Comparison of outcome for holmium laser enucleation prostate and Rezum system in benign prostate hyperplasia: a matched pair analysis - Scorecard - MDSpire
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Comparison of outcome for holmium laser enucleation prostate and Rezum system in benign prostate hyperplasia: a matched pair analysis
Clinical Scorecard: Evaluation of Outcomes for Holmium Laser Enucleation versus Rezum System in Treating Benign Prostatic Hyperplasia: A Matched Pair Study
HoLEP uses holmium laser to enucleate prostate tissue; Rezum delivers thermal energy via water vapour causing targeted cell necrosis
Target Population
Males aged 50–80 years with prostate volumes 50–150 mL, symptomatic BPH unresponsive to alpha-blockers
Care Setting
Tertiary care centre surgical setting with experienced surgeons
Key Highlights
HoLEP is size-independent, effective with less blood loss and considered gold standard for BPH surgery
Rezum is minimally invasive, preserves antegrade ejaculation, recommended for prostate <80 g and sexual function preservation
This study compares efficacy and safety of Rezum versus HoLEP in prostates >50 g including larger glands
Guideline-Based Recommendations
Diagnosis
Assess prostate volume via transrectal ultrasound
Evaluate symptoms using IPSS and Qmax measurements
Exclude patients with urethral stricture, bladder stones, neurogenic bladder, high PVR, or coagulopathy
Management
Initial treatment with behavioural and medicinal interventions (alpha-blockers)
Surgical intervention (HoLEP or Rezum) if medical treatment fails
HoLEP preferred for size-independent treatment; Rezum recommended for prostate <80 g and sexual function preservation
Monitoring & Follow-up
Follow-up at 6 and 12 months with Qmax, PVR, IPSS, PGI-I, and IIEF-5 assessments
Monitor for complications such as urine retention, haematuria, incontinence, UTI, and epididymitis
Risks
HoLEP associated with high rates (65–90%) of retrograde ejaculation
Potential perioperative morbidity including bleeding and catheterization duration
Rezum may have fewer sexual side effects but long-term efficacy in larger prostates requires further evaluation
Patient & Prescribing Data
Patients aged 50–80 years with symptomatic BPH, prostate volume 50–150 mL, refractory to alpha-blockers
Rezum performed under local anesthesia with sedation as day case; HoLEP under spinal anesthesia with hospitalization; choice influenced by prostate size and sexual function considerations
Clinical Best Practices
Perform thorough preoperative evaluation including symptom scores, uroflowmetry, and imaging
Select surgical modality based on prostate size, patient preference, and sexual function goals
Ensure experienced surgeons perform procedures to optimize outcomes
Use prophylactic antibiotics and appropriate anesthesia protocols
Monitor patients closely postoperatively for complications and functional improvements
