Pilot Study of "Less is More" Rezum for Treatment of BPH

OBJECTIVE To assess the outcomes of a "less is more" treatment approach consisting of a single water vapor treatment per prostate lobe for benign prostatic hyperplasia (BPH). METHODS Retrospective cohort study in a single urologic clinic of men with moderate to severe symptomatic BPH with and without median lobes undergoing thermal water vapor therapy. Single injection of thermal water vapor was given in each prostate lobe. The primary endpoint compared maximum urine flow rate (Qmax), post-void residual (PVR), International Prostatism Symptom Score (IPSS), and the IPSS Quality of Life scale (IPSS QoL) at baseline and at 1, 3, 6, and 12 months. RESULTS The study included 52 men with mean prostate volume and IPSS of 52.8cc and 20.3cc, respectively. IPSS was reduced by -3.95 +/- 7.5 at 3 months (P = .02875), -8.5 +/- 9.3 at 6 months (P = .01767), and -11.63 +/- 8.4 at 12 months (P = .005908). IPSS QoL improved by -1.75 +/- 1.2 t 12 months (P = .003799) and QMax by 5.36 +/- 3.7 mL/s at 12 months (P = .008445). Time to post-operative catheter removal was 3.5 +/- 1.3 days. One patient reported ejaculatory dysfunction. All other adverse events were mild to moderate in severity and resolved quickly. CONCLUSION Thermal water vapor therapy with single injection per lobe is both an effective and safe treatment for BPH that provides comparable improvements in lower urinary tract symptoms and quality of life to the traditional approach that employed variable number of injections by prostate volume. (C) 2022 Elsevier Inc.