There are instances where one finds themselves looking for a restroom first wherever they go, and waking up multiple times at night to urinate. This is a common daily experience for patients with benign prostatic hyperplasia (BPH). In fact, frequent urination, a weakened urine stream, and changes such as prolonged urination time are known to be major symptoms of BPH. This occurs because the prostate gland becomes excessively enlarged, compressing the urethra.
The problem is that in many cases of BPH, patients experience limitations with medication alone. Furthermore, for elderly patients or those with underlying medical conditions for whom general anesthesia is burdensome, surgical treatment options may even be restricted. In such situations, the 'Rezum procedure' can be considered as a treatment method that can be attempted without resection and general anesthesia.
The Rezum procedure is a method that delivers thermal energy by injecting high-temperature steam into the enlarged prostate tissue, without using electricity or a scalpel. The excessively grown tissue undergoes a process of necrosis after thermal damage and is gradually absorbed by the body. As a result, it is characterized by a reduction in prostate volume and alleviation of urethral compression. Furthermore, the risk of bleeding is relatively low, and it can be performed under local or sedation anesthesia, meaning the burden of the procedure is not significant. In many cases, discharge is possible on the same day as the procedure, making it an option for patients who wish to reduce the burden of recovery time.
It also shows distinct characteristics in terms of sexual function preservation. This is because the incidence of retrograde ejaculation, which can be problematic for some patients after Rezum treatment for BPH, is reported to be relatively low. According to 2021 data presented by the American Urological Association (AUA), the rate of retreatment required at 5 years post-Rezum therapy was reported to be approximately 4.4%.
In Korea, results analyzing the clinical effectiveness of the Rezum procedure continue to emerge. An interim analysis of numerous Rezum procedure cases performed from 2024 to mid-2025 showed that the total prostate volume decreased by an average of over 30% one year after the procedure, and urinary flow rate significantly increased. A correlation between the reduction in transitional zone volume and improvement in symptom scores was also observed, suggesting that structural changes contribute to the amelioration of voiding symptoms.
However, it is not always the case that increasing the number of injections during the Rezum procedure leads to greater effectiveness. Conversely, research results have also reported that if too few injections are administered, the likelihood of needing retreatment in the long term may increase. Since the size, shape, degree of transitional zone hypertrophy, and location of obstruction differ for each patient, the process of deciding where and how much to inject determines the treatment outcome. Indeed, international academic journals emphasize that precise localization and strategy formulation based on anatomical analysis are more crucial than the number of injections itself.
Ultimately, the Rezum procedure can be defined as one of the customized options selected based on the patient's prostate size and shape, general health condition, and treatment goals. Rezum may be considered when the prostate size is relatively not large and the patient wishes to reduce the burden of anesthesia. Conversely, if the prostate volume is large or the obstruction pattern is complex, other surgical treatments may be more appropriate.
In this context, BPH treatment is recently evolving towards an integrated approach. Various treatment methods, including Aquablation (waterjet robotic surgery), iTind, and HoLEP surgery, are being selectively applied based on the prostate size and shape, and the patient's general health condition, with Rezum at the center. Since the indications for these treatment methods differ, establishing a treatment strategy based on accurate diagnosis and structural analysis is extremely important. The Rezum procedure also holds a significant position as a meaningful option within this treatment spectrum for patients who wish to reduce the burden of resection and general anesthesia. (Director Kim Tae-heon, Goldman Urology Clinic Seoul Station Branch)