To evaluate outcomes after water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH), stratified by varying degrees of median lobe (ML) protrusion.
We enrolled men aged ≥45 years with BPH who underwent WVTT from July 2020 to September 2023. Inclusion criteria were an estimated prostate volume of 30-80 cc, International Prostate Symptom Score (IPSS) ≥12, and maximum urinary flow rate <16 mL/sec. ML protrusion was assessed using ultrasound (with bladder volume ≥250 cc) and flexible cystoscopy; the average of both measurements was used to classify ML protrusion into <5 mm, 5-10 mm, and >10 mm. Primary outcomes included postoperative complications such as surgical retreatment, acute urinary retention (AUR), and urinary tract infections (UTIs).
With a median follow-up of 29.1 months (range: 24-36), improvements in lower urinary tract symptoms (LUTS) were similar across all groups, with consistent symptom reduction (Δ = -13) in both obstructive and irritative IPSS components. Rates of AUR and UTIs showed no significant variation across groups: AUR (no ML 9.5%; <5 mm 8.7%; 5-10 mm 12%; >10 mm 17%; p = 0.7) and UTI (no ML 8.4%; <5 mm 4.3%; 5-10 mm 9.3%; >10 mm 8.3%; p = 0.8). Despite comparable preoperative characteristics, surgical retreatment rates varied significantly with ML protrusion: no ML (3.2%), <5 mm (4.3%), 5-10 mm (14%), and >10 mm (21%) (p = 0.007), highlighting increased retreatment risk associated with greater ML protrusion.
WVTT effectively relieves LUTS across all ML configurations. However, patients with greater ML protrusion may face a higher risk of retreatment, likely because of increased bladder neck and urethral involvement. These findings suggest that detailed ML assessment can aid in patient counseling and stratification.
Journal of endourology. 2026 Jan 21 [Epub]
Juan Fulla, Juan Sebastian Arroyave, Francisca Larenas, Steven A Kaplan, Michael Palese, Catherine Sanchez
Department of Urology, Hospital Clínico San Borja Arriarán, Santiago, Chile., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Clínica MEDS, Santiago, Chile.