Comparison between convective radiofrequency water vapor thermal ablation (Rezum) versus tamsulosin in management of lower urinary tract symptoms in patients with benign prostatic enlargement

Abstract

Objective: To assess the efficacy of REZUM water vapor thermal ablation therapy against the conventional medical treatment for benign prostatic hyperplasia using tamsulosin.

Patients and methods: A total of 94 patients with lower urinary tract symptoms due to benign prostatic hyperplasia were enrolled in the study. They were divided into 2 equal groups, Rezum group and tamsulosin group,. Both groups were assessed preoperatively and at 3, 6, 12 months post-procedure for International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max), quality of life (QoL), post-void residual (PVR) and complication.

Results: At 3 months, Rezūm was associated with significantly greater improvements in IPSS, QoL, Q_max, prostate volume, and PVR compared with tamsulosin (all P < 0.01). At 6 months, Q_max, QoL, and PVR remained significantly better in the Rezūm group (P < 0.001), while IPSS and prostate volume showed no significant difference. At 12 months, the Rezūm group continued to demonstrate significantly greater improvements in Q_max, QoL, prostate volume, and PVR (all P < 0.01), whereas IPSS was similar between groups (P = 0.792). The overall complication rate was significantly lower in the Rezūm group compared with the tamsulosin group (55.3% vs. 85.1%, P = 0.0017).

Conclusion: Compared with tamsulosin, Rezūm therapy achieved more durable improvements in urinary symptoms, flow rate, prostate size, and residual urine, with benefits maintained throughout follow-up. Importantly, it was also associated with a lower overall rate of complications and fewer sexual adverse effects.

Keywords: Rezūm, BPH, tamsulosin