Is Sexual Function Better Preserved After Water Vapor Thermal Therapy or Medical Therapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia?

Abstract

Background: Men often experience deterioration of sexual function after the use of a-blockers and 5-a reductase inhibitors for the treatment of lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia. Thus, an alternative treatment with water vapor thermal therapy (Rez um System, Boston Scientific, Marlborough, MA, USA) which is an efficacious minimally invasive surgical treatment that preserves sexual function was examined. Aim: To compare sexual function over 3 years after continuous daily treatment with pharmaceutical agents in the Medical Therapy of Prostatic Symptoms (MTOPS) study vs a single thermal therapy procedure (Rez um study) in subjects with matched criteria for LUTS severity and prostate size. Methods: We used sexual function data from sexually active cohorts in the MTOPS study (1,209) randomized to doxazosin, finasteride, combination drugs and placebo, and sexually active men who received thermal therapy (86). MTOPS study participants completed the Brief Male Sexual Function Inventory; men in the Rez um trial completed the International Index of Erectile Function and Male Sexual Health Questionnaire. Main Outcome Measure: Estimated mean changes from baseline for sexual function variables were compared using a linear mixed repeated measures model with fixed effects for treatment and follow-up visits. Results: With continued daily drug use, men experienced significant worsening of sexual desire, erectile and ejaculatory function with finasteride and combination drug therapy, and reduced desire and erectile function with doxazosin. Thermal therapy was not associated with significant negative changes in sexual function throughout 3 years after treatment. Clinical Implications: Water vapor thermal therapy can result in greater LUTS improvements than either doxazosin or finasteride alone, whereas combination drug therapy may equal that of this Rez um procedure, but all drug therapies did have a significant negative impact on sexual function in contrast to the preservation of libido, erectile, and ejaculatory function after thermal therapy. Strength & Limitations: The report includes high-quality data from 2 large randomized controlled trials in subjects with similar baseline inclusion criteria for LUTS severity and prostate size. It is the first longitudinal assessment of sexual function domains restricted to sexually active men treated with drugs or a single minimally invasive surgical treatment with the Rez um procedure. A limitation of the study is the use of 2 different, although validated sexual function inventories (Brief Male Sexual Function Inventory and International Index of Erectile Function). Conclusion: A single water vapor thermal therapy procedure for targeted prostate tissue ablation for LUTS/ benign prostatic hyperplasia had no deleterious effect on 4 sexual function domains compared with appreciable worsening of sexual function after long-term single or combination drug use. McVary KT, Rogers T, Mahon J, et al.

Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study

“…All drug treatments typically had significant negative impact on sexual function in contrast to preservation of libido, erectile, and ejaculatory function after thermal therapy. 23 There are multiple options for treating LUTS/BPH within the armamentarium of treatments including pharmaceutical agents, surgery, and the newer minimally invasive procedures. As value and quality-based reimbursement programs continue to evolve, cost-effectiveness becomes paramount.…”

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…Two papers compared efficacy and side-effects of the Rez um system to medical therapy [Medical Therapy of Prostatic Symptoms (MTOPS) subjects treated with doxazosin, finasteride or combination] [15,16]. Outcomes were compared for 3 years for symptom changes and clinical progression rates.…”

“…The Q max improved 4-5 mL/s after water vapour thermal therapy and doxazosin, while thermal therapy was superior to finasteride and combination drugs at 24 and 12 months (P < 0.001 and P < 0.01, respectively) [15]. McVary et al [16] used the same dataset to assess the differential effect of medical therapy and Rez um on sexual function. While medical therapy (in particular combination therapy) deteriorated sexual function over time, this was not the case after Rez um [16].…”

“…McVary et al [16] used the same dataset to assess the differential effect of medical therapy and Rez um on sexual function. While medical therapy (in particular combination therapy) deteriorated sexual function over time, this was not the case after Rez um [16]. However, these data have to be interpreted with great caution due to the study design (retrospective, comparative, placebo-run in only in MTOPS).…”

Interventional therapy in benign conditions of the prostate

“…Meanwhile, no EAU recommendations exist for Rezum ® . According to the AUA guidelines, Rezum ® may be offered to patients with PV <80 cc who desire to preserve ejaculatory function (conditional recommendation, evidence level: grade C; AUA)[2,4,[19][20][21][22].Radiologe 2020 • 60 (Suppl 1):S54-S62 https://doi.org/10.1007/s00117-020-00706-1 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020 therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures.…”