(282) The Impact of Convective Water Vapor Thermal Therapy (Rezūm) on Male Sexual Function: A Systematic Review and Meta-Analysis

Introduction Convective water vapor thermal therapy (Rezūm) is a minimally invasive surgical therapy for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Objective We aimed to systematically review and meta-analyze the impact of Rezūm on sexual function. Methods A systematic review and meta-analysis was conducted on studies retrieved from PubMed, Web of Science, and Scopus databases. Eligible studies assessed the sexual function of patients underwent Rezūm therapy for LUTS secondary to BPH by postoperative IIEF-5, IIEF-15, MSHQ total, and MSHQ Bother scores postoperatively. Pooled mean differences (MD) with 95% confidence intervals (CI) at 1, 3, 6, 12, and 24 months were calculated using a random-effects model. Statistical significance was defined as p < 0.05. Results A total of 19 studies were eligible for our study including 2,902 cases. Regarding the ED presence and severity, ten studies were included in the meta-analysis used IIEF-5. Our analysis found a transient but statistically significant decline in erectile function after 3 months postoperatively (MD: -2.434; 95% CI: -4.782 to -0.086; P= 0.042). This early decline was not sustained, with scores returning to baseline by 6 months (MD: 0.384; 95% CI: -1.564 to 2.332, P= 0.7) and showed no significant change at 12 or 24 months, indicating long-term preservation of erectile function throughout the follow-up period. Also, seven studies reported IIEF-15 results. The IIEF-15 demonstrated a characteristic "J-curve" pattern, with a statistically significant temporary decline at 1 month postoperatively (MD: -2.41; 95% CI: -4.17 to -0.66, P= 0.007) followed by a statistically significant improvement over baseline at 3, 6, and 12 months (P< 0.05). Conversely, the MSHQ total score showed no statistically significant change at any follow-up point from 1 to 24 months, suggesting functional neutrality. Eight studies were included in the assessment of sexual bother using the MSHQ Bother score. Rezūm therapy produced a consistent, statistically significant and durable reduction in patient-reported bother was observed at all postoperative time points: 1 month (MD: -0.351; 95% CI: -0.638 to -0.064; p=0.016), 3 months (MD: -0.491; 95% CI: -0.869 to -0.113), 6 months (MD: -0.666; 95% CI: -1.126 to -0.206), 12 months (MD: -0.660; 95% CI: -1.085 to -0.235), and 24 months (MD: -0.606; 95% CI: -1.094 to -0.117) (P< 0.05). Conclusions Rezūm therapy confers long-term preservation of erectile and overall sexual function with a transient early decline, and provides a consistent, significant reduction in sexual bother. These findings support Rezūm as a sexually functional-neutral to preservational option for men with LUTS/BPH, with primary benefit in reducing sexual bother for up to 24 months. Limitations include study heterogeneity and moderate follow-up durations. Disclosure No