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Rezūm — Water Vapor Thermal Therapy (WVTT) for BPH

Rezūm (Boston Scientific) is a minimally invasive water vapor thermal therapy that uses radiofrequency-generated steam to ablate obstructive prostatic transition-zone tissue in men with LUTS secondary to BPH. It provides durable symptom relief through 5 years with preservation of sexual function and a low surgical-retreatment rate (~ 4–5%).[1][2] For positioning vs other minimally invasive surgical therapies (MISTs) and TURP / HoLEP, see BPH & Male LUTS — chooser.

Mechanism of action​

Radiofrequency energy heats sterile water into vapor (~ 103 °C), delivered via a retractable needle through a transurethral handpiece. Each injection lasts ~ 9 seconds and delivers ~ 208 calories of convective thermal energy into the transition zone.[3] The vapor disperses through tissue interstitial spaces and releases stored thermal energy on contact, inducing apoptosis and necrosis of hyperplastic tissue. Thermal effects remain confined to the prostate, sparing the urethra, bladder neck, and external sphincter.[3] Necrotic tissue is reabsorbed over weeks, reducing prostatic volume by ~ 40% at 1 year.[3]

Procedure details​

  • Setting: office-based or ambulatory outpatient; can be performed under local anesthesia, oral sedation, or conscious sedation.[4][5]
  • Position: dorsal lithotomy.
  • Technique: cystoscopic confirmation of prostate contours; treatment needle positioned ~ 1 cm distal to the bladder neck, with injections delivered every 1 cm toward the verumontanum. Number of injections per lobe is determined by prostatic urethral length (mean ~ 11; range 4–28).[3][6]
  • Median lobe: can be treated per physician discretion.[1]
  • Procedure time: mean ~ 5–10 min.[6][7]
  • Post-procedure catheterization: typically required for a mean of 7–10 days.[6][7]
  • Pain under local anesthesia: mean VAS 3.5 / 10, with high patient satisfaction.[5]

Patient selection and indications​

  • FDA-cleared for prostate volumes 30–80 mL; real-world data support efficacy across a broader range (20–160 mL).[6][8]
  • Moderate-to-severe LUTS (IPSS ≥ 13, Qmax ≤ 15 mL/s) refractory to or intolerant of medical therapy.[1][4]
  • Applicable to lateral lobes and median lobe obstruction.[1][9]
  • Particularly attractive for men who wish to preserve sexual function (erectile and ejaculatory).[2][10]
  • May also be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue BPH medications.[11]
  • Patients with diabetes may have attenuated IPSS improvement.[12]

Clinical efficacy​

The pivotal multicenter RCT (n = 197, sham-controlled) and its 5-year follow-up demonstrated:

OutcomeAt 3 monthsAt 5 years
IPSS reduction~ 50%48%
Quality of life (QoL)~ 50%45%
Peak flow rate (Qmax)+6.2 mL/s44% improvement
BPH Impact Index~ 50%48%
Prostate volume reduction—~ 40%
Surgical retreatment rate—4.4%

References for table: Final 5-yr trial[1]; 3-yr[13]; 2-yr durability[9].

Real-world registries confirm pivotal data. A large Canadian prospective registry (n = 229, including 83 with prostates ≥ 80 mL) showed IPSS improvement of 59% and Qmax improvement of 74% at 12 months.[6] Symptom improvement is significant across all volume tertiles; medium and large glands may improve more quickly than small glands.[12]

At 12 months, 66–88% of patients are able to discontinue BPH medications.[11]

Safety profile​

Most adverse events are transient and mild (Clavien-Dindo Grade I–II):[3][14]

  • Gross hematuria — most common AE (59–80% in real-world data; typically self-limited).[8][11]
  • Dysuria ~ 21–23%.[3][15]
  • Urinary urgency ~ 20%.[3]
  • Urinary retention (requiring catheterization) ~ 19–34%.[3][15]
  • UTI ~ 20%.[3]
  • No de novo erectile dysfunction through 5 years in the pivotal RCT.[1]
  • Ejaculatory function preserved in most patients; anejaculation rate ~ 3%.[16]
  • No Clavien-Dindo Grade ≥ III events in the Canadian registry.[6]

Sexual function preservation​

A key differentiator. The pivotal RCT reported no device- or procedure-related sexual dysfunction and no sustained de novo erectile dysfunction through 5 years.[1] The Italian multicenter cohort actually showed a slight but statistically significant improvement in IIEF-5 at 6 months, likely attributable to alpha-blocker discontinuation.[7] This profile sets Rezūm apart from TURP, which carries retrograde-ejaculation rates of 65–75%.

Comparison with other treatments​

A European Urology network meta-analysis of 63 RCTs found:[17]

  • WVTT (Rezūm), PUL (UroLift), and PAE provide symptom and QoL improvements similar to TURP at short-term follow-up.
  • TURP provides the greatest improvement in objective flow rate.
  • Ejaculatory function favors WVTT and PUL over TURP.
  • No significant difference in urinary domain scores between UroLift and Rezūm at 24 months.[18]

A real-world head-to-head comparison of Rezūm vs UroLift (307 vs 110 patients) showed similar medium-term efficacy in AUA-SS, Qmax, and medication reduction. Rezūm had higher rates of postoperative dysuria (22.8% vs 8.3%) and non-clot retention (18.9% vs 7.3%); UroLift had higher clot retention (7.3% vs 2.6%).[15]

Durability and retreatment​

Five-year data from the pivotal RCT show a surgical retreatment rate of only 4.4%.[1] This compares favorably with UroLift, which has reported retreatment rates of ~ 13–14% at 5 years in some series. The Cochrane review noted that long-term comparative data remain limited and most MIST follow-up is primarily within 24 months.[16][19]

Advantages and limitations​

Advantages

  • Office-based, can be performed under local anesthesia
  • Short procedure time (~ 5–10 min)
  • Preserves erectile and ejaculatory function
  • Treats lateral lobes and median lobe
  • Durable 5-year outcomes with low retreatment rates
  • Allows BPH-medication discontinuation in most patients

Limitations

  • Post-procedure catheterization required (~ 7–10 days)
  • Transient irritative symptoms common in the early postoperative period
  • Less improvement in objective flow rate compared with TURP[17]
  • Most robust evidence limited to prostates 30–80 mL (though expanding)
  • Onset of maximal benefit takes ~ 3 months (not immediate)

See Also​

References​

1. McVary KT, Gittelman MC, Goldberg KA, et al. Final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2021;206(3):715–724. doi:10.1097/JU.0000000000001778

2. Kaltsas A, Giannakodimos I, Symeonidis EN, et al. To Rezūm or not to Rezūm: a narrative review of water vapor thermal therapy for benign prostatic hyperplasia. J Clin Med. 2025;14(12):4254. doi:10.3390/jcm14124254

3. Franco JV, Jung JH, Imamura M, et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database Syst Rev. 2021;7:CD013656. doi:10.1002/14651858.CD013656.pub2

4. McVary KT, Gange SN, Gittelman MC, 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):1529–1538. doi:10.1016/j.juro.2015.10.181

5. Burns R, Dreyer B, Khadhouri S, Al Jaafari F. Rezum: analysis of the tolerability and complications of the procedure performed under local anaesthetic. J Clin Med. 2026;15(7):2560. doi:10.3390/jcm15072560

6. Elterman D, Bhojani N, Vannabouathong C, Chughtai B, Zorn KC. Large, multi-center, prospective registry of Rezūm water vapor therapy for benign prostatic hyperplasia. Urology. 2022;165:261–267. doi:10.1016/j.urology.2022.02.001

7. Siena G, Cindolo L, Ferrari G, et al. Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study. World J Urol. 2021;39(10):3875–3880. doi:10.1007/s00345-021-03642-4

8. Ines M, Babar M, Singh S, Iqbal N, Ciatto M. Real-world evidence with the Rezūm system: a retrospective study and comparative analysis on the efficacy and safety of 12-month outcomes across a broad range of prostate volumes. Prostate. 2021;81(13):956–970. doi:10.1002/pros.24191

9. Roehrborn CG, Gange SN, Gittelman MC, et al. Convective thermal therapy: durable 2-year results of randomized controlled and prospective crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. J Urol. 2017;197(6):1507–1516. doi:10.1016/j.juro.2016.12.045

10. Nguyen DD, Li T, Ferreira R, et al. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: a review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis. 2024;27(1):22–28. doi:10.1038/s41391-023-00669-z

11. Babar M, Loloi J, Tang K, et al. Rezum water vapor therapy for patients with mild, moderate, or severe lower urinary tract symptoms: a retrospective study in a multiethnic population. Prostate. 2023;83(7):713–721. doi:10.1002/pros.24508

12. Lewer O, Felice MD, Copelan O, et al. Prostate size and its effect on lower urinary tract symptoms / benign prostatic hyperplasia improvement after convective water vapor thermal therapy. J Urol. 2025;214(1):48–57. doi:10.1097/JU.0000000000004516

13. McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezūm system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018;111:1–9. doi:10.1016/j.urology.2017.10.023

14. Kang TW, Jung JH, Hwang EC, et al. Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2020;3:CD013251. doi:10.1002/14651858.CD013251.pub2

15. Chin CP, Garden EB, Ravivarapu KT, et al. Medium-term real-world outcomes of minimally invasive surgical therapies for benign prostatic hyperplasia: water vapor thermal therapy (Rezum) vs prostatic urethral lift (UroLift) in a high-volume urban academic center. J Endourol. 2022;36(12):1559–1566. doi:10.1089/end.2022.0385

16. Franco A, Ditonno F, Manfredi C, et al. Systematic review and pooled analysis of functional and sexual outcomes of minimally invasive surgical treatments for benign prostatic obstruction. Eur Urol. 2026;89(4):318–331. doi:10.1016/j.eururo.2025.09.004

17. Cornu JN, Zantek P, Burtt G, et al. Minimally invasive treatments for benign prostatic obstruction: a systematic review and network meta-analysis. Eur Urol. 2023;83(6):534–547. doi:10.1016/j.eururo.2023.02.028

18. Tanneru K, Jazayeri SB, Alam MU, et al. An indirect comparison of newer minimally invasive treatments for benign prostatic hyperplasia: a network meta-analysis model. J Endourol. 2021;35(4):409–416. doi:10.1089/end.2020.0739

19. Franco JVA, Jung JH, Imamura M, et al. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int. 2022;130(2):142–156. doi:10.1111/bju.15653