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Injection density in Rezūm®: Less might not be more. A multicentric international study
I Schwartzmann1, S Secco2, A Farré1
1Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
Actas Urologicas Espanolas
|August 2, 2025
Summary
Optimizing injection density (ID) in Water Vapor Thermal Therapy (WVTT) for benign prostatic obstruction may improve treatment success. Higher ID showed a protective effect against failure without increasing complications or impacting sexual function.
Area of Science:
- Urology
- Minimally Invasive Surgery
Background:
- Water Vapor Thermal Therapy (WVTT) is a minimally invasive surgical therapy (MIST) for benign prostatic obstruction.
- The optimal number of intraprostatic injections for WVTT is not well-defined.
- This study introduces injection density (ID) as a metric to evaluate WVTT outcomes.
Purpose of the Study:
- To assess the impact of injection density (ID) on treatment failure after WVTT for benign prostatic obstruction.
- To determine the relationship between ID and postoperative complications and sexual function.
Main Methods:
- Multicentric retrospective study of 722 patients undergoing WVTT across 11 European centers.
- Data collected included baseline, surgical, and 24-month postoperative outcomes.
- Logistic regression analyzed treatment failure based on ID cut-off points (0.75-2.5 injections/10 cc).
Main Results:
- Intermediate ID (1.25-1.75 injections/10 cc) showed a protective effect against treatment failure, with 1.75 reaching statistical significance (P=.028).
- Higher ID (2.00-2.50 injections/10 cc) also demonstrated a protective effect, with 2.25 reaching significance (P=.024).
- No significant association was found between ID and complications; sexual function remained stable.
Conclusions:
- Optimizing injection density (ID) in WVTT may enhance treatment success rates for benign prostatic obstruction.
- A volumetric approach to WVTT, guided by ID, may offer improved outcomes compared to linear injection techniques.
- Higher ID can be safely implemented without adverse effects on complications or sexual function.
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