Clinical Report: Rezūm vs TURP for BPE-Related LUTS in Real-World Settings

Overview

This retrospective matched-cohort study compared Rezūm water vapor therapy and transurethral resection of the prostate (TURP) in men with benign prostatic enlargement (BPE)-related lower urinary tract symptoms (LUTS). Both treatments showed comparable baseline characteristics, but differed in perioperative outcomes, adverse events, and procedural success defined by a composite clinical endpoint.

Background

Non-neurogenic male LUTS associated with BPE significantly impair quality of life. While TURP remains the gold standard surgical treatment, concerns about sexual function and complications have driven interest in minimally invasive therapies like Rezūm water vapor thermal therapy. Rezūm delivers targeted thermal ablation sparing critical structures and has FDA approval since 2015, but comparative real-world data against TURP are limited. A novel composite definition of procedural success encompassing symptom relief, safety, and sexual function preservation has been proposed to better evaluate outcomes.

Data Highlights

Key Findings

• Baseline characteristics including age, prostate volume, IPSS, Qmax, and PVR were well matched between Rezūm and TURP groups.
• Rezūm was predominantly performed outpatient (89.6%) versus all TURP patients requiring admission.
• Median catheterization duration was significantly longer after Rezūm (5 days) compared to TURP (1.5 days).
• At 1 month post-procedure, storage symptoms and acute urinary retention were more frequent in Rezūm patients.
• Indications for surgery differed: medication side effects were more common in Rezūm patients, while poorly controlled LUTS predominated in TURP patients.
• Procedural success was defined by a composite endpoint including symptom improvement, safety, sexual function preservation, and no retreatment, enabling pragmatic outcome comparison.

Clinical Implications

Rezūm offers a minimally invasive outpatient alternative to TURP with comparable baseline patient profiles but distinct perioperative courses, including longer catheterization and higher early storage symptoms. The composite success definition aids clinicians in balancing symptom relief, safety, and sexual function preservation when counseling patients. Selection of therapy should consider patient preferences, surgical setting, and risk tolerance for early postoperative symptoms.

Conclusion

This pragmatic evaluation demonstrates that Rezūm water vapor therapy and TURP provide effective treatment for BPE-related LUTS with differing perioperative profiles. The novel composite success metric facilitates comprehensive outcome assessment, supporting informed shared decision-making in clinical practice.

References

1. 1 -- Non-neurogenic male LUTS and BPE impact
2. 2 -- Patient concerns about surgery and sexual function
3. 3 -- TURP as gold standard and emergence of minimally invasive therapies
4. 4,5 -- FDA approval and adoption of Rezūm
5. 6 -- Mechanism of Rezūm water vapor thermal therapy
6. 7,8 -- Clinical studies on Rezūm outcomes
7. 9,10 -- Guideline recommendations for Rezūm
8. 11 -- Pragmatic composite procedural success definition