Hypothesis / aims of study
Surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) ranges from minimally invasive to more invasive surgical procedures. These procedures have different profiles in terms of clinical efficacy, procedural costs, and treatment settings. This study’s aim was to identify the most important attributes of BPH surgical procedures for men with moderate-to-severe BPH undergoing convective water vapor thermal therapy (WVTT; Rezūm System).
Study design, materials and methods
This study received approval from University of Toronto’s research ethics committee. All patients provided consents to receive clinical surveys. Men with LUTS due to BPH who underwent a WVTT procedure between April 2019 and November 2020 in a Toronto urological clinic were invited to participate in an online survey. The questionnaire included patient demographics and survey instruments of relevant attributes for BPH surgical procedures (8 attributes) and WVTT (5 attributes) developed through literature review and validated by a clinical expert. Patients were asked how important each attribute was to them before they selected a BPH procedure and decided to undergo WVTT. We pilot tested and revised the questionnaire based on participants’ comments. The survey was then distributed via Microsoft Forms (Redmond, WA) to 170 patients between February 10 and March 3, 2021. To ensure the highest response rates, we sent a follow-up reminder to all patients two weeks post-initial email invite.
Out of 170 patients receiving the survey, 128 responded to the survey reflecting a 75% response rate. A majority of the respondents were 60-69 years old (45%), white (88%), married (83%), and had a gross household income of $100,000-$249,999 CAD (40%). A total of 97% of the respondents rated the ability to avoid further BPH treatments as very or extremely important, followed by duration to return to normal activities (79%), and avoiding a procedure that required general anesthesia (57%). Forty-seven percent of patients reported post-procedural catheterization was either a very or extremely important attribute of a BPH procedure. For WVTT attributes, 98% of the respondents rated avoiding more invasive surgical treatments such as TURP and 88 % rated a quick recovery as very or extremely important.
Interpretation of results
Men in this study reported the most important attributes for a BPH procedure were avoiding retreatment, not requiring general anesthesia, and returning to normal activities. Most men chose WVTT to avoid more invasive procedures and to have a quick recovery. Post-procedural catheterization was not a leading factor for men when choosing a BPH procedure.