The STEAM-MAP 1 Study is a single-arm, prospective feasibility trial evaluating the integration of MRI-transrectal ultrasound (TRUS) fusion guidance into Rezūm water vapor thermal therapy for men with symptomatic benign prostatic hyperplasia (BPH).

This study aims to assess the feasibility, procedural characteristics, and early safety of MRI-TRUS fusion-guided planning and delivery of Rezūm water vapor therapy in men with symptomatic benign prostatic hyperplasia.

Eligible patients with prior MRI prostate fulfilling the eligibility criteria will be enrolled from the participating hospitals. Baseline assessment including symptom severity and uroflowmetric measurements, urine culture will be performed in the usual routine pre-Rezūm nurse-led clinics. The intervention will consist of MRI segmentation and image-informed injection planning, with documentation of planned and delivered injection sites and performance metrics. .

Inclusion Criteria:

• Age 30-80 years old with symptomatic BPH.
• Prostate volume 30-80 mL (TRUS/MRI/US)
• Suitable for Rezum.
• Able to consent and comply with follow-up to 1 month.
• With prior prostate MRI within 2 years

Exclusion Criteria:

• Known/suspected prostate cancer requiring oncologic management.
• Prior prostate surgery impacting urethral anatomy within 12 months.
• Prior implant affecting urethral anatomy.
• Active UTI or untreated bacteriuria pre-op.
• Uncorrectable coagulopathy; inability to manage antithrombotics.
• Severe medical comorbidity precluding endoscopy.