Abstract
Abstract Introduction Benign prostatic hyperplasia (BPH) often leads to the development of lower urinary tract symptoms (LUTS), which can result in significant deterioration in quality of life (QoL). Rezum therapy has demonstrated efficacy in alleviating LUTS secondary to BPH across a broad range of prostate volumes (PVs). However, there is a scarcity of long-term real-world data on Rezum outcomes across a wide range of PVs. Objective To evaluate surgical and sexual function Rezum outcomes over a 4-year period in patients with PVs <30cc, 30-80cc, or >80cc. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were stratified into three cohorts based on PV: <30cc, 30-80cc, or >80cc. Outcome measures, including International Prostate Symptom Score (IPSS), QoL, International Index of Erectile Function (IIEF)-Erectile and Orgasmic function, maximum urinary flow rate (Qmax), BPH medication usage, adverse events (AEs), and decisional regret scores were collected and compared at baseline and 1-, 3-, 6-, 12-, and/or 48-months follow-up. Results A total of 252 patients were analyzed, with 35 (13.9%), 196 (77.8%), and 21 (8.3%) patients in the 30cc, 30-80cc, and >80cc cohorts, respectively. The >80cc cohort was significantly older (66.9 years [8.1]) than the <30cc cohort (63.4 years [8.5], p = 0.02). The <30cc cohort had a significantly higher baseline IPSS (21 [15-28]) and QoL (5 [4-6]) than the 30-80cc (IPSS 17 [10-23], p = 0.003; QoL 4 [3-5], p=0.02) and >80cc (IPSS 16 [6.5-22.5], p = 0.01; QoL 4 [3-5], p = 0.006) cohorts. The number of injections utilized per lateral prostatic lobe significantly increased with PV (<30cc: 1 injection [0-1] vs 30-80cc: 2 injections [1-2] vs >80cc: 3 injections [2-3.5], p < 0.001). When compared to baseline, the combined cohort saw significant percent changes at 48-months in IPSS (-70.6%, p < .001), QoL (-80%, p < .001), and Qmax (52%, p = 0.003). Within each PV cohort, significant improvements in IPSS and QoL were found at all follow-ups when compared to baseline. Qmax improvements were significant only in the 30-80cc cohort at all follow-ups. There were no significant differences in percent changes in IPSS, QoL, or Qmax between cohorts at 3-, 6-, 12-, or 48-months when compared to baseline. The <30cc and 30-80cc cohorts had significant decreases in BPH medication usage as early as 3-months that remained durable through 48-months (all p < 0.05). The >80cc cohort experienced a significant decrease in BPH medication usage at 3-months but it did not remain durable to 12- or 48-months. No significant differences in postoperative AEs or decision regret scores were observed between cohorts. There were no significant changes in erectile function and orgasmic function at 12-months within cohorts. No significant differences were found in 48-months reoperation rates between the <30cc, 30-80cc, and >80cc cohorts (0% vs 4.9% vs 5%, p = 0.49). Conclusions Rezum effectively improved LUTS secondary to BPH irrespective of PV, with improvements being durable over 4 years. However, patients with PVs >80cc should be counseled on the possibility of continuing their BPH medications following treatment. Disclosure No.
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