Clinical Comparison of Rezūm Alone versus RezUIP (Combined Rezūm and TUIP) for the Treatment of Lower Urinary Tract Symptoms

Jen-Chieh Lin¹、Chia-Chih Hsieh¹、Chung-Han Ho^3,4,5、Wen-Hsin Tseng^1,6、Chien-Liang Liu²、Steven K. Huang¹、Allen W.Chiu⁷

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

³Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan;

⁴Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

⁵Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan

⁶Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

⁷Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan;

*Corresponding Author:

Wen-Hsin Tseng, MD

Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

No.901, Zhonghua Rd., Yongkang Dist., Tainan City 710, Taiwan (R.O.C.)

Email: t.wen@yahoo.com.tw

Abstract

Purpose

Benign prostatic hyperplasia (BPH) is a leading cause of lower urinary tract symptoms (LUTS). While Rezūm water vapor thermal therapy provides effective relief and preserves sexual function, early postoperative edema can lead to transient voiding difficulties and failed trials without catheter (TWOC). Combining Rezūm with transurethral incision of the prostate (RezUIP) may offer synergistic benefits by providing immediate mechanical relief at the bladder outlet. This study compares the surgical safety and functional outcomes of Rezūm monotherapy versus RezUIP.

Materials and Methods

We retrospectively analyzed 60 patients who underwent surgical intervention for BPH: Rezūm alone (n = 37) and RezUIP (n = 23). Baseline parameters, including prostate-specific antigen (PSA), prostate size, International Prostate Symptom Score (IPSS), maximal flow rate (QMax), and post-void residual (PVR) volume, were recorded. Primary endpoints were improvements in IPSS and QMax at a minimum follow-up of 3 months. Secondary outcomes included catheterization duration and postoperative complications.

Results

The RezUIP group presented with significantly more severe baseline parameters, including larger prostate sizes (64.80 vs. 42.00 mL, p=0.0498), higher PVR (79.00 vs. 27.00 mL, p=0.001), and a higher prevalence of obstructive median lobes (86.96% vs. 40.54%, p=0.0004). Although operative time was longer for the combination group (24.00 vs. 15.00 min, p<0.0001), the RezUIP group achieved superior functional gains, including a significantly lower postoperative IPSS (7.00 vs. 14.00, p=0.0006) and a greater increase in maximal flow rate (𝚫QMax: 4.30 vs. 2.80 mL/s, p=0.0066). There were no significant differences between the two groups regarding failed trial without catheter (TWOC), median Foley indwelling time, or postoperative complications such as UTI, hematuria, or sepsis (all p > 0.05).

Conclusion

Combining Rezūm with TUIP (RezUIP) is a safe and effective modality that offers superior functional improvements compared to Rezūm alone. This synergistic approach is particularly beneficial for patients with more severe baseline obstruction and prominent median lobes without increasing perioperative morbidity or catheterization time.