Transurethral resection (TURP) has been the gold standard for the surgical management of benign prostatic hyperplasia (BPH). Water vapor thermal therapy (Rezum) is one of the novel, minimally invasive surgical modalities introduced for treating lower urinary tract symptoms in patients with BPH. Our study aimed to evaluate Pakistan's maiden experience with Rezum therapy and assess its safety and efficacy in improving urinary symptoms in patients with BPH.

After approval from the hospital's Ethical Committee, patients treated with Rezum system thermal therapy for BPH between December 2022 and October 2024 were included in the study. Pre- and post-Rezum (3 months) International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow rate (Qmax), and post-void residual volume (PVR) were assessed. Additionally, a 3-month post-operative catheter-free rate and incidence of sexual dysfunction were also recorded.

73 patients with a mean age of 67.1 ± 11.8 years and prostate size 62.9 ± 25.9 g were included in the study. 25 patients had prior urinary retention requiring catheterization. The most common co-morbidities were diabetes mellitus (34.2%), hypertension (30.1%), and ischemic heart disease (30.1%). The mean number of vapor injections was 7.2 ± 2.2. There were significant differences between the mean pre- and post-operative (3-month) levels of IPSS (19.9 ± 4.2 and 7.1 ± 2.4, p< 0.001), IPSS-QOL (4.6 ± 0.8 and 1.9 ± 1.3, p< 0.001), PVR (233 ± 253 and 94 ± 160, p<0.001), and Qmax (6.2 ± 4.3 and 14.8 ± 5.5, p< 0.001). These results indicate significant improvements of 64%, 59%, and 60% in IPSS, IPSS-QOL, and PVR respectively, and 8.6 ml/s in Qmax. The 3-month catheter-free rate was 89.0%. Most adverse events were minor and transient such as UTI (13.7%) and hematuria (9.6%). Only 1 patient (1.4%) reported decreased/anejaculation.

Rezum water vapor therapy has shown encouraging results in improving lower urinary tract symptoms while maintaining ejaculatory function and a high safety profile, in Pakistani patients. Our study adds to the growing body of evidence supporting the effectiveness of rezum therapy in BPH. Further research is ongoing regarding its long-term outcomes and comparison with other surgical modalities.