REZUM has been proposed as a treatment option for prostate volume of 30-80 grams including patients with obstructing median lobes. However, the evidence for REZUM in men with obstructing median lobe is limited. We aim to report the real world outcomes of REZUM in men with obstructing median lobe in a tertiary hospital in Singapore

79 men had undergone REZUM from July 2021 to July 2024 at Sengkang General Hospital, Singapore. Patient characteristics and outcome measures were collected from time of enrolment. They were prospectively followed up and outcomes were measured at 1 month, 3 months and 12 months post operatively. Failure of treatment is defined as need to restart BPH medication or required surgery for symptomatic BPH.

Group A consist of patients with significant obstructing median lobe, which is defined as intravesical prostatic protrusion (IPP) measuring ≥10 millimetres on ultrasound. Group B patients are those with no IPP or IPP measuring 1 to 9 millimetres. Baseline patient characteristic between Group A vs Group B in Table 1 There were no difference when comparing Group A vs Group B in terms of successful trial off catheter at one week (78.6% vs 73.0%, p= 0.561), overall complication rates (23.8% vs 16.2%, p= 0.402), clot retention rates (1.3% vs 0%, p=0.346), and rates of rehospitalisation ( 21.4% vs 13.5% p = 0.953). At 3 months follow up, there were also no difference when comparing Group A vs Group B in terms of improvement of Qmax (5.8 ml/s vs 4.1 ml/s, p=0.184), improvement in IPSS (11.6 vs 11.8, p= 0.205) and improvement of QOL scores (4.4 vs 4.6, p= 0.493). Total patients who failed treatment is 14 pts (17.7%). The failure rate is higher in Group A, 11 patients (26.2%) vs 3 patients (8.1%) in Group B, p =.0.036. In group A, 9 patients (21.4%) restarted medications due to worsening of symptoms compared to 1 patient (2.7%) in Group B, p=0.012. Overall, 6 out of 79 patients (7.6%) required subsequent transurethral resection of prostate (TURP). Of these cohort, Group A had higher rates of patients undergoing subsequent TURP, 4 patients (9.6%) vs 2 patient (5.4%) in Group B, although the difference is not clinically significant, p=0.491.

REZUM has excellent short-term outcomes for symptomatic BPH. However, in patients with obstructing median lobes, failure of treatment is high within 2 years post treatment. 21.4% of patients were restarted on BPH medication and 9.6% of patients required subsequent TURP. This will help guide treatment options and management of patient expectations.