What is the comparative effectiveness of water vapor thermal therapy and TURB (Transurethral Resection of the Bladder) for treating a high bladder neck?

Comparative Effectiveness of Water Vapor Thermal Therapy vs. TUIBN for High Bladder Neck

Water vapor thermal therapy (Rezūm) is more effective than transurethral incision of the bladder neck (TUIBN) for treating high bladder neck in patients with BPH, particularly for those who wish to preserve erectile and ejaculatory function. 1

Treatment Options Overview

Water Vapor Thermal Therapy (Rezūm)

• Indications: Prostate volume <80g 1, 2
• Mechanism: Uses targeted water vapor energy (steam) to create necrotic tissue in the prostate 3
• Effectiveness:
  • Significant improvements in IPSS scores (mean difference -6.9 points compared to sham) 3
  • Sustained improvements in IPSS, IPSS-QoL, and Qmax at 3-year follow-up 1, 2
  • Retreatment rates approximately 4.4% at 3 years 2

TUIBN (Transurethral Incision of Bladder Neck)

• Indications: Prostate volume <30g 1
• Limitations: Higher surgical retreatment rates compared to TURP 1
• Effectiveness: Less data available specifically for high bladder neck

Comparative Analysis

1. Symptom Improvement:

   • Water vapor thermal therapy shows greater symptom improvement with sustained results at 3 years 1, 2
   • Real-world studies show significant improvements in AUA-SS, Qmax, and PVR with water vapor thermal therapy 4

2. Sexual Function Preservation:

   • Water vapor thermal therapy preserves erectile and ejaculatory function 1, 2
   • No significant changes in IIEF-EF scores observed compared to baseline 1
   • Bother and function scores associated with ejaculation significantly improved at 12 and 36 months following treatment (P=.006 and P=.003 respectively) 1

3. Medication Reduction:

   • Alpha-blocker utilization significantly decreased following water vapor thermal therapy (73.9% to 46.6%, p<0.001) 4

4. Complications:

   • Water vapor thermal therapy has a favorable safety profile with primarily transient adverse events 3
   • Most common side effects include dysuria (22.8%) and non-clot-related retention (18.9%) 4
   • Erectile dysfunction and retrograde ejaculation are rare 4

5. Procedure Setting:

   • Water vapor thermal therapy can be performed in an office setting under local anesthesia 5, 6
   • Simple procedure with a short learning curve 6

Treatment Algorithm for High Bladder Neck

1. Assess prostate size:

   • If <30g: Both TUIBN and water vapor thermal therapy are options
   • If 30-80g: Water vapor thermal therapy is preferred 1
   • If >80g: Consider alternative treatments (e.g., HoLEP, ThuLEP) 1

2. Consider patient priorities:

   • If preservation of sexual function is important: Water vapor thermal therapy is preferred 1
   • If rapid symptom improvement is needed: Water vapor thermal therapy shows quicker results

3. Consider comorbidities:

   • For patients with multiple comorbidities: Water vapor thermal therapy has shown effectiveness even in higher-risk patients 7

Important Caveats

1. Patient Selection: Verify absence of obstructive middle lobe for optimal results with minimally invasive therapies 1

2. Retreatment Rates: While water vapor thermal therapy has relatively low retreatment rates (4.4% at 3 years), patients should be counseled about potential need for future intervention 2

3. Follow-up: Regular monitoring is essential to assess long-term outcomes and need for additional treatment

4. Procedure Customization: The number of water vapor injections should be customized based on prostate size and anatomical considerations 2, 7

5. Catheterization: Patients should be informed about the potential need for temporary catheterization following water vapor thermal therapy 3