Prostate steam treatment

Prostate steam treatment (Rezum), also called water vapor thermal therapy (WVTT), is a minimally invasive surgical procedure for men with lower urinary tract symptoms resulting from prostate enlargement (benign prostatic hyperplasia, BPH). It uses injections of steam to remove obstructive prostate tissue from the inside of the organ without injuring the prostatic part of the urinary tube (prostatic urethra).[1]

Prostate steam treatment
Other namesWater vapor thermal therapy
SpecialtyUrology

History

The Rezum system was introduced by NxThera (Maple Grove, Minnesota, US). It was approved by the United States Food and Drug Administration in 2015[2] and the National Institute for Health and Care Excellence (NICE) of the UK in 2018.[3] As of August 2018 the system was in use in 5 National Health Service hospitals in England, and due to be implemented in a further 15.[3]

Procedure

It is an outpatient or office-based procedure. The equipment consists of a vapor generator and a transurethral delivery device. The latter is similar to a cystoscope with an optical system with a 90° extending retractable 10.25 mm long injection needle (diameter 1.3 mm). From this needle water vapor is circumferentially delivered via 12 holes at the needle’s tip. Depending on the size of the prostate an adequate number of injections is delivered to the two side lobes and to the middle lobe of the prostate. Each injection lasts 9 seconds and the space between adjacent injections is about 10 mm.

Upon condensation of the vapor upon cell membranes, cell death and necrosis occur immediately. Over a period of about three months the dead cells are removed by the body, thus shrinking the prostate and relieving BPH symptoms.[4]

Benefits

The effects of the treatment were investigated by one randomized controlled trial (RCT) with a follow-up of three months and several observational studies with follow-ups of up to four years.

The RCT from 2016 comparing prostate steam treatment to a sham procedure (a placebo) found three months after the operation with moderate certainty that this procedure may improve quality of life for men with moderate urinary symptoms.[5][6]

Observational studies showed positive outcomes up to four years of follow-up.[4][7] Water vapor thermal therapy was looked at in larger volume prostates (>80 mL) and in those with middle lobes protruding into the bladder and appears to work.[4] The procedure has been shown to not affect sexual function across a few studies.[4][8][2][9][10]

References
  1. Ulchaker JC, Martinson MS (2018). "Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia". ClinicoEconomics and Outcomes Research. 10: 29–43. doi:10.2147/CEOR.S148195. PMC 5749396. PMID 29343977.
  2. Westwood J, Geraghty R, Jones P, Rai BP, Somani BK (November 2018). "Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia". Therapeutic Advances in Urology. 10 (11): 327–333. doi:10.1177/1756287218793084. PMC 6180381. PMID 30344644.
  3. National Institute for Health and Care Excellence (NICE): Rezum for treating benign prostatic hyperplasia, Medtech innovation briefing, 24 August 2018 (containing also information on costs and cost effectiveness).
  4. Pham H, Sharma P (April 2018). "Emerging, newly-approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy". The Canadian Journal of Urology. 25 (2): 9228–9237. PMID 29679999.
  5. Kang TW, Jung JH, Hwang EC, Borofsky M, Kim MH, Dahm P (March 2020). Cochrane Urology Group (ed.). "Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia". The Cochrane Database of Systematic Reviews. 3: CD013251. doi:10.1002/14651858.CD013251.pub2. PMC 7093307. PMID 32212174.
  6. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND; et al. (2016). "Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia". J Urol. 195 (5): 1529–1538. doi:10.1016/j.juro.2015.10.181. PMID 26614889.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. Doppalapudi SK, Gupta N (2021). "What Is New with Rezūm Water Vapor Thermal Therapy for LUTS/BPH?". Curr Urol Rep. 22 (1): 4. doi:10.1007/s11934-020-01018-6. PMID 33403529. S2CID 230783957.
  8. McVary KT, Rogers T, Mahon J, Gupta NK (December 2018). "Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?". The Journal of Sexual Medicine. 15 (12): 1728–1738. doi:10.1016/j.jsxm.2018.10.006. PMID 30446471.
  9. Leong JY, Patel AS, Ramasamy R (September 2019). "Minimizing Sexual Dysfunction in BPH Surgery". Current Sexual Health Reports. 11 (3): 190–200. doi:10.1007/s11930-019-00210-1. PMC 6714584. PMID 31467497.
  10. Miller LE, Chughtai B, McVary K, Gonzalez RR, Rojanasarot S, DeRouen K, Bhattacharyya S (July 2020). "Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Systematic review and meta-analysis". Medicine. 99 (30): e21365. doi:10.1097/MD.0000000000021365. PMC 7387023. PMID 32791742.
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