With increasing life expectancy for men and improved health care systems, there has been a growing demand for managing age related diseases; one of the most common being Benign Prostatic Hyperplasia (BPH). In a large proportion of BPH patients, prostate enlargement causes bladder outflow obstruction (BOO), resulting in troublesome lower urinary tract symptoms (LUTS). This can have a significant impact on a patient’s’ quality of life (QoL).

Rezum is an ablative water vapour minimally invasive treatment for symptomatic benign prostatic enlargement (BPE). There is little in the literature to describe or support the efficacy of steam vapour for treating larger prostate volumes. We report on our UK experience following Rezum tissue ablation on a cohort of patents with large glands.

Data collected prospectively for 475 patients, those have been categorized according to prostate volume into 2 groups (group 1:  glands <80mls - and Group 2:  glands >80mls). Median age for group 1 and 2 was (67&68 years) respectively, with average prostate volume of 48 cc for group 1 and 95 cc for group 2.
Both Objective parameters (flowmetry/ post voiding/ bladder scan/ reduction in prostate volume) and subjective parameters (IPSS/ QOL) has been recorded and compared between both groups. Patients were followed for up to 24 months with a minimum follow up of 6 months and data interpretation for comparison was used at point of 12 month.
Independent t-test used to compare both groups using SPSS-17 software.

389 were in group 1 whilst 86 were in group 2. Average increase in flow rate was 73% (from 10.8 pre-operatively to 18.7 at 12 months) in group 1 and there was 81 % increase in group to (from 8.7 to 15.8) with no statistical difference between both groups (p=0.321) (Fig 1). Residual urine showed reduction of 29% (from 165 cc pre-operatively to 116 cc post operatively) in group 1 and 46% (from 151 to 81 cc) in group 2. IPSS showed improvement of 17 point on the scale in both groups (from 21 preoperatively to 4 post operatively) in group 1 and (from 20 to 3) in group 2(Fig 2).Patients in both groups had significant improvement in their QOL (from 4.5 to 1.3) and (from 4.7 to 0.8) in group 1 and 2 respectively. Prostate volume reduction was 29% in group 1 (from 48 cc to 34 cc) and 32% (from 95 cc to 64 cc) in group 2

The outcomes of our study are confirming similar early results for this technique when treating larger prostate volumes > 80 cc in both objective and subjective parameters. This is more favourable when compared to outcomes from a previous study reporting on large gland volumes. (Darson et al)

Rezūm system has gained popularity and acceptance among many urologists. It is quick to perform and with a short learning curve. This treatment modality that can be adopted as an office or ambulatory outpatient procedure with minimal transient perioperative side effects, and an effective and durable alleviation of urinary symptom with favourable safety profile including preservation of erectile and ejaculatory function.

In this series of Rezum water vapor thermal therapy for BPH tissue ablation our analysis has demonstrated non inferiority in treating > 80 cc glands. The symptomatic improvement and favorable side effects profile previously reported for gland volumes of 30-80mls appears to extend to larger gland sizes.

Darson MF, Alexander EE, Schiffman ZJ, Lewitton M, Light RA, Sutton MA, Delgado-Rodriguez C, Gonzalez RR. Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezum system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Research and reports in urology. 2017;9:159.