ObjectiveThis report evaluates clinical experience with the Rezūm system after US Food and Drug Administration clearance in consecutive cases accrued by multiple community urologists for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Treatment techniques for transurethral convective radiofrequency water-vapor thermal therapy and outcomes with up to 12 months’ follow-up are presented.Materials and methodsA total of 131 patients with moderate–severe LUTS were included in a retrospective analysis of BPH procedures with the Rezūm system. Pre- and postprocedure assessments included International Prostate Symptom Score (IPSS), quality of life, peak urinary flow rate, voided volume, and postvoid residual urine volume. Urologists used their own discretion for patient selection, with variable prostate sizes, LUTS severity, urinary retention, or presence of an obstructing median lobe. Safety signals and surgical retreatment rates were monitored prospectively.ResultsMen aged 47–96 years with prostates 13–183 cm3 showed significant improvement in IPSS, quality of life, and postvoid residual volume durable through 12 months after thermal therapy. Patients with either moderate (IPSS 8–19) or severe (IPSS 20–35) symptoms achieved significantly improved scores. Postprocedure adverse events normally anticipated and related to endoscopic instrumentation were transient and mild–moderate in nature. No de novo erectile or ejaculatory dysfunction was reported.ConclusionThis study corroborates prior published pilot and randomized controlled trial results indicating significant relief of urinary symptoms and reproducibility of responses to thermal therapy. Convective radiofrequency thermal therapy with the Rezūm system warrants consideration as a first-line treatment for LUTS/BPH as an alternative to the use of pharmaceutical agents.

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Periurethral injection of bulking agents to cause coaptation of the urethral walls has long been used in the treatment of urinary incontinence. A new form of this treatment is the silicone Genitourinary Spheroidal Membrane (Genisphere), which is placed in the periurethral tissues with a special delivery tool. Among 39 women who received two or three Genispheres, 29 (77%) became dry or markedly improved with a significant increase in leak-point and proximal urethral closure pressures. Early sexual activity, a short urethra, atrophic tissue, bladder instability, incorrect positioning, and device rupture were the causes of failure. The device has several advantages over traditional bulking agents, including the absence of silicone particles that can migrate, and has proved to be a safe method of treating stress urinary incontinence.

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