Benign Prostatic Hyperplasia (BPH) is a common condition where the prostate gland enlarges. It can lead to bothersome urinary symptoms. By age 60, approximately 50% of men experience BPH signs, rising to about 90% by age 85. While BPH is not cancerous, it can cause issues such as frequent urination, a weak stream, or the sensation of incomplete bladder emptying. Modern, minimally invasive options like Rezum and Aquablation offer relief.
Understanding Rezum Therapy
Rezum therapy uses water vapor to reduce prostate size. It delivers sterile water vapor (steam) into prostate tissue. This transfers thermal energy, causing prostate cells to die and shrink, which opens the urethra and improves urine flow.
A handheld device is inserted through the urethra. Radiofrequency energy creates steam, injected into targeted areas in nine-second treatments. The number of treatments depends on prostate size and shape. Patients typically receive local anesthesia or sedation, and the procedure is often outpatient.
A catheter is usually needed for 3 to 7 days following Rezum to aid urination during initial healing. Temporary side effects like urinary frequency, urgency, or discomfort may occur. Most patients see symptom improvement within two weeks, with full benefits appearing around three months as the body naturally absorbs the treated tissue. This therapy is indicated for men aged 50 and older with a prostate volume between 30 cm³ and 80 cm³, and it can also treat hyperplasia of the central zone or a median lobe.
Understanding Aquablation Therapy
Aquablation therapy uses a high-velocity water jet for BPH. It precisely removes excess prostate tissue under robotic guidance. The system integrates real-time ultrasound imaging with a robotic handpiece to create a 3D map of the prostate.
Before tissue removal, a surgeon uses this map to outline specific areas for treatment, ensuring precise targeting and preservation of surrounding structures. A robotically controlled, heat-free water jet then ablates the designated tissue. The procedure typically takes less than an hour, performed under general or spinal anesthesia in a hospital setting, often involving an overnight stay.
After Aquablation, patients typically wake with a catheter, which may remain for 24 to 72 hours, though many are discharged without one after an overnight hospital stay. Common temporary side effects include blood in the urine, initial difficulty urinating due to swelling, and urinary urgency. Most patients experience rapid improvement in urine flow, with notable benefits often seen within the first few weeks. Aquablation is suitable for BPH symptoms across prostates of various sizes.
Comparing Rezum and Aquablation
Rezum and Aquablation offer distinct approaches to treating BPH. Rezum utilizes sterile water vapor to shrink prostate tissue through convective heat transfer, causing cell necrosis and absorption. Aquablation employs a high-velocity, heat-free water jet to precisely resect and remove prostate tissue under robotic guidance and real-time imaging.
Rezum can be performed under local anesthesia or oral sedation, suitable for an office or outpatient setting. Aquablation, a more involved surgical procedure, requires general or spinal anesthesia and is conducted in a hospital environment. Rezum treatments last only nine seconds each, while Aquablation procedures typically take less than an hour.
Both procedures are considered minimally invasive, accessing the prostate through the urethra without external incisions. Aquablation’s robotic precision and real-time imaging may offer enhanced control for tissue removal, particularly for larger or more complex prostates. While Rezum is indicated for prostate volumes between 30 cm³ and 80 cm³, Aquablation can be performed on prostates of any size and shape.
Recovery profiles differ. Following Rezum, a catheter is required for 3 to 7 days. Aquablation may involve an overnight hospital stay, with catheter removal often before discharge or within 24 to 72 hours. Symptom improvement for Rezum can take up to three months for maximum benefit, whereas Aquablation often provides rapid improvement in urine flow within the first fortnight.
Both therapies aim to preserve sexual function. Rezum has shown a low incidence of retrograde ejaculation, with erections generally not affected. Aquablation is also designed to avoid structures that control ejaculatory and erectile function, reporting low rates of irreversible complications related to sexual dysfunction. Common temporary side effects for both include urinary irritation, blood in urine, and discomfort, usually resolving as healing progresses.
Making an Informed Choice
Deciding on the most suitable BPH treatment involves individual circumstances, as the “better” procedure is personal. Factors like prostate anatomy, urinary symptom severity, and overall health play a role in this decision. Patients should also consider their preferences regarding anesthesia type and recovery expectations.
Sexual function preservation is another consideration that should be discussed. Given the nuances of each procedure and patient needs, consulting a urologist is a necessary step. A healthcare professional can assess these factors and help determine the most appropriate treatment plan.