, 2025-05-12 12:14:00
LAS VEGAS — Since its approval by the US Food and Drug Administration in 2015, transurethral water-vapor therapy has been gaining traction as an in-office procedure for reducing the symptoms of benign prostatic hyperplasia.
But how long the benefits of the treatment, marketed as Rezūm by Boston Scientific, last is less clear.
That part of the picture is coming into focus, thanks to a collection of posters about the approach at American Urological Association (AUA) 2025 Annual Meeting. In addition to exploring Rezūm’s durability, researchers detailed when the procedure is more likely to fail.
Five-Year Data
Researchers in the United Kingdom, where Rezūm was approved in 2018, cataloged how often men with large prostates (at least 80 g) who underwent the procedure required additional treatment to reduce the size of the gland within 5 years.
Their study of 48 men (average age, 69 years) found 10 needed another treatment within 5 years of undergoing the water-vapor therapy. Nine men had surgery to remove excess prostate tissue, while one had another course of Rezūm. The median time to retreatment was 2.7 years.
“Approximately 1 in 4 patients needed retreatment within 5 years of Rezūm, and most patients expressed satisfaction with their decision to undergo Rezūm,” according to the group, led by Lap Yan Yeung, MD, a urologist with the Imperial College Healthcare NHS Trust, London, England.
Back on the Meds
Researchers at the University of California San Diego (UCSD) reported on 179 men who underwent Rezūm at their institution. Within 5 years, more than half of these men (n = 92, 51.4%) had resumed medications for benign prostatic hyperplasia (BPH), and 11 surgeries (6.1%) were reported within 2 years of the procedure. No men reported new cases of retrograde ejaculation.
“There was a high rate of medication resumption after the procedure in our single-institution cohort. This information may be important when counseling patients on BPH treatment options, especially preoperatively,” according to Seth Bechis, MD, a urologist at UCSD and his colleagues.
Patient Selection
Clinicians in Qatar treated 325 men (mean age, 75 years) with Rezūm, of whom 34 had acute urinary retention linked to BPH.
After the procedure, 29 of the 34 (85%) patients reported being able to urinate again. The 5 men who could not urinate had lower prostate volumes (50.4 ± 19.4 cc vs 88 ± 52.9 cc; P = .011) and had received fewer vapor injections (5 ± 1 vs 7.7 ± 2.8; P = .045), and all had coronary artery disease (CAD; 100% vs 24.1%; P = .003).
“The study identifies prostate volume, total number of vapor injections, and presence of CAD as factors associated with treatment failure. These findings suggest that careful patient selection and optimization of procedural parameters may enhance the success of Rezūm” in men with acute urinary retention, according to the researchers.
New Year, More Knowledge
“With each passing year we have gained a greater understanding of [Rezūm’s] different uses, and we’re also getting real-world experience over the long term,” said Dean Elterman, MD, a urologist at the University of Toronto, Toronto, Ontario, Canada, who spoke at several sessions of the conference and helped select posters.
The real-world data are important, Elterman said, because the largest prostates in the pivotal Rezūm trials were around 80 g. But in his practice, he treats men with larger prostates, perhaps up to 150 g, with Rezūm. At the meeting, he presented 3-year data showing the technique works in such patients.
But prostate size is not the only selection criteria.
“We really recommend not doing Rezūm in anyone who’s had previous radiation,” he said, because in this case the prostate tissue will not respond to the treatment.
Another concern some men might have is if they will still be able to ejaculate after taking Rezūm. While limited ejaculation is a rare side effect, clinicians should discuss the possibility with men, Elterman said. “A whole part of this comes down to patient preference,” he added.
Elterman said future studies should try to determine the upper limit of the prostate size at which Rezūm remains effective; some prostates may simply be too big to respond well to the therapy. Another open question is whether some people can undergo Rezūm without needing a catheter during the recovery phase, which typically lasts 3-5 days, he said.
Elterman reported consulting for Boston Scientific, PROCEPT BioRobotics Corporation, and the Olympus Corporation. The presenters of the posters reported no financial conflicts of interest.
Posters IP03-26, IP03-24, and IPO3-22 were presented in April (26-29) at American Urological Association (AUA) 2025 Annual Meeting, in Las Vegas.
Marcus A. Banks, MA, is a journalist based near New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.
