Safety and Efficacy of Rezūm Water Vapor Energy Therapy for Benign Prostatic Hyperplasia With Continued Antithrombotic Therapy: A Comparative Study

OBJECTIVES: Evidence regarding the safety of water vapor energy (WAVE) therapy in patients continuing antithrombotic (AT) agents remains limited. This study compared the safety and efficacy of WAVE therapy between patients receiving AT therapy and those not receiving such therapy. METHODS: This retrospective comparative study included 103 consecutive patients who underwent WAVE therapy at a single institution between February 2023 and October 2024. Patients were divided into an AT group (n = 36) and a non-AT group (n = 67). All AT agents continued throughout the perioperative period. Postoperative complications were graded according to the Clavien-Dindo classification. Changes in symptom scores and uroflowmetry parameters were evaluated at baseline and at 3 and 6 months after treatment in patients without a preoperative indwelling catheter. RESULTS: Baseline characteristics were generally similar between the two groups, although patients in the AT group were significantly older than those in the non-AT group. Early postoperative bleeding events were comparable (11.1% in the AT group vs. 4.5% in the non-AT group, p = 0.24), and no grade ≥ 3 complications occurred in either group. Late complications occurred only in the non-AT group (6.0%). In the overall cohort, the median IPSS total score decreased from 18.5 (interquartile range: 12.0-25.0) at baseline to 9.0 (3.0-12.8) and 6.0 (3.0-10.8) at 3 and 6 months, respectively. Post-void residual volume decreased from 111 (interquartile range: 52.8-180) mL at baseline to 55.5 (27.3-102) and 50.5 (24.5-92.3) mL. These improvements were comparable between groups. CONCLUSIONS: WAVE therapy appeared feasible in patients who continued AT therapy, with acceptable short-term safety and symptomatic improvement.