The Rezūm Procedure for an Enlarged Prostate: A Guide for Australian Patients
If you are living with urinary symptoms from an enlarged prostate, you are not imagining it — and you are not alone. Benign Prostatic Hyperplasia (BPH) is common as people age, particularly men and other people with a prostate (including some trans women). It is not prostate cancer, but it can be relentlessly disruptive: weak stream, hesitancy, stop–start flow, feeling you never fully empty, and the classic sleep-wrecking nocturia.
There are now several effective ways to treat BPH, ranging from medications to minimally invasive procedures and more definitive operations. Rezūm (water vapour / “steam” therapy) sits in the middle: less invasive than traditional resection surgery, but generally more durable than “watch and wait” when symptoms are genuinely impacting quality of life.
This article is designed to help you make a grounded decision — what Rezūm is, who it tends to suit, what recovery is really like, and when I would steer someone toward a different option.
What Rezūm actually does (in plain language)
Rezūm is a transurethral treatment, meaning it is done through the urine channel (the urethra), not through cuts on the skin. A small telescope is used to reach the prostate from inside. A device then delivers short injections of water vapour (steam) into the prostate tissue. The steam transfers heat energy into the targeted tissue, which is intended to die off and then shrink over time, reducing the blockage around the urethra.
Key points that matter:
This is not an “instant channel-opening” operation. The improvement is gradual, typically over weeks to months, as the treated tissue resolves and the prostate remodels.
It can be tailored to prostate shape and, in appropriate cases, used to treat a median lobe (a central lobe that can bulge into the bladder).
In Australia, transurethral water vapour ablation has an MBS item number (37205, introduced 1 March 2024). (Fees and gaps still vary by setting.)
Who Rezūm tends to suit best
Rezūm can be a good fit if you:
Have moderate to severe lower urinary tract symptoms (LUTS) from BPH that are affecting sleep, work, travel, or day-to-day functioning.
Want to avoid (or have not tolerated) long-term medications, or medications are no longer doing the job.
Are looking for a minimally invasive approach with a lower likelihood of sexual side effects compared with traditional resection surgery (with the important caveat below).
Have prostate anatomy that is suitable on assessment.
In general, Rezūm is used for prostates above a certain size threshold, but in real-world practice suitability is less about one number and more about anatomy, symptom profile, and your priorities.
When Rezūm may not be the best choice
A good urology consult is not “Which procedure do you want?” It is: Which procedure matches your anatomy, symptom drivers, and goals — with the least trade-off?
I am more cautious about Rezūm when:
The prostate is very large, and you need a more definitive “debulking” operation.
There is significant concern that symptoms are driven by bladder dysfunction (overactivity, poor bladder contractility) rather than outlet obstruction.
You need rapid relief and cannot tolerate a period of irritative recovery.
There are complicating factors such as recurrent urinary tract infections, bladder stones, significant retention, or other findings where a different approach may better address the whole picture.
Rezūm is not automatically “wrong” in these situations — but it becomes a more nuanced decision, and sometimes another option is simply a better match.
What assessment should happen before deciding
If you are being offered a procedure after a five-minute chat, slow down.
A sensible pre-procedure work-up commonly includes:
Symptom scoring (e.g., IPSS) and a discussion of your most bothersome symptoms (night-time frequency vs weak stream vs urgency).
Medication review (including blood thinners).
Urine testing to exclude infection and clarify haematuria if present.
Prostate assessment (exam and/or ultrasound volume).
PSA discussion where relevant (PSA is not a “BPH test”, but the broader prostate health context matters).
Flow rate and post-void residual (how well you empty).
In many cases, cystoscopy (a look inside) to assess anatomy, median lobe, and exclude surprises.
This is where good outcomes are made: matching the right procedure to the right patient.
What happens on the day
Rezūm is performed using a telescope passed into the urethra. Steam injections are delivered into targeted prostate tissue, with the number and location of injections tailored to your anatomy. The procedural component is typically short.
Anaesthetic options
Depending on the setting and your medical profile, Rezūm may be done under a general anaesthetic or other anaesthetic approaches. The aim is comfort and safety, and the plan should be clear before the day.
Catheter: yes, usually
Most people will go home with a catheter for a short period. This is not because something has gone wrong; it is because the prostate swells immediately after treatment and the bladder can struggle to empty during that swelling phase.
Catheter duration varies, but commonly it is a few days. Some people need longer.
Recovery: the part people often underestimate
Here is the most honest summary I can give: Rezūm is minimally invasive, but the recovery is not always “minimal.” The procedure is quick; the healing is biological and takes time.
Days 1–7: the irritative phase
Common experiences include:
Burning/stinging with urination
Increased frequency and urgency
Mild blood in the urine
Pelvic “awareness” or pressure
If you have a catheter, the first week may feel more like catheter-management than recovery.
Weeks 2–6: fluctuating symptoms
This is where expectations matter. Symptoms can:
Improve gradually, then flare
Feel “worse before better” (especially urgency/frequency)
Require short-term medication support (often an alpha-blocker temporarily)
This is normal physiology: inflammation settles, tissue breaks down, and the channel opens.
Months 2–6: the payoff window
Many people notice more meaningful improvement as time passes, and outcomes continue to evolve for several months as the prostate remodels.
Sexual function: realistic reassurance
Rezūm is often chosen because it aims to reduce urinary symptoms without the same rate of ejaculatory side effects seen with traditional resection procedures.
However, two truths can coexist:
Rezūm is generally more “sexual-function friendly” than TURP for many patients, and
No procedure is a zero-risk promise for ejaculation changes, discomfort, or altered sensation — particularly in the early recovery window when inflammation is present.
If preservation of ejaculation is a top priority for you, say that clearly. It changes the decision-making.
Risks and trade-offs to understand
Every BPH treatment is a trade-off between:
Speed of relief
Durability (how long it lasts)
Recovery burden
Sexual side effects
Anaesthetic/surgical risk profile
For Rezūm, key risks and possibilities include:
Urinary retention requiring a catheter for longer
Urinary tract infection
Bleeding (usually mild)
Temporary worsening of urgency/frequency
Need for retreatment in the future (not common for everyone, but part of informed consent)
This is exactly why the “best procedure” is not a universal answer — it depends on your baseline anatomy, bladder function, and priorities.
How Rezūm compares with other common BPH treatments
Medications (e.g., tamsulosin, dutasteride/finasteride)
Pros: non-procedural, easily trialled
Cons: ongoing use, side effects, may lose effectiveness over time, may not be enough for severe obstruction
UroLift (prostatic urethral lift)
Pros: quick recovery for many, often favoured when ejaculation preservation is paramount
Cons: not suitable for all anatomies, durability varies, may not suit larger glands
TURP (traditional resection)
Pros: strong, reliable symptom relief; immediate “debulking”
Cons: more invasive, higher likelihood of retrograde ejaculation, longer recovery
HoLEP (laser enucleation)
Pros: excellent for larger prostates, durable outcomes
Cons: more invasive than Rezūm, different side-effect profile, typically requires anaesthetic and hospital resources
Prostate artery embolisation (PAE)
Pros: non-transurethral option in selected cases
Cons: outcomes depend on anatomy and operator expertise; not always as predictable as surgical options
The point is not that Rezūm is “better.” The point is that it is a useful tool in a modern BPH toolkit — particularly for people who want meaningful symptom improvement with a less invasive approach, and who can tolerate a gradual recovery curve.
Cost and access in Australia
From 1 March 2024, Medicare introduced item 37205 for transurethral water vapour ablation.
Two practical clarifications:
The presence of an MBS item does not mean “no out-of-pocket.” Private hospital, anaesthetist, surgeon, and device costs can still create gaps depending on setting and fund.
Ask for a written quote (surgeon + anaesthetist + hospital) so you can make an informed financial decision.
The decision framework I use in consults
If you want a high-quality conversation with your urologist, bring these questions:
What is driving my symptoms most — prostate obstruction, bladder overactivity, or both?
Is my anatomy suitable for Rezūm (including a median lobe)?
What should I expect in the first 2–6 weeks, realistically?
How likely is retreatment for someone like me (based on my prostate size/anatomy and history)?
If ejaculation preservation matters to me, which option best matches that priority?
What is Plan B if Rezūm doesn’t get me the result I want?
Good care is not choosing the newest option. It is choosing the option that best fits your life.
When to seek urgent help after Rezūm (or any BPH procedure)
Seek urgent medical care if you have:
Fever/rigors (possible infection)
Inability to pass urine (retention)
Heavy bleeding/clots or worsening haematuria
Severe pain not controlled with prescribed medications
Final thoughts
Rezūm is a legitimate option for BPH that can offer meaningful improvement without the invasiveness of traditional resection surgery, and it is now supported by an Australian MBS item number.
But it is not a shortcut. The procedure is quick; the recovery is a process. If you go in expecting “day surgery = instant fix,” you will likely be disappointed. If you go in understanding the recovery curve — and you are the right anatomical candidate — it can be an excellent middle path.
About the author
Dr Deanne Soares is a Melbourne-based urologist who assesses and manages a wide range of urological conditions, with an emphasis on thoughtful, individualised care.
