Prostate Size and Its Effect on Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Improvement After Convective Water Vapor Thermal Therapy.

Abstract

Purpose: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) affect quality of life. Convective water vapor thermal therapy (CWVTT; Rezūm) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30 cc and 80 cc with minimal de novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post CWVTT in men with LUTS/BPH.

Materials and methods: Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in International Prostate Symptom Score (IPSS) pre CWVTT compared with post CWVTT between PV tertiles-small (≤38.5 cc), medium (38.5 to ≤55.6 cc), and large (>55.6 cc). Secondary outcome was time to a minimally clinically important difference of 25% decrease in IPSS.

Results: One hundred seventy-one patients were divided into small (n = 56), medium (n = 54), and large (n = 61) PV tertiles. The change in IPSS preoperatively to 3 months was significant for all tertiles with mean difference of -7.51 (-10.14 to -4.83), -10.12 (-12.71 to -7.53), and -11.72 (-14.14 to -9.29) for small, medium, and large PVs, respectively (P = <.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3 months with average increase (95% CI) of 3.67 (0.23-7.11, P = .037) compared with not having diabetes. The median time (Q1, Q3) to -25% in IPSS for small, medium, and large PVs was 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared with small PV (HR [95% CI]: 2.10 [1.19-3.72], P = .011).

Conclusions: CWVTT results in significant and durable LUTS improvement across the PV spectrum. All PVs experience the same improvement in LUTS post CWVTT. However, medium and large glands may improve more quickly than small glands.