Sexual Function and Clinical Outcomes Following Rezūm Therapy for Benign Prostatic Hyperplasia: An Updated Systematic...

To evaluate sexual function and clinical outcomes following Rezūm water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH), with a dedicated focus on patients with large prostate volumes (> 80 mL).

A systematic search on PubMed, Scopus, and EBSCOhost was conducted through June 23, 2026. Studies reporting validated patient-reported outcome measures for erectile (IIEF) and ejaculatory (MSHQ-EjD) functions were included. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS) for 27 cohorts and the Cochrane RoB 2 tool for three randomized controlled trials (RCTs).

Thirty studies (N = 4635 patients) met inclusion criteria. Across gland sizes (30-150 mL), Rezūm demonstrated a consistent trend toward preservation of erectile and ejaculatory function. Although several studies reported statistically significant improvements in IIEF scores, these generally did not reach established thresholds for clinical significance. Ejaculatory function was preserved in the majority of patients, contrasting with high rates of ejaculatory dysfunction reported for resective comparators. Ten studies provided data for prostates > 80 mL; in this subgroup, Rezūm provided significant relief of lower urinary tract symptoms (LUTS) with sexual function outcomes that appeared comparable to those in standard-sized glands. Adverse events were predominantly Clavien-Dindo Grade I-II, with Grade ≥ III complications occurring in < 1% of patients. Overall, methodological quality was limited, with a high prevalence of low-to-moderate quality evidence, and all RCTs judged at high risk of bias.

Current evidence suggests that Rezūm preserves erectile and ejaculatory function while providing meaningful relief of urinary symptoms, including in large-volume prostates. However, confidence in these findings remains limited by the predominance of low-quality evidence and a high risk of bias.