Rezum Treatment for BPH - Dr. Dean Elterman

Technique description:

• Minimally Invasive treatment for BPH
• Water steam generated by radiofrequency
• Transmitted via convection throughout the targeted zone of the prostate over 9 seconds
• Targeted, controlled dose of thermal energy (steam) causes instant cell death and an ablation field
• Overlapping ablation zones open up the obstructing prostate tissue over the subsequent 3 months

Procedure Steps:

• 1. Baseline history, physical, cystoscopy, prostate volume assessment by imaging as preparation before day of treatment
• 2. Prepare and prime hand-piece. Small amount of lubrication
• 3. Gentle, atraumatic insertion of the hand-piece
• 4. Assess prostate length and presence of median lobe while entering
• 5. Begin 1cm back from bladder neck (2 fields of view) for first injection
• 6. Continue moving back 1cm at a time (2 fields of view) targeting the bulkiest part of the lateral lobe
• 7. Stop at apical tissue/verumontanum
• 8. Repeat steps 5 & 6 on contralateral lobe
• 9. If median lobe or central zone hypertrophy, treat 1cm back from crest of the lobe. Multiple steam injections may be required
• 10. Remove scope and insert Foley catheter

Learning Points:

• Know prostate volume ahead of time
• Be gentle when Inserting the hand-piece to avoid trauma
• Start 1cm back from bladder neck and inject laterally in 1cm (2 field of view) Increments
• Inject steam into the bulkiest part of the prostate, waiting 2 additional seconds (after the 9 second dose of steam) before retracting the needle
• Treat both lateral lobes followed by treating the median lobe or central zone as required

Clinical History:

• Case1: 67M, BPH 20 yrs, Prostate Volume 50 cc, IPSS 23/4, Qmax 8ml/sec, PVR 43mL, Meds: Doxazosin and Dutasteride
• Case 2: 63M, Prostate Volume 64cc, Urinary retention
• Case 3: 51M, Prostate Volume 49cc, IPSS 24/5, Qmax 3ml/sec, PVR 156mL, Meds tamsulosin
• Case 4: 67M, Prostate Volume 59cc, IPSS 24/4, Qmax 6mL/sec, PVR 59mL, Meds Silodosin