Efficacy and Safety of Rezūm Water Vapor Thermal Ablation in Large and Small Prostates: A Multicenter Comparative Analysis of 2,725 Patients.

Abstract

Background: Rezūm water vapor therapy is well established for benign prostatic hyperplasia in prostates less than 80 cm 3 ; however, evidence in larger glands remains limited despite increasing demand for minimally invasive alternatives to conventional operation. We compared outcomes after Rezūm therapy in patients with large prostate (LP) vs small prostate (SP).

Study design: In this multicenter retrospective study, 2,725 patients undergoing Rezūm therapy across 5 centers were stratified by prostate volume: LP (greater than or equal to 80 cm 3 ; n = 993) and SP (less than 80 cm 3 ; n = 1,732). Primary outcomes were 6-month changes in International Prostate Symptom Score (IPSS), IPSS quality of life, peak urinary flow rate, and post-void residual. Secondary outcomes included Sexual Health Inventory for Men scores, complications, and retreatment rates.

Results: At 6 months, LP and SP cohorts achieved comparable improvements in IPSS (41.4% vs 41.9%; p = 0.958), quality of life (50.0% vs 50.0%; p = 0.394), and peak urinary flow rate (122.2% vs 118.2%; p = 0.62). LP patients experienced greater reduction in post-void residual (68.8% vs 24.0%; p < 0.001). Sexual Health Inventory for Men scores remained stable in both groups despite a significant between-group difference. Complication rates were similar (5.0% vs 4.9%; p = 0.559). Over a median follow-up of 41 months, LP patients had lower surgical retreatment rates than SP patients (3.6% vs 7.2%; p < 0.001).

Conclusions: In this large multicenter cohort, Rezūm therapy provided comparable symptomatic and flow-rate improvements in prostates greater than or equal to 80 cm 3 and less than 80 cm 3 , with greater improvement in bladder emptying and lower long-term surgical retreatment rates among larger glands. These findings support the safety, effectiveness, and durability of Rezūm therapy in appropriately selected patients with prostates greater than or equal to 80 cm 3 .