Convective Water Vapor Energy Ablation (Rezum ^® ) Versus Prostatic Urethral Lift (Urolift ^® ): A 2-Year Prospective Study

<b><i>Introduction:</i></b> To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum^®) and prostatic urethral lift (Urolift^®). To identify predictive factors for treatment failures in both treatments. <b><i>Materials & Methods:</i></b> Prospective clinico-epidemiological data of patients who underwent Urolift^® or Rezum^® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. <b><i>Results:</i></b> From October 2019 to October 2022, 86 patients underwent Rezum^®, and 62 patients underwent Urolift^®. Rezum^® involved a longer indwelling catheter duration (12.38 ± 5.548 <i>vs</i> 1.39 ± 3.010 days, <i>p</i> < 0.001) compared with Urolift^®. Rezum^® was associated with more complications compared with Urolift^® (36 [41.9%] <i>vs</i> 10 [16.1%] cases, <i>p</i> < 0.001). Rezum^® had more cases of hematuria (17 [19.8%] <i>vs</i> 4 [6.5%] cases [<i>p</i> = 0.022]) and urinary tract infections (27 [31.4%] <i>vs</i> 3 [4.8%] cases, <i>p</i> < 0.001) compared with Urolift^®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift^® was associated with higher reoperation rates (5 [8.1%] <i>vs</i> 0 [0%] cases, <i>p</i> = 0.010) compared Rezum^®. Rezum^® had higher anticholinergic usage rates compared with Urolift^® post-operation (22 [25.6%] <i>vs</i> 8 [12.9%] cases, <i>p</i> = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. <b><i>Conclusions:</i></b> There was no difference in clinical outcomes of patients who underwent Rezum^® and Urolift^®. However, patients who had undergone Rezum^® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.