REZUM; A Water Vapor Thermal Therapy; as A Minimal Invasive Technique vs. Transurethral Resection of Prostate in saline as The Gold Standard in Management of Benign Prostatic Hyperplasia. A prospective randomized study

Abstract

Abstract Background Management of BPH involves a variety of treatment options tailored on patient’s symptoms, prostate size, and overall health status. Traditional treatments have ranged from watchful waiting for mild symptoms to medication and surgery for more severe cases. Objective Evaluation of REZUM and clarifying its position in the armamentarium of the surgical treatments of benign prostatic hyperplasia (BPH) of 30–90 g size, through comparing it with transurethral resection of prostate in saline (TURis); the evolution of the known gold standard TURP; regarding efficacy & safety. Methods It is a Prospective cohort interventional study on BPH patients treated with TURis or REZUM within a year from April 2022 till March 2023 in Ain-shams university hospital, National Institute of Nephrology & Urology and Katameya Clinic hospital, resp. The research involved (57) patients allocated in two groups, group A patients underwent TURis (34) and group B patients underwent REZUM (23). The comparison items were international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), operative time, catheter time, hospital stay for efficacy and using the incidence of complications and affection over sexual function for safety. Results Rezum significantly changed IPSS from the baseline score by -53.5%, QoL score by -60%, Qmax by + 63.5%, PVR by -56.7% and Ejaculatory function improved by 7.2% all at 6 months of follow up. On the other hand, these outcomes in efficacy were beneath the achieved values in patients underwent TURis at all time of follow up. Yet, Rezum therapy boasted a notably excellence in the safety parameters; reduced operative time and hospital stay. Furthermore, Rezum has minimal impact on sexual function. Conclusions Rezum therapy for BPH patients achieved significant and sustained improvements in urinary symptoms. Yet, Rezum therapy is still inferior to transurethral resection in saline. Data also underscores its high safety profile, minimal side effects, and suitability for patients who are either unsuitable for surgery or wish to avoid lifelong pharmacotherapy. In addition, Rezum considered a pioneer technique for patients considering sexual function is the main concern.