Water Vapor Thermal Therapy in Men With Prostate Volume ≥80 cm3: A Systematic Review and Meta-Analysis

Objectives To determine the safety and effectiveness of water vapor thermal therapy (Rezum) in men with large prostate volumes of at least 80 cm 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, 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. 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 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. Conclusions Rezum 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 cm 3 . Long-term outcomes with Rezum therapy in large prostates remain unclear.