The Gold Standard of surgical treatment for benign prostatic hyperplasia (BPH) has been transurethral resection for years. The development of new endourological energy sources has led to a change in the treatment of this entity in men in the last decade (1). The appearance in 2015 of the REZUM vaporization system, consisting of the application of radiofrequency energy to create thermal energy in the form of water vapor that is applied directly to the prostate tissue in a variable number of punctures (treatments) producing cell necrosis, resorption, and reduction of obstructive adenoma has been a further step in this type of therapy. Its advantages include an improvement in long-term functional results, preservation of sexual function and a reduction in the surgical removal rate(2).

The aim of our study was to evaluate the application of a new minimally invasive technique in the treatment of BPH in selected patients, data analysis and description of clinical, functional and safety results.

A retrospective observational analysis of 62 patients who received REZUM treatment between June 2021 and November 2023 for emptying LUTS due to prostatic growth was performed
This therapy was indicated for patients with LUTS secondary to prostate growth with the following characteristics:
The median follow-up was 14 months (6-20). The mean age was 67 years (45-85). All patients underwent a complete medical history, PSA analysis, digital rectal examination, IPSS, flowmetry and preoperative ultrasound. All patients with PSA ≥ 4 or positive digital rectal examination were excluded from treatment as a screening for possible prostate cancer.
The main variables evaluated prior to surgery were: Qmax, IPSS and prostate volume.
29 patients were receiving alpha-blocker treatment and 13 were receiving combined alpha-blocker treatment with a 5-alpha-reductase inhibitor. Additionally, 10 men had a urinary catheter prior to the intervention.

Patients received a mean of 5.3 treatments (2-7) (water vapor injections) during surgery.
No intraoperative complications were described. Postoperative complications were grade I and II of the Clavien-Dindo classification, being the most frequent  adverse event the acute urinary retention after removal of the bladder catheter (n=9) and the presence of macroscopic hematuria at some point during follow-up (n=9). All patients were discharged on the same day of the intervention. The mean post-surgical catheterization time was 9.8 days (7-30).
Baseline patient clinical situation and flowmetric parameters varied as follows:
Initial International Prostate Symptom Score (IPSS): 20 (4-25), mean maximum flow rate (Qmax) prior to surgery: 7.89 ml/s (4-18) and postvoid residual (PVR):100cc (0-180).
These results improved within 3 months after surgery and remained consistenly durable throughout one year with the following data: mean IPSS of 4.8 (0-20),  mean Qmax of 17.46 ml/s (10-39) and a PVR of 30.2cc (0-100). 
Definitive removal of the bladder catheter was achieved in 9 of 10 treated patients. 2 patients (3.22%) required a new surgical intervention due to persistence of obstructive symptoms at 9 and 12 months after the procedure.

The application of REZUM water vapor injection therapy provides an improvement in the clinical and functional results reflected in the literature(3) (IPSS, Qmax). This change is associated with an improvement in the patient's quality of life and allows the abandonment of pharmacological treatment.
The data from our series are consistent with those described and, furthermore, we have verified that it has allowed us to eliminate bladder catheterization in the majority of patients with indwelling catheterization.
In relation to safety, the data from our study also coincide with the published literature.
In our series we were especially strict in the indication of vapor therapy to patients who had not improved with medical treatment, with a prostate volume of no more than 50cc, who wanted to preserve sexual function and/or presented a high surgical risk and/ or anesthetic. It is also expected that with time and accumulated experience we will expand the surgical indication to larger prostates, maintaining the rest of the criteria as reported by Elterman et al in their series of 83 patients treated with REZUM, with prostate volume > 80cc in all cases, also presenting an improvement in clinical and functional parameters.

-Water vapor therapy offers an improvement in all functional parameters at 3, 6 and 12 months of follow-up.
- It also improves the clinical situation of the patients reflected in the IPSS score.
-It is a safe procedure, with a low rate of complications, all of them minor, and with the possibility of being performed as major outpatient surgery.
-There are no randomized studies that compare this technique with the Gold Standard treatment (conventional prostate TUR). These studies are necessary to confirm the good results offered by REZUM therapy in the initial series and to establish treatment recommendations and safety profiles.
- Long-term studies are necessary that allow us to affirm the persistence of improvement over time.

Yalçin S, Tunç L. Indications, techniques, and role of new minimally invasive benign prostate hyperplasia surgical options. Turk J Urol 2020; 46(Supp. 1): S79-S91
Cornu (Chair) J.N., et al. European Association of Urology Guidelines on non-neurogenic male lowe urinary tract symptoms (LUTS), incl.. benign prostatic obstrucion (BPO). In: EAU Guidelines published at the 38th EAU Annual Congress, Milan 2023. Arnhem, The Netherlands.
McVary, K.T., et al. Rezum water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-Year results from randomized controlled study. Urology. 2019, 126: 171-179.