Convective Radiofrequency Water Vapor Thermal Therapy with Rezūm System
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Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue.
The current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety profile of water vapor therapy up to 2 years. Subjects treated with water vapor therapy demonstrated a 51% reduction in IPSS from baseline, sustained at 24 months (p < 0.0001). Durable improvements in max flow rate (Qmax) and quality of life (QoL) were also achieved, while no changes in sexual function were observed. Reporting of adverse events (AEs) reveals predominantly Clavien grade I complications that were self-limited.
The clinical efficacy and safety of water vapor therapy are durable to 24 months making it an attractive alternative for patients seeking a minimally invasive treatment for LUTS due to BPH.
KeywordsProstate Prostatic hyperplasia Lower urinary tract symptoms Thermal conductivity Minimally invasive therapies
Compliance with Ethical Standards
Conflict of Interest
Sevann Helo and Bradley Holland each declare no potential conflicts of interest.
Kevin T. McVary reports and Lilly/ICOS Self 1/1/11 Present Consultant or Advisor, Scientific Study or Trial, Honorarium, Principal Investigator Y Tadalafil ED and BPHÐIDDK Self 1/1/11 Present Principal Investigator and consultant Y N/A OAB and EDÛoston Scientific (formerly AMS) Self 7/1/13 Present Principal Investigator—Fellowship Grant Y N/A ED and is a section editor for Current Urology Reports.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 7.Hahn DW, Özişik MN. Heat Conduction Fundamentals. Heat Conduction, Third Edition. 2012:1–39.Google Scholar
- 8.• Dixon CM, Rijo Cedano E, Mynderse LA, Larson TR. Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum((R)) system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol. 2015;7:13–8. Histographic and radiographic of a patient after the Rezum procedure shows thermal ablation isolated to the transition zone. PubMedPubMedCentralGoogle Scholar
- 9.• Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, et al. Efficacy and safety of Rezum system water vapor treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology. 2015;86(5):1042–7. Pilot study for the Rezum procedure showing improvements in IPSS and Qmax sustainable for 12 months with no sexual side effects. CrossRefPubMedGoogle Scholar
- 10.• Mynderse LA, Hanson D, Robb RA, Pacik D, Vit V, Varga G, et al. Rezum system water vapor treatment for lower urinary tract symptoms/benign prostatic hyperplasia: validation of convective thermal energy transfer and characterization with magnetic resonance imaging and 3-dimensional renderings. Urology. 2015;86(1):122–7. MRI shows 38% reduction in prostate transition zone volume. CrossRefPubMedGoogle Scholar
- 14.Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol. 2013;190(6):2161–7.CrossRefPubMedGoogle Scholar
- 15.Norby B, Nielsen HV, Frimodt-Moller PC. Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia. BJU Int. 2002;90(9):853–62.CrossRefPubMedGoogle Scholar
- 16.Bruskewitz R, Issa MM, Roehrborn CG, Naslund MJ, Perez-Marrero R, Shumaker BP, et al. A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol. 1998;159(5):1588–93. discussion 93-4CrossRefPubMedGoogle Scholar
- 18.Mosli HA, Abdel-Meguid TA, Abdulwahhab MH, Al-Sayyad A, Farsi HM, Tayib A. Photoselective vaporization of the prostate using GreenLight 120-W lithium triborate laser to treat symptomatic benign prostatic hyperplasia: a single-centre prospective study. Can Urol Assoc J. 2013;7(3–4):E193–6.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European multicentre randomised trial—the GOLIATH study. Eur Urol. 2014;65(5):931–42.CrossRefPubMedGoogle Scholar
- 20.• McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195(5):1529–38. Randomized control trial of the Rezum system showed 50% reduction in IPSS at 3, 6, and 12 months. Peak flow rate increased by 6.2 ml per second. No erectile dysfunction reported in this cohort. CrossRefPubMedGoogle Scholar
- 22.• McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Erectile and ejaculatory function preserved with convective water vapor energy treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: randomized controlled study. J Sex Med. 2016;13(6):924–33. Throrough evaluation of sexual health in men included in the randomized controlled trial of Rezum showed no treatment or device related de novo erectile dysfunction. CrossRefPubMedGoogle Scholar
- 23.Roehrborn CG, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Convective radiofrequency water vapor thermal therapy with Rezum system: durable two-year results of randomized controlled and prospective crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. J Urol. 2016;Google Scholar
- 29.Hoffman RM, Monga M, Elliott SP, Macdonald R, Langsjoen J, Tacklind J, et al. Microwave thermotherapy for benign prostatic hyperplasia. The Cochrane database of systematic reviews. 2012(9):Cd004135.Google Scholar
- 33.Roehrborn C, McConnell J, Barry M, Benaim E, Bruskewitz R, Blute M, et al., editors. American Urological Association guideline: management of benign prostatic hyperplasia (BPH). American Urological Association; 2003.Google Scholar