(481) Beyond Obstruction Relief: Contrasting Safety, Sexual Function, and Recovery Profiles of Turp and RezūM™ for BPH Treatment (Focuses on Patient-Relevant Factors)

Introduction Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are highly prevalent in aging men and significantly impact quality of life. For decades, Transurethral Resection of the Prostate (TURP) has been the surgical gold standard, offering effective relief from obstruction. However, TURP is associated with potential morbidity, including significant rates of sexual dysfunction, particularly retrograde ejaculation. Minimally Invasive Surgical Therapies (MISTs), such as Rezūm™ water vapor thermal therapy, have emerged to provide symptom relief while aiming to minimize risks and preserve sexual function. Direct comparative data focused on patient-priorities remains crucial. Objective To compare the perioperative characteristics, safety, and functional outcomes of TURP versus Rezūm™ water vapor thermal therapy for treating prostatic obstruction, with a specific focus on sexual health outcomes. Methods This comparative analysis included 200 patients (100 TURP, 100 Rezūm™). Baseline characteristics, procedural data, and postoperative outcomes (complications, urinary retention) were compared. Sexual health was comprehensively assessed using the International Index of Erectile Function-5 (IIEF-5), the Male Sexual Health Questionnaire (MSHQ) ejaculatory bother score, and rates of antegrade ejaculation. Continence status was also recorded. Number Needed to Treat (NNT) was calculated to assess clinical significance. Results Groups were similar in age and comorbidities. Rezūm™ had significantly shorter operative times (10.5 vs 69.3 min, p<0.001). Postoperatively, TURP had a nine-fold higher complication rate (18% vs 2%, p<0.001), driven primarily by bleeding (13% vs 0%, p<0.001). Rezūm™ was associated with higher transient urinary retention (20% vs 4%, p<0.001). Crucially, Rezūm™ demonstrated superior sexual health and continence outcomes: the Rezūm™ group showed a statistically significant improvement in mean IIEF-5 scores from baseline (16.2 ± 2.8) to 12 months (17.5 ± 2.6; p=0.03). In contrast, antegrade ejaculation was preserved in 58% of sexually active Rezūm™ patients versus 0% in the TURP group (p<0.001), and patients reported significantly better 12-month MSHQ scores (8.5 vs 5.4, p<0.001). Furthermore, continence was preserved in 100% of Rezūm™ patients (vs 91% for TURP, p=0.002). The NNT to prevent one complication with Rezūm™ was 6.3; the NNT to preserve antegrade ejaculation was 1.7. Conclusions Rezūm™ offers significant advantages in procedural efficiency, safety, and preservation of both erectile and ejaculatory function compared to TURP, at the cost of higher transient urinary retention. This comprehensive sexual health data is critical for shared decision-making, establishing Rezūm™ as an optimal choice for patients prioritizing sexual health. Disclosure No