PEOPLE who know Jamaican consultant urologist Dr Belinda Morrison will tell you that she is persistent in her quest to provide the best treatment for her patients.

It’s therefore not surprising that she and Dr Leroy Harrison are now the first urologists in Jamaica to offer Rezum water vapour therapy, a minimally invasive procedure that relieves men of the discomforts associated with an enlarged prostate, also known as benign prostatic hyperplasia (BPH).

Essentially, the Rezum system delivers controlled water vapour to the enlarged prostate tissue through a transurethral device. It uses the natural energy stored in steam to shrink excess prostate tissue, eventually relieving symptoms of BPH that affect many older men.

Those uncomfortable symptoms include frequent or urgent need to pee, urinating more often at night, weak urine stream, trouble starting to urinate, not being able to fully empty the bladder, and dribbling at the end of urination.

The Rezum treatment has been available abroad since 2015 when it was developed and commercialised by NxThera, a privately held company based in Maple Grove, Minnesota, United States.

In March 2018, Boston Scientific announced that it entered into an agreement to acquire NxThera, and last November Dr Morrison was able to purchase the system for use here.

“I’ve been going to meetings and seeing results being presented, hearing my colleagues overseas talking about using it, and I saw the benefit that it had during the COVID period to do ambulatory surgery on patients who just couldn’t go into hospital,” Dr Morrison told the Jamaica Observer.

“About two or three years ago, one patient reached out to me saying he had read an article I did for the
Observer from 2021. He said he was now having these issues and wanted to know if, for BPH, I offered this treatment. I said to him, we didn’t have it in Jamaica,” she related.

“I had maybe about two other queries asking if we offered it… because the patients were now reading and their relatives overseas were having it done,” Dr Morrison said, adding that on learning that a few of the patients travelled overseas to have the procedure done, she thought it was necessary to bring it here.

Now Dr Morrison has already treated 21 patients, and she, as well as her patients, are satisfied.

“What we’ve seen is within six weeks the flow rate has doubled, and their symptom bother has gone down by a half,” Dr Morrison told the Sunday Observer.

Urology experts explain that the flow rate is essentially the measurement of the amount of urine excreted over a specific time period, typically in millilitres per second (ml/s). A normal urine flow rate generally falls between 10 and 20 ml/s.

One of Dr Morrison’s patients, whose identity we will not reveal, expressed pleasure with the procedure.

“I am elated… I am not having any urinary problems. I have been having great urinary flow for the past four months, so I am grateful for Dr Morrison,” he said in a voice note.

“I can sleep through the night without waking up, so I am very grateful for the surgery and the process,” he added.

His testimonial was music to her ears.

“Without a doubt, there is benefit, and it is in keeping with what the data from overseas have shown that… when they saw the patients initially, they followed them up at three months, and within three months there was significant increase in the flow, less bother, and it was sustained. So it’s not something that you’re going to do now and then, you’re going to have to do it again in another year. No, it’s sustained,” Dr Morrison said.

She shared that men interested in the procedure need only contact her, they don’t need to be referred.

When they get to the centre, after a discussion to determine their symptoms, patients are required to do a urine flow test and fill out “an objective questionnaire to see how bothered they are by their symptoms”.

Next the prostate size is assessed by an ultrasound, which can be done in the office or at an external facility.

On receiving that result, the procedure is done in the office using a delivery device, a bag of saline and local anaesthetic to block the nerves around the prostate, thus preventing the patient from feeling pain.

The patient, Dr Morrison explained, remains awake during the procedure and can observe the process.

“So the needle goes into the prostate and delivers steam for nine seconds. Typically, we give six to seven injections in the one treatment,” she said, adding that the size of the prostate will determine the number of injections administered.

However, the entire process, she said, runs for about a minute.

“Once we do that, we put a very tiny catheter in the penis, it’s connected to a bag; the man jumps off the bed, he goes home. So there’s no overnight, there’s no recovery needed — no layover. It’s true ambulatory surgery,” Dr Morrison explained.

Asked how long the patient is required to have the catheter in place, Dr Morrison said: “That depends on how big the prostate is. Some patients, it may be three to five days, for some it may be seven days, and then they come back to remove it. And within the next two to three weeks, what you’re seeing is that the steam is taking its effect; the cells are dying, some men tell you they actually see stuff come out, or the body just reabsorbs it. And over time, what they find is if they were having a slow stream before, it gets much more powerful.

“If they were going often, especially at night, to urinate, it cuts down. And what we do is we time them over the period of time from surgery, to maybe about a month to two months, to continue taking their BPH medication. Afterwards, they stop [taking] it.”

She pointed out that the treatment does not kill cancer; however, there’s emerging evidence that scientists are going to conduct research to determine if it can be used for that purpose.

“But right now, it’s strictly indicated for an enlarged prostate,” the consultant urologist shared, even as she admitted that in a few cases of men with localised prostate cancer who are having difficultly urinating because of the size of the gland, the procedure can be done.

“But in most cases, an enlarged prostate is not due to cancer,” she stated.

“This treatment is good for them. It is effective, it’s long-lasting as well,” she argued.

Asked about the cost of Rezum therapy, Dr Morrison said it is much cheaper than the TURP (transurethral resection of the prostate) surgical procedure which is used to remove a section of the prostate gland, primarily to relieve urinary obstruction caused by BPH.

She explained that patients who opt for the TURP procedure are normally put on medication for life, but that may deliver side effects, among them erectile dysfunction or the lack of ejaculate.

“Those things are very, very bothersome to them. So in that situation, they may say, ‘Let’s abandon medication and choose the surgery.’ The surgery is more expensive than this by far, because you have to consider hospital cost for, on average, two nights for that procedure, plus the surgical cost. So it is more expensive,” Dr Morrison pointed out.

“Not only is it more expensive, there are more complications with hospitalisation. So if you have somebody who is not even in the fittest state, I mean, we’ve done very old men here — I think the oldest I’ve done is maybe 82 years old; he’s not very well medically, having a lot of bother with urination… but maybe he’s not the best candidate for surgery because of his age and comorbidities. This is a procedure for them,” she said.

“So it is ambulatory surgery that allows you to, overall, get rid of the challenges that you face with medication or doing the gold standard surgery,” Dr Morrison argued.

Asked about the side effects of the Rezum therapy, Dr Morrison said, initially, patients may have some blood in the urine “because once you inject the needle, you’ll have a little bit of blood”. That tends to happen in the first 48 hours.

“Some people may get a urinary tract infection, but we protect against that by making sure they’re covered with antibiotics, and they get medication before the procedure, even on the day of the procedure,” she said.

However, the benefit of the procedure, she emphasised, “is that it doesn’t affect erections”.

“I go back to that, because that’s the side effect of the other options. The Rezum procedure does not affect erections, it does not affect ejaculation, all of those are preserved on it and we’ve proven it with our patients,” Dr Morrison told the Sunday Observer.

“Other side effects, I think other than in the early days, if you take out the catheter a little bit too early, they may not be able to pee very well initially, because in the first couple of weeks after the procedure is done, urine feels a little sluggish and then improves quickly after.

“I think the only other thing I would say is some patients, maybe about 15 to 20 per cent, will tell you in the early days when the procedure is taking effect [that] there’s burning, [but] it doesn’t last for long, and we cover it with anti-inflammatory medication,” she said.

Her patient confirmed that he had one side effect while urinating after the procedure, but considered it minor and as such issued an appeal to other men experiencing urinary discomfort.

“I am saying to those males out there who are having these issues, get it checked out. Speak to Dr Morrison, she might just be your miracle. She really came through for me and I am grateful,” he said.

The screen of the Rezum water vapour therapy device shows the features of the system that is used to shrink enlarged prostate glands. (Photos: Joseph Wellington)

Dr Belinda Morrison holds a bag of saline in her right hand while demonstrating how the solution is used in the Rezum water vapour therapy device to help shrink enlarged prostate glands. Morrison and Dr Leroy Harrison are the only urologists offering the service in Jamaica at this time. (Photos: Joseph Wellington)