Which procedure has worse side effects, Rezum (transurethral steam injection) or HoLEP (Holmium Laser Enucleation of the Prostate)?

Side Effects of Rezum vs HoLEP: Comparative Analysis

HoLEP has a more favorable side effect profile compared to Rezum, with lower retreatment rates and more durable outcomes, though Rezum offers better preservation of ejaculatory function. 1

Comparison of Side Effects

HoLEP Side Effects:

• Bleeding risk: Lower transfusion rates compared to TURP (2.6% vs 4.4%) 1
• Urinary incontinence: Transient stress urinary incontinence rate of approximately 1.5% 1
• Urethral stricture: Approximately 2.6% 1
• Sexual function effects:
  • Similar short and mid-term erectile function changes compared to TURP
  • Better long-term IIEF scores than TURP 1
  • Ejaculatory dysfunction in about 53.8% of patients (preservation possible in up to 46.2%) 1
• Catheterization time: Shorter than TURP 1, 2
• Hospital stay: Shorter than TURP 1, 2

Rezum Side Effects:

• Transient adverse events: Higher incidence of non-serious transient adverse events 1
• Sexual function effects:
  • No reported de novo erectile dysfunction 1
  • Better preservation of ejaculatory function compared to HoLEP 1, 3
• Retreatment rates: Higher than surgical alternatives 3
• Efficacy limitations: Less effective than bipolar TURP for symptom improvement 3

Clinical Decision Algorithm

1. For patients prioritizing ejaculatory function preservation:

   • Rezum is preferred (no significant changes in IIEF-EF scores or ejaculatory function) 1

2. For patients with larger prostates (>80g):

   • HoLEP is preferred (size-independent efficacy) 1

3. For patients on anticoagulation/antiplatelet therapy:

   • HoLEP is preferred (can be safely performed with minimal bleeding risk) 1

4. For patients requiring durability and lower retreatment rates:

   • HoLEP is preferred (lower retreatment rates) 1, 4

5. For patients with prior failed BPH treatments:

   • HoLEP can be performed successfully after prior treatments including Rezum 4

Important Clinical Considerations

• HoLEP demonstrates superior relief of bladder outlet obstruction compared to other procedures 2
• HoLEP requires longer operation time but removes more prostate tissue 2
• Rezum has significantly shorter operative time and hospital stay compared to surgical alternatives 3
• Rezum therapy provides approximately 55% improvement in IPSS and 50% improvement in QoL at 2 years 3
• HoLEP can be performed after failed Rezum treatment 4

Potential Complications to Monitor

HoLEP:

• Transient urinary incontinence (monitor for resolution within weeks to months)
• Urethral stricture or bladder neck contracture (2.6%)
• Bleeding (though less than TURP)

Rezum:

• Transient dysuria and irritative symptoms
• Temporary worsening of symptoms during healing phase
• Higher likelihood of requiring retreatment

Both procedures have demonstrated safety profiles superior to traditional TURP, with HoLEP showing more durable outcomes but Rezum offering better preservation of ejaculatory function.