Benign prostatic hyperplasia (BPH) is common in ageing male populations, with prevalence increasing as patients get older.1
Timely recognition of suitable patients and appropriate referral are key components of care.
Treatment Options
Guide your patients to the right care at the right time.
The treatment you choose for your patients will depend on how significantly their symptoms impact their quality of life, among other factors. Medication plays an important role in early BPH management, but it may not be suitable or sufficient for everyone.
Alternatives to Medication
Evidence‑based options for patients needing more than pharmaceutical therapy.
For patients who prefer to avoid long‑term medications —or experience insufficient relief— several minimally invasive options can be considered. These typically offer durable symptom improvement, shorter recovery time, and preservation of sexual function, depending on the technique.
Minimally invasive treatment options
There are several types of minimally invasive treatments for an enlarged prostate.
Rezūm Water Vapour Therapy is a minimally invasive transurethral thermal therapy intended to relieve symptoms, obstructions and reduce prostate tissue associated with BPH; indicated for men with prostate volume ≥ 30 cm³, including central zone/median lobe.
Laser Treatments are another example of minimally invasive techniques that remove or vaporise obstructive tissue.
What does the data tell us?
Learn how Rezūm Water Vapour Therapy can safely and effectively decrease enlarged prostate tissue.
Rezūm therapy has demonstrated: 5,6,7
- Significant improvement in IPSS scores
- Sustained symptom relief in long-term follow-up
- Low retreatment rates
- Preservation of erectile and ejaculatory function in clinical studies
- Effectiveness in patients with median lobe enlargement
New randomised clinical evidence3
The VAPEUR randomised controlled trial (RCT) compared Rezūm Water Vapour Therapy to combination drug therapy in sexually active men with symptomatic BPH after alpha blocker failure.
In the VAPEUR RCT , Rezūm demonstrated significantly greater improvement in lower urinary tract symptoms (IPSS) at 1 year compared to combination medical therapy (alpha-blocker + 5-ARI), supporting its effectiveness as a next-step treatment after alpha blocker failure.
Rezūm Water Vapour Therapy provides symptomatic relief that is clinically meaningful and superior to standard combination medications for patients not responding to alpha blockers.
BPH Care Pathway: When to treat, when to refer, and what to expect
The pathway below is based on European Association of Urology (EAU) guidance and is designed to support confident, evidence based referral, without replacing clinical judgement or local practice.
- Relevant medical history including comorbidities
- PSA testing as appropriate
- Prostate size assessment (if available)
- Self-evaluation surveys to assess LUTS symptom severity
- Impact on daily quality of life
Mild Symptoms
- Watchful waiting
- Lifestyle modifications such as fluid and diet changes
- Kegel and bladder retraining
Moderate Symptoms
- Alpha-blockers
- 5-alpha reductase inhibitors
- Combination therapy where appropriate
- Water vapour therapy
Medication remains central to early BPH management. However, it may not provide adequate relief for all patients, and side effects can impact adherence.2,5
Reassess patients periodically and consider referral to Urology if:
- Symptoms remain moderate to severe (persistent IPSS elevation)
- Side effects reduce medication adherence
- Patients prefer to avoid long-term pharmacotherapy
- There are complications (e.g., recurrent urinary retention)
This is often the optimal time to discuss referral to a urologist.
Refer patients when:
- Symptoms persist despite medical therapy
- Medication intolerance limits treatment
- The patient seeks durable symptom relief
- Prostate volume ≥ 30 cm³ and minimally invasive therapy may be appropriate
- There is a patient preference for alternatives to ongoing medication
Referral enables specialist evaluation and appropriate treatment selection. Early referral supports informed shared decision-making and broadens patient options.
Support Your Patients with Educational Resources
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Frequently asked questions
Rezūm therapy may be considered for men with symptomatic BPH who are seeking an effective, minimally invasive treatment option—particularly those who wish to preserve sexual function.¹
It may be appropriate for patients who:
- Are looking to avoid initiating long-term pharmacotherapy
- Wish to discontinue medication due to insufficient relief or side effects
- Are considered frail or not ideal candidates for surgical intervention²
Rezūm therapy is indicated for men with a prostate volume between 30 and 150 cm³.
Clinical studies have shown that Rezūm therapy provides symptom relief without clinically significant impact on sexual function.6
It can be performed under local anaesthesia with sedation or general anaesthesia depending on centre practice.
As with any interventional procedure, Rezūm therapy is associated with potential risks and side effects. Commonly reported events include transient urinary symptoms such as dysuria, urgency, frequency, haematuria or urinary retention. Most adverse events are mild to moderate and resolve over time. Patients should be counselled on potential risks and benefits as part of shared decision-making.
References:
2. European Association of Urology. (2022). Information for Patients: Benign Prostatic Enlargement. Retrieved from Uroweb.org: I https://patients.uroweb.org/wp-content/uploads/2022/11/PI_Benign-Prostatic-Enlargement-QR-
3. Mathieu R, Xylinas E, Fournier M, et al. Water Vapor Thermal Therapy with Rezüm vs combination therapy for male LUTS/BPO: 1-year results from a prospective, multicenter randomized controlled trial (VAPEUR-RCT). Presented at: 41st Annual European Association of Urology (EAU) Congress; 2026; London, UK. Abstract LB26-0074.
4. Data on file with Boston Scientific.
5. McVary KT, Gittelman MC, Goldberg KA, et al. Final 5-year outcomes of the multicenter randomized sham-controlled trial of Rezûm water vapor thermal therapy for treatment of moderate-to-severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2021 Sep;206(3):715-24.
6. McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med. 2021 Oct 30;9(6):100454.
7. Gupta N, Rogers T, Holland B et al. Three-year treatment outcomes of water vapour thermal therapy compared to doxazosin, finasteride and combination drug therapy in men with benign prostatic hyperplasia: Cohort data from the MTOPS trail. J Urol. 2018; 200: 405-13.
8. McVary, K. T., Gange, S. N., Gittelman, M. C., Goldberg, K. A., Patel, K., Shore, N. D.,... Roehrborn, C. G. (2016). Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Journal of Urology, 195(5), 1529-1538. doi:doi: 10.1016/j.juro.2015.10.181
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The Rezüm System is intended to relieve symptoms, obstructions, and reduce prostate tissue associated with BPH. It is indicated for men with a prostate volume ≥ 30 cm³. The Rezüm System is also indicated for treatment of prostate with hyperplasia of the central zone and/or a median lobe.
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