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Rezūm Water Vapour Therapy for Enlarged Prostate

Rezūm Water Vapour Therapy for Enlarged Prostate

📖 7 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: September 6, 2026

Rezūm is a minimally invasive treatment for urinary symptoms caused by benign prostate enlargement (BPH). A small instrument is passed through the urethra and delivers short bursts of sterile water vapour into selected areas of the prostate. The vapour transfers heat into the obstructing tissue, which is gradually reabsorbed over the following weeks. Rezūm can improve urinary symptoms without removing a large amount of prostate tissue and usually has a low risk of new erectile or ejaculatory problems. It is not, however, the best option for every prostate size, anatomy or degree of obstruction.

What is Rezūm therapy?

Rezūm is also called water vapour thermal therapy. Unlike TURP or HoLEP, the treatment does not mechanically cut or enucleate the prostate. The steam is injected into targeted zones of the transition area of the gland. As the treated cells die, the body gradually clears them and the prostate channel becomes less compressed.

The important practical point is that the benefit is not immediate. Swelling can temporarily make urination more difficult during the first days after treatment, and symptom improvement usually develops over several weeks.

Who may be suitable for Rezūm?

Selection depends on symptoms, prostate anatomy, residual urine, bladder function and the patient’s priorities. Most of the strongest Rezūm evidence is in men with moderate-to-severe symptoms and moderately enlarged prostates; that evidence should not be automatically extrapolated to every very large gland or every patient in chronic retention.

  • Bothersome weak stream, hesitancy, frequency or incomplete emptying despite conservative measures or medicines.
  • A prostate commonly in the moderate size range; much of the guideline evidence is for about 30-80 mL/g.
  • A patient who values preservation of ejaculation and wants to avoid a more tissue-removing operation if clinically appropriate.
  • A patient who accepts that improvement is gradual and that a temporary catheter may be needed.
  • Selected median-lobe obstruction can be treated with Rezūm when anatomy is suitable and the surgeon is experienced with the technique.

When may another treatment be better?

  • Very large prostates or severe, fixed obstruction where a more powerful debulking procedure such as HoLEP may provide more predictable emptying.
  • Repeated urinary retention, very high residual urine or concern about poor bladder muscle function, where additional evaluation may be needed before choosing a minimally invasive option.
  • Bladder stones, recurrent infection, kidney swelling or renal impairment caused by obstruction, where durable de-obstruction is usually the priority.
  • A patient who wants the fastest possible improvement and is willing to accept the sexual side-effect profile of conventional surgery.
  • Suspected prostate cancer, urethral stricture or another cause of urinary symptoms that should be evaluated first.

Where Rezūm sits in current guidelines

Rezūm has randomised sham-controlled data and five-year follow-up showing meaningful symptom improvement with a favourable sexual-function profile in selected men. However, the 2026 EAU guideline still places convective water-vapour therapy among alternative ablative techniques under investigation because direct randomised comparisons with established reference operations remain limited and objective improvements in flow and residual urine are generally greater after TURP.

Rezūm can be effective in selected men. The trade-off is a less invasive procedure with a favourable chance of preserving ejaculation, but slower improvement and less mature comparative evidence than established operations such as TURP or HoLEP.

How is Rezūm performed?

The procedure is performed through the urethra. A cystoscopic delivery device is positioned within the prostatic urethra and small injections of water vapour are placed into the obstructing tissue. The number and location of injections depend on prostate length and configuration.

Local anaesthesia with sedation, regional anaesthesia or a short general anaesthetic may be used depending on the centre and patient. Rezūm is commonly a day-care procedure.

Will I need a catheter?

Many men need a temporary urinary catheter after Rezūm because the prostate can swell before it shrinks. The duration varies with baseline obstruction, prostate size, residual urine and whether the patient was already in retention. A catheter should not be removed simply by the calendar if the treating team feels the bladder is unlikely to empty safely.

Benefits and limitations

Potential benefit Important limitation
No tissue resection Improvement is slower than after TURP or HoLEP.
Low risk of new erectile dysfunction Temporary burning, urgency and frequency are common.
Ejaculation is often preserved Some patients still need retreatment or later surgery.
Usually day-care A catheter may be required for several days.
Can reduce dependence on BPH medicines Not ideal for every prostate size, anatomy or bladder problem.

What is recovery like?

Burning while passing urine, urgency, frequency, pelvic discomfort and a small amount of blood in the urine can occur during the early recovery period. Symptoms may fluctuate because treated tissue is inflamed before it is reabsorbed.

Many patients can return to light routine activities within a few days, but heavy exercise, cycling and strenuous lifting are usually delayed until bleeding and discomfort have settled. Symptom improvement often begins within several weeks and may continue for a few months.

Sexual function after Rezūm

One reason men consider Rezūm is its favourable sexual-function profile. Trials and guideline reviews report a low risk of new erectile dysfunction and a low incidence of ejaculatory dysfunction compared with tissue-removing operations. This does not mean the risk is zero, and ejaculation can already be affected by age, medicines, diabetes, prostate disease or previous procedures.

Risks and side effects

  • Temporary burning, frequency, urgency or pelvic discomfort.
  • Blood in the urine or semen for a short period.
  • Urinary retention requiring catheterisation or a longer catheter period.
  • Urinary infection.
  • Persistent symptoms or insufficient improvement.
  • Need for additional BPH medication, repeat minimally invasive treatment or later prostate surgery.
  • Rare urethral or bladder-neck scar formation after instrumentation.

When should you seek urgent medical care?

  • You cannot pass urine after catheter removal and the lower abdomen becomes painful or distended.
  • Fever, chills or feeling significantly unwell, especially with poor urine drainage.
  • A catheter stops draining despite a feeling of bladder fullness.
  • Heavy bleeding, large clots or persistent bright-red urine that obstructs flow.
  • Severe or worsening pain rather than the expected mild postoperative discomfort.

What to bring for consultation

  • Ultrasound report with prostate volume and post-void residual urine.
  • Uroflowmetry report if already performed.
  • Urine routine/culture and serum creatinine if available.
  • PSA report when relevant to your age and clinical evaluation.
  • Current prostate medicines and any blood-thinning medicines.
  • Details of previous catheterisation, retention, TURP, prostate procedures or urethral surgery.

FAQs

How quickly does Rezūm improve urine flow?

It is not an instant-opening procedure. Early swelling can temporarily worsen symptoms. Improvement usually becomes noticeable over the following weeks and may continue for several months.

Does Rezūm preserve ejaculation?

In many appropriately selected men, ejaculation is preserved. The risk of ejaculatory dysfunction is generally lower than with TURP or HoLEP, although no treatment can guarantee preservation in every patient.

Can Rezūm treat a median lobe?

Yes, selected obstructing median lobes can be treated with water vapour therapy. Anatomy still matters, and a cystoscopic or ultrasound assessment may influence whether Rezūm is a sensible choice.

Is Rezūm better than TURP?

They solve the same problem in different ways. Rezūm offers a less invasive recovery and better odds of preserving ejaculation, while TURP generally produces faster and stronger de-obstruction. The better option depends on prostate size, severity, complications and patient priorities.

Can symptoms return after Rezūm?

Yes. Rezūm can provide durable improvement, but some men need BPH medicines again or require another procedure later. Retreatment risk should be part of the decision before choosing any minimally invasive therapy.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.