Rezūm Water Vapor Therapy Is Effective for Larger Benign Prostatic Hyperplasia Glands

Al-Ogaili M, Dham J, Rangchi A, Rabie A, et al. Efficacy and Safety of Rezūm Water Vapor Thermal Ablation in Large and Small Prostates: A Multicenter Comparative Analysis of 2,725 Patients. J Am Coll Surg. June 2026.

Rezūm water vapor therapy is well established for benign prostatic hyperplasia in prostates <80 cc; however, evidence for larger glands remains limited despite increasing demand for minimally invasive alternatives to conventional surgery. Al-Ogaili et al. compared outcomes after Rezūm therapy in patients with large versus small prostates.

In this multicenter retrospective study, 2,725 patients undergoing Rezūm therapy across five centers were stratified by prostate volume: large prostate (LP, ≥80 cc; n = 993) and small prostate (SP, <80 cc; n = 1,732). Primary outcomes were 6-month changes in International Prostate Symptom Score (IPSS), IPSS Quality of Life (QoL), peak urinary flow rate (Qmax), and post-void residual (PVR). Secondary outcomes included Sexual Health Inventory for Men (SHIM) scores, complications, and retreatment rates.

At 6 months, LP and SP cohorts achieved comparable improvements in IPSS (41.4% versus 41.9%; p=0.958), QoL (50.0% versus 50.0%; p=0.394), and Qmax (122.2% versus 118.2%; p=0.62). LP patients experienced a greater reduction in PVR (68.8% versus 24.0%; p<0.001). SHIM scores remained stable in both groups despite a significant between-group difference. Complication rates were similar (5.0% versus 4.9%; p=0.559). Over a median follow-up of 41 months, LP patients had lower surgical retreatment rates than SP patients (3.6% versus 7.2%; p<0.001).

In this large multicenter cohort, Rezūm therapy provided comparable symptomatic and flow-rate improvements for prostates ≥80 cc and <80 cc, with greater improvement in bladder emptying and lower long-term surgical retreatment rates among larger glands. These findings support the safety, effectiveness, and durability of Rezūm therapy in appropriately selected patients with prostates ≥80 cc.