Rezum水蒸氣熱消融術之治療優化：雙層注射策略與高治療循環／體積比對攝護腺縮減效益之影響

曾名睿¹、吳其翔²、溫晨越³

¹彰化基督教醫院 外科部 ; ²彰濱秀傳紀念醫院 泌尿部 ; ³彰化秀傳紀念醫院 泌尿部

Optimizing prostate volume reduction after Rezum therapy: enhancing clinical efficacy of the "Double-decking method" with high treatment cycles per unit prostate volume strategy

Ming-Jui Tseng¹, Chi-Hsiang Wu², Chen-Yueh Wen ³,

¹Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

² Department of Urology, Changbing Show Chwan Memorial Hospital, Changhua, Taiwan

³Department of Urology, Changhua Show Chwan Memorial Hospital, Changhua, Taiwan

Purpose:

Water vapor thermal therapy (Rezum) is an innovative, minimally invasive procedure that utilizes convective radiofrequency thermal energy to induce coagulative necrosis and subsequent resorption of hyperplastic prostatic tissue. While standard protocols typically yield a modest volume reduction of 25% to 30%, our study evaluates the efficacy of the "Double-decking method." By strategically increasing the treatment cycles per unit of prostate volume (CPV) to over 0.15, we aim to provide more comprehensive thermal coverage and achieve superior tissue reduction compared to conventional techniques.

Materials and Methods:

We retrospectively analyzed 11 male patients (mean age: 67.1 years) who underwent the Rezum procedure between April 2025 and February 2026. Key clinical parameters—including International Prostate Symptom Score (IPSS), prostate volume, voiding volume, maximum urinary flow rate (Qmax), post-void residual (PVR) volume, and PSA levels—were evaluated preoperatively and at 3 months post-procedure. Statistical significance was determined using the Wilcoxon signed-rank test for paired non-parametric data.

Results:

The high-CPV strategy yielded significant clinical improvements across all primary endpoints. At 3 months, the mean prostate volume decreased by 51.1% (from 60.7 to 29.7 mL; p = 0.001), substantially exceeding conventional expectations. Symptomatic relief was equally robust, with the mean IPSS dropping by 76.6% (to 5.8; p = 0.001). Functional outcomes demonstrated a 203.7% surge in Qmax (to 26.1 mL/s; p = 0.001) and a 95.3% reduction in PVR (to 6.4 mL; p = 0.001). Notably, ejaculatory function was preserved in 100% of patients. Regarding safety, two cases of acute prostatitis complications occurred underscoring the necessity of stringent perioperative management.

Conclusion:

The double-decking strategy with a CPV >0.15 markedly enhances the efficacy of Rezum therapy, yielding >50% prostate volume reduction. Despite these outstanding outcomes, the increased treatment intensity necessitates stringent infection control and proactive monitoring to prevent urosepsis.