Urology Clinical Lead at North Hampshire Hospital
Consultant Urologist at Hampshire Hospital Foundation Trust
New techniques to treat benign prostatic hyperplasia (BPH) are being hailed as minimally invasive. But what do they entail? Two consultant urologists explain:
Recently in the UK, new, less invasive treatments have been approved to treat an enlarged prostate, known as BPH. While a TURP (Transurethral resection of the prostate) procedure is the most recognised option, it does carry risks, including erectile dysfunction (around 5-10%) and retrograde ejaculation (when semen enters the bladder instead of emerging through the penis during orgasm), which occurs in the majority of cases after a TURP.
Using water vapour to shrink the enlarged prostate gland
The Rezum procedure involves delivering steam into the prostate gland, which destroys tissue and shrinks the gland over the following weeks. This is particularly useful in the longer term because the prostate does continue to grow with ageing.
Rezum was given NICE approval in August 2018. Since then, Professor Hindley has begun training surgeons across the UK and Europe in delivering the treatment.
He explains: “When I first heard about Rezum, and with my previous experience of similar procedures, it seemed like it had great potential and was complimentary to the other minimally invasive options. Here in the UK, we have traditionally been very loyal to TURP because it is a very good treatment, however, we are now developing a portfolio of minimally invasive treatments as we understand that the TURP procedure isn’t for everyone, especially those who still have an active sex life.”
Professor Hindley first carried out the procedure in March 2017, and it is now available in many more centres as more surgeons are trained. “With a treatment time of roughly 15–20 minutes, my hope is that this procedure could transform NHS waiting lists as well as reducing medication, as there are fewer side effects.”
Patient feedback is overwhelmingly positive
While medication and surgery (TURP usually) are the two most common options for BPH sufferers, Prof Hindley hopes that minimally invasive treatments such as Rezum could fill a gap.
“The feedback we get is very positive” says Mr Hindley. “I get men telling me that they have been waiting years for a treatment like this.”
The technique is now rolling out across the NHS. Mr Amr Emara, another consultant urologist also at Hampshire Hospitals, who was also an early adopter of this procedure. He says men are now much happier knowing they have several options when diagnosed with BPH.
“Men, typically, don’t like to talk about their concerns to avoid big operations, but this new treatment is really opening up the conversation. I find many men have already done their homework and asked for a referral for the procedure. My job then is to make sure that they are suitable.”
Are minimally invasive treatments suitable for everyone?
While there are other minimally invasive treatments that can be offered with BPH, they are not suitable for everyone.
Mr Emara says: “There are some cases where the prostate may be bigger than the range we recommend for Rezum (up to 90 cc), which may require a longer recovery period, but the feedback we have had is that men would much prefer a day procedure with symptoms improvement that develop over a period of time, rather than a surgical procedure with an immediate outcome that carries more risk.”
Most common side effects are the short-term, catheter related discomfort, and blood in urine in the early post-operative period. “We have had no new cases of erection problems or urinary leakage after Rezum in all the cases we have treated so far, and this is a better profile of side-effects than with current medication,” explains Professor Hindley.
“We do need more data, particularly around the issue of whether, in the future, younger, sexually active men should be offered a minimally invasive intervention instead of medication. We suspect this may be better for men but we need to better understand the cost-effectiveness of this strategy. A study investigating this issue is soon to be underway in France. We are keen for something similar in the UK,” says Professor Hindley.
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