Video: Treating BPH with Rezum Steam Treatment with Stephen Gange, MD | Off The Cuff with Dr. Mark Moyad

Off The Cuff With Dr. Mark Moyad | Transcription

Dr. Moyad: So the other one is Rezum, right? R-E-Z-U-M, is that right?

Dr. Gange: That's right.

Dr. Moyad: And can you tell us a little about this and why this gets a lot of attention?

Dr. Gange: And so I've had a bigger experience with Urolift, but I haven't had no experience with Rezum. I did the first of these procedures in North America as part of a prospective clinical trial, so I was involved early. I did 40 Rezum procedures; I've done 400 Urolifts, and I essentially exclusively do Urolift and its hard to balance different procedures in one practice. It just can be hard logistically and from a cost standpoint. 

So, so, what Rezum is, is a very unique type of heat delivery to the prostate. So the two we mentioned earlier are what are called convective—pardon me—conductive heating mechanisms. So the TUNA and the microwave, essentially, if you can just imagine a fire underneath a pot of water. And the metal pot, the farther away you get from the fire, it gets cooler and cooler, right? So it's just sort of dissipation of heat. Whereas the water on the inside is heated convectively and molecules kind of swirl through molecules to get more of a uniform heating which is why the whole pot boils at the same time. So what Rezum is, is the delivery of steam, water molecules, vapor, into the prostate, and that works its way through the cells in a very different way than the previous heat delivery systems worked. So conductive heating didn't work; convective heating seems better.

Dr. Moyad: This is really, really hot water.

Dr. Gange: Yeah. It's really hot water. 

Dr. Moyad: We're talking... I saw a number. Like 100 plus Celcius or something crazy like that? 

Alright, so, in the end how long does that procedure take? And as good as anything else out there? Similar? I mean, how long does that procedure take, just put a bunch of hot water in my prostate?

Dr. Gange: It doesn't take long, and it can be done in a matter of five minutes, kind of like what we were talking about with Urolift.

Dr. Moyad: That's good.

Dr. Gange: Maybe even a little faster than Urolift if it gets right down to it. The process, though, of delivering heat is a little more intense for a patient than the process of having the prostate pushed aside. So my experience with it was that it was simply more painful. The other issue is heat, no matter how you deliver it, causes swelling of tissue. And swelling of tissue means that's it's going to be harder for a patient to urinate before it gets easier. So we routinely would place a catheter in a patient who has a Rezum procedure, and even once that catheter is removed the heating has still caused enough swelling that the symptoms are going to kind of linger. Those sorts of things. So, when I compare Rezum to Urolift, and maybe I shouldn't do this just yet, I just think that the patient experience—what I describe for the Urolift patient—is different than that for the Rezum patient. It doesn't mean it's not great therapy. I think it's way better than our previous heat therapies, but there's just some downsides. And as patients, if they were aware of the two options, you're going to get a catheter with this one, you're probably not going to get one with this one. Your symptoms are going to recover a little faster with Urolift than they are with Rezum. In the end, I can't tell you yet which procedure is going to prove to be the best. We've got five-year data with Urolift. We've got three-year data with Rezum. It's looking good.

Dr. Moyad: Yeah.

Dr. Gange: So, I think there's some value to it.

Dr. Moyad: So, but in terms of the time, it's all very short. Both of them are very short, right? It's all done in the office.

Dr. Gange: mm-hmm, yeah. It's done in the office.

Dr. Moyad: And, I wonder if it's possible to go back and do a second Rezum if the first one doesn't work.

Dr. Gange: Absolutely, but I think then we have to start looking at the tissue change. I don't think that's been...

Dr. Moyad: That's what I'm wondering.

Dr. Gange: I don't think that's been done yet. I mean, I think what happens is we're killing cells, we're also affecting blood flow to that tissue, and then if we treat sort of ischemic tissue or denatured cells where is the vapor going to go? Is it going to be a nice uniform process, or are we gonna hit speedbumps, or are we gonna be diverted into places where we don't want to be? So I have that concern about retreatments. I also have that concern about post-radiation patients because that's not normal tissue. So delivering that kind of therapy in a virgin environment is one thing, but in an environment, you know again, where within the cells the proteins have been denatured, the over blood flow has been changed, there might be scars, you know, I'm nervous about it.