Safety, Efficacy, and Short-Term Outcomes of Rezūm Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia Under Local Anesthesia With Intravenous Sedation: A Single-Center Retrospective Study of 129 Patients in the Kurdistan Region of Iraq

Benign prostatic hyperplasia (BPH) is a common condition in aging men and is a major cause of lower urinary tract symptoms (LUTS), including urinary frequency, urgency, nocturia, weak urinary stream, intermittency, hesitancy, and incomplete bladder emptying. Although transurethral resection of the prostate (TURP) has historically been considered the standard surgical treatment, it may be associated with bleeding, retrograde ejaculation, erectile dysfunction, incontinence, and the need for spinal or general anesthesia. Minimally invasive surgical therapies such as Rezūm water vapor thermal therapy (WVTT) have emerged as alternatives for selected patients.

This retrospective observational study was conducted at the Department of Urology, Royal Hospital, Sulaymaniyah, Kurdistan Region of Iraq, between September 3, 2025, and March 12, 2026. The study includes 129 consecutive male patients aged 45 years or older with moderate-to-severe LUTS secondary to BPH, including patients with prostate volumes between 30 and 120 grams, those who failed or were intolerant to medical therapy, and selected patients with catheter-dependent urinary retention related to BPH.

All patients underwent preoperative evaluation including medical history, physical examination, digital rectal examination, International Prostate Symptom Score (IPSS), quality of life assessment, International Index of Erectile Function (IIEF), prostate-specific antigen testing, renal function tests, urinalysis, urine culture, uroflowmetry, post-void residual measurement, prostate imaging, and cystoscopic assessment. Selected patients with possible neurogenic bladder dysfunction underwent urodynamic testing when indicated.

All procedures were performed using the Rezūm System under local anesthesia with intravenous sedation. Treatment details, including number and location of injections, were determined according to prostate anatomy and size. Postoperatively, all patients received urethral catheterization for a duration based on prostate size, antibiotic prophylaxis, and alpha-blocker therapy.

Primary outcome measures include changes in IPSS, maximum urinary flow rate (Qmax), post-void residual volume (PVR), quality of life score, erectile function, and prostate volume reduction at follow-up. Secondary outcome measures include intraoperative and postoperative complications, catheter duration, discharge time, urinary retention after catheter removal, urinary tract infection, hematuria, sexual side effects, and need for retreatment or alternative surgical intervention.

The purpose of this study is to assess the safety, feasibility, and short-term effectiveness of Rezūm therapy performed under local anesthesia with intravenous sedation in a real-world clinical setting, including patients with significant comorbidities and larger prostate volumes.

Inclusion criteria

• Male patients aged 45 years or older.
• Moderate-to-severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (IPSS ≥8).
• Maximum urinary flow rate (Qmax) less than 15 mL/s on uroflowmetry.
• Prostate volume 30 to 120 g on transrectal or transabdominal ultrasonography.
• Failure of medical therapy or intolerance to medical therapy.
• Catheter-dependent urinary retention secondary to benign prostatic hyperplasia in patients who were not candidates for or declined conventional surgical intervention.
• Consecutive patients who underwent Rezūm water vapor thermal therapy during the study period.

Exclusion criteria

• Pre-existing erectile dysfunction not attributable to benign prostatic hyperplasia medication side effects.
• Retrograde ejaculation not caused by alpha-blocker therapy.
• Lower urinary tract symptoms attributable to causes other than benign prostatic hyperplasia, including neurogenic bladder or bladder overactivity unrelated to benign prostatic hyperplasia.
• History of previous bladder surgery, prostate surgery, or urethral stricture surgery.
• Presence of vesical calculi.
• Confirmed neurogenic bladder.
• Suspected or confirmed prostate malignancy.