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Comparison of lower urinary tract symptoms and sexual function response to convective radiofrequency thermal therapy of prostate (Rezûm®) to MTOPS study cohort

Helo, S1; Tadros, N1; Gupta, N2; Holland, B1; Dynda, D1; Kohler, TS3McVary, KT1

1: Southern Illinois University School of Medicine, United States; 2: Rutgers Robert Wood Johnson Medical School, United States; 3: Mayo Clinic, United States

Objective: Medical therapy is commonly used to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), but can negatively impact sexual function. Rezum (REZ), a convective radiofrequency thermal therapy, shows promising results for LUTS/BPH. We report the effect of REZ on LUTS and sexual function compared to the Medical Therapy of Prostatic Symptoms (MTOPS) study historical cohort.

Material and Methods: Results from the treatment arm of a double-blinded, randomized, controlled trial of REZ were compared to results of the MTOPS therapy arms, doxazosin (DOX), finasteride (FIN), or combination of both (COM) in subjects with prostate volumes ≥ 30cc and IPSS ≥ 13. IPSS, BPH Impact Index (BPHII), peak flow rate (Qmax), PVR, erectile and ejaculatory function were compared at 3, 6, 12, and 24 months. Propensity score weighting was performed to eliminate differences in IPSS, QOL and prostate volume between groups at baseline; outcomes were assessed at 3, 6, 12, and 24 months.

Results: Treatment arms included 129 (REZ), 368 (DOX), 394 (FIN), and 386 (COM) subjects. Baseline age, BMI, PSA, Qmax, and PVR were similar. At baseline, REZ subjects had substantially higher erectile function, but lower PSA, larger prostate volume, and worse QOL compared to the MTOPS cohort. Upon treatment, REZ subjects demonstrated greater improvement in LUTS than DOX and FIN treatment arms through 24 months. Propensity score weighted analysis showed no difference in IPSS or BPHII at all time points. DOX cohort saw a statistically significant decrease in sexual desire, with worsening erectile function and satisfaction, compared to the REZ cohort at 24 months. No statistically significant changes were detected in REZ versus COM or REZ versus FIN cohorts in erectile function, orgasmic function, sexual desire, or satisfaction at 24 months.

Conclusion: REZ achieves similar outcomes compared to combined medical therapy for treatment of LUTS/BPH when adjusted for propensity score. Although baseline erectile function was higher in REZ subjects, it is unclear to what degree these differences are attributable to instrument versus cohort differences. REZ offers a favorable sexual side effect profile, which may be a superior option for patients unwilling to sacrifice sexual function. Primary treatment decision depends on a discussion of adverse events and medication burden. Longer-term follow-up is necessary to assess durability of REZ prostate ablation.


Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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