Rezum treatment for the enlarged prostate

What does the procedure involve?

This minimally invasive treatment system opens the blocked urethra by injecting steam into the prostate via a small telescopic device through the penis. The steam causes shrinkage of prostatic tissue over time with the aim of improving the flow of urine. The improvement in flow is gradual over time as the tissue is re-absorbed.

What are the alternatives to this procedure?

Use of a catheter, monitoring of symptoms, lifestyle advice, medication, Urolift (staples to open the prostate), surgery to open the prostatic channel by for example transurethral resection of the prostate (telescopic procedure) or laser surgery (telescopic procedure) or open prostatic surgery. Other alternative may be prostatic artery embolization which is insertion of beads to block the blood supply to the prostate.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. You might receive an appointment for pre-assessment, to assess your general fitness and to perform some initial investigations. After admission, you will be seen by members of the medical team including the consultant, the anaesthetist and your named nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for Warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran, apixaban, edoxaban, ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)

What happens during the procedure?

A fine telescope-like instrument is inserted into your urethra. This device enables the surgeon to deploy a small needle and inject steam into the prostatic tissue. The heat created outside the body is delivered into the prostate tissue through a tiny needle with emitter holes to remove the targeted obstructive prostate tissue. This leads to shrinkage of tissue over a few weeks. The procedure takes approximately three to seven minutes and can be performed in a day surgery setting. A small catheter (plastic tube) is inserted to drain the bladder during the procedure.

Throughout the insertion of the device and during the treatment saline (salty water) is running to help ensure better views and to prevent the urethra from overheating.

The operation is either performed under a general anaesthetic (so you will be asleep for the entire procedure) or under sedation (which means you will feel pleasantly drowsy) Typically, you will go home on the same day as the surgery. You will need someone to take you home after surgery.

What happens immediately after the procedure?

You will be discharged with a catheter (temporary tube to drain the urine from bladder) which will be removed after between five and seven days. This can be on a leg bag or tap at the end of the catheter with no bag. The catheter can be tucked away in your underwear. You will be advised where catheter is likely to be removed at the time of discharge.

During the three to five days after your procedure, you may have some blood in your urine or around the catheter. You may have stinging in the urethra (water pipe). This is normal and should clear after a few days. Sensitivity in the penis due to the operation can last a few weeks, and usually settles after healing is complete.

If you have some discomfort following the operation or from the catheter, over-the-counter pain killers like paracetamol are generally quite sufficient. You will be prescribed antibiotics to prevent urinary infection.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than 1 in 10)

• Blood in the urine (usually temporary with resolution usually in days)

Occasional (between 1 in 10 and 1 in 50)

• Frequency and urgency to pass urine (usually temporary with resolution usually in days)
• Temporary pelvic discomfort or pain
• Urinary tract infection
• Continuing enlargement of the prostate and need for further prostate surgery
• Failure to resolve symptoms (due to continuing blockage or a bladder problem). Over 95 in 100 patient have a good response to treatment with improvements in their symptoms
• Reduced volume of ejaculation (known as retrograde ejaculation) happens in 5 to 10 people out of 100

Rare (less than 1 in 50)

• Prolonged retention

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. You can safely undertake light exercise after the operation, but you must avoid heavy lifting, straining, long journeys and sexual activity in the first month. You should maintain a good fluid intake of 1.5 to 2 litres a day, drink steadily throughout the day, and avoid taking too much tea, coffee, fizzy drink and alcohol as these may irritate your bladder. You should pass urine according to how you feel the need to do so. You might need to have up to two weeks off work, although the average return to normal activity is five days. It is sensible to avoid driving in this period. It is common to have less control passing urine for a short time after surgery.

What else should I look out for?

After you have had prostate surgery, contact your GP (general practitioner) or the ward if you have any problems such as pain, bleeding or symptoms of urinary infection or feeling generally unwell. If severe, please go to your nearest accident and emergency department.

Privacy & Dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

Signature……………………………….……………Date…………….………………….