(086) Comparative Risk of Erectile and Ejaculatory Dysfunction Following UroLift vs. Rezūm in Men Undergoing Minimally Invasive BPH Therapy: A Propensity-Matched Cohort Study

Introduction Minimally invasive surgical treatments (MISTs) for benign prostatic hyperplasia (BPH), including UroLift and Rezūm, are increasingly adopted due to their favorable safety profiles and functional outcomes. While both are marketed as preserving sexual function, direct comparative data on erectile dysfunction (ED) and ejaculatory dysfunction (EJD) are limited. Objective To compare outcomes of ED and EJD following UroLift versus Rezūm using large real-world dataset with long-term follow-up. Methods We conducted a retrospective cohort study using TriNetX research network. Men undergoing UroLift (CPT 52441) or Rezūm (CPT 53854) for BPH (ICD-10 N40) were identified. Prior to matching, the UroLift and Rezūm cohorts included 9,145 and 4,477 patients, respectively, across 90 and 79 health care organizations. Cohorts were propensity score matched (PSM) 1:1 based on demographics and comorbidities: age, race, BMI, hypertension, diabetes, hyperlipidemia, testicular hypofunction. Primary outcomes were incident ED (ICD-10 N52) and EJD (ICD-10 N53.1) within the follow-up period. Risk differences and five-year Kaplan-Meier (KM) survival analyses were used to compare outcomes. Patients with prior diagnoses of ED or EJD were excluded. Results A total of 8,710 patients were included following 1:1 propensity score matching (4,355 per group). Median follow-up duration was approximately 33.7 months (IQR: 18.7–72.3) for UroLift and 25.1 months (IQR: 14.2–64.2) for Rezūm. ED occurred in 11.3% of UroLift patients and 12.3% of Rezūm patients, with a non-significant absolute risk difference of -0.997% (95% CI -2.594%, 0.601%, p=0.2215) and a risk ratio of 0.919 (95% CI 0.802, 1.052). KM excluding patients with baseline ED demonstrated significantly improved ED-free survival in the UroLift cohort compared to Rezūm (82.6% vs. 78.8% at 5 years), with a hazard ratio of 0.787 (95% CI 0.681–0.91, p=0.0012). EJD was significantly lower in the UroLift group (0.683%) compared to Rezūm (1.174%) with an absolute risk reduction of 0.491% (95% CI -0.899% to -0.084%) and risk ratio of 0.582 (95% CI 0.369, 0.917, p = 0.0183). Five-year KM survival analysis demonstrated a significantly higher EJD-free survival probability in the UroLift group (98.996%) versus Rezūm (97.969%), (log-rank p= 0.0024). Conclusions Both UroLift and Rezūm are effective MISTs for BPH with low absolute rates of ED and EJD. In this large, propensity-matched real-world cohort, UroLift was associated with a statistically significant reduction in the risk of both ED and EJD compared to Rezūm. These findings highlight differences in side-effect profiles that may inform individualized procedure selection based on patient preferences and clinical priorities. Disclosure No