Real-world comparison of Rezūm® water vapor therapy and transurethral resection of the prostate using a pragmatic composite definition of procedural success

Category	Detail
Condition	Non-neurogenic male lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE)
Key Mechanisms	Rezūm delivers thermal energy via water vapor causing targeted prostatic tissue necrosis while sparing surrounding structures; TURP involves transurethral resection of prostate tissue
Target Population	Men with BPE-related LUTS, prostate volume 30-80 mL, no prior prostate surgery or cancer, non-neurogenic LUTS
Care Setting	Rezūm predominantly outpatient; TURP requires inpatient admission

Rezūm is a minimally invasive water vapor thermal therapy approved by FDA in 2015 with growing adoption
Procedural success defined by composite criteria including symptom improvement, safety, sexual function preservation, and no retreatment
Study matched 96 Rezūm patients to 96 TURP patients showing comparable baseline characteristics and differing perioperative profiles

Assessment includes IPSS, QoL IPSS subscale, Qmax, PVR, PSA, and sexual function history

First-line medical therapy includes α-blockers, 5-alpha reductase inhibitors, anticholinergics, beta-3 agonists
Surgical options include TURP (gold standard) and minimally invasive therapies like Rezūm
Rezūm recommended moderately by AUA (evidence level C); EAU has not endorsed Rezūm

Routine postoperative assessments at 1, 3, 6, and 12 months including IPSS, Qmax, PVR, PSA, sexual function, and PGI-I
Monitor for short-term adverse events such as storage/voiding symptoms, acute urinary retention, haematuria, UTI

Rezūm associated with higher rates of storage symptoms and acute urinary retention at 1 month
TURP requires inpatient admission and shorter catheterization duration
Potential sexual function impact considered in procedural success criteria

Men with BPE-related LUTS refractory or intolerant to medical therapy, prostate volume 30-80 mL

Rezūm favored in patients concerned about sexual function and medication side effects; TURP preferred for poorly controlled LUTS

Use propensity score matching to ensure comparable baseline characteristics in comparative studies
Define procedural success using composite endpoints including symptom improvement, safety, sexual function preservation, and retreatment avoidance
Adopt structured follow-up schedules with standardized assessments at multiple postoperative time points
Consider patient preference and clinical indications when selecting between Rezūm and TURP
Counsel patients on differences in perioperative profiles including catheterization duration and risk of early postoperative symptoms

Clinical Scorecard: Pragmatic Evaluation of Procedural Success: A Comparison of Rezūm® Water Vapor Therapy and Transurethral Resection of the Prostate in Real-World Settings