How to cite: Bechis SK. BPH procedures: tips & tricks: Rezūm™. Grand Rounds in Urology. November 2025. Accessed February 2026. https://grandroundsinurology.com/bph-procedures-tips-tricks-rezum/
Summary
Seth K. Bechis, MD, MS, Associate Professor of Urology, University of California, San Diego, San Diego, California, provides a case-based walkthrough of the Rezūm™ water vapor thermal therapy procedure, focusing on anatomy-driven planning and technical nuances that optimize outcomes while minimizing postoperative symptoms. Dr. Bechis demonstrates how careful measurement, injection spacing, and median lobe strategy are essential to effective Rezūm™ treatment.
He begins with a brief overview of Rezūm™ as a minimally invasive surgical therapy for benign prostatic hyperplasia (BPH). Rezūm™ ablates the transition zone using convective water vapor energy, leading to tissue necrosis and subsequent volume reduction while preserving erectile and ejaculatory function. The ability to treat a median lobe is emphasized as a key advantage.
Dr. Bechis walks through a representative case of a man with a 56 cc prostate and a ball valve median lobe. The procedural setup is reviewed, including device priming, anesthesia considerations, and the option to perform the procedure in an office or an ambulatory surgery center. Emphasis is placed on understanding prostate anatomy and accurately measuring prostatic urethral length to determine the appropriate number and location of steam injections.
Each steam injection creates an approximately 1-centimeter spherical ablation zone, making spacing critical. Injections should be placed at least two fields of view distal to the bladder neck to avoid detrusor injury and irritative symptoms, while remaining proximal to the verumontanum. Dr. Bechis explains that visible steam leakage suggests suboptimal needle positioning and may increase postoperative irritation, reinforcing the importance of maintaining lateral pressure during delivery.
Median lobe treatment strategy is discussed in detail. Rather than referencing the bladder neck alone, injection planning should consider the extent of the median lobe tissue itself to ensure adequate coverage while avoiding the bladder neck. A “less is more” philosophy is emphasized, favoring fewer injections when borderline, as short-term irritative symptoms are reduced without compromising one-year outcomes.
Dr. Bechis addresses counseling considerations, including discussion of retreatment rates and long-term expectations. His presentation offers concise, practical guidance for clinicians incorporating Rezūm™ into BPH management.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Seth K. Bechis, MD, MS, is an Associate Professor of Urology at the University of California, San Diego. Dr. Bechis specializes in all procedures of the prostate, including minimally invasive procedures such as Rezum water vapor therapy and UroLift, as well as robotic surgery and GreenLight Laser photoselective vaporization of the prostate. His current research focuses on improving surgical techniques and clinical outcomes in stone disease, as well as tools for stone diagnosis and opiate-sparing pathways for managing pain.
Dr. Bechis earned his Master’s of Science in Biomedical Sciences and his medical degree from the University of California, San Francisco. He completed his residency at Harvard University in Boston, Massachusetts. Dr. Bechis then completed a fellowship in Laparoscopy/Robotics and Endourology at the University of California, San Francisco.
Dr. Bechis is a member of several professional medical organizations, including the American Urological Association (AUA), the Endourological Society, and the Western Section of the AUA. He has won numerous awards and honors over the years, including the Whitehill Award for Excellence in Clinical Teaching in 2019, Plenary Address for Best Abstract from the American Urological Association in 2015, and first place in the 2014 Max K. Willscher Resident Research Award Competition. Dr. Bechis has been invited to speak nationally and internationally at conferences on topics including benign prostatic hyperplasia and stone disease. His research has been featured in peer-reviewed medical journals, including Journal of Urology, Journal of Endourology, and World Journal of Urology. Additionally, Dr. Bechis was editor of First Aid Q&A for the USMLE Step 1, Second Edition, and has authored chapters for university handbooks.
