Comparison of outcome for holmium laser enucleation prostate and Rezum system in benign prostate hyperplasia: a matched pair analysis.

PURPOSE: Our aim was to assess the efficacy and safety of Rezum therapy in patients with symptomatic benign prostatic hyperplasia (BPH) in comparison to Holmium laser enucleation of the prostate (HoLEP).

METHODS

The retrospective study included 338 patients (204 HoLEP and 134 Rezum) operated on for BPH between January 2020 and November 2024. A 1:1 matching of treated patients (Rezum) to HoLEP patients based on the closest propensity score value was conducted for 131 successful matching pairs. The groups were compared regarding; Age, Prostate volume, PSA, Catheter-dependence, Qmax, PVR, IIEF, IPSS, PGI-I, operation time (OT) and hospital time (HS).

RESULTS

Concerning perioperative data, there was a statistically significant difference between the Rezum and HoLEP groups regarding OT (8.29 ± 1.21 vs. 68.01 ± 31.01 min; P < 0.001) and HS (1 vs. 2.61 ± 1.53 days; P < 0.001) with higher values for HoLEP. At the same time, the catheter duration was longer in the Rezum group (7.6 ± 2.19 vs. 3.49 ± 1.16 days; P < 0.001). In terms of clinical outcomes, there was a statistically significant improvement in Qmax, IPSS and a decrease in PVR at 12 months for the HoLEP group compared to the Rezum group (16.82 ± 2.27 ml/sn vs. 22.14 ± 7.17 ml/sn, P < 0.001; 12.1 ± 2.1 vs. 7.1 ± 1.9, P < 0.001; 43.05 ± 32.62 ml vs. 29.73 ± 43.73 ml, P = 0.006; respectively). PGI-I scores (p = 0.620) and antegrade ejaculation (p < 0.001) were in favour of Rezum therapy.

CONCLUSION

The HoLEP technique demonstrates superior functional outcomes compared to Rezum, particularly in cases with larger prostates. However, Rezum is an ejaculation-sparing technique demonstrating high tolerability, and patient satisfaction even in larger prostates.