Patients seeking treatment for an enlarged prostate now have more options as hospitals in Kenya expand urological services, with more introducing minimally invasive procedures alongside established treatment.
The latest addition is Rezum Water Vapour Therapy, a procedure for benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.
Kenyatta National Hospital (KNH) became the first public health institution in Kenya to perform the procedure in January.
Aga Khan University Hospital Nairobi (AKUH-N) introduced it in June, while AAR Hospital performed its first Rezum procedure this week, bringing to five the number of hospitals offering the therapy.
BPH becomes more common with age and can cause weak urine flow, difficulty urinating, frequent trips to the toilet at night and a feeling of incomplete bladder emptying.
Treatment depends on the severity of symptoms, prostate size and the patient’s overall health. Men with mild symptoms may initially be monitored and advised on lifestyle changes, while drugs like alpha blockers and 5-alpha reductase inhibitors can be prescribed to improve urine flow or reduce the size of the prostate.
Patients requiring procedures have traditionally had options like transurethral resection of the prostate (TURP), in which excess tissue blocking urine flow is removed through the urethra, and laser procedures that remove or vaporise the tissue.
Rezum uses water vapour to destroy excess prostate tissue rather than cutting it out or vaporising it with a surgical instrument. The vapour is delivered through the urethra without external incisions, after which the treated tissue gradually shrinks, relieving obstruction and improving urine flow.
‘Open prostatectomy is no longer practised. Transurethral resection of the prostate using electrocautery is used. After that, we started using laser to enucleate the prostate. Recently, Rezum has emerged as an additional treatment option,’ said Dr Amadadin Alhlib, a consultant urologist at AKUH.
Dr Patrick Mararo, a consultant urologist at AAR Hospital, says the treatment gives appropriately selected patients another option for symptom relief, with a shorter recovery period and less treatment burden than conventional surgery.
‘This is a milestone for urological care in Kenya. Rezum uses water vapour to treat the enlarged part of the prostate without the need for conventional surgical incisions. For appropriately selected patients, it offers the potential for effective symptom relief with a shorter recovery period and less treatment burden,’ Dr Mararo said.
The technology received the European CE Mark in 2013 and US Food and Drug Administration clearance in 2015. Rezum, however, is not suitable for every patient. Dr Amadadin says assessment includes an ultrasound to establish prostate size, uroflowmetry to check for obstruction and a prostate-specific antigen (PSA) test to help rule out cancer.
The procedure cannot be used in men with infections or prostates larger than 120 grammes. It is also not a treatment for prostate cancer.
Though BPH and prostate cancer affect the prostate and can produce similar urinary symptoms, BPH is non-cancerous. Patients, therefore, require assessment to establish the cause of their symptoms before treatment.
‘Rezum is actually a thermoablation of the prostate adenoma. We insert a small scope through the urethra and inject water vapour at around 70 degrees Celsius into the prostatic parenchyma. This causes thermoablation, destroying the prostatic tissue,’ Dr Amadadin said.
‘It’s only for benign enlargement of the prostate. We cannot use Rezum for prostate cancer or prostate-cancer-induced urinary symptoms.’
The procedure takes 10 to 15 minutes and is performed on an outpatient basis. Clinical studies cited by AKUH found symptom improvement of up to 50 percent within weeks, with about nine in 10 patients avoiding further surgery.
The treatment comes at a high cost, though, ranging from about Sh600,000 to Sh700,000, depending on hospital. The figure excludes some out-of-pocket expenses.
Private insurance may reduce the amount paid, but the Social Health Authority (SHA) does not cover the procedure.
Other hospitals offering the procedure are Advanced Urology Clinic and its affiliated Male Wellness and Urology Clinic and URO-CARE.
The 2022 Kenya Demographic and Health Survey (KDHS) found that more than 14,400 men aged 15 to 54 reported a prostate-related diagnosis, with only 14 percent getting treatment.