?
Rezum therapy is a minimally invasive procedure that uses transurethral needle ablation or transurethral microwave therapy, which uses the principle of conductive heat therapy. The mechanism of action involves convective heat transfer that alters the thermodynamic properties of water. The device has a radiofrequency generator, a single-use transurethral delivery device, and a 4mm 30-degree cystoscopy lens. In the individual in the lithotomy position, the needle penetrates around 10mm in depth. The water vapor when it comes in contact with the body temperature tissue. The concentrated energy is then transferred to the cell membranes of the targeted tissue with hypertrophy and triggers instant cell necrosis. The irrigation solution used is saline which also helps in visualization. Studies conducted with gadolinium-enhanced magnetic resonance imaging to check the efficacy of rezum therapy have successfully produced necrosis in targeted tissues and preserved non-affected tissue. Although anesthesia and sedation may be required as advised by the doctor, most cases require only oral sedation.
What Are the Advantages of Rezum Therapy?
Rezum therapy provides substantial, prolonged, and symptomatic relief. In addition, there are improvements seen in lower urinary tract symptoms and urine flow. Furthermore, these improvements are brought about without affecting the erectile or ejaculatory function, which is usually associated with transurethral resection of the prostate.
Other advantages include the following:
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The procedure is performed on an outpatient basis and does not require hospital admission.
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Does not require general anesthesia and can be performed under sedation.
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Strong short-term safety profile.
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New cases have not reported sexual dysfunction.
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It can be performed in individuals with obstructive median lobes.
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Time taken for the procedure is short.
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Cost-effective.
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There is improvement seen in post-residual volume, international prostate symptom score, quality of life, and urine flow rate.
What Are the Disadvantages of Rezum Therapy?
The disadvantages include the following:
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The number of individuals that qualify for the procedure is limited because of the exclusion criteria.
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Individuals with urinary retention and large prostate are not eligible; this excludes a huge population.
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Individuals with a history of recurrent urinary tract infections are excluded.
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More than 50 % of the cases require catheterization after the procedure.
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Individuals who have undergone radiation on the prostate and prior invasive treatment procedures are unsuitable.
Case Selection Criteria and Procedure Planning:
Not all cases are suitable for rezum therapy, and a selection criterion becomes important. Before the procedure, the individual is made to undergo a cystoscopy examination to check for an enlarged prostate, which also helps assess the individual's tolerance level to rigid cystoscopy. In addition, prostate volume is assessed by ultrasound before the procedure. Below mentioned are the criteria used:
Inclusion Criteria:
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The patient should be above 45 years old and have symptomatic benign prostatic hyperplasia.
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International prostate symptom scores 13 or above.
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Qmax value between 5 ml and 15 ml per second.
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Prostate volume above 120 cc.
Exclusion Criteria:
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Individuals with a history of recurrent urinary tract infections are excluded.
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Individuals who have undergone radiation on the prostate and prior invasive treatment procedures are unsuitable.
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Post-residual volume should be above 300 ml.
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Prostate-specific volume should be greater than 2.5 ng/ml.
What Are the Complications of the Procedure?
The complications of rezum therapy are minor and resolve within a few weeks after the procedure. However, the individual may experience hematuria (blood in urine), dysuria (pain or discomfort while urinating), hematospermia (blood in semen), urgency, and urinary tract infections.
Conclusion
Rezum therapy is a transurethral water vapor therapy that uses thermal energy as a mode of treatment. It is a minimally invasive procedure used to treat benign prostatic hyperplasia. As the name suggests, benign prostatic hyperplasia is a noncancerous prostate gland enlargement. Rezum therapy has a good prognosis and very few minor complications. It is clinically effective and overcomes the drawbacks present in other modes of treatment.
