The minimally invasive radiofrequency thermal water vapour thermal therapy (Rezūm) and the prostatic lift (Urolift) procedures offer minimally-invasive treatment for lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia. Rezūm is a novel treatment modality that has demonstrated safety and efficacy in patients with LUTS. There have been no published head-to-head comparisons of the relative efficacy of the Rezūm and Urolift systems. We report the indirect analysis of clinical symptoms and quality of life of two previously published studies of three-year outcomes.
Clinical outcomes were obtained from published prospective data. International Prostate Symptom Score (IPSS) and IPSS – Quality of Life (QoL), Maximum flow rate (Q-max), post-void residual volume (PVR), Benign Prostate Hyperplasia Impact Index (BPHII) scores along with MSHQ-EjD function and bother domains were outcomes of interest. Outcomes were assessed at 3, 12, 24, and 36 months. The Indirect between-group analysis was followed by a within-group analysis of changes across time points. An adjusted indirect comparison was conducted at 3 years for all outcomes.
All baseline features were similar between the two groups except for Q-max which was higher in the Rezūm, and both BPHII and age which were higher in the Urolift group. Compared to the Urolift, the Rezūm resulted in an 18.48% and 19.73% greater reduction in IPSS score at 24-months and 36-months (p=0.04). The improvement in the MSHQ-EjD function domain was significantly higher with Urolift at 3,12, 24, and 36 months. Although Q-max improvement was favoured the Rezum group at 3 months (p<0.01) this was not durable. At 36 months the Q-max improvements were not statistically different between the Rezum and Urolift. Regarding MSHQ-EjD bother, the improvements were similar at 12 months and thereafter in both groups.
This analysis Rezūm demonstrated improved relief of LUTS attributed to BPH, with a significantly greater 3 year IPSS improvements compared to Urolift. Despite limitations of the published Urolift study in respect to the exclusion of participants who presented with an obstructive median lobes, considerable relief of LUTS with acceptable morbidity and functional outcomes warrants further of comparison of Rezūm against other minimally-invasive surgical therapies for BPH.
