Nuffield Health The Manor Hospital, Oxford
Mr Musaab Yassin · Consultant Urological Surgeon & Andrologist
Steam, not cutting. A fifteen-minute day-case treatment for an enlarged prostate that reliably protects erections and ejaculation — provided you understand the trade-off that comes with it.
01 · Understanding Rezūm
Benign enlargement squeezes the urethra from within. Most operations remove the obstructing tissue by cutting or lasering it away. Rezūm does something different — it injects steam into the tissue and lets your own body clear it away over the following weeks.
A fine needle is deployed into the obstructing tissue through a telescope in the urethra, and sterile water vapour at 103°C is injected in nine-second bursts. Steam disperses easily through the spaces between cells, and the moment it meets cooler tissue it condenses back to water — releasing all its stored energy at once, evenly, into the cells immediately around it. The treated cells die, and over the following weeks the immune system resorbs them. The prostate shrinks, and the channel opens.
The elegance is in what doesn't happen. The prostate is enclosed in a firm fibrous capsule, and the steam cannot cross it. The nerves responsible for erections run outside that capsule, as does the sphincter responsible for continence. They are never in the field of treatment — which is the anatomical reason Rezūm preserves sexual function where cutting operations often do not.
Performed under a local anaesthetic with sedation, avoiding the cardiovascular and respiratory risks of a general — which matters if you have other medical problems.
Five-year trial data show no new erectile dysfunction, and dry orgasm in under 5% — against 75–90% after enucleation.
Roughly a 48% fall in symptom score and 44% improvement in flow, sustained across five years of follow-up.
Unlike some minimally invasive implants, steam can be directed into a protruding median lobe — a common reason other options are ruled out.
02 · Is it right for you
Rezūm is recommended by NICE and works best in moderately enlarged glands, roughly 30 to 80 mL. Beyond that size it becomes less reliable, and an enucleation is usually the better answer. The assessment measures your gland rather than guessing at it.
Every option below relieves obstruction. They differ in what they cost you, and the two currencies are ejaculation and durability.
| Procedure | Gland size | Anaesthetic | Dry orgasm | Retreatment |
|---|---|---|---|---|
| Rezūm | 30–80 mL | Local & sedation | Under 5% | ~4.4–8% at 5 yrs |
| Aquablation | 30–150 mL | General | Under 10% | ~1–4% at 5 yrs |
| HoLEP | Any size | Spinal & sedation | 75–90% | Under 2% at 10 yrs |
| Bipolar TURP | 30–80 mL | General / spinal | 65–75% | ~10–15% at 10 yrs |
What Rezūm costs you
Two things, and both are worth knowing before you choose it. Relief is not immediate — you go home with a catheter and improvement builds over weeks rather than arriving the day after surgery. And it is less durable than enucleation: roughly one man in fifteen to one in twelve needs a further procedure within five years, against fewer than one in fifty after HoLEP. If your priority is having one operation and never thinking about it again, HoLEP is the better fit. If preserving ejaculation matters more, Rezūm is.
Other options exist and are discussed at the assessment: Aquablation for larger glands where ejaculation still matters; UroLift, which uses implants rather than treating tissue but cannot be used where there is a median lobe; and TURP or HoLEP where durability is the priority.
03 · On the day
04 · Recovery
This is the single most important thing to understand about Rezūm, and the reason men lose faith in it around week three. The steam kills tissue, the body inflames as it clears that tissue, and the symptoms flare before the channel opens. Expect it, and it stops being alarming.
The catheter stays in for three to seven days while the initial swelling settles — longer if your prostate was large or you were retaining urine beforehand. Drink two to three litres a day. Rest, no heavy lifting, no strenuous activity. The full catheter guide is in the next section.
Removed painlessly in clinic. You stay until you have passed urine and a bladder scan confirms you are emptying. Worth knowing in advance: between one in ten and one in four men do not manage it at the first attempt and need the catheter back for a few more days. That is a delay, not a failure, and it is commoner in men who started with a large gland or a high residual volume.
Symptoms often feel worse than before the procedure. Burning on passing urine, going frequently, sudden urgency, and blood in the urine or semen as treated tissue sloughs away. All expected. Two to three litres of water daily, avoid caffeine, alcohol and spicy food, and take simple painkillers regularly rather than waiting.
Most men notice a tangible change in flow from around two weeks, building steadily. The irritative symptoms settle over the same period.
Maximum benefit is usually reached at around three months, once the body has finished resorbing the treated tissue and the channel is fully open. This is the point at which the result is judged, not before.
Paracetamol regularly is usually enough. Anti-inflammatories help but can prolong bleeding, so take one only if your team has cleared it. Hydration is doing more work than any tablet: two to three litres a day keeps the urine dilute so that small clots do not form. Cut caffeine, alcohol, fizzy drinks and spicy food while the bladder is irritable, and avoid heavy lifting and cycling for the first few weeks.
05 · Managing your catheter
It is a soft flexible tube sitting in the bladder, held by a small internal balloon, draining continuously into a bag strapped to your thigh or calf under your trousers. Nobody will know it is there. Here is how to manage it.
Empty it when it is about half to three-quarters full. Letting it get heavy drags uncomfortably on the tube.
Warm water and soap, dried on a clean towel, before you touch the catheter or the bag. This is the single most effective thing you can do to avoid an infection.
Stand over the toilet, or sit on the edge of the seat, and bring the valve at the bottom of the bag over the bowl.
Flip or slide the tap at the bottom of the bag to open, and let it drain completely. Try not to touch the tip of the valve with your fingers or let it touch the toilet.
Make sure the tap is fully closed and locked, then dab the end of the valve with clean tissue so stray drops do not mark your clothes. Wash your hands again.
You will be given a larger night bag so you can sleep without getting up to empty the leg bag.
Bladder spasms and leaking around the tube
A sudden strong urge to pass urine, sometimes with a little urine escaping alongside the catheter, is common and usually just the bladder objecting to the tube. It is not a sign the catheter has failed and it does not mean it needs replacing. Keep drinking, and mention it at your appointment. If spasms are frequent and troublesome, medication can settle them.
06 · When to contact the clinic
Contact the clinic straight away, or go to your nearest A&E out of hours, if any of the following happens.
With the catheter in: if the bag has stayed empty for two to three hours and your lower abdomen feels painfully full, the tube may be blocked. Check first that it is not simply kinked under your clothing, then ring us.
After the catheter is out: being unable to pass urine at all is an emergency and needs to be dealt with the same day, not tomorrow.
Who to call
The clinical team will assess your symptoms and tell you what to do next.
Out of hours, or if you cannot pass urine at all, do not wait. Go to your nearest Accident and Emergency department and tell the staff you have recently had Rezūm water vapour therapy to the prostate. WhatsApp and email are not monitored out of hours.
07 · Questions
This is the reason most men choose Rezūm, and the evidence supports it. Five-year data from the pivotal randomised trial show no new erectile dysfunction — because the steam is contained within the capsule and the nerves that produce erections run outside it. Men who arrive with good erections keep them; men who arrive with difficulties are not made worse.
Ejaculation is preserved in the great majority. Dry orgasm occurs in under 5%, against 75–90% after enucleation. A small number of men notice a modest reduction in the volume of ejaculate. If preserving forward ejaculation is your priority, this is the procedure that does it.
Because the treatment works by causing controlled tissue death, and dying tissue swells before the body clears it. For a few days the prostate is temporarily bigger than it was when you walked in. Without a catheter a significant number of men would simply be unable to pass urine.
It is inconvenience rather than complication, it lasts three to seven days, and it is the price of an approach that does not cut anything.
Most men notice their stream improving from around two weeks, with the full benefit at approximately three months. Nothing about the result should be judged before then.
The awkward part is weeks two to four, when symptoms often feel worse than before treatment — burning, urgency, frequency and blood, as the treated tissue sloughs. This is the treatment working, not failing.
Possibly. Roughly 4.4% to 8% of men need a further procedure within five years — between one in twenty-two and one in twelve. That compares with under 2% at ten years after HoLEP.
That difference is the central trade-off. Rezūm protects your sexual function and asks less of you on the day; enucleation is more definitive and more likely to be a once-only operation. Neither answer is wrong, and which is right depends on what you are optimising for.
Rezūm performs best in glands of roughly 30 to 80 mL. Larger than that and durability falls away, and an enucleation usually serves you better. The assessment measures your prostate on ultrasound or MRI rather than estimating it, and also looks for a protruding middle lobe — which Rezūm can treat, but which rules out some alternatives.
Often yes, and you will be given a specific instruction at pre-assessment about whether and when to pause them. Do not stop anticoagulant or antiplatelet medication on your own initiative — the risk of stopping is sometimes greater than the risk of continuing, and that judgement is made case by case with your cardiologist where needed.
Yes. The National Institute for Health and Care Excellence has assessed Rezūm and recommends it for men with moderate to severe lower urinary tract symptoms and a moderately enlarged prostate, concluding that it relieves symptoms, improves quality of life, preserves sexual function, and is cost-saving compared with more invasive surgery.
Taking the next step
Symptom score, flow rate, residual volume, and the size and shape of your prostate — then a straight conversation about whether steam, waterjet, laser or resection fits what you want to protect. If Rezūm is not the right answer for your anatomy, I will tell you so.
WhatsApp is for appointments and practical questions. Please do not send clinical details or images through it.