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UPJ INSIGHT Long-Term Water Vapor Thermal Therapy Outcomes Across a Broad Range of Prostate Volumes
By: Noah Hawks-Ladds, BA, Albert Einstein College of Medicine, Bronx, New York; Marc-Mina Tawfik, BS, Albert Einstein College of Medicine, Bronx, New York; Mustufa Babar, BS, Albert Einstein College of Medicine, Bronx, New York; Michael Zhu, BA, Albert Einstein College of Medicine, Bronx, New York; Justin Loloi, MD, Montefiore Medical Center, Bronx, New York; Kevin Labagnara, MD, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, New York; Rahman Sayed, BS, Albert Einstein College of Medicine, Bronx, New York; Azizou Salami, BS, Albert Einstein College of Medicine, Bronx, New York; Matthew Ines, BS, DSS Urology, Queens Village, New York; Nazifa Iqbal, BA, DSS Urology, Queens Village, New York; Michael Ciatto, MD, DSS Urology, Queens Village, New York | Posted on: 17 Jul 2024
Hawks-Ladds N, Tawfik M-M, Babar M, et al. Long-term water vapor thermal therapy outcomes across a broad range of prostate volumes. Urol Pract. 2024;11(4):727-734. doi:10.1097/UPJ.0000000000000596
Study Need and Importance
When pharmacologic therapy fails to suffice for benign prostatic hyperplasia treatment, numerous surgical and minimally invasive options exist. Among these, water vapor thermal therapy (WVTT) has gained significant attention in recent years. Our study addresses the crucial need for more long-term, real-world outcomes on WVTT, particularly in 2 key areas: (1) in men with small (<30 cc) and large (>80 cc) prostates, and (2) in diverse, multiethnic patient populations.
What We Found
Functional outcomes such as International Prostate Symptoms Score (part A of Figure) and quality of life significantly improved from baseline across all prostate volume sizes, noticeable as early as 1 month and enduring through 48 months postoperatively. Patients with 30 to 80 cc prostates showed the most promising sexual function outcomes, highlighted by an improvement in the International Index of Erectile Function–Orgasmic Function domain at 48 months compared to baseline. Rates of alpha blocker and/or 5-alpha reductase inhibitor usage decreased significantly in patients with < 30 cc and 30 to 80 cc prostates, persisting through 48 months. However, for patients with prostates > 80 cc, decreases in medication usage remained durable only up to 6 months post-WVTT (part B of Figure). Adverse events and reoperation rates showed no significant differences across prostate volumes.
Limitations
Limitations include our retrospective study design and the lack of generalizability of our multiethnic, urban practice center led by 2 urologists. Additionally, small sample sizes at time points due to loss to follow-up may introduce bias. Lastly, our exclusion of the Male Sexual Health Questionnaire limits the comprehensive analysis of ejaculatory function, focusing solely on the International Index of Erectile Function.
Interpretation for Patient Care
Our study offers compelling evidence that WVTT yields efficacious outcomes even in patients with small (<30 cc) and large (>80 cc) prostates up to 48 months post treatment, despite the device’s current indication for patients only with prostate volumes < 80 cc. Clinicians treating > 80 cc patients with WVTT should inform them about the potential need for ongoing benign prostatic hyperplasia medications to manage lower urinary tract symptoms postoperatively.
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