Open Access

ARTICLE

Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes

Dean Elterman¹, Shaun Shepherd¹, Seyed Hossein Saadat¹, Mark N. Alshak², Naeem Bhojani³, Kevin C. Zorn⁴, Enrique Rijo⁵, Vincent Misrai⁶, Katherine Lajkosz¹, Bilal Chughtai²

1 University Health Network, Toronto, Ontario, Canada
2 Weill Cornell Medicine ,New York, New York, USA
3 Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
4 University of Montreal, Montreal, Quebec, Canada
5 Hospital Quiron Barcelona, Barcelona, Spain
6 Clinique Pasteur, Service d’Urologie, Toulouse, France
Address correspondence to Dr. Dean Elterman, Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst Street, MP-8-317, Toronto, ON M5T 2S8 Canada

Canadian Journal of Urology 2021, 28(5), 10824-10833.

Abstract

Introduction: Half of men aged > 60 years will develop benign prostatic hyperplasia (BPH) with 40% of these men having moderate-to-severe lower urinary tract symptoms (LUTS). There is limited knowledge on a head-to-head comparison of prostatic urethral lift (UroLift) and convective water vapor ablation (Rezum) for the treatment of LUTS secondary to BPH. We sought to compare randomized controlled trials with 3-year clinical outcome data.
Materials and methods: After a thorough literature search, two multicenter sham-controlled double-blind randomized trials for UroLift and Rezum were identified and compared. Both studies had similar designs, baseline characteristics, reported outcomes, and low risks of bias.
Results: Rezum and UroLift resulted in significant improvement of International Prostate Symptom Score (IPSS) at 3 months (51.4% and 49.9%, respectively) and 50% reduction of IPSS Quality of Life that was durable across all time points. At 24 and 36 months, there was a statistically significant difference in IPSS between groups, favoring Rezum (-11.2 ± 7.3 versus -9.13 ± 7.62, p = 0.04, and -11.0 ± 7.1 versus -8.83 ± 7.41, p = 0.04, respectively). While Rezum had greater improvement in Qmax at 3 months (6.4±7.2 versus 4.29±5.16, p<0.01), there was no difference in improvement from 12-36 months between treatments. Only UroLift experienced improvements of Men’s Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD) function from baseline and was better than Rezum at all time points (p<0.01). Rezum failed to significantly reduce the MSHQ-EjD bother at 3 months, while UroLift demonstrated a significant reduction of 27.56% (p < 0.01). Both systems offered equal improvements in the bother score by 12-36 months. Surgical re-treatment rates favored Rezum over Urolift (4.4% vs. 10.7%, respectively).
Conclusions: Rezum achieved a greater improvement in symptom relief compared to UroLift. Improvement in ejaculatory dysfunction in patients treated with UroLift was greater than Rezum.

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