Which improvements does Rezum bring to BPH management? A network meta-analysis and comparison of water vapor therapy and conduction ablation techniques.

Introduction: This study evaluated the effectiveness and safety of Rezum water vapor thermal therapy (Rezum) and compared them with those of traditional conduction ablation methods for the management of benign prostatic hyperplasia.

Evidence acquisition: A comprehensive review of studies from the PubMed, Cochrane, and EMBASE databases was performed. Only randomized clinical trials that reported the outcomes of thermal ablation treatments, including transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), and Rezum, were included. A network meta-analysis was performed to compare these treatments.

Evidence synthesis: Sixteen studies comprising 1622 patients were included. Rezum did not show efficacy superior to that of traditional conduction ablation methods in terms of the International Prostate Symptom Score, quality of life, peak urinary flow rate, and postvoid residual volume. The incidence of acute urinary retention associated with Rezum was similar to that associated with other conduction ablation methods of TUMT and TUNA and transurethral resection of the prostate. Regarding ejaculatory dysfunction, Rezum resulted in outcomes comparable to those of sham treatment. According to the surface under the cumulative ranking curve, Rezum resulted in the lowest incidence of ejaculatory dysfunction.

Conclusions: Rezum provides functional outcomes of urinary symptoms that are comparable to those of conduction ablation therapies. Notably, among the minimally invasive thermal ablation therapies evaluated during this study, Rezum resulted in the lowest incidence of ejaculatory dysfunction.