Predictors of surgical retreatment following Rezūm water vapor therapy: a multi-center real-world cohort study
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Mario Henrique Bitar Siqueira1, Mohammed Aldoukhi1, Naeem Bhojani2
1Department of Surgery, Division of Urology, University of Toronto, 399 Bathurst Street, MP-8-317, Toronto, ON, M5T 2S8, Canada.
Introduction:
Rezūm water vapor thermal therapy (WVTT) is an effective minimally invasive treatment for benign prostatic hyperplasia (BPH), offering durable symptom relief while preserving sexual function. However, real-world data on predictors of surgical retreatment remain limited. This study evaluates the incidence of surgical re-intervention following Rezūm therapy in a large multi-center cohort and identifies clinical and procedural factors associated with retreatment.
Methods:
A retrospective analysis was conducted using a prospectively maintained registry from two high-volume international centers in Canada and Italy. Men undergoing Rezūm therapy between April 2019 and August 2025 were included. Baseline demographics, comorbidities, functional outcomes, and intraoperative characteristics were compared between patients with and without surgical retreatment. Univariable and multivariable Cox proportional hazards models were used to evaluate predictors of time to re-intervention. Kaplan-Meier estimates were generated for cumulative incidence of retreatment.
Results:
Among 837 treated men, 43 (5.1%) underwent surgical retreatment over a median follow-up of three years. The cumulative probability of re-intervention was 2.3% at 1 year, 5.3% at 2 years, and 6.9% at 3 years. Most retreatment procedures consisted of GreenLight photovaporization (56%), TURP (20%), or repeat Rezūm (9%). Baseline demographic and clinical characteristics-including age, prostate volume, median lobe presence, medical therapy, and comorbidities-were not significantly associated with retreatment. The only baseline functional measure differing between groups was the BPH Impact Index (BPHII), which was higher among patients who required re-intervention (8.8 vs. 7.5, p = 0.010). In multivariable Cox analysis, BPHII remained independently predictive, with each one-point increase associated with an 18% higher hazard of retreatment (adjusted HR 1.18, p = 0.008).
Conclusion:
In this large, real-world multi-center cohort, Rezūm therapy demonstrated a low incidence of surgical retreatment for BPH.The BPHII emerged as the only independent predictor of retreatment, suggesting that patient-reported symptom impact may reflect disease severity or treatment resistance. These findings may support preoperative counseling and help guide patient selection for WVTT.