Expert consensus on Rezūm™: Indications, surgical technique and postoperative care

Abstract

Background

Lower urinary tract symptoms associated to benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated to a high clinical, economic and humanistic burden. Currently, there is a wide range of therapeutic options, both pharmacological and surgical. In recent years, several minimally invasive therapies have emerged, but they still have limitations. In this context, water vapour thermal therapy (WVTT), Rezüm™, is a new minimally invasive surgical technique with a low retreatment rate and the ability to preserve sexual function. The objective of this study is to establish recommendations for the correct execution of WVTT, as well as to define the ideal patient profile for the intervention.

Methods

A literature search was conducted in PubMed, without date limitations, using the terms ‘benign prostatic hyperplasia’, ‘benign prostatic enlargement’, ‘prostatic hyperplasia’, ‘bph’, ‘Rezūm’, ‘water vapour thermal therapy’, ‘quality of life’ and ‘HRQOL’. A systematic review of the evidence was conducted and subsequently discussed in a face-to-face meeting with a panel of five experts in the field of urology. The aspects addressed were classified into patient profile, pre-intervention, intervention and post-intervention.

Results

The search returned 172 results, ultimately leading to the analysis of 49 articles. Evidence and expert opinion showed that WVTT could be a good option for patients with moderate to severe symptomatology, no age restriction, Qmax <15 mL/s and prostate volume greater than 30 cm³, but not necessarily less than 80 cm³. Low retreatment rate and low impact on erectile capacity and ejaculatory function were also demonstrated.

Conclusions

WVTT is considered a safe treatment option, even as a first-line approach for certain patient profiles. However, further research is needed in areas where evidence and clinical experience remain limited, including postoperative catheter management, anaesthesia, antibiotic prophylaxis and follow-up care for patients after the procedure.