Introduction of a Structured Reporting Protocol and Surgical Checklist for Rezum Water Vapor Therapy (VAPOR-SRP)

Background/Objectives: Rezum water vapor therapy for benign prostatic obstruction lacks standardized documentation, complicating data comparison. This study evaluates the completeness of non-standardized Rezum operative reports and validates a novel Rezum-Structured Reporting Protocol (SRP) to enhance documentation quality. Methods: Following the establishment of content validity, the SRP-which includes detailed diagrams for various prostatic urethral lengths (PUL) and intravesical prostatic protrusion (IPP) to document injection sites, along with a comprehensive 10-item checklist capturing factors that may influence outcomes-was retrospectively applied to 100 Rezum cases. Operative videos and non-standardized reports were analyzed and compared against the SRP. For criterion validity, inter-rater reliability was evaluated through a blinded review of 20 cases by three Rezum users and the protocol development panel, comparing checklist item ratings. Results: Median number of injections was 4.0 (IQR: 2-6), injection density was 12.7 (IQR: 10-16.7) mL (PVOL)/injection, and injection interval was 0.7 (IQR: 0.5-1) cm (PUL)/injection. Variations in injection techniques were noted, including non-standard locations in 10% of cases and alternating injection sequences between lobes in 22%. Only 30% of reports detailed injection sites accurately. The intraclass coefficient for the rating of PUL was 0.94 (95% CI: 0.89-0.97). The Fleiss Kappa for MLE and IPP was 0.84 (95% CI: 0.66-1.02) and 0.85 (95% CI: 0.67-1.03), respectively. The agreement rate was 93% for bladder neck/urethra morphology and 100% for injection sequence. Kendall's W was 0.37 (p = 0.343) for the item of injection sites. Conclusions: Variability in Rezum surgical techniques was observed, particularly in injection density, injection intervals, and precise injection locations, as well as in the structured information of non-SRP-standardized operative reports. Content validity of the SRP was achieved, leading to high inter-rater reliability in its application. The SRP promotes the standardization and completeness of Rezum data, thereby supporting improved, consistent, and high-quality Rezum documentation.