Sexual outcomes following Rezum therapy with and without median lobe resection

Le résumé fourni par la source

Transurethral water vapor thermal therapy (Rezum) is a newer minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses convective radiofrequency water vapor to ablate prostate tissue. In a randomized controlled trial by Roehrborn et al.,1 eight patients required secondary treatment following Rezum therapy within 24 months, with six cases related to untreated median lobes. Subsequent multicenter randomized controlled trials of Rezum with a 5-year follow-up demonstrated a total surgical retreatment rate of 4.4% (6 out of 135 patients), with 4 out of these 6 patients having an obstructive median lobe that was initially left untreated.2 Despite our center administering at least one steam treatment for the median lobe to all patients, follow-up cystoscopy for obstructive symptoms revealed inadequately treated median lobes in several cases. Upon reviewing previous surgical notes, we discovered that patients who had undergone two or more steam treatments specifically targeting the median lobe (and thus tended to me much larger or more significant), often were deemed treatment failures. Twenty out of 107 patients required a subsequent procedure specifically for an unresolved large obstructing median lobe (Supplementary Figure S1). To address this challenge, we developed a novel hybrid approach—which we named “Rezurp”—combining conventional Rezum treatment for the lateral lobes with targeted transurethral resection of the prostate for the median lobe in patients with significant median lobe enlargement. Transurethral resection of prostate (TURP) with median lobe only resection has previously been described to enhance sexual function preservation.3

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