Benign prostatic hyperplasia or benign enlargement of the prostate gland is a very common condition
affecting 50% of men over the age of 50. So, a large proportion of men will have symptoms
due to this condition. They can be very mild or they can be more troublesome and require treatment.
So, it's an extremely common condition of the ageing male. It's like developing arthritis,
and what happens is that our prostate glands grow as we get older and that's stimulated
by a hormone called testosterone. So, it's part of ageing that the prostate gland enlarges
or becomes hyperplastic, and then it can then press or kink or narrow
the urethra or water pipe where it runs through the prostate gland.
The symptoms of prostatic enlargement or benign prostatic hyperplasia are varied,
but typically they wax and wane. So, you can have a good
day or bad day or a good week or a bad week and they're typically going to the loo more
frequently, getting up more often at night. One may notice that the flow is slower than
it had been previously, or it can be intermittent or difficult starting the flow.
Sometimes the bladder can become irritable as a result of the obstruction and then there is a need
to rush to the loo and we have urinary urgency, and this essentially can cause disruption
not just with night-time sleeping but also with daytime activities and it can make car
journeys difficult, it can make going to meetings difficult, so, it has a knock-on effect in
terms of our quality of life and day-to-day activities and it can be quite significant – particularly as we get older.
So traditionally we've had medications and bigger operations.
Rezum is a minimally-invasive therapy which involves passing an instrument
up through the urethra or water pipe, and when we get to the prostate gland just short
of the bladder, we make little injections of steam into the prostate gland and that
would be anything between 4 or 5 up to 15 injections of steam. It's very quick to perform,
taking 15-20 minutes and it can be carried out under local anaesthetic with sedation
or a short general anaesthetic. What is happening when we inject the steam is we are literally
heating up a water droplet up to 103 degrees Celsius and injecting it into the prostate gland
– into the benign enlarged prostate tissue component of the prostate gland, which
is pressing on the urethra or kinking the urethra and affecting the urine flow.
Each little injection of steam destroys or kills or ablates an area of prostate tissue about
one and a half centimetres in diameter and we work our way around the prostate gland
and destroy about 45% of the volume of this enlarged prostate tissue, and what's good
about it is that we're not leaving anything behind. Once we've injected the steam, the
healthy tissue dies immediately, and then our own body develops a reaction to that and
heals it and the dead tissue shrinks and disappears and the swelling settles down and that takes
the pressure off the water pipe and improves the symptoms steadily over the two or three
months that follow the intervention.
So before having the procedure, it's important, of course, that we do a number of tests.
We'll make sure that there isn't any evidence of prostate cancer, we'll do a urine test and
have an understanding of the size of the prostate gland and a flow test. So, we just need to
be sure that there is an obstruction and to know what sort of size the prostate gland is.
Typically we would treat men with a gland
volume ranging from between 30-100 ml in volume, but we have treated some men with prostates
slightly bigger than that, and of course we'd run through all the issues that might be helpful
in terms of the post-operative recovery and try and sort of manage each individual's expectations,
because no two patients are the same and so we would talk through various issues before
the intervention. Afterwards, typically, men are discharged
home the same day. 1-2% might need to stay overnight but the vast majority of men go
home the same day with a little catheter or tube that enables urine to drain from the bladder.
Normally there is a little tap on the end of the tube, a little valve that,
so that when your bladder is full you open the tap and urine drains out and you would
go home with that for a few days and normally returning after the weekend to have it removed.
Once the catheter has been removed, slowly but surely, the urinary symptoms improve.
It can take a few weeks for those symptoms to settle down and to really start to see
an advantage, because we're relying on the body's natural healing properties to shrink
and remove that dead tissue so that the prostate becomes smaller and takes the pressure off
the water pipe or urethra, and so it's usually at about week three that we start to see a
real sort of improvement in the urinary symptoms and that continues for two or three months,
and we can see benefit sometimes for up to six months after the procedure. From the American
data, the proportion of men needing to go back onto medication or having another surgical
intervention is very low, with I think about 8% of men by four years needing either to
go back on medication in about half of them (about 4%) or having another surgical intervention
in the other 4%, and I would anticipate, though I can't say this with certainty because we
don't have longer follow-up data, that around about 10% (maybe slightly more) of men might
need another intervention within a decade of the procedure. But the advantages are that
the treatment is of course very unlikely to cause any harm and therefore is an attractive
option, particularly I think to men in their 50s and 60s.
So, the benefits of Rezum, which is one of the minimally invasive therapies, over the traditional surgical options
are that it can be performed as a day case and potentially under local anaesthetic with sedation, but
more importantly, I think it's about the favourable side effect profile. So, it is less likely
to upset sexual function. So, it's less likely to damage the erection quality after the procedure.
In fact, it's extremely unlikely to do that and it's also very unlikely that it will upset
ejaculation after the procedure. And I think the other issue that men are particularly
concerned about is the concern that they may leak urine or lose urinary control after the
procedure and that is something that just doesn't happen after Rezum.