Sensation of not emptying the bladder properly, weak and jerky flow, more frequent cravings… Characteristic signs of benign prostatic hyperplasia (BPH). Also called prostate adenoma or benign prostatic hyperplasia, this non-cancerous condition is caused by an overgrowth of cells.
As a reminder, the prostate is a gland of the male genitalia. It produces a fluid that serves to keep sperm alive and helps them exit the body during ejaculation. “But as they age, some men see their prostate become larger and this hinders the emission of urine. Depending on the severity of the symptoms, BPH can affect the quality of life or even cause a drop in strength during ejaculation. informs Dr. Hervé Quintens, head of the urology department of the CHPG of Monaco.
The risk of suffering from BPH increases with age: after the age of 60, around 60% of men have it… and this figure rises to 90% after the age of 85.
Until recently, there were only two treatment options: medication or surgery. In recent years, an alternative has emerged: Rezum steam. Developed in the United States and in the Nordic countries five years ago, this method has been offered at the CHPG of Monaco (1) for a year. Update on how it works.
What is the principle of Rezum vapor?
The Rezum system turns sterile water into thermal energy – in the form of steam – to destroy prostate tissue. It consists of a radiofrequency generator (which looks like a small pistol) allowing injections of water vapor (103°C) to be administered by endoscopic route. “The steam condensation process results in immediate necrosis.” says Dr. Quintens. Urine can flow freely again.
Who is he talking to?
For the moment, the Rezum method is aimed at men who do not have too large a prostate volume. “Because the intervention takes place under local anesthesia. A prostate that is too big requires injecting a lot of water vapor and this could be painful for the patient.”
Rezum vapor may be for men who have side effects (such as erectile dysfunction) or little effectiveness with drug treatments. It may also be indicated in patients who do not wish to have surgery.
“In consultation, I receive many men who have prostate problems but who do not want to have surgery, observes Carol Burté, andrologist and sexologist and member of the urology team at the CHPG of Monaco.
“Indeed, the high risk of sexual disorders associated with surgery can represent a real blockage. It’s not just a question of fertility and procreation, but also of body image.”
How is the intervention carried out?
At the CHPG, the project is co-constructed with the patient. “That is to say that upstream, he will have an important time of exchange with a nurse who will coordinate his course. On D-day, the patient returns to the hospitalization department one hour before the treatment and stays for less than 24 hours.
The intervention is not carried out in an operating room, but in a room called Room ISO7, on a technical consultation platform. In addition to local anesthesia, the patient can opt for the hypnosis method.
Performed by a urologist, the Rezum treatment lasts approximately 10 minutes. The patient leaves the next day with a urinary catheter which he will keep for four days. Then he can resume his usual activities.
What are the advantages?
The most important benefits are clearly the ease of performance (outpatient procedure without the need for general anesthesia), but above all the preservation of erection and ejaculation, unlike surgery and medication, two treatments that can lead to sexual disorders.
What are the disadvantages?
Improvement is more gradual with Rezum than with surgery. “We do not have enough hindsight, but the result may not be definitive and an additional session may be considered”completes Dr. Quintens.
What conclusions do you draw from this method?
Since the arrival of this technique at the CHPG of Monaco, 28 patients have already benefited from Rezum. “We had very positive feedback on the care and the course, but especially on the quality of life of the patients, which has improved significantly”observes Dr. Hervé Quintens.
Today, the CHPG’s urology department wants to invest in research by conducting a study on the benefits of Rezum vapor. “And why not help other establishments to develop – too – this treatment.”
>> 1. In the Paca region, it is also offered at the Aix hospital, by Dr Marc Fourmarier.
