Rezum is a minimally invasive treatment for benign prostatic hyperplasia (BPH, a non-cancerous enlargement of the prostate). It uses convective water vapour to treat the prostate tissue. I was certified in Rezum and Urolift, another minimally invasive technique for the enlarged prostate, and I have been offering both procedures to patients in the UAE.
My first Rezum case was in 2021. In July 2025 I performed my 21st case at NMC Al Ain. After more than twenty procedures, here is what I would tell anyone starting out.
Warn patients about the dip before the improvement
Expect symptoms to get worse for a while before the final improvement. Patients need to hear this in the pre-op conversation, not after their first post-op call in distress. Postoperative oedema (swelling of the treated tissue) is real and temporary, but it feels like failure if you did not set expectations.
Plan the catheter for larger glands
Larger prostates often need a suprapubic catheter (a catheter placed through the lower abdomen into the bladder) and more than one voiding trial. Plan for it. Rushing the trial void with a urethral catheter in a larger gland is how you end up with an emergency call at 2 am.
The technique is unforgiving
Rezum works. The water vapour mechanism has solid data behind it, including publication in NEJM Evidence and several randomised controlled trials. But the technique is unforgiving. Needle angle, the number of treatment sites per lobe and avoiding the surgical capsule all matter more than most people expect for what looks like a simple office procedure.
Patient selection decides the outcome
Patient selection is the variable that separates good outcomes from complications. Median lobe anatomy, prior urinary retention and baseline bladder function each shift the risk profile in a meaningful way.
The tool is sound. The results depend on what the surgeon does with it.