Benign prostatic hyperplasia (BPH) is a common condition in older men, causing problems with urination that can significantly impact quality of life. These urinary issues are often linked to sexual problems, such as erectile dysfunction (ED). In fact, men with more severe urinary symptoms are more likely to experience ED. Treatment for BPH is complicated by the fact that standard medications can worsen sexual dysfunction, and while surgical options like transurethral resection of the prostate (TURP) address urinary problems effectively, they may also result in sexual side effects, including ED.

The Rezum treatment system offers a minimally invasive alternative by using water vapor to treat the prostate without major surgery. While it has shown promise in smaller studies, long-term data on its effects, especially on sexual function, are limited. Therefore, a new study aimed to provide a real-world look at the sexual function outcomes of Rezum over four years, specifically comparing men with and without ED before the procedure, in a diverse group of patients.

This study included patients who underwent Rezum treatment by two urologists for prostate issues between 2017 and 2019. Patients were included in the study if they had follow-up data for up to four years.

Before the procedure, all patients received antibiotics, and some temporarily stopped blood-thinning medications to reduce bleeding risks. Heated water vapor was then injected into the prostate to reduce its size during the treatment. Afterward, patients were sent home with a catheter and pain medications.

The authors of the study compared changes in the men’s sexual function using the International Index of Erectile Function (IIEF), which measures aspects like erectile and orgasmic function, sexual desire, satisfaction, and overall well-being. The data collected also included prostate size, urinary flow rates, and symptom severity scores. Various statistical methods were used to analyze the differences between men with and without ED, and results were compared over time to assess the effectiveness of the treatment.

A total of 91 patients underwent Rezum treatment and met the inclusion criteria for this study. Of those included, 51 (56%) were in the non-ED group, while 40 (44%) were in the ED group. The average age of the participants was 62, with most patients being Hispanic, Non-Hispanic Black, or Asian. Prostate size was similar between groups, but patients with ED were more likely to have diabetes and use ED medications.

At the start, patients without ED had better scores in sexual function measures compared to those with ED. By 12 months, the ED group saw a decline in orgasmic function, sexual desire, and overall satisfaction, but by 48 months, improvements in erectile function, sexual desire, and intercourse and overall satisfaction were noted, with most ED patients reporting no ED.

In the group without ED, the only noticeable change was a small improvement in erectile function after 12 months. All other aspects of sexual function stayed about the same when compared to the starting point, even at the 12-month and 48-month check-ups.

Overall, both groups experienced reduced use of alpha-blockers and 5-AR inhibitors after treatment. Anesthesia preferences and procedural details were also noted, with a higher percentage of patients without ED opting for general anesthesia.

This study was the first to examine long-term sexual function outcomes after Rezum treatment for BPH over 48 months, with a focus on how pre-existing ED affects results. It builds on earlier research that only looked at outcomes up to 12 months. The researchers found that patients without baseline ED generally maintained their sexual function over the long term, and those with baseline ED initially saw a temporary drop in sexual function but showed significant improvement after 48 months.

The research also compared Rezum with other treatments for BPH, like TURP, which traditionally has higher risks of sexual side effects. Rezum appears to preserve sexual function better than TURP and some other minimally invasive treatments, making it a favorable option for patients concerned about sexual health. However, the study’s limitations include its small sample size and retrospective design, which may affect the reliability of the results. As such, more research is needed to better understand Rezum’s impact compared to other treatments and to provide clearer guidance for patients.

References:

• Hawks-Ladds, N., Cook, R., Babar, M., Zhu, M., Schulz, A., Loloi, J., Masoud, Z., Singh, J., Jamil, H., Sayed, R., Ines, M., & Ciatto, M. (2024). Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction. The Journal of Sexual Medicine, 21(9), 777–786. https://doi.org/10.1093/jsxmed/qdae087