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Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men



Management of urinary symptoms in elderly patients with benign prostatic hyperplasia (BPH) is complex given challenges with medications and invasive surgeries. Rezum, a minimally invasive water vapor therapy, is an emerging alternative. We compare real-world Rezum outcomes between young and elderly patients over 4 years.


We retrospectively analyzed a multiethnic population treated with Rezum at a single center between 2017–2019. Patients were stratified into young (<65 years) or elderly (≥65 years) cohorts. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), decisional regret scores, and adverse events (AEs) were assessed at baseline, 1-, 3-, 6-, 12-, and/or 48-months. Descriptive statistics were compared using t-tests, Chi-squared, or Mann-Whitney U tests. Changes in outcomes were assessed using Wilcoxon signed-rank tests, stratified by age.


256 patients – 146 (57%) young and 110 (43%) elderly – were included. The majority were Asian (33.2%) or non-Hispanic Black (28.9%). Significant improvements were observed in the combined cohort at 4-years in IPSS, QoL, and Qmax when compared to baseline (all p < 0.05). Between the age cohorts, there were no significant differences in IPSS, QoL, or Qmax at any follow-up. Within both cohorts, significant improvements in IPSS and QoL were found from baseline to all follow-ups. In the young cohort, Qmax was significantly improved from baseline to all follow-ups while in the elderly cohort, this was observed only at the 3-month follow-up. No significant differences in AEs or regret was found between cohorts. There was no significant difference in 4-year surgical retreatment rates between cohorts (elderly 4.0% vs young 4.4%, p = 0.86).


There were no significant differences in IPSS, QoL, or AEs between elderly and younger men over 4 years following Rezum, suggesting comparable benefits and risks. Future research is warranted to clarify the impact of Rezum on Qmax in elderly men.

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Fig. 1: 4-year follow-up of IPSS, QoL, and Qmax.

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.


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We thank Dr. David S. Schnapp for helping to create the database and the staff at DSS Urology for providing assistance throughout the period of data collection.

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Authors and Affiliations



Manuscript writing: MZ, MB, NHL, MMT, JL. Data analysis: MZ, MB, KL. Data collection: MZ, MB, KL, RS, KT, AS, SS, JS, MI, NI. Supervision, idea conception: MC, MB.

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Correspondence to Michael Zhu.

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The authors declare no competing interests.

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This study was approved by the Western Institutional Review Board under protocol #11181739-1.

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Zhu, M., Babar, M., Hawks-Ladds, N. et al. Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men. Prostate Cancer Prostatic Dis (2023).

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