We pass a telescope through the into the . We use the Rezūm device to Rezūm water vapour pass a needle under vision into the enlarged therapy prostate tissue. Radiofrequency energy is used to heat water to create water vapour. The water vapour is About Rezūm dispersed into the prostate tissue via the Rezūm therapy is a new minimally invasive needle. We usually repeat this process treatment for benign prostate enlargement. between two and eight times depending on the size of your prostate. Rezūm therapy uses the thermal energy from water vapour to ablate prostate tissue, The heat from the water vapour travels resulting in a reduction in the size of the through the enlarged prostate tissue causing prostate. the cells to die. In the weeks to months following the procedure the body reabsorbs Why is Rezūm required? the cells which have died, causing the prostate to shrink. This relieves the bladder obstruction Rezūm therapy is used for the treatment of which is causing your urinary symptoms. urinary symptoms which are due to enlargement of the prostate. These symptoms At the end of the procedure we place a may include: catheter in the bladder. The catheter is usually • Waking through the night to void. removed seven days after the procedure. • Needing to pass urine frequently throughout the day. What is the recovery after Rezūm? • Having to pass urine urgently. You will have a catheter after the procedure. • Reduced urine flow. The catheter will drain urine into a bag. The • Difficulty starting . bag can be secured to your leg and can be • Stop-start flow. concealed under your trousers. The catheter • Dribbling after passing urine. will be removed in our office seven days after • A feeling of incomplete bladder emptying. the procedure. Rezūm therapy is an option for you if: After Rezūm therapy, the body creates an • You do not want to take or are unable to inflammatory response which will initially make take medications for prostate enlargement your urinary symptoms worse. For around four (such as prazosin, , silodosin, weeks after the procedure it is common to dutasteride or finasteride). have burning and stinging when passing urine. • You do not want to have a more invasive It is also common to have slow urine flow, procedure such as transurethral resection urgency and frequency which is worse than it of the prostate (TURP) or Greenlight laser was before the procedure. prostatectomy. You may need to take medications to manage • Your prostate is between 30 and 80 grams. your urinary symptoms for around six weeks (A normal sized prostate is less than 25 after the procedure. grams.) You should notice your urinary symptoms gradually improving between four and twelve What does Rezūm involve? weeks after the procedure. We perform Rezūm therapy in hospital as a Depending on your job, you may be able to day surgery. We perform the procedure under return to work around three days after the general anaesthetic.

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procedure, although some men prefer to wait treatment for prostate enlargement in the until the catheter has been removed. future. You will not be able to drive for at least 24 The improvement in your urinary symptoms hours after the procedure. Some men prefer after Rezūm therapy may not be as marked as not to drive until the catheter has been the improvement seen with other prostate removed. surgeries such as transurethral resection of the prostate (TURP) or Greenlight laser What are the benefits of Rezūm prostatectomy. Rezūm therapy is an alternative to taking long- Other risks of Rezūm therapy include: term medications for urinary symptoms due to Very common risks (most patients) benign prostate enlargement. • Burning and stinging when passing urine for If you are already taking medications for several weeks after the procedure. urinary symptoms (such as prazosin, • Urinary frequency, urgency and reduced tamsulosin, silodosin, dutasteride and urine stream for several weeks after the finasteride), in 90% of cases you will be able to procedure. stop the medications after the procedure. • Blood in the urine for several weeks after Rezūm therapy can be performed as a day the procedure. surgery – you can go home on the day of the • Blood in the for weeks to months procedure provided you are accompanied by a after the procedure. responsible adult. Occasional risks (1/10 – 1/50) Some medications and prostate surgeries can • Urinary tract infection. cause retrograde . Retrograde • An inability to pass urine after the catheter ejaculation results in a reduced volume of is removed (urinary retention), requiring the semen during (dry orgasm). The risk catheter to be replaced. of retrograde ejaculation after Rezūm therapy • Failure to improve your urinary symptoms. is around 4-6%, which is lower than many • Prolonged or persistent urinary frequency, other treatment options. urgency, or burning and stinging when Some medications and prostate surgeries can passing urine. cause . The risk of erectile • Scarring in the urethra (). dysfunction after Rezūm therapy is very low. Rare risks (1/50 – 1/250) What are the risks of Rezūm? • Scarring at the neck of the bladder (bladder neck contracture). Rezūm therapy is a new surgical technology • Retrograde ejaculation (~4-6% risk) which has only been available overseas since 2015 and in Australia since 2018. As such we Theoretical risks do not have as much experience with Rezūm While there are no reports of these therapy as we do with other surgical complications occurring with Rezūm therapy, it techniques for the treatment of prostate is theoretically possible that the procedure enlargement. could cause: Currently there are no studies which have • Erectile dysfunction. looked at the long-term outcomes from Rezūm • Urinary incontinence. therapy. It is possible that the benefits of the • Injury to the rectum. treatment will decrease over time. For some The risks of anaesthesia have not been listed men it may be necessary to have further here.

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What are the alternatives to Rezūm? • Holmium laser enucleation of the prostate (HoLEP). • Surveillance – no treatment. • Open or robotic simple prostatectomy. • Lifestyle changes. • Prostate artery embolisation. • Medications. • Other treatments are available but are not • Transurethral resection of the currently recommended. prostate (TURP). • Greenlight laser prostatectomy. See www.brisbaneurologyclinic.com.au for • Urolift. information regarding these alternative treatment options.

For more information please visit www.brisbaneurologyclinic.com.au. This is general information only. Please consult your doctor for more information and treatment options. For appointments and enquiries please contact 07 3830 3300.

National Institute for Health and Care Excellence (NICE). Rezum for treating benign prostatic hyperplasia. Medtech innovation briefing. August 2018. Westwood J et al. Rezūm: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018. 10: 327-333.

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