Predictors of Treatment Failure and Second-Line Therapy Outcomes After Rezūm Therapy for Benign Prostatic Hyperplasia

Background Rezūm water vapor thermal therapy has emerged as a minimally invasive treatment option for benign prostatic hyperplasia (BPH). However, data regarding predictors of treatment failure and outcomes of second-line therapies after failed Rezūm therapy remain limited. This study aimed to evaluate functional outcomes, predictors of treatment failure, and outcomes of second-line therapies following Rezūm therapy. Methods We conducted a retrospective, single-center study of patients who underwent Rezūm therapy between January 2019 and January 2023. Baseline demographic and clinical characteristics, including age, prostate volume, prostate-specific antigen (PSA), post-void residual volume (PVR), and International Prostate Symptom Score (IPSS), were collected. Treatment failure was defined as the need for secondary intervention. Multivariable logistic regression was performed to identify predictors of treatment failure. Outcomes of second-line therapies and incidental prostate cancer (iPCa) detection were analyzed. Results A total of 106 patients were included in the final analysis, with a median follow-up of 34 months. The median IPSS reduction after Rezūm was 6 points. Overall, postoperative complications occurred in 28 of 106 patients (26.4%). During the follow-up period, 33 of 106 patients (31.1%) required a secondary intervention. Elevated baseline PVR was identified as an independent predictor of treatment failure (OR 1.009, 95% CI 1.004-1.013; p < 0.001), whereas age, prostate volume, and baseline IPSS were not significantly associated with treatment failure. Among patients requiring secondary intervention, patients undergoing ablative retreatment experienced significant symptom improvement, with a mean IPSS reduction of 10.5 points (95% CI 8.9-12.1; p < 0.001). iPCa was detected in 3 of 28 patients (10.7%) undergoing histological evaluation after secondary surgery. Conclusions Rezūm therapy was associated with significant symptom improvement in patients with symptomatic BPH. Elevated baseline PVR was independently associated with an increased likelihood of treatment failure. Patients undergoing ablative retreatment experienced substantial postoperative symptom improvement following failed Rezūm therapy. Careful patient selection and assessment of bladder dysfunction may improve long-term treatment durability.