Convective Water Vapor Energy Ablation (Rezum) Versus Prostatic Urethral Lift (Urolift): A 2-Year Prospective Study.

To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum) and prostatic urethral lift (Urolift). To identify predictive factors for treatment failures in both treatments. Prospective clinico-epidemiological data of patients who underwent Urolift or Rezum in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. From October 2019 to October 2022, 86 patients underwent Rezum, and 62 patients underwent Urolift. Rezum involved a longer indwelling catheter duration (12.38 ± 5.548 1.39 ± 3.010 days, < 0.001) compared with Urolift. Rezum was associated with more complications compared with Urolift (36 [41.9%] 10 [16.1%] cases, < 0.001). Rezum had more cases of hematuria (17 [19.8%] 4 [6.5%] cases [ = 0.022]) and urinary tract infections (27 [31.4%] 3 [4.8%] cases, < 0.001) compared with Urolift. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift was associated with higher reoperation rates (5 [8.1%] 0 [0%] cases, = 0.010) compared Rezum. Rezum had higher anticholinergic usage rates compared with Urolift post-operation (22 [25.6%] 8 [12.9%] cases, = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. There was no difference in clinical outcomes of patients who underwent Rezum and Urolift. However, patients who had undergone Rezum faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.