# Real-world comparison of Rezūm® water vapor therapy and transurethral resection of the prostate using a pragmatic composite definition of procedural success

## TL;DR

This study compares two prostate treatments, Rezūm water vapor therapy and TURP, using a new success definition that considers symptoms, safety, and sexual function.

## Contribution

A new composite definition of procedural success integrating symptom improvement, safety, and sexual function preservation is introduced and applied.

## Key findings

- Rezūm allowed outpatient treatment and preserved sexual function better than TURP.
- TURP had greater long-term durability with less retreatment compared to Rezūm.
- Both treatments achieved similar overall procedural success rates.

## Abstract

To compare Rezūm water vapor therapy and transurethral resection of the prostate (TURP) using a newly proposed composite definition of procedural success that integrates symptom improvement, safety, and preservation of sexual function.

This multicenter retrospective cohort included 192 matched patients (96 Rezūm, 96 TURP) treated between 2020 and 2024. Groups were matched for age, prostate volume, International Prostate Symptom Score (IPSS), Qmax and post-void residual urine. Procedural success required simultaneous achievement of all the following: ≥50% IPSS reduction, ≥ 50% Qmax improvement, ≥ 50% (or ≥ 1-point) QoL improvement, absence of intraoperative or Clavien–Dindo grade ≥ III complications, preservation of erectile and ejaculatory function, and no retreatment.

Baseline characteristics were comparable between groups. Rezūm was mostly performed as an outpatient procedure (89.6%), while all TURP patients required admission (p < 0.001). Catheterization duration was longer after Rezūm (5 vs. 1.5 days, p < 0.001). Both techniques significantly improved IPSS, Qmax, PVR, and PSA with no difference in median changes. Ejaculatory preservation favored Rezūm (87.5% vs. 50.0%, p < 0.001), whereas retreatment was more frequent (46.9% vs. 15.6%, p < 0.001). Overall procedural success was comparable (53.1% vs. 47.9%, p = 0.47). Median follow-up was 46 months.

Rezūm and TURP achieved similar overall procedural success. Rezūm offered superior sexual function preservation and outpatient feasibility, whereas TURP provided greater long-term durability, supporting tailored treatment selection.

The online version contains supplementary material available at 10.1007/s00345-026-06315-2.