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Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia: An Umbrella Review and Updated Meta-Analysis
Zhuoxin Li1,2, Chenrui Wang1, Yupeng Wu3
1Shenzhen University Medical School, Shenzhen University, Shenzhen, China.
Purpose:
Water vapor thermal therapy (WVTT) is an emerging minimally invasive therapy for benign prostatic hyperplasia (BPH). This umbrella review and updated meta-analysis aims to evaluate the comprehensive outcomes of WVTT for the management of BPH.
Materials And Methods:
Up to January 2025, randomized clinical trials and observational studies were included in the updated meta-analysis, while systematic reviews and meta-analyses were included in the umbrella review. Both were conducted in accordance with PRISMA criteria. The umbrella review protocol was pre-registered under registration identifier CRD42024514038. The research compared outcomes including International Prostate Symptom Score (IPSS), peak urinary flow (Qmax), postvoid residual volume (PVR), sexual function, retreatment rates, adverse events and cost-effectiveness. Outcomes were analyzed using a random effects meta-analysis model. The source of heterogeneity was identified by meta-regression.
Results:
The umbrella review comprised 6 systematic reviews and the updated meta-analysis included 25 primary studies involving 3,308 patients. The meta-analysis revealed, at 3 months post-operation, a mean reduction of 10.96 points in IPSS (95% confidence interval [CI], 9.71 to 12.20; I²=89%), a mean increase of 4.70 mL/s in Qmax (95% CI, 4.22 to 5.19; I²=31%), and a mean reduction of 69.52 mL in PVR (95% CI, 52.15 to 86.89; I²=84%). At 12 months, the analysis revealed a mean reduction of 12.35 points in IPSS (95% CI, 10.74 to 13.95; I²=94%), a mean increase of 5.27 mL/s in Qmax (95% CI, 4.46 to 6.07; I²=84%), and a mean reduction of 37.07 mL in PVR (95% CI, 18.29 to 55.85; I²=97%). Our umbrella review showed that WVTT also resulted in low retreatment rates and preserved sexual function. Adverse events were mostly mild and self-limiting.
Conclusions:
WVTT is an effective and safe treatment for BPH leading to symptom relief with low retreatment rates and wide application scenarios. Clinicians should consider WVTT as a viable minimally invasive alternative for BPH patients who are not suitable for more invasive therapies.
