Water vapor thermal therapy effective for lower urinary tract symptoms associated with BPH: Study

USA: A minimally invasive water vapor thermal therapy was shown to provide effective symptom relief and improved quality of life (QOL) in patients with moderate to severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), says a new study. Symptom relief and improved QOL remained durable throughout 4 years. 

"Results imply that for men with moderate to severe LUTS at risk for BPH progression early intervention with this thermal therapy rather than using pharmaceutical agents or invasive surgery may be an ideal option," Kevin T. McVary, Department of Urology, Loyola University Medical Center, Maywood, IL, and colleagues wrote in their study published in the journal Urology. 

 Approximately 70% of men by the seventh decade of life have benign prostatic hyperplasia. This condition is commonly associated with progressive development of voiding and storage related LUTS. There are many option for BPH management with a range of efficacy, invasiveness, and cost. Giving therapy to a patient should rely on careful physical evaluation and informed discussion with his provider. Decision making varies in accordance to gland size, severity of symptoms, anatomical features, and efficacy and safety of the different treatments. 

Minimally invasive surgical treatments (MISTs), both thermal and mechanical expander options, represent alternative intervention before or after any pharmacotherapy. The most recent MIST is water vapor thermal therapy using radiofrequency to create thermal energy (Rezūm System, Boston Scientific, Marlborough, MA) in the form of water vapor. 

Against the above background, Dr. McVary and colleagues report 4-year outcomes of the randomized controlled trial of water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. 

For the purpose, the researchers followed 188 subjects; 135 men ≥50years old, International Prostate Symptom Score ≥ 13, maximum flow rate (Qmax) ≤15 mL/s and prostate volume 30 to 80 cc treated with Rezūm System thermal therapy for 4 years. Subset of 53 men who requalified for crossover from control to active treatment were followed 3 years. 

DOI: https://doi.org/10.1016/j.urology.2018.12.041