Rezūm in one honest paragraph
Rezūm (also called water-vapour therapy) treats an enlarged prostate with steam. A handful of brief steam injections are placed into the overgrown tissue; that tissue is then reabsorbed by the body over the following weeks, so the prostate shrinks and the channel opens up. Its appeal is that it's done in the clinic under local anaesthetic — no operating theatre, no spinal or general anaesthetic — and it preserves sexual function, including ejaculation. The honest trade-offs are about time and patience: the result is gradual rather than immediate, you'll usually need a catheter for several days while the treated prostate settles, and there can be an early spell of burning and urgency before things improve. In return, the longer-term durability is good and the chance of needing another procedure is low. It suits men with small-to-moderate prostates who want to avoid surgery, protect their sexual function, and are willing to wait a few weeks for the benefit to arrive.
Quick navigation
What Rezūm is
Rezūm uses the natural energy stored in water vapour. A slim device is passed along the urinary passage — there's no external cut — and a small needle delivers a few seconds of sterile steam directly into the bulky parts of the prostate. The steam spreads evenly through that pocket of tissue and gently kills the cells there. Over the next few weeks, the body clears away the treated tissue, the prostate shrinks back, and the pressure on the urine channel eases. Each steam injection takes only around nine seconds, and several are placed depending on the size and shape of the gland — including into a middle (median) lobe if you have one. Because the effect relies on the body slowly reabsorbing tissue, the benefit appears gradually rather than on the day.
Who is a good candidate
Rezūm is commonly considered when:
- Symptoms are bothersome but you'd prefer to avoid an operation and a general or spinal anaesthetic
- Preserving ejaculation and erections is a priority — Rezūm has a very low rate of sexual side effects
- Medicines aren't working well, cause side effects, or you'd rather not take them long-term
- The prostate is small to moderate in size — the procedure was studied mainly in glands of about 30–80 cc, though larger glands and middle lobes can also be treated
- You're comfortable trading a fast result for a gentler, office-based treatment
- You're on blood thinners that are awkward to stop, as Rezūm involves little bleeding and these often don't need pausing
When it is less suitable:
It is generally not the best fit if you need the largest, most immediate opening of the channel, if the prostate is very large, or if there are issues such as bladder stones or significant retained urine that are better handled by removing tissue.
Related page
When Rezūm is often preferred
Like UroLift, Rezūm trades a little flow improvement for a gentler experience and preserved sexual function — but the two get there differently, and that difference is the main reason to choose one over the other. Rezūm is often the better fit when: • Keeping normal ejaculation matters to you — retrograde ("dry") ejaculation occurs in only around 2–4% of men, versus 50–75% after TURP • You'd prefer a clinic-based treatment under local anaesthetic, without an operating theatre • You want to come off, or avoid starting, daily BPH medication • You have a middle (median) lobe — steam can be directed into it, which some other light treatments handle less well • A low chance of needing a repeat procedure matters, and you're willing to wait weeks for the benefit — re-treatment is low (roughly 1 in 14 over three years, and as low as about 1 in 20 over four years in the original trial) It's only fair to be clear about the flip side: Rezūm asks for patience. The prostate is briefly swollen by the steam before it shrinks, so a catheter is needed for several days, the full benefit takes up to three months to arrive, and there's often an early phase of burning and urgency. For a man who wants relief within days, or the biggest possible improvement in flow, TURP or laser surgery is more dependable. Choosing Rezūm doesn't close any doors, though — TURP, laser, or a repeat treatment all remain possible later.
Pre-procedure evaluation (the tests that actually change the decision)
1. Urine test (and culture)
rules out infection and checks for blood in the urine. An active infection is treated first.
2. Ultrasound (KUB) with post-void residual
measures how much urine is left after voiding, estimates prostate size, and checks the kidneys. For Rezūm, size and shape matter: the gland should ideally be in the small-to-moderate range, and the presence and size of a middle lobe is checked, as it influences how the steam can be planned to treat it.
3. Symptom scoring and bladder diary
an IPSS questionnaire plus a frequency-volume chart, giving an objective baseline to measure improvement against. Because Rezūm works gradually, this baseline is what later visits are compared to. How much preserving ejaculation matters to you is discussed here.
4. PSA and digital rectal exam, read in context
to interpret the prostate and decide whether anything needs ruling out first. PSA is not a standalone cancer test.
5. Flow rate and selected studies
uroflowmetry, and in some cases a cystoscopy to confirm the prostate's shape is suitable for steam treatment.
6. A brief fitness and medication review
Rezūm is light on the body and usually done under local anaesthetic, but your general health and any blood thinners are still reviewed; these often don't need to be stopped.
Consent and Questions
You'll also go through consent — what the procedure involves, the realistic (gradual) benefit, and the common short-term effects — and have the chance to ask questions beforehand.
What happens during Rezūm
There is no external cut, and the whole procedure is done through the natural urinary passage, usually in a clinic room rather than an operating theatre. • Anaesthesia. A local anaesthetic block numbs the prostate; many men also take a mild oral sedative or anti-anxiety tablet beforehand. A general anaesthetic is usually not needed. • Access. A slim device is passed along the urethra to the prostate. No incision is made on the body. • Steam injections. A fine needle delivers a few seconds of steam into each bulky area of the prostate. Several injections are placed — the number depends on the size and shape of the gland — including into a middle lobe where present. • Quick treatment. Each injection lasts only around nine seconds, and the active treatment is brief; the whole appointment is typically about 15 to 30 minutes. • Catheter placed. Because the steam makes the prostate swell at first, a catheter is fitted at the end to keep urine draining while that early swelling settles. You can usually go home shortly afterwards, with the catheter in place for the next few days.
Catheter and recovery
Expect a catheter for roughly three to seven days (often around five) while the initial swelling goes down; once it's removed, the large majority of men pass urine normally. It's normal to have some burning, urgency, frequency, and a little blood — and occasionally tiny fragments of treated tissue — in the urine for the first few weeks. These are part of normal healing and usually settle. Drinking plenty of fluids helps. Many men are back to light activity within a few days, but it's wise to avoid heavy lifting and straining for a few weeks to limit bleeding, and you'll usually be advised to hold off on ejaculation for a short period, as it can trigger bleeding while the prostate heals. Most men can stop their BPH medication around a month after the procedure, once the benefit is established. A follow-up visit is normally arranged at two to three weeks.
Expected benefits and timeline
Early (first couple of weeks)
This is the patient part. The prostate is still settling, so symptoms may not improve straight away — and can briefly feel worse — before the tissue begins to shrink.
Around one month
Many men start to notice a stronger stream and less urgency and frequency as the treated tissue is reabsorbed.
By about three months
The improvement reaches its stride — better flow, more complete emptying, and fewer night-time trips — and continues to firm up to around six months. Night-time frequency can be the slowest symptom to settle, because the bladder takes time to recover from years of working against obstruction.
Over the longer term
Symptom relief has been shown to hold steady through four years, with sexual function preserved throughout. The flow improvement is genuine but more modest than tissue-removing surgery; Rezūm's value is in avoiding surgery and an anaesthetic while keeping ejaculation intact.
Risks and side effects
• Early irritative symptoms — burning, urgency, frequency, and some blood in the urine in roughly 1 in 6 men, usually in the first few weeks and usually settling on their own. • The catheter period — a catheter is needed for several days; a small number of men need it a little longer if voiding is slow to return. • Passing small tissue fragments — occasionally bits of treated prostate appear in the urine as it clears; this is expected, not alarming. • Urinary infection — uncommon; treated with antibiotics. • Temporary worsening before improvement — because the prostate swells first, symptoms can dip before they get better. • Sexual side effects — uncommon: retrograde ("dry") ejaculation in about 2–4%, and little to no new erectile dysfunction. • Re-treatment — a minority need a further procedure over the following years (see below). Seek urgent help if: you can't pass urine, you have heavy bleeding or clots, or you develop a fever or chills (a temperature above about 38 °C / 101 °F).
How Rezūm compares to UroLift, PAE, TURP, and HoLEP/ThuLEP
UroLift
Tiny implants hold the prostate open; no tissue cut, heated, or removed. Local anaesthesia, usually no catheter, day case, and a return to normal within days. Uniquely, it preserves ejaculation and erections. Trade-offs: the flow improvement is the most modest of this group, early burning and bleeding are common but short-lived, and roughly 1 in 7 to 1 in 8 men need a further procedure within five years. Best for small-to-moderate prostates where preserving sexual function is the priority.
Rezūm
The other ejaculation-sparing, minimally invasive option, using steam to destroy tissue that the body reabsorbs. Two honest differences from UroLift weigh against it for many men: relief is gradual, over weeks to months rather than within days, and a catheter is usually needed for several days while the treated prostate swells — often with an early phase where symptoms feel worse before they improve. In its favour, its re-treatment rate (~7% at 3 years) is a little lower than UroLift's. Best for selected smaller prostates where avoiding implants is preferred.
PAE (Prostate Artery Embolization)
A minimally invasive option performed by an interventional radiologist (not a urologist) through the wrist artery. It preserves ejaculation and avoids a catheter, but improvement is gradual, flow gains are smaller, the evidence is weaker, and it has the highest re-treatment rate of this group (~15–20% at 3–5 years, roughly 1 in 5 to 1 in 7 men).
TURP
The long-standing benchmark. It removes tissue, so it delivers a larger, more durable improvement in flow and a low long-term re-treatment rate — but it usually means a spinal or general anaesthetic, a catheter, a couple of days in hospital, and a high chance of "dry" (retrograde) ejaculation. Best when the obstruction needs the most definitive relief.
HoLEP / ThuLEP
Laser enucleation that also removes tissue, with the most durable results of the group (re-treatment under 2% at 5 years) and the ability to treat very large prostates. Like TURP, it commonly causes retrograde ejaculation and needs anaesthesia and a catheter.
Comparison Summary
| Rezūm | UroLift | PAE | TURP | HoLEP/ThuLEP | |
|---|---|---|---|---|---|
| How it works | Shrinks (gradual) | Holds lobes open | Shrinks (gradual) | Removes tissue | Removes tissue |
| Anaesthesia | Local/sedation | Local ± sedation | Local | Spinal/general | Spinal/general |
| Catheter after | Yes (~3–7 days) | Usually no | Usually no | Yes (1–few days) | Yes (routine) |
| Speed of relief | Weeks-months | ~2 weeks | Weeks-months | Early (days) | Early (days) |
| Peak-flow gain | ~+6 mL/s | ~+4–6 mL/s | ~+4–6 mL/s | +10–12 mL/s | +12–15 mL/s |
| Early burning/irritation | ~16–17% | ~34% | ~10–15% | ~6% | Uncommon |
| Retrograde ejaculation | ~2–4% | 0% | 0% | 50-75% | 60-80% |
| Re-treatment | ~7% (3 yr) | ~14% (5 yr) | ~15–20% (3-5 yr) | ~5–10% (10 yr) | <2% (5 yr) |
FAQs
Talk to a doctor / plan your Rezūm
For a Rezūm decision review, share your ultrasound report (prostate size and shape — including any middle lobe — plus post-void residual), urine report, PSA history, symptom pattern, and current medications (especially blood thinners). We'll tell you plainly whether Rezūm fits, whether a different option (UroLift, TURP, HoLEP/ThuLEP, or PAE) would serve you better, what recovery timeline is realistic, and what follow-up protects your result.
Have questions about this procedure?
Speak to our specialists and get a free second opinion.
