Rezūm is a minimally invasive office-based procedure that uses targeted water vapour (steam) to destroy obstructing prostate tissue. It is performed under local or light sedation anaesthesia, requires no incisions, and is associated with a low risk of retrograde ejaculation. It is suited to men with prostates up to 80cc (including those with a median lobe) who want to avoid long-term medication but prefer a less invasive approach than surgery.
What is Rezūm?
Rezūm uses the NxStage system to deliver precisely timed injections of sterile water vapour (steam) directly into targeted prostate tissue. When steam contacts tissue, it condenses back into water, releasing stored thermal energy in the process. This energy destroys the cells in the treated zone. Over the following 4–12 weeks, the body gradually reabsorbs the treated tissue, and the urinary channel opens as a result.
Unlike TURP or Aquablation, no tissue is physically removed during the procedure itself — the destruction and reabsorption happen in the weeks following treatment. Rezūm is NICE approved (IPG688, 2020) and FDA cleared.
How it differs from TURP and Aquablation
The differences between Rezūm and surgical BPH treatments are clinically significant and directly relevant to patient choice:
- No tissue removed during the procedure — the body reabsorbs treated tissue over 4–12 weeks
- Local anaesthetic or light sedation — no general or spinal anaesthetic required in most cases
- Day case only — no hospital admission; patients go home the same day
- Ejaculation preservation rate much higher — approximately 80–90% of men preserve normal ejaculatory function
- Results take longer to manifest — 6–12 weeks for full effect, compared with more immediate improvement from TURP
- Suitable for smaller-medium prostates — typically up to approximately 80cc
- Not suitable for very large prostates — Aquablation or HoLEP is preferred for glands over 80cc
The WATER study (the pivotal Rezūm clinical trial) showed that 79% of patients maintained normal ejaculatory function at 2 years, compared to approximately 10–15% with TURP. Symptom improvement (IPSS reduction) was clinically significant and durable at 4 years of follow-up.
Who is Rezūm suited to?
Rezūm tends to be discussed with men who meet most of the following criteria:
- BPH symptoms not adequately controlled by medication
- Wants to avoid long-term tablets (alpha-blockers or 5-alpha-reductase inhibitors)
- Prefers a day-case procedure without general anaesthetic
- Sexually active and wishes to preserve ejaculatory function
- Prostate volume up to approximately 80cc
- Median lobe present — Rezūm can treat this effectively, unlike some other minimally invasive procedures
- No previous pelvic radiotherapy
- Not requiring immediate symptom relief — results take several weeks to develop
What happens on the day
The procedure takes approximately 10 minutes to perform. Local anaesthetic gel is applied to the urethra, and a fine needle delivers precisely timed steam injections directly into the prostate tissue. The number of injections depends on prostate size and anatomy. A catheter is placed at the end of the procedure — usually removed within 5–7 days. The patient goes home the same day.
Some burning on urination for 2–3 weeks after the procedure is normal and expected as the treated tissue begins to be reabsorbed. Over-the-counter anti-inflammatory medication helps manage this discomfort.
Recovery — what to expect
- Days 1–7: catheter in situ, some urinary discomfort, minimal activity restrictions
- Week 1–2: catheter removed, urinary urgency and frequency common as healing begins
- Weeks 2–6: gradual improvement begins as treated tissue is absorbed by the body
- Weeks 6–12: most men experience significant symptom improvement
- Return to driving: next day after catheter removal
- Return to work (desk-based): within a few days of catheter removal
- Sexual activity: typically 2–4 weeks post-procedure
- Full benefit: most evident at 3 months; continues to improve to 6 months
Is Rezūm available on the NHS?
NICE approved Rezūm in 2020 (IPG688), but NHS availability remains limited. Access varies significantly by trust and by individual consultant expertise. Privately, Rezūm is available at specialist centres with trained urologists. When seeking treatment, it is worth asking specifically whether your consultant performs Rezūm personally — not all urologists offering BPH treatment have training in this technique.
Questions to ask at your consultation
- What is my prostate volume — am I in the right range for Rezūm?
- Do I have a median lobe and does that affect my suitability?
- What is the expected time to symptom improvement in my case?
- How does my ejaculation preservation chance compare between Rezūm and alternatives such as Aquablation?
- What happens if symptoms do not improve sufficiently, or if I need retreatment in the future?
Frequently asked questions
Local anaesthetic makes the procedure tolerable for most men. Some describe pressure or a brief burning sensation during steam delivery. Post-procedure discomfort is usually mild and controlled with over-the-counter anti-inflammatory pain relief. The catheter in the first week causes more discomfort than the procedure itself for most patients.
Erectile function is generally well-preserved after Rezūm. Unlike TURP, Rezūm does not involve electrical energy near the neurovascular bundles that control erections. Erectile dysfunction is uncommon after this procedure. Ejaculatory function is preserved in approximately 80–90% of men, which is significantly better than TURP.
Published data shows durable results at 4 years, with the majority of patients maintaining clinically significant symptom improvement. Longer follow-up data (5 or more years) continues to emerge. As with all BPH treatments, some men may require retreatment over time as the prostate continues to grow with age — this does not mean the procedure has failed.
Yes. Rezūm can treat median lobe BPH effectively. This is an important advantage over some other minimally invasive procedures — such as UroLift — that cannot address median lobe anatomy. Your suitability will be confirmed at consultation using ultrasound measurements.
If symptom improvement is insufficient after allowing adequate time for tissue reabsorption (typically 3–6 months), other BPH treatments remain available. Rezūm does not close off future options — TURP, HoLEP or Aquablation can all still be performed if needed. This is one of the procedure's practical advantages.
Discuss Rezūm at your consultation
Mr Torath Ameen offers assessment and treatment for benign prostate enlargement including Rezūm therapy at his London clinics. Book a consultation to discuss whether Rezūm is appropriate for your anatomy and priorities.
This article is intended for general patient education only. It does not constitute medical advice and may not apply to every individual's circumstances. Clinical decisions should always be made in consultation with a qualified healthcare professional. If you are concerned about your health, please seek prompt medical assessment.