Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction.

Background: Rezum alleviates lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) while preserving sexual function, but long-term sexual function outcomes are lacking in patients with baseline erectile dysfunction (ED).

Aim: The study sought to analyze 4 years of real-world sexual function outcomes of Rezum using the International Index of Erectile Function (IIEF) questionnaire, stratified by baseline ED status.

Methods: Participants included multiethnic Rezum-treated patients from a single outpatient office. IIEF domains and BPH medication usage were compared at baseline and 6, 12, and 48 months using t tests, Mann-Whitney U tests, chi-square tests, and Wilcoxon signed rank tests.

Outcomes: Primary outcomes over 4 years included the IIEF functional domains (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS]) and BPH medication usage.

Results: A total of 91 patients were included: 40 (44%) in the ED cohort and 51 (56%) in the no ED cohort. History of diabetes was more prevalent in the ED cohort (35% vs 15.7%; P = .048). Baseline scores in the EF, OF, IS, and OS domains were lower in the ED cohort. Compared with baseline, there were no significant changes in any IIEF domains in either cohort at 6 months. At 12 months, the ED cohort had significant percent decreases in OF (-25%; P = .02), SD (-22.2%; P = .04), and OS (-33.3%; P = .004); the no ED cohort had a significant percent increase in EF (5%; P = .04). At 48 months, the no ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in EF (30%; P = .01), SD (22.5%; P = .02), IS (20%; P = .01), and OS (58.3%; P = .008). Both cohorts significantly discontinued BPH medications at all follow-ups. At 48 months, there were no cases of de novo ED in the no ED cohort.

Clinical implications: As modern BPH therapies continue to demonstrate efficacy in alleviating lower urinary tract symptoms, the preservation or improvement of sexual function emerges as an increasingly important consideration for patients, with our study suggesting Rezum as a compelling option.

Strengths and limitations: Our study has the strength of long-term Rezum outcomes in an ethnically diverse patient population, stratified by the presence of baseline ED, but is limited by retrospective design, single-center nature, and small sample sizes at long-term follow-ups.

Conclusion: Rezum preserved long-term sexual function in patients without baseline ED and improved sexual function in those with baseline ED; however, individuals with ED may experience temporary decreases in sexual function at 12 months.