Men with benign prostatic hyperplasia may still need medications after water vapor therapy

Long-term results from a real-world analysis presented at the 2025 Annual Meeting of the American Urological Association (AUA 2025) in Las Vegas, Nevada revealed a high rate of medication resumption among men who underwent water vapor therapy for benign prostatic hyperplasia (BPH) at a clinic in Southern California.

Water vapor thermal therapy (Rezum) is a minimally invasive surgical technique that has emerged as a possible option for the treatment of lower urinary tract symptoms associated with BPH. Rezum, which uses steam to shrink the prostate tissue, is recommended for men with moderate BPH symptoms and smaller prostate volumes who are looking to safeguard ejaculatory function. In clinical studies, Rezum was associated with low rates of surgical retreatment and complications such as retrograde ejaculation [McVary KT et al. J Urol. 2021 Sep;206(3):715-724]. However, long-term data regarding the durability of symptom relief after Rezum are still emerging. 

Researchers at the University of California, San Diego (UCSD) School of Medicine collected data from patients who underwent Rezum at their clinic between 2017 and 2022 to determine how many individuals restarted BPH medications within 5 years. They assessed various postoperative measures, including adverse events (urinary tract infection, urinary retention, bleeding), retreatment rates, retrograde ejaculation, and BPH medication reinitiation (defined as alpha-blockers or 5-alpha reductase inhibitors prescribed within 5 years postoperatively).

Approximately half of the 179 participants were followed up to the 2-year mark (90 people, 50.3%), with a mean follow-up of 24.5 months. During this time, only 6% (n=11) of patients required surgical retreatment, and no patients reported de novo retrograde ejaculation after Rezum. However, 51.4% (92) of patients resumed pharmacotherapy for BPH within 5 years after the Rezum procedures. 
“This finding is important when counseling patients on BPH treatment options,” said presenting author Spencer Chau, a student at the UCSD School of Medicine. “Further research should investigate differences in post-procedure management across urology departments, including variations in medication resumption practices and follow-up protocols.”