When treating patients with benign prostatic hyperplasia (BPH), physicians often hear similar questions. Many patients ask, “I don’t want to take medication for the rest of my life. Are there other options?” or “Surgery sounds too burdensome. Is there a simpler treatment?” Behind these questions lies a common desire: patients want to reduce the burden of treatment while still maintaining effective symptom relief. As a result, BPH treatment is gradually evolving beyond simple symptom management toward approaches that also consider recovery time and preservation of sexual function.
Within this shift, the Rezūm procedure—introduced in South Korea in 2023—has emerged as a potential treatment option. Rezūm therapy reduces enlarged prostate tissue using water vapor. During the procedure, a device is inserted through the urethra, and a small needle delivers high-temperature water vapor directly into the enlarged prostate tissue. The injected vapor causes the targeted tissue to undergo necrosis, and over time the tissue shrinks in volume. Rezūm therapy received approval from the U.S. Food and Drug Administration (FDA) in 2015, and after receiving authorization from Korea’s Ministry of Food and Drug Safety in 2022, it has been applied in clinical practice in Korea since 2023.
However, Rezūm is not a procedure where outcomes are determined solely by the equipment. In real clinical practice, three major factors largely determine the quality and effectiveness of the procedure.
The first factor is precise anatomical mapping. The success of Rezūm depends on exactly where and how accurately water vapor is injected into the enlarged prostate tissue. Physicians must carefully evaluate the degree of enlargement in both the left and right prostate lobes, determine whether a median lobe is obstructing the bladder outlet, and assess the length and angle of the prostatic urethra. Based on this analysis, the physician determines the number and location of injections. In particular, when median lobe enlargement is present, the distance from the verumontanum—an anatomical structure closely related to ejaculation function—must be carefully considered. If too little vapor is delivered, the tissue reduction effect may be insufficient. If excessive vapor is delivered, complications such as pain, hematuria, or swelling may occur. Without a detailed understanding of prostate anatomy, mechanically performing the procedure may not produce satisfactory outcomes.
The second factor is careful patient selection. Because Rezūm involves injecting water vapor directly into prostate tissue through a needle, it is considered a minimally invasive but still invasive procedure. Therefore, it should not be performed in patients with active urinary tract infections. Conditions such as urethritis, cystitis, prostatitis, or pyelonephritis must be ruled out before the procedure. If Rezūm is performed while infection is present, bacteria may spread deeper into the tissue or enter the bloodstream. The combination of tissue necrosis from the heated vapor and an existing infection may increase the risk of severe prostatitis or even sepsis. For this reason, physicians typically perform urine tests to check for infection before the procedure, and if infection is detected, antibiotic treatment is completed before proceeding. This is a fundamental principle for maintaining the safety of Rezūm therapy.
The third factor is complication management and post-procedure care. Compared with traditional resection surgeries, Rezūm generally involves less bleeding. However, because the prostate can temporarily swell after treatment, a urinary catheter is often maintained for three to seven days following the procedure. During this period, proper management of pain, hematuria, and possible acute urinary retention is important for patient safety and recovery. In rare situations where unexpected anatomical findings or complications occur, physicians must also be prepared to convert to a resection procedure such as holmium laser enucleation of the prostate (HoLEP). The ability to integrate newer minimally invasive techniques with established surgical approaches—such as TURP or HoLEP—requires comprehensive clinical judgment from an experienced urology specialist.
Analysis of clinical outcomes at our institution showed that patients who underwent Rezūm therapy experienced meaningful improvements. The average peak urinary flow rate (Qmax) increased from 11.39 mL/s before the procedure to 15.8 mL/s afterward. Post-void residual urine volume decreased from an average of 85.4 mL to 39.4 mL. In addition, prostate volume showed a decreasing trend, from an average of 50 grams before treatment to approximately 29.3 grams after treatment.
These results are consistent with international research. Multicenter clinical trials used for FDA approval, as well as long-term follow-up studies, have repeatedly reported significant improvements in the International Prostate Symptom Score (IPSS) and peak urinary flow rate. Five-year follow-up data have shown that only about 4.4% of patients required additional treatment.
Nevertheless, Rezūm is not the ideal solution for every patient with BPH. In cases where the prostate is extremely large or when anatomical structures make resection more appropriate, surgical treatments such as HoLEP may provide better outcomes. Ultimately, the most important factor is not the procedure itself, but how appropriately it is applied.
The outcome of Rezūm therapy depends not only on the device, but on three essential elements: precise anatomical mapping, accurate patient selection, and systematic post-procedure management. For patients considering treatment for benign prostatic hyperplasia, it is important to evaluate whether these three conditions are properly established before deciding which treatment option to choose.
Urologic conditions that affect middle-aged and older adults can significantly impact quality of life. Through clear and accessible explanations of these conditions, the goal is to help patients better understand their health and make informed decisions about treatment.