Convective water vapor thermal therapy (WVTT, Rezum™) is an established minimally invasive surgical technique for men with LUTS secondary to benign prostatic hyperplasia (BPH). Despite increasing adoption, patient selection, peri-procedural management, technical execution, and training remain heterogeneous. We conducted a live modified Delphi consensus to define pragmatic, expert-driven recommendations for WVTT practice in Italy.
A 10-member steering committee screened the literature and drafted candidate statements across eight predefined domains. A live modified Delphi process was conducted with 22 Italian urologists. Panelists voted using a four-level response scale; justifications were required for any response other than full agreement. Statements below the predefined consensus threshold were discussed, reformulated when appropriate, and re-voted. Consensus was defined a priori as ⩾75% full agreement.
Twenty-six statements were voted. Consensus was achieved for 21/26 (80.8%) statements. Five statements did not reach consensus: routine preoperative cystoscopy (72.8%), routine semen culture (31.8%), restricting general anesthesia to selected cases/early learning curve (50.0%), continuation of antibiotics for the entire catheterization period (68.2%), and mandatory "complete" follow-up at 6 months (72.7%). Two items underwent iterative reformulation and re-voting: prostate volume ⩽ 80 cm3 (77.3% → 100%) and supervision during the initial learning curve (31.8% → 61.9% → 90.5%).
This live Delphi consensus provides practice-oriented guidance for WVTT and defines areas of strong expert agreement alongside persistent evidence gaps. The findings support standardized adoption of WVTT within defined indications while prioritizing future research on peri-procedural protocols and follow-up pathways.
Urologia. 2026 Apr 16 [Epub ahead of print]
Silvia Secco, Francesco Greco, Federico Pierella, Piergiorgio Tuzzolo, Giulio Bevilacqua, Eros Scarciglia, Francesco Pinto, Emanuele Rubilotta, Stefano Cavalleri, Giuseppe Abatangelo, Claudio Lamon, Daniele Romagnoli, Simonetta Fracalanza, Francesco Visalli, Stefano De Luca, Francesco Varvello, Roberto Renzetti, Gennaro Annunziata, Sebastiano Condorelli, Evangelista Martinelli, Carlo Marenghi, Raffaele Balsamo, Alberto Olivero, Roberto Castellucci, Petros Sountoulides, Luca Cindolo
Ospedale Niguarda, Milano, Italy., Centro Salute Uomo, Bergamo, Italy., Aurelia Hospital, Roma, Italy., Campus Biomedico, Roma., Policlinico Umberto I, Roma., Policlinico Gemelli, Roma, Italy., Azienda Ospedaliera Universitaria Integrata Verona/Osp. Maggiore Borgo Trento, Italy., Osp. Sacro Cuore Don Calabria, Negrar, Italy., AULSS 8 Berica/Osp. San Bortolo, Vicenza, Italy., AULSS 2 Marca Trevigiana/Osp. Ca' Foncello, Treviso, Italy., Policlinico di Abano Terme, Italy., Azienda Ospedale-Università Padova, Italy., AULSS 2 Marca Trevigiana/Osp. Conegliano, Veneto, Italy., Ospedale San Luigi di Orbassano, Italy., Ospedale Pietro e Michele Ferrero, Verduno, Italy., Ospedale Santo Spirito, Pescara, Italy., Presidio Ospedaliero Giuseppe Tatarella, Cerignola, Italy., Presidio Ospedaliero "Vittorio Emanuele", Gela, Italy., Ospedale Di Venere, Bari, Italy., Ospedale Guido Salvini, Garbagnate Milanese, Italy., Urology Unit, Department of Surgical Sciences AORN dei Colli, Monaldi Hospital, Naples, Italy., Centro Urologico Europeo, Modena., 1st Urology Department, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.