Convective Water Vapor Energy Ablation (Rezum ® ) Versus Prostatic Urethral Lift (Urolift ® ): A 2-Year Prospective Study

Introduction: To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum^®) and prostatic urethral lift (Urolift^®). To identify predictive factors for treatment failures in both treatments. Materials & Methods: Prospective clinico-epidemiological data of patients who underwent Urolift^® or Rezum^® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. Results: From October 2019 to October 2022, 86 patients underwent Rezum^®, and 62 patients underwent Urolift^®. Rezum^® involved a longer indwelling catheter duration (12.38 ± 5.548 vs 1.39 ± 3.010 days, p < 0.001) compared with Urolift^®. Rezum^® was associated with more complications compared with Urolift^® (36 [41.9%] vs 10 [16.1%] cases, p < 0.001). Rezum^® had more cases of hematuria (17 [19.8%] vs 4 [6.5%] cases [p = 0.022]) and urinary tract infections (27 [31.4%] vs 3 [4.8%] cases, p < 0.001) compared with Urolift^®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift^® was associated with higher reoperation rates (5 [8.1%] vs 0 [0%] cases, p = 0.010) compared Rezum^®. Rezum^® had higher anticholinergic usage rates compared with Urolift^® post-operation (22 [25.6%] vs 8 [12.9%] cases, p = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. Conclusions: There was no difference in clinical outcomes of patients who underwent Rezum^® and Urolift^®. However, patients who had undergone Rezum^® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.