Four-year outcomes of water vapor thermal therapy for benign prostatic hyperplasia

The Rezūm system offers a minimally invasive treatment option for alleviating lower urinary tract symptoms associated with benign prostatic hyperplasia. We report the 48-month outcomes from a single tertiary center. A retrospective study was conducted to review Rezūm therapy from 2021 to 2025 at our tertiary hospital. Qmax (Maximum urinary flow rate), I-PSS (International Prostate Symptom Score), QOL (quality of life), PVR (post-void residual), PV (prostate volume), and adverse events were actively monitored. Analysis was performed at baseline and follow-up intervals (3, 12, 24, 36, and 48 months). Eighty-six patients (mean age of 66.7 ± 7.3 years) were assessed in our study; eleven were catheter dependent. The mean preoperative prostate size was (71.4±15.6 cc). A statistically significant improvement was recorded in all voiding parameters at 3 months, including Qmax, IPSS, QoL, and PVR (p < 0.001), with sustained benefits at 48 months. Adverse events were mostly Clavien grade 1 and 2, including urinary retention (11.6%). Two patients (2.3%) required endoscopic intervention for clot retention, representing grade 3B complications. No sexually related adverse events were recorded in our study. The retreatment rate increased at 48 months, with 41.8% requiring medical therapy and 19.7% undergoing surgical retreatment. Rezūm therapy demonstrates both safety and efficacy in managing BPH-related lower urinary tract symptoms, offering maximum benefit within the first 2 years after treatment. Patient selection and counselling regarding the potential need for future medical or surgical retreatment are recommended to optimize long-term outcomes and patients’ satisfaction.