REZUM; A water vapor thermal therapy; as a minimal invasive technique Vs transurethral resection of prostate in saline as the gold standard in management of benign prostatic hyperplasia; a prospective randomized study.

Background: Benign prostatic obstruction is a major reason older men undergo surgery, but concerns about sexual function often deter them.Objective: To evaluate REZUM’s role in treating benign prostatic hyperplasia (BPH) of 30–90g by comparing it with transurethral resection of the prostate in saline (TURis), an evolution of the gold-standard TURP, regarding efficacy and safety.Methods: A prospective cohort interventional study on BPH patients treated with TURis or REZUM between April 2022 and March 2023 at Ain Shams University Hospital, National Institute of Nephrology and Urology, and Katameya Clinic Hospital. A total of 57 patients were allocated into two groups: TURis (34) and REZUM (23). Outcomes included international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), operative time, catheter time, hospital stay, complication incidence, and sexual function.Results: REZUM significantly improved IPSS (-53.5%), QoL (-60%), Qmax (+63.5%), PVR (-56.7%), and ejaculatory function (+7.2%) at six months, though TURis showed superior outcomes at all follow-ups. However, REZUM demonstrated notable advantages in safety, reducing operative time and hospital stay with minimal sexual function impact.Conclusions: REZUM provides significant, lasting urinary symptom relief but remains inferior to TURis. Its strong safety profile and minimal side effects make it a viable option for patients unsuitable for surgery or avoiding lifelong pharmacotherapy. It is particularly beneficial for those prioritizing sexual function preservation.