Rezum therapy is a treatment for benign prostatic hyperplasia (BPH) that helps improve symptoms within a relatively short period. It is a minimally invasive procedure that reduces enlarged prostate tissue using water vapor and has gained attention as an alternative treatment option. The procedure begins with a thorough examination of the prostate through cystoscopy. A urology specialist evaluates the size, location, and pattern of the enlarged prostate tissue. Based on this assessment, the physician measures the prostate from the bladder neck and plans the exact treatment area.
A special device equipped with a needle is then used to inject high-temperature, high-pressure water vapor into the prostate tissue. One characteristic of this procedure is that the prostate capsule separates normal tissue from enlarged tissue. This allows the treatment to target only the hyperplastic prostate tissue while protecting surrounding normal structures. Over the following one to three months, the treated tissue gradually shrinks, which can lead to improvement in urinary symptoms.
The entire Rezum procedure typically takes about ten minutes. It is generally suitable for patients aged 50 or older with prostate sizes between 30 and 80 grams. One of its main advantages is that it allows symptom relief with minimal recovery time and is less complex than many conventional prostate surgeries.
Rezum therapy has both advantages and limitations. When compared with holmium laser enucleation of the prostate (HoLEP), one major advantage is the reduced risk of retrograde ejaculation. HoLEP can sometimes cause retrograde ejaculation, whereas Rezum therapy tends to preserve normal ejaculation function more often. Additionally, Rezum is often performed under local anesthesia, making it a suitable option for elderly patients who may have underlying medical conditions that make general or spinal anesthesia difficult.
Recovery after Rezum therapy is generally faster than after HoLEP surgery. A simple urinary catheter with a valve is typically used to help control urination temporarily, minimizing discomfort and allowing patients to return to daily activities more easily. HoLEP, by contrast, involves more extensive tissue removal and therefore often requires a longer recovery period. Patients may also need to use a urine collection bag and may experience temporary discomfort due to bleeding or irritation.
However, Rezum therapy also has disadvantages. One of the main drawbacks is cost, as the procedure requires specialized disposable equipment. In comparison, HoLEP surgery is covered by national health insurance in Korea and is therefore relatively less expensive. Rezum may also be somewhat less effective than HoLEP in terms of symptom improvement. Another limitation is that the treated prostate tissue becomes necrotic and is gradually absorbed by the body, which can take one to three months before the full effect is realized.
Rezum therapy can also be compared with the prostatic urethral lift procedure, commonly known as UroLift. Overall, Rezum offers several advantages over UroLift. Clinical data indicate that Rezum has better long-term outcomes, with a recurrence rate of approximately 4.4% after five years, compared with about 13.6% within five years for UroLift. This suggests more durable results over time.
In addition, UroLift requires the permanent insertion of implants into the body, which can cause inflammation or discomfort in some patients. Rezum therapy, on the other hand, does not leave any foreign materials inside the body. UroLift can also be difficult to perform in patients with a significantly enlarged median lobe of the prostate, whereas Rezum can treat such cases by targeting specific areas through water vapor injections, making it applicable to a broader range of BPH conditions.
Dr. Ryu Je-man of Goldman Urology Clinic’s Seoul Station branch emphasized that no single treatment method guarantees the best results for every patient. Each surgical option has its own advantages and limitations, and the most appropriate treatment depends on the patient’s symptoms as well as the size, location, and pattern of the enlarged prostate tissue. He added that providing patients with clear and objective information is essential to help them make informed decisions, reduce uncertainty about treatment, and ultimately improve satisfaction with the outcome.