Minimal approach to WVTT linked to favorable post-operative outcomes

A minimal approach to water vapor thermal therapy (WVTT) involving 1 treatment per prostate lobe was associated with decreased post-operative complications in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), according to study findings published in Urology.¹

The re-treatment rate at 2 years was comparable between both arms.

The study also found that International Prostate Symptom Score (IPSS), maximum flow rate, and surgical retreatment rates were comparable when comparing the minimal approach (1 per lobe) to a non-minimal approach (2 or more per lobe).

“We present the largest multi-institutional study to evaluate the impact of minimal WVTT, defined as a single injection per lobe, on postoperative outcomes among men with LUTS from BPH,” the authors wrote. “We demonstrated that this minimal approach, regardless of prostate size, resulted in equivalent measures, both subjectively via IPSS and objectively via uroflowmetry, lasting through 12 months postoperatively when compared to patients who received multiple injections per lobe.”

In total, the study included 146 patients with BPH-related LUTS, with 73 patients in each study arm. Baseline demographics and pre-operative medication use were not significantly different between both cohorts. IPSS, quality of life sub-scores, voiding sub-scores, and storage sub-scores were also comparable at baseline.

Treatment of the median lobe was more common among patients in the non-minimal cohort. In total, 62% of patients in the non-minimal arm had their median lobe treated compared with 42% of patients in the minimal arm (P = .020). The average number of treatments was 2.3 + 0.5 in the minimal arm vs 5.0 + 1.3 in the non-minimal arm (P < .001).

The percentage of patients experiencing an adverse event (AE) following the procedure was numerically lower in the minimal cohort, though this difference did not achieve statistical significance. Specifically, 19% of patients in the minimal arm experienced an AE vs 38% of patients in the non-minimal arm (P = .10).

At 2 years, 3% of patients in the minimal cohort vs 1% of patients in the non-minimal cohort were re-treated (P = .444).

Urinary tract infection was reported in 1% of patients in the minimal cohort vs 12% of patients in the non-minimal cohort (P = .009). Similarly, urinary retention was reported in 4% of patients in the minimal cohort vs 21% of patients in the non-minimal cohort (P = .003). Both post-operative catheter duration and persistence storage phase symptoms beyond 30 days were comparable between the 2 cohorts (P = .602 and P = .360, respectively).

The risk of postoperative storage phase symptoms increased with a greater number of total WVTT treatments (P = .039) and treatment of the median lobe (P = .008). An increasing number of total WVTT treatments was also a significant risk factor for postoperative urinary retention (P = .005).

Average patient-reported IPSS, Qmax, and voided volumes were both similar between the cohorts at 1, 3, 6, and 12-month follow-up. Patients in the minimal cohort had significantly reduced post-void residual at follow-up within 90 to 180 days (P = .048) and follow-up after 180 days (P = .026) compared with that of the non-minimal cohort.

Based on these data, the authors suggest that further research is warranted.

“Minimal WVTT with a single injection per lobe, including median lobe if present, is a safe and effective option for patients undergoing surgical treatment for BPH,” they wrote. “Further studies are needed to investigate the effect of this minimal approach on longer-term outcomes.”

REFERENCE

1. Nguyen V, Cerrato C, Nguyen MV, et al. Minimal approach to water vapor thermal therapy for benign prostatic hyperplasia: Is less more? Urology. 2025:S0090-4295(25)00297-3. doi:10.1016/j.urology.2025.03.040