Rezūm water vapor therapy vs. thulium laser enucleation for the treatment of benign prostatic hyperplasia in patients with large prostates: a multicenter prospective comparative study

Background: Despite the growing body of evidence supporting the use Rezūm in patients with benign prostatic hyperplasia (BPH) and large prostates, comparative studies with the current gold standard in this clinical setting are lacking. Aim: To compare the efficacy and safety of Rezūm and Thulium Laser Enucleation of the Prostate (ThuLEP) in patients with BPH and large prostates. Methods: We conducted a multicenter prospective comparative study. Consecutive patients with prostate volume (PV) ≥ 80 mL undergoing ThuLEP or Rezūm were included. Patient evaluation was performed at baseline and at 3, 6, and 12 months after surgery. International Prostate Symptom Score (IPSS)-Total was chosen as the primary outcome, while International Index of Erectile Function (IIEF-EF), four-item version of Male Sexual Health Questionnaire (MSHQ-EjD Short Form), and postoperative complications Clavien-Dindo (CD) grade ≥ III were selected as the secondary outcomes. Results: A total of 246 patients were enrolled (126 ThuLEP, 120 Rezūm). Mean (SD) PV was 106.0 (16.5) mL in the ThuLEP group and 101.4 (14.8) mL in the Rezūm group (p = 0.55). Mean (SD) IPSS-Total was statistically significantly lower in the ThuLEP group compared to the Rezūm group at every postoperative time point (p < 0.001); however, the difference between the mean values never reached the Minimal Clinically Important Difference (MCID). IIEF-EF score significantly improved in both groups (p < 0.001), with no significant difference between the two procedures. Significant differences in MSHQ-EjD Function and Bothers in favor of Rezūm were observed at all postoperative time points (p < 0.001). Bleeding with clots requiring reintervention (CD ≥ III) for hemostasis and evacuation occurred in 5 (3.96%) men undergoing ThuLEP and 1 (0.83%) man undergoing Rezūm (p = 0.21). Conclusions: Both ThuLEP and Rezūm significantly improve urinary symptoms in patients with BPH and large prostates. ThuLEP appears statistically but not clinically superior to Rezūm in improving LUTS.