2. UroToday Home
  3. Recent Abstracts
  4. Endourology & Urolithiasis
  5. Minimally Invasive Procedures

Retreatment for Lower Urinary Tract Symptoms (LUTS) After Water Vapor Thermal Therapy - Beyond the Abstract

Several procedures are available for the management of benign prostatic hyperplasia (BPH).1,2 Water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA) is a minimally invasive surgical treatment (MIST) that induces cell death through transurethral transfer of thermal energy and is often desired by patients due to preservation of erectile and ejaculatory function.3,4

With the recent emergence and rising popularity of these MISTs, it is critical to characterize the longevity of these procedures and to assess retreatment rates as a surgical outcome. Thus, the objective of our retrospective study was to identify predictors of retreatment within 2 years for recurrent lower urinary tract symptoms (LUTS) among patients with BPH who undergo WVTT. We specifically chose 2 years given the surgical retreatment rate began to plateau around this timeframe (2.2% retreatment at 1 year, 3.7% at 2 years, 4.4% at 3-5 years) in the original study by McVary et al.3

The key takeaways from our study are as follows:

  • Among our cohort of 192 patients, there was a 5% retreatment rate (n=10) during median follow up of 25 months
  • Median time to retreatment was 11 months
  • Retreatment modalities included Greenlight photovaporization of prostate (n=4, 40%), transurethral resection of prostate (TURP) (n=4, 40%), and repeat WVTT (n=2, 20%)
  • Prostate volume (cc) was significantly greater in the non-retreatment group (50.4 vs 48.5; p=0.003)
  • Number of thermal injections was significantly higher in the retreatment group (4.4 vs 5.2; p<0.001)
  • Treatment of the median lobe did not differ between the non-retreatment and retreatment groups (42% vs 40%; p=0.68)
  • International Prostate Symptom Scores (IPSS) were significantly higher among the retreatment group at 6 months (18.5 vs 10.1; p=0.044)
  • On multivariate analysis, patients who received >1 injection per lobe were more likely to require retreatment (HR 8.5, 95% CI [1.1-65.3]; p=0.039)
  • Complication rates (postoperative UTI, de novo urinary retention requiring repeat catheterization, Emergency Department visits, readmission within 30 days) did not significantly differ between the two cohorts
One limitation of our study was that we focused on surgical retreatment; further studies are needed to gather data on pharmacologic retreatment after WVTT.

In summary, we demonstrate that WVTT is associated with a low retreatment rate. Men who underwent retreatment received a greater initial number of injections per lobe and showed worsening of IPSS at 6 months postoperatively. Treatment of median lobe, if present, does not appear to affect the risk of retreatment. Decreasing the number of treatments during initial WVTT may help reduce the risk of treatment failure. We are currently pursuing a multi-institutional study to generate a larger series.



Written by: Vi Nguyen, MD,1 Michelle C. Leach, MD,1 Clara Cerrato, MD,2 Mimi V. Nguyen, MD,1 Seth K. Bechis, MD1
  1. Department of Urology, UC San Diego Health, San Diego, CA, USA
  2. Department of Urology, Università degli Studi di Verona, Verona, Italy
References:

  1. Lerner LB, McVary KT, Barry MJ, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. J Urol. 2021;206(4):806-817.
  2. Lerner LB, McVary KT, Barry MJ, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART II-Surgical Evaluation and Treatment. J Urol. 2021;206(4):818-826.
  3. McVary KT, Gittelman MC, Goldberg KA, et al. Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2021;206(3):715-724.
  4. McVary KT, Gange SN, Gittelman MC, et al. Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med. 2016;13(6):924-933. 
Read the Abstract