For many men, changes in urination are initially easy to dismiss. A weaker stream, increased frequency, urgency or waking several times at night may simply be attributed to ageing. But when these symptoms last longer, or begin to interfere with sleep, work and everyday life, they may indicate Benign Prostatic Hyperplasia (BPH), or an enlarged prostate.
Medication is often the first line of treatment for BPH symptoms. For some men, medicines provide effective and lasting relief. However, for others, symptoms may continue despite treatment, medications may cause unwanted side effects, or taking them indefinitely may not be the preferred approach. This is where minimally invasive options such as Rezūm Water Vapour Therapy can become relevant.
When is medication no longer enough?
Persistent or worsening symptoms, poor response to medicines and the impact of urinary problems on quality of life are important factors to consider. Symptoms such as frequent urination at night, difficulty starting to urinate, a weak or interrupted flow, and the persistent feeling of not emptying your bladder completely can greatly affect your daily life.
A urologist might also consider intervention if medication is not giving enough relief or if a patient wants an alternative to long-term drug therapy. The choice depends on things like prostate size, anatomy, symptoms and the individual’s treatment expectations.
Understanding Rezūm Water Vapour Therapy
Rezūm is a minimally invasive procedure that treats the enlarged prostate tissue blocking urine flow. The procedure involves inserting a small device into the urethra and delivering precise amounts of sterile water vapor to targeted areas of the prostate. The thermal energy destroys the obstructing tissue, which is then absorbed by the body's natural healing process. This shrinking of the treated tissue can make the urinary passage.
The procedure generally takes less than 30 minutes and can be performed without an incision or general
anaesthesia. A temporary urinary catheter may be required while the prostate heals. Importantly, improvement is not necessarily immediate. Symptoms can temporarily worsen during the early recovery period, with improvement generally becoming noticeable over the following weeks and, in some cases, taking up to three months.
A minimally invasive alternative
One of the reasons Rezūm has attracted attention is its balance between symptom relief and preservation of sexual function. Clinical studies have reported meaningful and sustained improvements in urinary symptoms and flow, with studies showing benefits lasting several years. Research has also reported low rates of new sexual dysfunction following treatment.
However, Rezūm is not automatically the right treatment for every man with BPH. Temporary urinary urgency, discomfort while urinating, blood in the urine or semen, urinary infection and urinary retention are among the possible risks. A thorough urological evaluation is therefore essential before deciding on treatment.
The key question is not whether medication can be replaced, but whether a man's current treatment is still meeting his needs. When BPH symptoms continue to interfere with quality of life despite medication, it may be time to discuss minimally invasive options such as Rezūm with a urologist. For appropriately selected patients, moving beyond medication can mean moving towards a treatment strategy designed to address the underlying obstruction while limiting the disruption associated with conventional surgery.
Dr Biju Sukumaran Pillai, Senior Consultant, Urology & Andrology, Apollo Adlux Hospital, Angamaly, Kerala
