Rezum water vapour therapy for benign prostatic hyperplasia

摘要

A new minimally invasive technique for managing benign prostatic hyperplasia provides real choice for patients. Here the authors describe the technique and discuss how it compares to the other established management options. The use of ablation techniques in medicine is not a new phenomenon. The targeted destruction of tissue in the absence of cutting has been used primarily in cardiology but also in dermatology, gynaecology and neurosurgery for decades. In urology, ablation techniques are increasingly used to destroy areas of prostate cancer using energy sources such as cryoablation and high-intensity focused ultrasound. In the treatment of benign prostatic hyperplasia (BPH) tissue, techniques such as transurethral needle ablation (TUNA) of the prostate and laser prostate ablation have been evaluated and trialed since the 1990s. However, issues relating to high retreatment rates and irritative symptoms in the early postoperative period have led to a decline in the use of these techniques. The injection of water vapour with the Rezum delivery system uses radiofrequency energy to heat up water droplets to 103 degrees Celsius. The delivered steam destroys the prostate tissue but does this by convective rather than conductive heating (common to previous interstitial treatments such as TUNA). Water vapour is uniformly dispersed at low pressure into the zone of the prostate into which it is injected, thereby destroying a predictable volume of tissue.