Efficacy, Safety, and Sexual Dysfunction Outcomes of Water Vapor Thermal Therapy (Rezum) in Patients with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: An Updated Systematic Review

Abstract

ABSTRACT Introduction Benign prostatic hyperplasia (BPH) is an exceedingly common condition affecting a large portion of men, often leading to progressive development of lower urinary tract symptoms (LUTS). Water vapor thermal therapy, also known as The Rezum System (Boston Scientific Corporation, Marlborough, MA, USA), is a novel, minimally invasive surgical technology used to treat LUTS secondary to BPH. Rezum utilizes convective radiofrequency water vapor to ablate the lateral and median lobes of the prostate, decreasing prostate size and improving LUTS. Despite its FDA approval in 2015, there is a sparsity of studies, particularly systematic reviews, describing outcomes. Objective To evaluate the latest efficacy and safety profile of Rezum in patients with LUTS secondary to BPH. Methods PubMed/MEDLINE and The Cochrane Library databases were systematically searched, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, for relevant articles in the English language till June 1, 2021. Search strategy included the following terms: “water vapor thermal therapy” OR “Rezum” OR “convective water vapor thermal therapy” OR “convective radiofrequency water vapor thermal therapy”. Randomized and non-randomized studies that evaluated urinary outcomes and/or adverse events of Rezum in patients with LUTS secondary to BPH were deemed eligible. Results 16 studies (N=1,703), published in 22 papers, met the inclusion criteria and were included in the systematic review. Of the 16 studies, one was an RCT, five were prospective studies, eight were retrospective studies, and two were case series. When compared to baseline, international prostate symptom score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) significantly improved as early as 1-month post-treatment and remained durable for up to 5 years. Significant percent improvements from baseline to 3-month in IPSS, QoL, and Qmax ranged between 39 to 86% (median: 55%), 45 to 86% (median: 65%), and 32 to 74% (median: 62%), respectively. Most adverse events were transient and non-serious and occurred in between 0 to 83% of patients (median: 47%), with dysuria, urinary retention, urinary tract infection, and hematuria being the most common. Five studies reported no de novo erectile dysfunction, while three studies reported rates between 2.4 to 3.1%. One study reported de novo anejaculation rate of 2.9% while another study reported it at 10.8%. Three studies reported decreases in ejaculatory volume rates between 2.9 to 10.8%, one study reported retrograde ejaculation rate at 3.1%, and one study reported painful ejaculation rate at 1.6%. The surgical retreatment rate ranged between 1.0 to 3.1% at 1 year and between 4.4% and 7.5% at 5 years (Table 1). Conclusions Rezum effectively improved LUTS secondary to BPH with durable outcomes at 5 years post-operatively. Real-world outcomes showed that non-serious adverse events were considerable, but transient, and with low rates of sexual dysfunction. In light of these findings, Rezum remains an attractive surgical modality for men with LUTS secondary to BPH. Disclosure No