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

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

References

  1. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in america project: benign prostatic hyperplasia. J Urol. 2008;179:S75–80. https://doi.org/10.1016/j.juro.2008.03.141.

    Article  PubMed  Google Scholar 

  2. Taylor BC, Wilt TJ, Fink HA, Lambert LC, Marshall LM, Hoffman AR, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006;68:804–9. https://doi.org/10.1016/j.urology.2006.04.019.

    Article  PubMed  Google Scholar 

  3. Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72:318–21. https://doi.org/10.1016/j.urology.2008.03.057.

    Article  PubMed  Google Scholar 

  4. Bortnick E, Brown C, Simma-Chiang V, Kaplan SA. Modern best practice in the management of benign prostatic hyperplasia in the elderly. Ther Adv Urol. 2020;12:1756287220929486. https://doi.org/10.1177/1756287220929486.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Leslie SW, Chargui S, Stormont G. Transurethral Resection Of The Prostate. StatPearls. StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.

  6. Westwood J, Geraghty R, Jones P, Rai BP, Somani BK. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018;10:327–33. https://doi.org/10.1177/1756287218793084.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Babar M, Loloi J, Tang K, Syed U, Ciatto M. Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review. Low Urin Trac Symptoms. 2022;14:140–54. https://doi.org/10.1111/luts.12435.

    Article  Google Scholar 

  8. Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, et al. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol. 2023;55:249–53. https://doi.org/10.1007/s11255-022-03408-w.

    Article  PubMed  Google Scholar 

  9. Eredics K, Wehrberger C, Henning A, Sevcenco S, Marszalek M, Rauchenwald M, et al. Rezūm water vapor therapy in multimorbid patients with urinary retention and catheter dependency. Prostate Cancer Prostatic Dis. 2022;25:302–5. https://doi.org/10.1038/s41391-021-00462-w.

    Article  CAS  PubMed  Google Scholar 

  10. Babar M, Masoud Z, Labagnara K, Loloi J, Sayed R, Singh S, et al. Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population. Low Urin Tract Symptoms. 2023. https://doi.org/10.1111/luts.12482.

  11. Campobasso D, Siena G, Chiodini P, Conti E, Franzoso F, Maruzzi D, et al. Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study. Prostate Cancer Prostatic Dis. 2022. https://doi.org/10.1038/s41391-022-00587-6.

  12. Higazy A, Osman D, Osman T. Rezum: a novel minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. A review article. Int Urol Nephrol. 2021;53:1747–56. https://doi.org/10.1007/s11255-021-02878-8.

    Article  PubMed  Google Scholar 

  13. Gao B, Lu S, Bhojani N, Zorn KC, Chughtai B, Elterman D. Office-based procedures for BPH. Curr Urol Rep. 2021;22:63. https://doi.org/10.1007/s11934-021-01081-7.

    Article  PubMed  Google Scholar 

  14. Leong JY, Tokarski AT, Roehrborn CG, Das AK. UroLift and Rezum: minimally invasive surgical therapies for the management of benign prostatic hyperplasia. Can J Urol. 2021;28:2–5.

    PubMed  Google Scholar 

  15. Spinos T, Katafigiotis I, Leotsakos I, Grivas N, Zabaftis C, Ermidis D, et al. Rezūm water vapor therapy for the treatment of patients with urinary retention and permanent catheter dependence secondary to benign prostate hyperplasia: a systematic review of the literature. World J Urol. 2023;41:413–20. https://doi.org/10.1007/s00345-022-04258-y.

    Article  CAS  PubMed  Google Scholar 

  16. Siena G, Sessa F, Cindolo L. Use of a Schelin Catheter for analgesia during Rezum treatment of the prostate. Prostate Cancer Prostatic Dis. 2023:1–3. https://doi.org/10.1038/s41391-023-00644-8.

  17. McVary KT, Rogers T, Roehrborn CG. Rezūm water vapor thermal therapy for lower urinary tract symptoms associated with Benign Prostatic Hyperplasia: 4-year results from randomized controlled study. Urology. 2019;126:171–9. https://doi.org/10.1016/j.urology.2018.12.041.

    Article  PubMed  Google Scholar 

  18. Mooney R, Goldberg K, Wong D, Roehrborn C. Convective radio frequency thermal therapy for treatment of Benign Prostatic Hyperplasia: single office experience with 255 patients over 4 years. Urol Pract. 2020;7:28–33. https://doi.org/10.1097/UPJ.0000000000000061.

    Article  PubMed  Google Scholar 

  19. Cindolo L, Campobasso D, Conti E, Uricchio F, Franzoso F, Maruzzi D, et al. Do patients treated with water vapor therapy and meeting randomized clinical trial criteria have better urinary and sexual outcomes than an unselected cohort? J Endourol. 2023;37:323–9. https://doi.org/10.1089/end.2022.0637.

    Article  PubMed  Google Scholar 

  20. Rowaiee R, Akhras A, Lakshmanan J, Sikafi Z, Janahi F. Rezum therapy for Benign Prostatic Hyperplasia: Dubai’s initial experience. Cureus. 2021;13:e18083. https://doi.org/10.7759/cureus.18083.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Babar M, Loloi J, Azhar U, Tang K, Ines M, Singh S, et al. Rezum outcomes in relationship to number of injections: is less more? J Endourol. 2023;37:157–64. https://doi.org/10.1089/end.2022.0390.

    Article  PubMed  Google Scholar 

  22. Aladesuru O, Amankwah K, Elterman D, Zorn K, Bhojani N, Te A, et al. Pilot study of "less is more" Rezum for treatment of BPH. Urology. 2022;165:256–60. https://doi.org/10.1016/j.urology.2022.01.039.

    Article  PubMed  Google Scholar 

  23. Babar M, Azhar U, Loloi J, Sayed R, Labagnara K, Zhu M, et al. Water vapour thermal therapy (Rezum) outcomes at 4 years in relationship to the number of injections: is the ‘less is more’ treatment approach durable? BJU Int. Mar 2023. https://doi.org/10.1111/bju.16017.

  24. Raizenne BL, Bouhadana D, Zorn KC, Barber N, Gilling P, Kaplan S, et al. Functional and surgical outcomes of Aquablation in elderly men. World J Urol. 2022;40:2515–20. https://doi.org/10.1007/s00345-022-04137-6.

    Article  PubMed  Google Scholar 

  25. Campobasso D, Morselli S, Greco F, De Nunzio C, Destefanis P, Fasolis G, et al. Efficacy and safety profile of GreenLight laser photoselective vaporization of the prostate in ≥ 75 years old patients: results from the Italian GreenLight Laser Study Group. Aging Clin Exp Res. 2023;35:877–85. https://doi.org/10.1007/s40520-023-02351-9.

    Article  PubMed  Google Scholar 

  26. Bouhadana D, Nguyen DD, Zhang X, Mao J, Elterman D, Te A, et al. Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol. 2021;39:4405–12. https://doi.org/10.1007/s00345-021-03779-2.

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Albert Einstein College of Medicine, Bronx, NY, USA

    Michael Zhu, Mustufa Babar, Noah Hawks-Ladds, Marc-Mina Tawfik, Kevin Labagnara, Rahman Sayed, Kevin Tang & Azizou Salami

  2. Department of Urology, Montefiore Medical Center, Bronx, NY, USA

    Justin Loloi

  3. DSS Urology, Queens Village, New York, NY, USA

    Sandeep Singh, Jaskirat Singh, Matthew Ines, Nazifa Iqbal & Michael Ciatto

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  1. Michael Zhu
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Contributions

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.

Corresponding author

Correspondence to Michael Zhu.

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Competing interests

The authors declare no competing interests.

Ethics approval

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). https://doi.org/10.1038/s41391-023-00703-0

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