Short-term postoperative functional outcomes of Rezūm vs. Greenlight PVP 180W XPS: A propensity match score study
Iman Sadri1, David-Dan Nguyen2, Adel Arezki2, David Bouhadana2, Naeem Bhojani3, Dean Elterman4, Kevin C. Zorn3.
1Division of Urology, McGill University Health Centre, Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada; 4Division of Urology, University Health Network, Toronto, ON, Canada
Introduction: Rezūm steam vapor therapy has recently gained popularity as a new minimally invasive surgical technique for patients with benign prostatic hyperplasia (BPH). The currently available literature on Rezūm has been promising, showing good lower urinary tract symptom relief outcomes and favorable sexual outcomes. In this multicenter study, we sought to compare the functional outcomes of Rezūm against a similar cohort of patients undergoing 180W XPS GreenLight (GL) photoselective vaporization of the prostate (PVP).
Methods: Data were obtained from the Global GreenLight Group database, which includes eight high-volume, experienced surgeons from a total of seven international centers, as well as data from the Canadian Rezūm Database. Patients with previous BPH surgery were excluded. Six-month changes in International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), and postvoid residual (PVR) were compared between GL and Rezūm using regression models, with inverse propensity treatment weighting adjusting for age and prostate size.
Results: The GL and Rezūm groups had significant baseline differences in age and Qmax (Table 1). At six-month followup, Rezūm demonstrated a Qmax of 12.6 ml/s compared to 18.7 ml/s (p<0.01), a PVR of 105 ml compared to 30 ml, and an IPSS score of 9.5 compared to 6.6 (p<0.01) in the GL group, respectively (Figure 1). Notably, compared to Rezūm, regression models demonstrate that GL boasts statistically significant advantages in IPSS change from baseline (4.4, 95% confidence interval [CI] 3.0–5.9, p<0.01), Qmax change from baseline (9.3 ml/s, 95% CI 5.8–12.7, p<0.01), and PVR decrease from baseline (157 ml, 95% CI 97–219, p<0.01) at six-month followup.
Conclusions: Rezūm and GL both demonstrated significant IPSS lower urinary tract symptom improvements, as well as postoperative functional parameters when compared to baseline. The significant differences in postoperative outcomes between the observed technologies relate to the degree of tissue ablation with the tradeoff of reduced side effects, sexual dysfunction, procedure time, length of stay, and cost. Such details should be discussed and evaluated during patient consultation and counselling.
