Some men find themselves looking for the nearest restroom wherever they go, and waking up several times during the night to urinate. This is a common experience for patients with benign prostatic hyperplasia (BPH). Frequent urination, a weakened urine stream, and longer urination time are well-known symptoms of the condition. These symptoms occur because the enlarged prostate compresses the urethra.
The challenge is that medication alone does not always provide sufficient relief for BPH. In addition, elderly patients or those with underlying medical conditions may have limited treatment options if general anesthesia poses a risk. In such situations, a treatment option that does not require tissue removal or general anesthesia—known as Rezūm therapy—may be considered.
Rezūm therapy works by injecting high-temperature water vapor into the enlarged prostate tissue without using electrical energy or surgical blades. The steam delivers thermal energy to the tissue, causing controlled cell damage. Over time, the damaged tissue undergoes necrosis and is gradually absorbed by the body. As a result, the prostate volume decreases and pressure on the urethra is relieved. The procedure is also associated with a relatively low risk of bleeding and can often be performed under local anesthesia or mild sedation, making it less burdensome for patients. In many cases, patients can return home on the same day, which reduces concerns about prolonged recovery.
Rezūm therapy also has advantages in terms of preserving sexual function. The rate of retrograde ejaculation—a side effect that can occur after some BPH surgeries—has been reported to be relatively low with this treatment. According to data presented by the American Urological Association in 2021, the rate of patients requiring retreatment five years after Rezūm therapy was approximately 4.4%.
Clinical analyses of Rezūm therapy are also being conducted in Korea. In a mid-term analysis of multiple procedures performed between 2024 and mid-2025, the total prostate volume was found to decrease by an average of more than 30% one year after treatment, while urinary flow rates increased significantly. Researchers also observed a correlation between the reduction in transitional zone volume and improvement in symptom scores, suggesting that structural changes in the prostate contribute to the improvement of urinary symptoms.
However, increasing the number of steam injections during the procedure does not necessarily lead to better results. Conversely, studies have reported that too few injections may increase the likelihood of retreatment in the long term. Because the size, shape, degree of transitional zone enlargement, and location of obstruction differ among patients, determining where and how much steam to inject is a key factor influencing treatment outcomes. International medical journals emphasize that anatomical analysis and strategic planning are more important than the number of injections alone.
Ultimately, Rezūm therapy can be considered one of several personalized treatment options chosen based on a patient’s prostate size, anatomical characteristics, overall health condition, and treatment goals. It may be particularly suitable for patients with relatively moderate prostate enlargement who wish to minimize the burden of anesthesia. On the other hand, patients with significantly enlarged prostates or complex patterns of obstruction may benefit more from other surgical treatments.
In this context, BPH treatment has recently evolved toward a more integrated approach. Along with Rezūm therapy, other options such as aquablation (waterjet robotic surgery), iTind, and holmium laser enucleation of the prostate (HoLEP) are now selected depending on prostate size, anatomical structure, and the patient’s overall health. Because the indications for each treatment differ, establishing a treatment strategy based on accurate diagnosis and structural analysis is essential. Within this spectrum of therapies, Rezūm has emerged as a meaningful option for patients seeking to reduce the need for tissue removal and general anesthesia. (Dr. Kim Tae-heon, Goldman Urology Clinic, Seoul Station Branch)