Medium-Term Real-world Outcomes of Minimally Invasive Surgical Therapies for benign prostatic hyperplasia: Water Vapor Thermal Therapy (Rezum) Versus Prostatic Urethral Lift (UroLift) in a High Volume Urban Academic Center.

Water Vapor Thermal Therapy (WVTT, i.e. Rezum®) and Prostatic Urethral Lift (PUL, i.e. Urolift®) are minimally invasive surgical therapy (MIST) options for benign prostatic hyperplasia (BPH).

Few studies have directly compared the two procedures. We examined the clinical characteristics and postoperative outcomes of patients undergoing WVTT and PUL at our high-volume urban academic center.

We reviewed our institutional MIST database to identify patients with prostate sizes ≥30 and ≤80 cc who underwent WVTT or PUL for treatment of BPH between January 2017 and September 2021. Pre- and post-operative outcomes including retreatment rates, AUA symptom score (AUA-SS), maximum flow (Qmax), post-void residual (PVR), medication usage, trial of void success rates, catheterization requirements, and postoperative complications within 90 days were extracted and compared between procedures.

307 patients received WVTT and 110 patients received PUL with average follow-up times of 11.3 and 12.8 months, respectively. WVTT patients showed significant improvements in AUA-SS, Qmax, and PVR, whereas PUL patients showed improvements in only AUA-SS and Qmax. Both WVTT and PUL patients with longitudinal follow-up demonstrated improvements in AUA-SS, Qmax, and PVR. Postoperatively, alpha-blocker utilization was significantly decreased following both WVTT and PUL (WVTT: 73.9% to 46.6%, PUL: 76.4% to 38.2%, both p<0.001). Compared to patients receiving PUL, WVTT patients more frequently reported postoperative dysuria (22.8% vs 8.3%, p=0.001) and non-clot-related retention (18.9% vs 7.3%, p=0.005); PUL patients more frequently experienced postoperative clot retention (7.3% vs 2.6%, p=0.027). There were no differences in rates of postoperative bladder spasm, TOV success, urinary tract infections, or emergency department visits. Postoperative erectile dysfunction and retrograde ejaculation were rare and occurred at similar rates.

In the real-world setting, WVTT and PUL have similar medium-term efficacy in improving symptoms and decreasing medication utilization for patients with BPH. Differences in postoperative complication profiles should inform patient counseling.

Journal of endourology. 2022 Aug 30 [Epub ahead of print]

Chih Peng Chin, Evan Garden, Krishna Teja Ravivarapu, Devki Shukla, Olamide Omidele, Micah Levy, Daniel Qian, Joseph Sewell Araya, Robert Valenzuela, Avinash Reddy, Susan Marshall, Jay Motola, Craig Nobert, Mantu Gupta, Alex C Small, Steven Kaplan, Michael A Palese

Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., University of Chicago Pritzker School of Medicine, Urology, Chicago, Illinois, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; ., Albert Einstein College of Medicine, Urology, Bronx, New York, United States; ., Icahn School of Medicine at Mount Sinai, New York, New York, United States; ., Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States; .

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