For many patients with benign prostatic hyperplasia (BPH), daily life revolves around finding the nearest restroom. Frequent daytime urination and waking several times at night to urinate are common experiences. A man in his early 70s recently visited our clinic with similar symptoms. During the day, he needed to urinate frequently, and at night he woke up three to four times because of the urge to urinate. His urinary stream had gradually weakened, and the time required to empty his bladder had become noticeably longer. Although he initially tried to manage the condition with medication, his symptoms did not improve significantly.
In this patient’s case, the overall prostate size was not extremely large (under 80 grams). However, due to underlying medical conditions, general anesthesia posed a significant risk. For this reason, the Rezūm System was recommended as a treatment option.
Rezūm therapy does not use electricity or surgical blades. Instead, it delivers high-temperature water vapor directly into the prostate tissue. The thermal energy from the vapor causes the enlarged prostate tissue to undergo necrosis. Over time, the body gradually absorbs the damaged tissue, which reduces prostate volume and relieves pressure on the urethra. Compared with conventional surgery, Rezūm therapy typically involves less bleeding, lower anesthesia burden, and the possibility of same-day discharge. These advantages can be particularly beneficial for older patients. In addition, because the procedure has a relatively low rate of retrograde ejaculation, it has attracted attention from patients who wish to preserve sexual function. Despite being a minimally invasive procedure, long-term data show strong durability, with a retreatment rate of approximately 4.4% even five years after treatment.
Clinical outcomes from our institution also support these findings. A mid-term analysis of 47 Rezūm procedures performed between April 2024 and June 2025 showed significant improvements. On average, one year after treatment, total prostate volume decreased from 50 grams to 29.3 grams, representing a reduction of approximately 34%. The transition zone volume decreased from 24.6 grams to 12.4 grams. Meanwhile, the maximum urinary flow rate (Qmax) improved from 10 mL/s to 15 mL/s. The analysis also demonstrated a clear correlation between prostate volume reduction and symptom improvement. Specifically, for every 10% decrease in prostate volume, the International Prostate Symptom Score (IPSS) improved by an average of 7.5%.
However, Rezūm therapy should not be understood as a simple procedure in which water vapor is injected into the prostate. Injecting more vapor does not necessarily lead to better results, and using fewer injections does not automatically make the procedure safer. The size and shape of the prostate, the degree of enlargement in the transition zone, and the pattern of urinary obstruction vary significantly between patients. Therefore, the key to successful Rezūm treatment lies in determining where, how much, and how precisely the vapor should be delivered.
Several international studies have reported that increasing the number of vapor injections does not always produce greater symptom improvement. On the other hand, when the number of injections is too low, the likelihood of requiring additional surgery within four years tends to increase.
For this reason, the most important factor in Rezūm therapy is not the absolute number of injections but the development of a personalized treatment strategy. Physicians must carefully analyze each patient’s anatomical structure and obstruction pattern to determine the optimal injection locations and dosage. Even if symptoms appear relatively mild, delivering vapor to a precisely obstructed area can lead to significant improvement. Conversely, when the prostate is larger than 80 grams, other treatment options may be more appropriate.
At our institution, we continue to monitor not only the short-term outcomes of Rezūm therapy but also long-term structural changes and recurrence rates. Our goal is to develop a predictable treatment model based on careful analysis of clinical data. Rather than relying solely on symptom severity, we aim to consider both the anatomical structure of the prostate and the patient’s quality of life when determining treatment strategies.
Rezūm should therefore be viewed not simply as a procedure, but as a personalized treatment approach that requires careful evaluation, planning, and clinical judgment.
As men age, various urologic conditions may gradually interfere with everyday life. By providing objective and practical information about urologic health, the goal is to help individuals maintain a healthier and more comfortable quality of life during middle age and beyond.