Sexual function after rezum therapy for BPH: A scoping review

The review article titled“Sexual dysfunction after Rezum therapy for benign prostatic hyperplasia: A scoping review for the current insights and findings”, was published on December 10, 2024 in UroPrecision.

BPH is a prevalent condition among aging men, affecting a significant portion of the male population globally. As men age, the likelihood of developing BPH increases, with a notable rise in prevalence from around 8% in the fourth decade of life to 80% in the ninth decade. This condition often leads to lower urinary tract symptoms (LUTS), which can severely impact patients' quality of life. Moreover, there is a strong link between LUTS and erectile dysfunction (ED), as both share common pathophysiological mechanisms.

Traditional medical and surgical treatments for BPH, such as alpha-blockers, 5-alpha reductase inhibitors, and procedures like transurethral resection of the prostate (TURP), frequently cause sexual dysfunction. This includes issues like ED, ejaculatory dysfunction, and decreased libido. For example, TURP is associated with a high rate of retrograde ejaculation, occurring in approximately 70%-90% of cases. This has led to a growing need for minimally invasive interventions that can alleviate BPH symptoms while minimizing sexual side effects.

The Rezum system, a water vapor therapy, has emerged as a promising treatment option. It works by using convective heat transfer based on the thermodynamic properties of water to target and reduce excess prostate tissue. The unique mechanism of Rezum allows it to preserve sexual function by minimizing damage to the nerves involved in ejaculation and erectile function.

To comprehensively assess the impact of Rezum therapy on sexual function, a scoping review was conducted following the Joanna Briggs Institute methodology. A search of the PubMed and Scopus databases was carried out up to August 2024. Studies were included if they involved BPH patients treated with Rezum and reported sexual function using validated scoring tools like the International Index of Erectile Function (IIEF) and the Male Sexual Health Questionnaire (MSHQ).

Fifteen studies, involving 2,425 patients, met the inclusion criteria. The results showed a mixed but generally favorable impact on sexual function. Regarding erectile function, seven studies reported no significant change, six demonstrated improvements, and two reported a decline. For ejaculatory function, most studies showed no significant change or improvement, with only one study reporting a worsening in ejaculatory function.

In conclusion, Rezum therapy for BPH shows promising outcomes for sexual function, either having no negative impact or even improving it in some cases. However, the review also identified limitations, such as heterogeneity in patient demographics, treatment settings, and follow-up periods. Future research should aim to address these limitations by conducting more standardized studies with longer follow-up periods and direct comparisons with other treatment modalities. This will help to further validate the benefits of Rezum therapy and establish it as a preferred option in BPH management, especially for patients who prioritize maintaining sexual function.

DOI: 10.1002/uro2.93