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Comparative Post-Operative Outcomes of Rezūm Prostate Ablation in Patients with Large versus Small Glands.

Introduction Rezūm water vapor thermal ablation is a new minimally invasive technique used to treat benign prostatic hyperplasia (BPH). Major advantages include minimal anesthesia and recovery time, low rate of sexual side effects and durable clinical improvement. However data is lacking regarding use of Rezūm in prostate glands >80cc. Here we seek to examine clinical outcomes of men with large prostate glands following Rezūm. Methods We retrospectively reviewed patients who underwent Rezūm therapy at our institution since 7/2017. Three month postoperative outcomes were analyzed including AUA symptom score, peak flow, and post-void residual. Complications, including hematuria and urinary tract infections, were also assessed. All statistical analyses were conducted using RStudio 1.2.1335. Results 182 patients undergoing Rezūm were identified of which 25.8% had prostate volume >80cc. Mean gland volume in this group was 119cc and 55.3% were catheter dependent. Following Rezūm, statistically significant improvement was seen in AUASS from 22 to 13.4 (p=0.04) and post-void residual from 305cc to 149cc (0.05). Statistically significant improvement was seen in peak flow rate from 7.7 mL/second to 12.7 mL/second (p=0.002). In a subset of catheter dependent patients, the postoperative catheter free rate was 83% for men with glands >80cc which was comparable to 88% in the smaller gland group. Postoperative complication rate was not significantly different between large or small glands. Conclusions In our experience, Rezūm is efficacious in patients with glands >80cc. Patients experience symptomatic and objective improvement in voiding parameters that is comparable to patients with glands smaller than 80cc. Among catheter dependent patients with glands >80cc, over 80% are catheter free after Rezūm. Our experience supports the consideration of Rezūm in patients with prostate glands >80cc; further studies are warranted to confirm long-term outcomes.