Shrinking an Enlarged Prostate with Steam: A Urologist’s Honest Guide to Rezūm Therapy

Q: "What should I expect during recovery? Will I need a catheter?"

One of the most important things I tell my patients is to be patient with the timeline. Unlike laser surgery where tissue is carved away immediately, Rezūm works by causing tissue to gradually shrink over time. ``` [ Day 1: Procedure ] ──> [ Days 3–7: Temporary Catheter ] ──> [ Weeks 2–3: Initial Relief ] ──> [ Months 3–6: Full Results ] (15-min steam therapy) (Manages swelling & blockage) (Flow begins to improve) (Maximum symptom relief) ``` ### 1. The Catheter (Days 3 to 7) Because steam causes localized tissue swelling (inflammation) immediately after treatment, you will need a temporary urethral catheter for roughly 3 to 7 days after the procedure. This keeps your bladder draining safely while initial swelling peaks. ### 2. The First 2 to 3 Weeks (Temporary Flare-Up) It is completely normal for your urinary symptoms (frequency, urgency, mild burning, or small spots of blood in the urine) to temporarily feel worse before they get better. This is simply your body's inflammatory response clearing the treated tissue. We often prescribe anti-inflammatories or short courses of medication to keep you comfortable during this window. ### 3. Weeks 3 to 12 (Noticeable Improvement) Most men begin noticing a significantly stronger stream, easier bladder emptying, and fewer nighttime bathroom trips between weeks 3 and 6, with maximum results typically achieved by 3 to 6 months.

Dr. Sarp Korcan Keskin
Aug 6
4 min read

By Prof. Keskin, Consultant Urological Surgeon

If you are a man over 50 experiencing a weak urine flow, waking up three times a night to use the bathroom, or feeling like your bladder never quite empties, you are likely dealing with Benign Prostatic Hyperplasia (BPH)—an enlarged prostate gland.

For years, the standard path for BPH was a choice between taking daily prescription medications for life (which often bring side effects like fatigue or sexual dysfunction) or undergoing invasive operating room surgery like a TURP (Transurethral Resection of the Prostate).

Today, minimally invasive treatments have changed the landscape. Chief among them is Rezūm Water Vapor Therapy. In this detailed guide, I will answer the exact questions patients ask in my clinic—and search for online—so you can decide if Rezūm is right for you.

"What is Rezūm Water Vapor Therapy, and how does steam shrink a prostate?"

Rezūm is a minimally invasive, in-office procedure that uses the natural thermal energy stored in water vapor (steam) to shrink enlarged prostate tissue.

The prostate surrounds the urethra—the tube that carries urine from your bladder out of your body. As the prostate grows, it squeezes the urethra like a clamp.

Here is how the treatment works step-by-step:

Targeted Delivery: Using a specialized handheld device with a tiny camera (cystoscope) inserted into the urethra, we navigate to the obstructing prostate tissue.
Steam Injection: A micro-needle deploys into the target area and delivers a 9-second burst of sterile water vapor.
Cell Destruction: The steam instantly disperses through the targeted prostate cells, releasing stored thermal energy that causes those obstructive tissue cells to die (necrosis).
Natural Absorption: Over the next 3 to 12 weeks, your body’s natural immune system clears away the dead tissue, shrinking the gland and naturally widening the urethral opening.

Most procedures require between 2 to 6 injections depending on the size and shape of your prostate (including whether you have an enlarged central "median lobe"). The entire treatment takes less than 15 minutes.

"Am I a good candidate for Rezūm?"

Rezūm is not a one-size-fits-all solution, but it is an ideal option for many men.

You are likely an ideal candidate if:

You want to stop taking daily BPH medications: You dislike the side effects of alpha-blockers or 5-ARIs (like tamsulosin or finasteride) such as dizziness, low libido, or ejaculatory changes.
Your prostate size is between 30cc and 80cc: Rezūm is clinically proven and most effective for small-to-moderate prostate enlargement.
Preserving sexual function is a top priority: Preserving normal erectile and ejaculatory function is critical to your quality of life.
You prefer to avoid major operating room surgery: You want a procedure performed under local anesthesia or light sedation without an overnight hospital stay.

You may NOT be a candidate if:

You have a very large prostate (>80cc to 100cc+), where surgical approaches like HoLEP or Aquablation yield better clearance.
You have an active urinary tract infection or severe underlying bladder muscle damage.
You have a urinary sphincter implant or penile prosthesis.

"What should I expect during recovery? Will I need a catheter?"

One of the most important things I tell my patients is to be patient with the timeline. Unlike laser surgery where tissue is carved away immediately, Rezūm works by causing tissue to gradually shrink over time.

[ Day 1: Procedure ] ──> [ Days 3–7: Temporary Catheter ] ──> [ Weeks 2–3: Initial Relief ] ──> [ Months 3–6: Full Results ]
  (15-min steam therapy)    (Manages swelling & blockage)    (Flow begins to improve)       (Maximum symptom relief)

1. The Catheter (Days 3 to 7)

Because steam causes localized tissue swelling (inflammation) immediately after treatment, you will need a temporary urethral catheter for roughly 3 to 7 days after the procedure. This keeps your bladder draining safely while initial swelling peaks.

2. The First 2 to 3 Weeks (Temporary Flare-Up)

It is completely normal for your urinary symptoms (frequency, urgency, mild burning, or small spots of blood in the urine) to temporarily feel worse before they get better. This is simply your body's inflammatory response clearing the treated tissue. We often prescribe anti-inflammatories or short courses of medication to keep you comfortable during this window.

3. Weeks 3 to 12 (Noticeable Improvement)

Most men begin noticing a significantly stronger stream, easier bladder emptying, and fewer nighttime bathroom trips between weeks 3 and 6, with maximum results typically achieved by 3 to 6 months.

How Does Rezūm Compare to Other BPH Treatments?

Choosing a BPH procedure comes down to balancing invasiveness, recovery time, and sexual side effects:

Feature / Consideration	BPH Medications	Rezūm Therapy	TURP / Laser Surgery
Type of Treatment	Daily lifelong pills.	Minimally invasive in-office procedure.	Surgical procedure in operating room.
Anesthesia Needed	None.	Local nerve block or mild sedation.	General or spinal anesthesia.
Erectile Function Risk	Low to Moderate risk.	Extremely low / Preserved (<1%).	Low risk (1–3%).
Retrograde Ejaculation	High (with alpha-blockers).	Very Low (~2–5%).	High (60–80% dry ejaculation).
Catheter Requirement	None.	Yes (3 to 7 days).	Yes (1 to 3 days post-op).
Durability (5-Year)	Requires continuous use.	~95% free of re-treatment at 5 years.	Very high durability (>90%).

"What are the main risks and side effects?"

Rezūm has an excellent safety profile, but as with any medical intervention, you should be fully informed:

Common / Temporary Side Effects: Mild blood in the urine (hematuria), stinging or burning during urination, frequent urge to pass urine, and catheter discomfort during week one. These typically resolve within 2 to 4 weeks.
Urinary Tract Infection (UTI): A small risk exists whenever instruments enter the urinary tract. You will usually be given a short preventative antibiotic course.
Urinary Retention: If the catheter is removed before swelling subsides, you may temporarily be unable to void, requiring the catheter to stay in for a few additional days.
Impact on Ejaculation: Unlike traditional TURP surgery (which results in "dry orgasms" or retrograde ejaculation in up to 80% of patients), clinical trial data shows Rezūm preserves normal ejaculation in over 90–95% of men.

Final Thoughts from Prof. Keskin

If your enlarged prostate is controlling your daily schedule, disrupting your sleep, or forcing you to stay on daily medications you dislike, Rezūm represents a sophisticated bridge between pills and major surgery.

It offers lasting relief while respecting your body’s anatomical integrity and preserving your sexual health. If your prostate is under 80 grams, talk to your urologist about having a flexible cystoscopy and ultrasound scan to confirm if you are a candidate for steam therapy.