Retreatment for Lower Urinary Tract Symptoms After Water Vapor Thermal Therapy

Vi Nguyen; Michelle C Leach; Clara Cerrato; Mimi V Nguyen; Seth K Bechis

doi:10.1016/j.urology.2024.04.022

Retreatment for Lower Urinary Tract Symptoms After Water Vapor Thermal Therapy

Urology. 2024 Apr 25:S0090-4295(24)00299-1. doi: 10.1016/j.urology.2024.04.022. Online ahead of print.

Authors

Vi Nguyen¹, Michelle C Leach², Clara Cerrato³, Mimi V Nguyen², Seth K Bechis²

Affiliations

¹ Department of Urology, UC San Diego Health, San Diego, CA. Electronic address: vin016@health.ucsd.edu.
² Department of Urology, UC San Diego Health, San Diego, CA.
³ Department of Urology, Università degli Studi di Verona, Verona, Italy.

PMID: 38677371
DOI: 10.1016/j.urology.2024.04.022

Abstract

Objective: To identify predictors of retreatment for symptomatic recurrence among men who undergo water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA), a minimally invasive surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Methods: We retrospectively reviewed patients treated with WVTT at a single institution from August 2017 to February 2022. Patients who underwent a second benign prostatic hyperplasia procedure for persistent or recurrent lower urinary tract symptoms within 2years of original treatment were compared to the remaining cohort who did not undergo retreatment. Multivariate analysis was used to assess for predictors of retreatment.

Results: Data were obtained from 192 patients. 10 (5%) patients were retreated. The retreatment cohort had smaller prostate volumes (50.4±18.2 cc vs 48.5±35.7 cc; P = .003) and received a greater number of water vapor injections (4.4±1.8 vs 5.2±3.9; P < .001). At 6month follow-up, total International Prostate Symptom Score (IPSS; 10.13 ± 7.40 vs 18.5 ± 11.55, P = .044) and voiding subscores (4.59 ± 4.39 vs 9.5 ± 7.84, P = .006) were significantly worse in the retreatment group. On multivariate analysis, >1 treatment per lobe was independently associated with increased risk of retreatment (hazard ratio 8.509, 95% CI [1.109-65.293]; P = .039).

Conclusion: WVTT has a low retreatment rate. Men who required retreatment received more injections and showed worsened voiding symptom scores 6months postoperatively. Decreasing the number of injections may help reduce treatment failure rates.