Water Vapor Thermal Therapy in Men With Prostate Volume ≥80 cm 3 : A Systematic Review and Meta-Analysis.

Objective: To determine the safety and effectiveness of water vapor thermal therapy (Rezum) in men with large prostate volumes of at least 80cm ³ .
Methods: We performed systematic searches for studies of Rezum therapy in men with prostate volume of at least 80 cm ³ . Meta-analysis outcomes included the International Prostate Symptom Score (IPSS), IPSS Quality of Life (IPSS-QOL), Qmax, postvoid residual, International Index of Erectile Function-Erectile Function (IIEF-EF), and serious (Clavien-Dindo grade III-V) complications, surgical retreatments. Outcomes were analyzed using a random effects meta-analysis model.
Results: The review included 15 studies (11 retrospective) of 471 men with prostate volume at least 80 cm ³ treated with Rezum therapy and followed for a median of 6months (range: 3-17months). Rezum therapy resulted in statistically significant improvements in IPSS (mean change: -11.0; 95% CI: -12.2, -9.7; P < .001), IPSS-QOL (mean change: -2.9; 95% CI: -3.5, -2.4; P < .001), Qmax (mean change: 6.5 mL/s; 95% CI: 4.8, 8.2 mL/s; P < .001), and postvoid residual (mean change: -101 mL; 95% CI: -145, -57; P < .001). No change in IIEF-EF was observed (mean change: 0.3; 95% CI: -1.1, 1.6; P = .71). Serious complications occurred in <0.1% (95% CI: 0.0%, 0.4%) and surgical retreatment in 1.2% (95% CI: 0.0%, 3.5%) of patients.
Conclusion: Rezum therapy provides a statistically significant and clinically important short-term improvement in lower urinary tract symptoms with low complication rates in men with prostate volume of at least 80 cm ³ . Long-term outcomes with Rezum therapy in large prostates remain unclear.
Competing Interests: Declaration of Competing Interest K. McVary reports consultancy, honoraria, and role as Principal Investigator on grants received from NxThera; consultancy, honoraria, role as Principal Investigator on grants received from ProMedeon; consultancy, stock options, role as Principal Investigator on grants received from Rivermark; consultancy, role as investigator, honoraria from Urotronic; consultancy, role as investigator, honoraria from Francis Medical; consultancy, role as investigator from Zenflow; role as Principal Investigator on grants received from NIDDK; patents received, stock ownership in Uronext; royalties from UpToDate; and grants pending, honoraria from Boston Scientific. L. Miller discloses financial support from Boston Scientific. S. Bhattacharyya, K. DeRouen, E. Turner, and P. Zantek report employment with Boston Scientific. M. Abdel-Rassoul reports consultancy with Boston Scientific. T. Miyauchi reports no conflicts of interest. T. Alzahrani reports no conflicts of interest. T. Kohler reports consultancy and research funding with Coloplast.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)