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Minimal Approach to Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia: Is Less More? - Beyond the Abstract

Several surgical treatment options are available for benign prostatic hyperplasia (BPH), with the recent emergence of minimally invasive surgical therapies (MIST). Water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA) is desirable given preservation of erectile and ejaculatory function. However, the optimal number of injections in a single procedure remains unclear. Our group previously demonstrated a more minimal approach (less is more) may lead to successful treatment response while minimizing adverse events, but this study was limited by the small sample size and single institutional nature.

Thus, the objective of our study was to conduct a multi-institutional study to evaluate the effect of a minimal approach of WVTT, defined as 1 vapor treatment per prostate lobe, on postoperative outcomes. The study design is summarized in Figure 1.


Figure 1. Less is more WVTT study design.

We then performed propensity score matching (PSM) to generate patient cohorts at a 1:1 ratio based on number of treatments per lobe. Patients were matched for age, BMI, and preoperative prostate volume. After PSM, we identified a total of 146 men, with 73 patients in each arm.

No preoperative differences were identified between the two cohorts. Intraoperatively, patients in the non-minimal group were significantly more likely to have a median lobe, which was subsequently treated. Postoperatively, the minimal cohort experienced lower rates of adverse events, lower rates of UTI, and urinary retention. Surgical retreatment rates were comparable (Table 1).

WVTT_study_BTA.png

There was no significant difference in Qmax and voided volumes. PVR was significantly reduced within 90-180 days and follow up after 180 days in the minimal cohort group compared to the non-minimal group (Table 2). IPSS was comparable at all follow up time points (Figure 2).

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Figure 2. IPSS trends between two patient cohorts at baseline, 1, 3, 6, and 12 months

This is the first multi-institutional study examining the less is more approach for WVTT, which was able to capture various practice settings and patient populations. We were able to generate two comparative study arms using PSM. We also captured both subjective, patient-reported outcomes (IPSS) and objective outcomes (uroflowmetry, surgical retreatment). We acknowledge our study was limited by its lack of generalizability to patients with preoperative urinary retention and larger prostates based on our exclusion criteria, as well as mean prostate volume of 46-49cc. We also did not evaluate sexual function as an outcome of our study. We were able to capture surgical retreatment rates but did not account for medical retreatment. Longer follow up is needed to evaluate durability of this approach.

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Written by: Vi Nguyen MD,1 Clara Cerrato MD,2 Mimi V. Nguyen,3 Michelle C. Leach,1 Jamie L. Finegan BA,1 Kevin C. Zorn MD,4 Dean Elterman MD,5 Naeem Bhojani MD,6 Bilal Chughtai MD,7 Seth K. Bechis MD,1

  1. UC San Diego Health, San Diego, CA, USA
  2. University Hospital Southampton NHS Trust, Southampton, UK
  3. Mayo Clinic, Scottsdale, AZ, USA
  4. BPH Canada Prostate Institute, Mont-Royal Surgical Center, Montreal, QC, Canada
  5. University Health Network, University of Toronto, Toronto, ON, Canada
  6. University of Montreal Hospital Center, Montreal, QC, Canada
  7. Northwell Health, New Hyde Park, NY, USA
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