Head-to-head comparison of prostatic urethral lift and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: a real-life study.

This study aimed at reporting a head-to-head comparison between water vapor thermal therapy using the Rezūm™ system and prostatic urethral lift using the Urolift™ system in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).

From December 2017 to November 2019, consecutive patients who underwent Rezūm™ and Urolift™ procedures in two urology centers have been retrospectively considered. Only patients with a prostate size less than 80 mL were included. We used the PSM method to adjust baseline differences between both groups. The co-primary endpoint included the change in International Prostate Symptom Score (IPSS) and IPSS- quality of life (QoL) from baseline to 12 months.

A total of 61 (52.1%) and 56 (47.9%) patients underwent Rezum™ and Urolift™ procedures, respectively. After PSM adjustment, 24 patients were included in both groups. No serious adverse events occurred (> Clavien II) in both groups. At 12 months, higher IPSS improvement was observed in the Rezum™ group (median:4 [IQR 3-5]) than in the Urolift™ group (median:8 [IQR 7-12]), without statistical difference (p = 0.08). The improvement in term of QoL at 12 m was similar (p = 0.43). The retreatment rates were 25% (Urolift™) and 8.3% (Rezum™), p = 0.24. Erection and ejaculatory function scores did not change significantly in either treatment group. Results in the full cohort showed that Rezum™ appeared to deliver greater improvements for IPSS and IPSS-QoL (p < 0.001 and p = 0.006, respectively) and lower reintervention rate (p = 0.006) than Urolift™.

In this small retrospective study, our results indicate that both Rezum™ and Urolift™ provide a clinically significant improvement in symptoms and QoL, although some of these improvements were greater in the Rezum™ arm. Future studies are needed to definitively assess which treatment would be best suited for each patient.

International urology and nephrology. 2021 May 29 [Epub ahead of print]

Michael Baboudjian, Marc Fourmarier, Bastien Gondran-Tellier, Benjamin Pradere, Mickael Userovici, Camille Alegorides, Nicolas Barry Delongchamps

Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France. ., Department of Urology, Aix-en-Provence Hospital, Aix en Provence, France., Department of Urology and Kidney Transplantation, La Conception Hospital, AixMarseille University, APHM, Marseille, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, Cochin Hospital, APHP, University of Paris Descartes, Paris, France.