CASES OF THE WEEK - “Rezum treatment for BPH” by Dr Ahmad Abdul-Rahman, Consultant Urology, NMC Royal Hospital Sharjah
Fifty seven year old male with history of Benign prostatic hyperplasia (BPH) since 2013. patient was very symptomatic with voiding Lower urinary tract symptoms, with variable urine stream and flow and incomplete bladder emptying (Residual of urine 300 mls), and PSA1.2 patient was treated Dual therapy with Proscar 5 mgs and Silosin 8mgs. Ultrasound scan showed Prostate volume 35 cc. IPSS score 21, and Q/L 4 unhappy.
Cystoscopy showed trabeculation bladder and obstructive enlarged vascularised bilateral prostatic lobes.
Urodynamics test showed a large bladder capacity 650mls with delayed bladder sensation. Minimal detrusor overactivity DO and urgency and no urgencyIncontinence. Voiding phase revealed a good detrusor pressure with low flow of urine, Bladder outflow obstruction (BOO).
Patient was not satisfied with the medications and its side effects and Nocturia, therefore, surgery was discussed with the patient but he was only keen for Rezum surgery.
The operation was done at AlZahra Hospital for the first time in Sharjah, UAE. Patient had full GA anesthesia in a lithotomy position where 6 injections of Sterile steam (Rezum) were done in both lobes and a catheter left in for 3 days. The operation took only 15 minutes with no complications. The patient was discharged back home with no pain the same day.
Rezum treatment for BPH, is one of the first of its kind as minimally invasive procedure has shown to significantly reduce the symptoms of BPH using water vapor therapy. It has the FDA approval since 2015 and it has entered to UAE in 2020 after the MOH registration.
The primary options for treating Enlarged prostate were through medications or surgery, making Rezum a new option for patients who are dissatisfied with their current choices for treating BPH and causing less complications comparing to the other surgical methodes.
The Rezum therapy is completed in a single treatment and there is no need for ongoing therapy.
It works by delivering very small amounts of steam to the enlarged prostate which damages the cells causing obstruction, thus reducing the overall size of the prostate and the symptoms associated with BPH such as:
- A weak urine stream
- Trouble starting the flow of urine
- Starting and stopping again when urinating
- Not emptying your bladder completely
- Urinating more often, especially at night
- Sudden urges to urinate
- Leaking or dribbling after you urinate
- Straining to urinate
Your doctor can help you decide if Rezūm is right for you. A few tests must be done prior to treatment. Treatment is a minimally invasive procedure conducted in theater or office that might not require general anesthesia. Patients are able to drive themselves home and may return to regular activities within a few days.
During the initial postoperative period, there can be an increased urinary bother including increased frequency and urgency of urination, pain with urination and perhaps blood in the urine. As the treated area shrinks over time, patients notice the improvement. Most patients experience symptom relief within several weeks after treatment, and most have noticed further improvement within 2 to 3 months. If symptoms recur in the future, the treatment can be repeated.
One of the main advantages of the rezum procedure is that in most men it does not interfere with erection or ejaculation.
