CATEGORY: MEN’S HEALTH
The first pill usually works, until it doesn’t. Plenty of men taking an alpha-blocker such as tamsulosin for an enlarged prostate still find themselves up twice a night, and the standard next move is a second daily pill. A French trial of 151 such men has now tested that next move against a one-time steam treatment of the prostate. The steam won on symptoms. At one year, scores on the standard 35-point symptom questionnaire had dropped 10.8 points after the procedure versus 6.2 points on the two-pill routine, and that 4.6-point gap is well beyond the 3 points a man can reliably feel.1
A Second Pill, or Nine Seconds of Steam
Every man in the trial was at least 45, had a prostate large enough to block flow, and still had bothersome symptoms on his alpha-blocker. From there, a randomization list made the call, not the patient and not his urologist. To qualify, a man needed a symptom score of at least 13 of 35, a weakened urinary stream on flow testing, and a gland of at least 30 milliliters. Half then added a 5-alpha-reductase inhibitor, a daily pill that slowly shrinks the gland over months; most received dutasteride. The other half got water vapor therapy, sold as Rezūm. In that procedure, a device passed through the urethra injects nine-second bursts of steam into the gland, about five bursts in all, and the scalded tissue shrinks away over the following weeks. It’s an outpatient visit. Men went home the same day, though they carried a catheter for roughly six days, and everyone’s symptoms were then tracked for a year.1
Fewer Rescues, Different Side Effects
The steam group needed less rescuing as the year went on. Surgery for returning symptoms: 1.3% after steam versus 9.2% on the pills. A symptom slide big enough to notice: 2.7% versus 13%. Quality-of-life ratings improved more after the procedure too. Sexual side effects sorted the other way around. New erection problems appeared in two steam patients and nine pill patients, loss of libido in none versus eleven, though on the trial’s formal ejaculation score the difference between groups didn’t reach statistical significance. The pills weren’t useless, and 12% of the steam group eventually went back on medication anyway. Flow measurements told a similar story in miniature. The steam group’s peak urinary flow jumped early and the pill group’s crept up behind it, narrowing the gap by the twelfth month, while the amount of urine left behind after voiding fell by about 33 milliliters after the procedure and didn’t budge on the pills. As a package, one procedure did more than the second prescription.1
The Price Is Paid in the First Weeks
Steam’s costs came early and concentrated. Serious adverse events hit 12% of the procedure group against 1.3% on pills, mostly urinary retention, infections and blood in the urine in the weeks after treatment; 93% of those problems had resolved by the year’s end. The pill group’s troubles were quieter but lingering, mainly the erection and libido effects that 5-alpha-reductase inhibitors are known for. Three honest caveats. The trial was open-label, meaning everyone knew who got what. It was funded by Boston Scientific, which makes the device, and several authors work there. And pill adherence leaned on the men’s own reports, with a quarter admitting they’d drifted from the regimen by year’s end, which is part of the case the authors make for a one-time fix. And one year is as far as this comparison sees. The durability question beyond that sits with longer-running research on the procedure itself.1
Key Takeaways
- Among men whose enlarged-prostate symptoms persisted on one pill, a single steam procedure outperformed adding a second: 10.8 versus 6.2 points of improvement at one year, with fewer men needing surgery later.
- The advantage had an up-front cost. Serious complications, mostly short-term urinary problems, affected 12% of the steam group and about 1% of the pill group.
- Sexual side effects ran in the opposite direction, appearing mainly in the men on the two-pill combination.
- This was one year of follow-up in an open-label, manufacturer-funded trial; it measured symptoms and complications, not long-term outcomes.
References
- Vincendeau S, Xylinas E, Mathieu R, et al. Water Vapor Thermal Therapy with Rezūm Versus Combination Pharmacotherapy for Male Lower Urinary Tract Symptoms due to Benign Prostatic Obstruction: 1-Yr Results From a Prospective, Multicenter, Pragmatic Randomized Controlled Trial (VAPEUR-RCT). European Urology Focus. 2026;doi:10.1016/j.euf.2026.08.001. link