Minimal Approach to Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia: Is Less More?

Vi Nguyen; Clara Cerrato; Mimi V Nguyen; Michelle C Leach; Jamie L Finegan; Kevin C Zorn; Dean Elterman; Naeem Bhojani; Bilal Chughtai; Seth K Bechis

doi:10.1016/j.urology.2025.03.040

Minimal Approach to Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia: Is Less More?

Urology. 2025 Apr 3:S0090-4295(25)00297-3. doi: 10.1016/j.urology.2025.03.040. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, UC San Diego Health, San Diego, CA. Electronic address: vin016@health.ucsd.edu.
² Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
³ Department of Urology, Mayo Clinic, Scottsdale, AZ.
⁴ Department of Urology, UC San Diego Health, San Diego, CA.
⁵ Department of Urology BPH Canada Prostate Institute, Mont-Royal Surgical Center, Montreal, Quebec, Canada.
⁶ Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada.
⁸ Department of Urology, Northwell Health, New Hyde Park, NY.

PMID: 40187697
DOI: 10.1016/j.urology.2025.03.040

Abstract

Objective: To evaluate postoperative outcomes after a minimal approach of water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA), defined as 1 treatment per prostate lobe, among men with benign prostatic hyperplasia.

Methods: We performed a multi-institutional retrospective review of patients who underwent WVTT from 2018 to 2022. Propensity score matching was utilized to generate patient cohorts based on number of treatments per lobe (1 per lobe, including median lobe if present [minimal group], vs ≥2 per lobe [nonminimal group]) matched for age, body mass index, and preoperative prostate volume. Primary outcome was postoperative complications and storage phase symptoms beyond 30days. We then conducted a non-propensity score matching independent t test to analyze differences in International Prostate Symptom Score (IPSS), uroflowmetry, and surgical retreatment rate postoperatively.

Results: 146 patients were included, with 73 in each arm. The nonminimal group had their median lobe treated more frequently (P=.021) and experienced higher postoperative de-novo retention (P=.009) and urinary tract infection (P=.003) rates. On multivariate analysis, increasing number of treatments (hazard ratio 1.3, P=.039) and median lobe treatment (hazard ratio 4.7, P=.008) were significant risk factors for postoperative storage phase symptoms. Mean IPSS and uroflowmetry parameters were similar at 1, 3, 6, and 12months postoperatively. Surgical retreatment rates were comparable at 2years (3% vs 1%; P=.444).

Conclusion: Minimal approach to WVTT is associated with decreased postoperative complications with comparable IPSS, maximum flow rate, and surgical retreatment rate. Further studies are needed to investigate longer term outcomes.