Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study

Abstract

Purpose Rezūm is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezūm for BPH. Methods We prospectively followed 135 consecutive patients treated by Rezūm at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded. Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc. Results The median operative time was 10.5 (IQR 8.7–15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7–10) days. A significantly decrease of IPSS from baseline at first ( p = 0.001) and third ( p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery ( p = 0.06) that turned significant at 3 months postoperatively ( p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months ( p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption. Conclusion Rezūm treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.

Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review

“…After removing duplicates, 461 records were screened for eligibility based on title and abstract, of which 36 records were selected for full-text review. Twenty-five articles were included in the systematic review, of which six were from an RCT, [11][12][13][14][15][16] six were from five prospective studies [17][18][19][20][21][22] in which two articles were of the same study 18,19 and one article was of the crossover arm from the RCT, 17 eleven were from retrospective studies, [23][24][25][26][27][28][29][30] and two were from case series 31,32 (Figure 1).…”

“…McVary et al 27 Baboudjian et al 34 Bassily et al 35 Besides the pilot study by Dixon et al 18,19 all the studies were conducted in the United States before 2020. [11][12][13][14][15][16][17]23,24 Recently, however, more studies have been conducted in different countries including France, 26,30,34 United Kingdom, 21,31 Italy, 22 and Ireland. 32 Sample size and patient follow-up in each study ranged from 10 to 255 patients (median 65 patients) and 1 to 60 months (median 12 months), respectively ( 2).…”

“…Mean procedure time ranged from 4.4 to 13.0 minutes (median 7.0 minutes). Out of the 19 studies, 11-35 14 [11][12][13][14][15][16][18][19][20][21][22][24][25][26][27][28][29][30][31][32][33][34][35] reported postoperative urinary catheter rates which ranged from 65% to 100%, with 13 studies 21,22,[25][26][27][28][29][30][31][32][33][34][35] having a rate of 100%. The mean number of days patients were catheterized postoperatively ranged from 3.0 to 32.2 days, with the upper limit reserved for those who had urinary retention at baseline (Table 3).…”

“…In addition to treating patients with obstructing median lobes, Rezum has also been shown to effectively treat patients with urinary retention and large prostate volumes (≥80 g). Nine studies [21][22][23][26][27][28]31,34,35 treated patients with urinary retention and reported an overall catheter-free rate in 158/190 patients (83%, range 68%-100%), of which five studies 26,27,31,34,35 reported achieving it at a median of 14 days (range 13-2 days) following treatment.…”

Emerging Data on the Safety and Efficacy of Transurethral Water Vapour Therapy for Benign Prostatic Hyperplasia

“…In 2020, a Cochrane review was published on this technology, however it only considered data from one study, the randomized trial. 14,21 The heterogeneity of parameters reported among published studies and wide range of follow up periods preclude formal meta-analysis in previous and current study. However, consistent improvements in clinical outcomes after Rezum can be observed across all the studies.…”