Retreatment for Lower Urinary Tract Symptoms (LUTS) After Water Vapor Thermal Therapy

Objectives To identify predictors of retreatment for symptomatic recurrence among men who undergo water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), a minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods We retrospectively reviewed patients treated with WVTT at a single institution from August 2017 to February 2022. Patients who underwent a second BPH procedure for persistent or recurrent LUTS within 2 years of original treatment were compared to the remaining cohort who did not undergo retreatment. Multivariate analysis was used to assess for predictors of retreatment. Results Data was obtained from 192 patients. 10 (5%) patients were retreated. The retreatment cohort had smaller prostate volumes (50.4 + 18.2 cc vs 48.5 + 35.7 cc; p=0.003) and received a greater number of water vapor injections (4.4 + 1.8 vs 5.2 + 3.9; p<0.001). At 6 month follow-up, total International Prostate Symptom Score (IPSS; 10.13 ± 7.40 vs 18.5 ± 11.55, p=0.044) and voiding sub-scores (4.59 ± 4.39 vs 9.5 ±7.84, p=0.006) were significantly worse in the retreatment group. On multivariate analysis, >1 treatment per lobe was independently associated with increased risk of retreatment (HR 8.509, 95% CI [1.109 – 65.293]; p=0.039). Conclusions WVTT has a low retreatment rate. Men who required retreatment received more injections and showed worsened voiding symptom scores 6 months postoperatively. Decreasing the number of injections may help reduce treatment failure rates.