Benign Prostatic Hyperplasia (BPH) is a common condition in older males where the prostate gland grows larger. This enlargement can constrict the urethra, leading to bothersome urinary symptoms like frequent urination, a weak stream, and the sensation of incomplete emptying. Historically, treatment relied on medication or invasive surgery, but medical technology has shifted toward minimally invasive therapies. These newer procedures aim to relieve symptoms while reducing the risks and recovery time associated with traditional surgery. This analysis compares two leading modern options, Aquablation and Rezūm, detailing the differences in their approach and outcomes.
How Aquablation Works
Aquablation uses robotic technology to precisely remove obstructing prostate tissue with a high-velocity jet of sterile water. The surgeon first creates a personalized surgical map using a camera inserted through the urethra combined with real-time ultrasound imaging. This dual-imaging provides a three-dimensional view, helping identify the exact tissue to be removed while preserving structures responsible for continence and sexual function.
A robotically controlled device then delivers a powerful, heat-free waterjet to resect the targeted tissue. The lack of heat minimizes potential thermal damage to surrounding nerves and tissues. The ablation phase is typically quick, often lasting only a few minutes, and the procedure is effective for prostates of virtually any size and shape. Aquablation is typically performed under general or spinal anesthesia.
How Rezūm Works
In contrast to Aquablation’s mechanical removal, the Rezūm system uses targeted thermal energy delivered through sterile water vapor to shrink the enlarged tissue. A small device is inserted through the urethra into the prostate, where it generates steam using radiofrequency energy. This steam is then injected into the hyperplastic tissue in controlled, nine-second bursts.
The thermal energy is released as the vapor turns back into water within the tissue, causing immediate cell death. The body’s natural healing response then works to absorb the damaged tissue over the following weeks. This gradual volume reduction creates a wider channel for urine flow, relieving BPH symptoms. Rezūm is often performed in an outpatient setting, requiring only local anesthesia or light sedation.
Recovery and Potential Side Effects
The recovery experience differs significantly between the two procedures, primarily related to the invasiveness of the treatment. Following Aquablation, patients typically require an overnight stay in the hospital and wake up with a catheter to manage drainage and clear any blood or debris. The catheter may remain in place for a few days after discharge, and patients often experience mild burning during urination for a couple of weeks as they heal.
Rezūm, being less invasive, is an outpatient therapy, but it causes significant initial swelling of the treated tissue. This swelling necessitates the use of a temporary catheter, which typically remains for two to five days post-procedure. Patients may notice that their urinary symptoms temporarily worsen before they begin to improve, as the body works to absorb the ablated tissue. Most patients are able to return to their regular activities within a few days of the Rezūm procedure.
A major concern for men is the preservation of sexual function, and both procedures show favorable outcomes compared to traditional surgery. Clinical data for Aquablation indicates a high rate of preservation, with studies showing 100% of men preserved erectile function and approximately 89% to 99% preserved ejaculatory function. This preservation is attributed to the heat-free, precise targeting of the procedure. Rezūm is similarly known for preserving sexual function, with studies indicating no significant negative changes in erectile or ejaculatory function over several years of follow-up. The main short-term risk unique to Rezūm is the higher incidence of temporary urinary retention immediately after the procedure, which is addressed by the use of the catheter. Aquablation, being a resective surgical procedure, carries a small risk of bleeding that occasionally requires a blood transfusion, though this is uncommon.
Long-Term Efficacy and Patient Selection
Both Aquablation and Rezūm have demonstrated significant and sustained improvements in BPH symptoms, measured by common urological scoring systems. Aquablation, as a resective procedure, results in a rapid and substantial improvement in urinary flow rate, with studies showing an average increase of over 7 mL/s and symptom score reductions of around 10 to 16 points. This level of tissue removal contributes to high durability, with a low rate of retreatment reported at five years.
Rezūm also provides robust symptom relief, with men often seeing improvements comparable to those with smaller prostates, even in cases of very large glands. While the tissue absorption is gradual, the long-term durability is also strong, with a lower retreatment rate observed at five years compared to other minimally invasive options. Patient anatomy is a key factor that physicians consider when recommending a treatment. Aquablation is a versatile option, suitable for prostates of any size or shape, including those with a median lobe. Rezūm is generally indicated for prostates between 30 and 80 milliliters, but it is also effective for larger prostates and treating the median lobe. The final decision often depends on the patient’s prostate size, preference for the setting, and tolerance for anesthesia. Patients with very large prostates or those desiring the most significant tissue removal often lean toward Aquablation, while those prioritizing a rapid return to work and avoiding general anesthesia may opt for the outpatient Rezūm procedure.