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

Although it is a relatively new technique, one trial showed positive outcomes in a four-year follow-up.[2]

According to a review article published in 2020,

WVTT provided [clinically important] improvement in BPH symptoms …, preserved sexual function, and was associated with low surgical retreatment rates over 4 years.[3]

Medical uses

As of 2019, trials including one randomized control trial show encouraging results for benign prostatic hypertrophy.[4] A 2018 review found four trials that showed positive outcomes at 1 to 2 years of follow up.[5] It however has not been compared to transurethral resection of the prostate as of 2018.[6]

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.[5] The procedure has been shown to not affect sexual function across a few studies.[5][7][8][2]

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.[5]

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[8] and the National Institute for Health and Care Excellence (NICE) of the UK in 2018.[9] 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.[9]

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". Clinicoecon Outcomes Res. 10: 29–43. doi:10.2147/CEOR.S148195. PMC 5749396. PMID 29343977.
  2. Leong JY, Patel AS, Ramasamy R (2019). "Minimizing Sexual Dysfunction in BPH Surgery". Curr Sex Health Rep. 11 (3): 190–200. doi:10.1007/s11930-019-00210-1. PMC 6714584. PMID 31467497.CS1 maint: multiple names: authors list (link)
  3. Miller, Larry E; Chightai, Bilal; McVary, Kevin; Gonzalez, Ricardo R; Rojanasarot, Sirikan; DeRouen, Kyle; Bhattacharyya, Samir (24 July 2020). "Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Systematic review and meta-analysis". Medicine (Baltimore). 99 (30). PMID 32791742. Retrieved 22 August 2020.
  4. Green, Z; Westwood, J; Somani, BK (31 May 2019). "What's New in Rezum: a Transurethral Water Vapour Therapy for BPH". Current Urology Reports. 20 (7): 39. doi:10.1007/s11934-019-0903-7. PMID 31152253.
  5. Pham H, Sharma P (2018). "Emerging, newly-approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy". Can J Urol. 25 (2): 9228–9237. PMID 29679999.
  6. Magistro, G; Weinhold, P; Stief, CG; Gratzke, C (May 2018). "The new kids on the block: prostatic urethral lift (Urolift) and convective water vapor energy ablation (Rezūm)". Current Opinion in Urology. 28 (3): 294–300. doi:10.1097/MOU.0000000000000502. PMID 29538166.
  7. McVary KT, Rogers T, Mahon J, Gupta NK (2018). "Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?". J Sex Med. 15 (12): 1728–1738. doi:10.1016/j.jsxm.2018.10.006. PMID 30446471.CS1 maint: multiple names: authors list (link)
  8. Westwood J, Geraghty R, Jones P, Rai BP, Somani BK (2018). "Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia". Ther Adv Urol. 10 (11): 327–333. doi:10.1177/1756287218793084. PMC 6180381. PMID 30344644.CS1 maint: multiple names: authors list (link)
  9. 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).
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