Comparing complications of Rezum and Urolift for BPH/LUTS using the Accordion Severity Grading System

To compare the short- and long-term complication profiles of Rezum and Urolift using standardized approaches.

We analyzed published data from the pivotal randomized trials of Rezum and Urolift. The severity of complications was independently graded by urologists using the Accordion Severity Grading System, developed by the American College of Surgeons National Surgical Quality Improvement Program. Short- (3 months) and long-term (5 years) complication rates were assessed. Long-term complications included medical retreatment, surgical retreatment, and surgical implant removal. We calculated the weighted postoperative morbidity index (PMI) values (0-1 scale) for each procedure and performed Monte Carlo simulations to account for uncertainty in complication rates and severities.

Short-term PMI values were similar between the Rezum (0.091) and Urolift (0.092) groups, with dysuria, hematuria, pain, and urinary urgency most commonly reported. Over 5 years, the cumulative complication rates were 15.4% for Rezum and 33.6% for Urolift. The associated 5-year PMI was 0.055 for Rezum and 0.165 for Urolift, indicating a three-fold higher long-term severity-weighted complication burden with Urolift. Monte Carlo simulations confirmed the robustness of these findings.

This study identified significant differences in the long-term complication profiles of Rezum and Urolift when considering both the incidence and severity of postoperative complications. These findings may help guide clinical decision-making when selecting minimally invasive surgical options for BPH/LUTS treatment.