Introduction & Objectives: Benign prostatic hyperplasia (BPH) is a common condition characterized by enlarged prostate gland and leading lower urinary tract symptoms (LUTS). Two common procedures used to treat BPH are Rezum and TURP. Rezum is a minimally invasive procedure that uses steam to shrink and ablate excess prostate tissue. This leads to a reduction in LUTS and an improvement in urinary flow. Rezum has been shown to be effective in treating BPH with lower risk of complications. TURP, on the other hand, is a more invasive surgical procedure that involves removing excess prostate tissue using a resectoscope. This procedure has been used for decades and has a high success rate in treating BPH. However, it has a higher risk of complications. Materials & Methods: We undertook 1:1 matched-pair analysis (age and prostate volume) of 177 consecutive patients treated for benign prostatic obstruction, including 55 Rezum and 55 TURP. Inclusion criteria were: LUTS or IPB, IPSS ≥12, prostate-specific antigen (PSA) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy and peak flow <15 mL/s. At 12 months follow-up : peak flow, IIEF-5, IPSS and rate of retrograde ejaculation. A Tetrafecta positive outcome was defined as the combination of IPSS <8, IIEF-5 >20, peak flow ≥ 12 ml/s and antegrade ejaculation. Results: 110 patients, 55 Rezum and 55 TURP, have been included in the study. Median age was 64 years old (IQR: 59.0-68.0), median peak flow was 9.0 (IQR: 6.9-11.6), median IPSS was 23.0 (IQR: 18.0-28.0), median PSA was 1.75 (IQR: 0.9-2.65) and median prostate volume was 54.5 (IQR: 40.0-68.0). We did not observe any statistical significance difference regarding age (p=0.85), prostate volume (p=0.15), IPSS (p=0.75) and peak flow (p=0.11) between groups. After 12-months of follow-up, in Rezum group the median change of peak flow was 5.8 (IQR 3.0-9.3), median change of IPSS was -10 (IQR: -18.0, -6.0) and median change of IIEF-5 was 0.0 (-1.0, 5.0); in TURP group the median change of peak flow was 9.1 (IQR 4.1-13.9)(p<0.01), median change of IPSS was -18 (IQR: -22.0, -11.0)(p<0.01) and median change of IIEF-5 was 2.0 (0.0-3.0)(p=0.19). The rate of retrograde ejaculation was 27.45% (14/55) and 72.55% (37/55) in Rezum and TURP groups, respectively (p=0.01). The rate of Tetrafecta was 11.11% (2/55) and 88.89% (16/55) in Rezum and TURP groups, respectively (p=0.01). At the logistic regression analysis adjusted for prostate volume, TURP was an independent predictor of Tetrafecta (odds ratio: 10.94; 95% CI 2.35-50.83; p<0.01). Conclusions: After 1-year of follow-up, TURP demonstrated to be more frequently associated with Tetrafecta outcomes respect to Rezum. This latter, however, has more chance to maintain antegrade ejaculation. These results should be taken into account during the counselling of patients before surgery
Water Vapor Thermal Therapy vs. TURP for the treatment of benign prostatic obstruction: A Multicenter Propensity-Score Matched Pair “tetrafecta” Analysis (URAN Collaborative Group)
Bertolo, R.;
2024-01-01
Abstract
Introduction & Objectives: Benign prostatic hyperplasia (BPH) is a common condition characterized by enlarged prostate gland and leading lower urinary tract symptoms (LUTS). Two common procedures used to treat BPH are Rezum and TURP. Rezum is a minimally invasive procedure that uses steam to shrink and ablate excess prostate tissue. This leads to a reduction in LUTS and an improvement in urinary flow. Rezum has been shown to be effective in treating BPH with lower risk of complications. TURP, on the other hand, is a more invasive surgical procedure that involves removing excess prostate tissue using a resectoscope. This procedure has been used for decades and has a high success rate in treating BPH. However, it has a higher risk of complications. Materials & Methods: We undertook 1:1 matched-pair analysis (age and prostate volume) of 177 consecutive patients treated for benign prostatic obstruction, including 55 Rezum and 55 TURP. Inclusion criteria were: LUTS or IPB, IPSS ≥12, prostate-specific antigen (PSA) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy and peak flow <15 mL/s. At 12 months follow-up : peak flow, IIEF-5, IPSS and rate of retrograde ejaculation. A Tetrafecta positive outcome was defined as the combination of IPSS <8, IIEF-5 >20, peak flow ≥ 12 ml/s and antegrade ejaculation. Results: 110 patients, 55 Rezum and 55 TURP, have been included in the study. Median age was 64 years old (IQR: 59.0-68.0), median peak flow was 9.0 (IQR: 6.9-11.6), median IPSS was 23.0 (IQR: 18.0-28.0), median PSA was 1.75 (IQR: 0.9-2.65) and median prostate volume was 54.5 (IQR: 40.0-68.0). We did not observe any statistical significance difference regarding age (p=0.85), prostate volume (p=0.15), IPSS (p=0.75) and peak flow (p=0.11) between groups. After 12-months of follow-up, in Rezum group the median change of peak flow was 5.8 (IQR 3.0-9.3), median change of IPSS was -10 (IQR: -18.0, -6.0) and median change of IIEF-5 was 0.0 (-1.0, 5.0); in TURP group the median change of peak flow was 9.1 (IQR 4.1-13.9)(p<0.01), median change of IPSS was -18 (IQR: -22.0, -11.0)(p<0.01) and median change of IIEF-5 was 2.0 (0.0-3.0)(p=0.19). The rate of retrograde ejaculation was 27.45% (14/55) and 72.55% (37/55) in Rezum and TURP groups, respectively (p=0.01). The rate of Tetrafecta was 11.11% (2/55) and 88.89% (16/55) in Rezum and TURP groups, respectively (p=0.01). At the logistic regression analysis adjusted for prostate volume, TURP was an independent predictor of Tetrafecta (odds ratio: 10.94; 95% CI 2.35-50.83; p<0.01). Conclusions: After 1-year of follow-up, TURP demonstrated to be more frequently associated with Tetrafecta outcomes respect to Rezum. This latter, however, has more chance to maintain antegrade ejaculation. These results should be taken into account during the counselling of patients before surgery
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