It is evident that the Rezum system has many strengths that endorse its use. Despite this, it is not without its disadvantages. A significant benefit of TURP is its use in incidental identification of prostate cancer, with positive detection on 4.1–16.7% of TURP specimens.
17 In contrast, Rezum does not collect tissue specimens; therefore, it lacks the ability to ascertain incidental cases of prostate cancer. Furthermore, the nature of the exclusion criteria limits the number of patients who qualify for the procedure. Patients with urinary retention and large prostate burdens potentially would not be eligible, excluding a significant section of patient population.
Catheterization post procedure is at the discretion of the clinician. In a pilot trial by Dixon and colleagues,
8 55% of patients were catheterized prior to discharge plus an additional 17% requiring catheterization post discharge, with an average duration of catheter use of 4.1 days. Of note, many of the sites involved in this trial adopted default position of catheter placement.
There is a lack of long-term follow up; currently, there is only one RCT providing data for a period up to 36 months as part of a 5-year trial.
10 It can be argued that further evidence and longer-term data are required to demonstrate that the benefits provided by Rezum can be sustained. Furthermore, all evidence collected to date has been sponsored by NxThera (Maple Grove, MN, USA), which is a potential be a conflict of interest.
Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia