To evaluate postoperative outcomes after a minimal approach of water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), defined as 1 treatment per prostate lobe, among men with benign prostatic hyperplasia (BPH).
We performed a multi-institutional retrospective review of patients who underwent WVTT from 2018 to 2022. Propensity score matching (PSM) was utilized to generate patient cohorts based on number of treatments per lobe (1 per lobe, including median lobe if present [minimal group], vs ≥2 per lobe [non-minimal group]) matched for age, body mass index, and preoperative prostate volume. Primary outcome was postoperative complications and storage phase symptoms beyond 30 days. We then conducted a non-PSM independent T-test to analyze differences in International Prostate Symptom Score (IPSS), uroflowmetry, and surgical retreatment rate postoperatively.
146 patients were included, with 73 in each arm. The non-minimal group had their median lobe treated more frequently (p=0.021) and experienced higher postoperative de-novo retention (p=0.009) and urinary tract infection (p=0.003) rates. On multivariate analysis, increasing number of treatments (hazard ration [HR] 1.3, p= 0.039) and median lobe treatment (HR 4.7, p=0.008) were significant risk factors for postoperative storage phase symptoms. Mean IPSS and uroflowmetry parameters were similar at 1, 3, 6 and 12 months postoperatively. Surgical retreatment rates were comparable at 2 years (3% vs 1%; p=0.444).
Minimal approach to WVTT is associated with decreased postoperative complications with comparable IPSS, maximum flow rate, and surgical retreatment rate. Further studies are needed to investigate longer term outcomes.
Urology. 2025 Apr 03 [Epub ahead of print]
Vi Nguyen, Clara Cerrato, Mimi V Nguyen, Michelle C Leach, Jamie L Finegan, Kevin C Zorn, Dean Elterman, Naeem Bhojani, Bilal Chughtai, Seth K Bechis
Department of Urology, UC San Diego Health, San Diego, CA, USA. Electronic address: ., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Mayo Clinic, Scottsdale, AZ, USA., Department of Urology, UC San Diego Health, San Diego, CA, USA., Department of Urology BPH Canada Prostate Institute, Mont-Royal Surgical Center, Montreal, QC, Canada., Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada., Department of Urology, University of Montreal Hospital Center, Montreal, QC, Canada., Department of Urology, Northwell Health, New Hyde Park, NY, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40187697