A systematic review of associations-exploring whether prostate size is related to sexual function outcomes following water vapor thermal therapy

Rezūm water vapor thermal therapy (WVTT) is a safe and effective treatment for lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in patients with prostate sizes between 30 and 80 cm3 and preserves sexual function. However, its effect on sexual function in patients with large prostate volumes (≥80 cm3) is unknown.

This systematic review aims to assess the association of prostate size with sexual function outcomes in lower urinary tract symptoms/benign prostatic hyperplasia patients after treatment with WVTT.

Medline and Embase were searched (2013-2024) to identify articles reporting sexual function outcomes for both average (≤80 cm3) and large gland (>80 cm3) patients within the same study at baseline and ≥12 months. Adverse events impacting sexual function, postoperative benign prostatic hyperplasia medication usage, and baseline/≥12-month data for sexual function outcomes were extracted in DistillerSR. Outcomes were summarized for each subgroup (average gland, large gland). ROBINS-I was used to assess risk of bias, and the Grading of Recommendations, Assessment, Development and Evaluation system was used to assess certainty of evidence.

Of 394 articles, 4 were included. Corresponding to three distinct studies reporting sexual function outcomes at baseline and ≥12 months post-WVTT (306 average and 85 large gland patients at baseline). Scales included International Index of Erectile Function (IIEF)-15, IIEF-5 (Sexual Health Inventory for Men-SHIM), IIEF-Ejaculatory Function (EF) Domain, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD) Bother, and MSHQ-EjD Function. At follow-up, all three studies reported no clinically significant associations between sexual function outcomes and prostate size for large gland and average gland patients.

Despite limited studies reporting sexual function outcomes in both average and large gland patients, this systematic review showed there was no clinically meaningful association between prostate size and erectile or ejaculatory function at ≥12 months after WVTT.