Predictors of Achieving a Minimal Clinically Important Difference in Lower Urinary Tract Symptoms 3 Months after Rezum Therapy

Benign prostatic hyperplasia (BPH) is a prevalent condition that frequently leads to lower urinary tract symptoms (LUTS) in aging men, significantly impacting their quality of life. Traditional treatment options have ranged from medications to surgical interventions, including minimally invasive procedures like The Rezum System (Rezum: Boston Scientific, Marlborough, MA, USA), which uses water vapor therapy to reduce prostate size.

This study aimed to identify predictors for achieving a minimal clinically important difference (MCID) in LUTS following Rezum, providing valuable insights into patient outcomes and preoperative counseling. MCID is defined as the smallest change in a treatment outcome that a patient perceives as beneficial and reflects a meaningful improvement in their condition—in this study, a ≥25% improvement in the International Prostate Symptom Score (IPSS).

Our retrospective analysis of 174 patients treated with Rezum highlights several key findings. We found that 77% of patients experienced a clinically significant improvement in LUTS within 3 months of treatment. Two main predictors of achieving MCID were identified: higher baseline LUTS severity (measured by IPSS) and larger prostate volumes. Patients with severe LUTS and prostate volumes greater than 60 cc were more likely to experience meaningful improvements in urinary function. Notably, our study also shows that symptom improvement is rapid and durable, with patients continuing to see benefits up to 12 months post-treatment.

However, our study also cautions that patients with moderate LUTS may require more nuanced counseling regarding their expectations, as they were less likely to experience a MCID. Additionally, although Rezum offers a promising alternative to more invasive procedures like transurethral resection of the prostate (TURP), we note that further investigation is needed to assess long-term outcomes and retreatment rates.

In conclusion, our study offers practical insights into patient selection for Rezum therapy, emphasizing its effectiveness in those with severe LUTS and larger prostate volumes. These findings contribute to the growing body of literature supporting minimally invasive treatments for BPH, potentially expanding the therapeutic options for patients who would otherwise require more invasive surgical intervention.

Written by: Mustufa Babar,^1,2 Max Abramson,¹ Kevin Labagnara,¹ Justin Loloi,³ Hasan Jamil,^4,5 Rahman Sayed,¹ Kevin Tang,¹ Matthew Ines,² Sandeep Singh,² Nazifa Iqbal,² Michael Ciatto²

Albert Einstein College of Medicine, New York, United States of America.
DSS Urology, New York, United States of America.
Department of Urology, Montefiore Medical Center, New York, United States of America.
School of Public Health, St. Luke International University, Tokyo, Japan.
Division of Surveillance and Policy Evaluation, National Cancer Centre Institute for Cancer Control, Tokyo, Japan.

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