One of our Members has been exploring whether Rezum is likely to be offered in Scotland, specifically in Lothian. In August 2018, we reported on this website that the use of Rezum (which involves the use of steam treatment for large prostates) had been approved by NICE for use in England.(Read more here) He has read the NICE statement, noted that the treatment has been positively assessed in the US and that 5 hospitals in England offered it with more on the way, and that its minimally invasive out-patient treatment appeared to be of lower risk to the sexual function and also cost effective. He has corresponded with the Lothian Medical Director, Dr Tracey Gillies, and Professor Alan McNeil of the Department of Urology at the Western. Dr Gillies advised that the Board would only consider offering Rezum if a business case was made by the Department. Professor McNeil has made it clear that he has no intention of making a business case. In a letter to our Member, commenting on the NICE decision and the treatment’s introduction in England, he said “While media coverage showed Rezum in a very positive light, my look at the evidence upon which the introduction was based led me to conclude that it would not be as durable or reliable a procedure as transurethral resection of the prostate”(TURP). He went on to say that as he was not aware of any other colleagues who are pushing a business case and that “it seems unlikely that Rezum will become available in NHS Lothian in the near future”. Our Member’s view is that in these circumstances and recognising that a developing a business case is a demand on the time of very busy people, it may be best to wait and see what the longer term effects of this treatment are compared to TURP and then maybe push again.