Rezum Treatment for BPH - Dr. Dean Elterman

Procedure Steps:

• 1. Baseline history, physical, cystoscopy, prostate volume assessment by imaging as preparation before day of treatment

• 2. Prepare and prime hand-piece. Small amount of lubrication

• 3. Gentle, atraumatic insertion of the hand-piece

• 4. Assess prostate length and presence of median lobe while entering

• 5. Begin 1cm back from bladder neck (2 fields of view) for first injection

• 6. Continue moving back 1cm at a time (2 fields of view) targeting the bulkiest part of the lateral lobe

• 7. Stop at apical tissue/verumontanum

• 8. Repeat steps 5 & 6 on contralateral lobe

• 9. If median lobe or central zone hypertrophy, treat 1cm back from crest of the lobe. Multiple steam injections may be required

• 10. Remove scope and insert Foley catheter

Learning Points:

• Know prostate volume ahead of time

• Be gentle when Inserting the hand-piece to avoid trauma

• Start 1cm back from bladder neck and inject laterally in 1cm (2 field of view) Increments

• Inject steam into the bulkiest part of the prostate, waiting 2 additional seconds (after the 9 second dose of steam) before retracting the needle

• Treat both lateral lobes followed by treating the median lobe or central zone as required

Clinical History:

• Case1: 67M, BPH 20 yrs, Prostate Volume 50 cc, IPSS 23/4, Qmax 8ml/sec, PVR 43mL, Meds: Doxazosin and Dutasteride

• Case 2: 63M, Prostate Volume 64cc, Urinary retention

• Case 3: 51M, Prostate Volume 49cc, IPSS 24/5, Qmax 3ml/sec, PVR 156mL, Meds tamsulosin

• Case 4: 67M, Prostate Volume 59cc, IPSS 24/4, Qmax 6mL/sec, PVR 59mL, Meds Silodosin