Water Vapor Thermal Therapy in Men With Prostate Volume ≥80 cm3: A Systematic Review and Meta-Analysis
Kevin T. McVary, Larry E. Miller, Samir Bhattacharyya, Kyle DeRouen, Erin Turner, Paul F. Zantek, M. Abdel Rassoul, Toshihide Miyauchi, Tarek M. Alzahrani, Tobias Köhler
Abstract
ObjectivesTo determine the safety and effectiveness of water vapor thermal therapy (Rezum) in men with large prostate volumes of at least 80 cm3.MethodsWe performed systematic searches for studies of Rezum therapy in men with prostate volume of at least 80 cm3. Meta-analysis outcomes included the International Prostate Symptom Score (IPSS), IPSS Quality of Life (IPSS-QOL), Qmax, post-void residual (PVR), International Index of Erectile Function-Erectile Function (IIEF-EF), surgical retreatments, and serious (Clavien-Dindo grade III-V) complications. Outcomes were analyzed using a random effects meta-analysis model.ResultsThe review included 15 studies (11 retrospective) of 471 men with prostate volume at least 80 cm3 treated with Rezum therapy and followed for a median of 6 months (range: 3 to 17 months). Rezum therapy resulted in statistically significant improvements in IPSS (mean change: -11.0; 95% CI: -12.2, -9.7; p<0.001), IPSS-QOL (mean change: -2.9; 95% CI: -3.5, -2.4; p<0.001), Qmax (mean change: 6.5 ml/s; 95% CI: 4.8, 8.2 ml/s; p<0.001), and PVR (mean change: -101 ml; 95% CI: -145, -57; p<0.001). No change in IIEF-EF was observed (mean change: 0.3; 95% CI: -1.1, 1.6; p=0.71). Serious complications occurred in <0.1% (95% CI: 0.0%, 0.2%) and surgical retreatment in 1.2% (95% CI: 0.0%, 3.5%) of patients.ConclusionsRezum therapy provides a statistically significant and clinically important short-term improvement in LUTS/BPH symptoms with low complication rates in men with prostate volume over 80 cm3. Long-term outcomes with Rezum therapy in large prostates remain unclear.