Long-Term Water Vapor Thermal Therapy Outcomes Across a Broad Range of Prostate Volumes.

INTRODUCTION: Water vapor thermal therapy (WVTT) is a minimally invasive therapy designed to treat lower urinary tract symptoms associated with benign prostatic hyperplasia. Long-term outcomes with large (>80 cc) and small (<30 cc) prostate volumes (PVs) remain limited. We report 48-month outcomes for a multiethnic cohort of WVTT-treated men, stratified by PV. METHODS: In this single-center retrospective study, patients were stratified by PV: < 30 cc, 30 to 80 cc, or > 80 cc. Outcome measures, including International Prostate Symptom Score, quality of life, International Index of Erectile Function, medication usage, and adverse events, were analyzed at baseline and at 1-, 3-, 6-, 12-, 24-, 36-, and/or 48-month follow-up. RESULTS: Two hundred fifty-two patients met inclusion; 35 (13.9%) had PVs < 30 cc, 196 (77.8%) had PVs 30 to 80 cc, and 21 (8.3%) had PVs > 80 cc. Most patients were Asian (33.7%) or non-Hispanic Black (29.4%). International Prostate Symptom Score and quality of life improved in all cohorts from baseline at all follow-ups (all P < .05), with no differences between cohorts. International Index of Erectile Function-Orgasmic Function and -Erectile Function domains improved in 30 to 80 cc patients at 48 months. Alpha blocker and/or 5-alpha reductase inhibitor usage decreased at all follow-ups in < 30 cc and 30 to 80 cc patients and remained durable to only 6 months for > 80 cc patients. No significant differences in adverse events or reoperation rates were observed between cohorts. CONCLUSIONS: Our study suggests WVTT to be efficacious, durable, and safe in managing lower urinary tract symptoms across PVs, although PV > 80 cc patients may require benign prostatic hyperplasia medication at long-term follow-up. Further research is desired to clarify WVTT's role regarding sexual function and in treating men with larger PVs.

Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men.

BACKGROUND: Management of urinary symptoms in elderly patients with benign prostatic hyperplasia (BPH) is complex given challenges with medications and invasive surgeries. Rezum, a minimally invasive water vapor therapy, is an emerging alternative. We compare real-world Rezum outcomes between young and elderly patients over 4 years. METHODS: We retrospectively analyzed a multiethnic population treated with Rezum at a single center between 2017-2019. Patients were stratified into young (<65 years) or elderly (≥65 years) cohorts. International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), decisional regret scores, and adverse events (AEs) were assessed at baseline, 1-, 3-, 6-, 12-, and/or 48-months. Descriptive statistics were compared using t-tests, Chi-squared, or Mann-Whitney U tests. Changes in outcomes were assessed using Wilcoxon signed-rank tests, stratified by age. RESULTS: 256 patients - 146 (57%) young and 110 (43%) elderly - were included. The majority were Asian (33.2%) or non-Hispanic Black (28.9%). Significant improvements were observed in the combined cohort at 4-years in IPSS, QoL, and Qmax when compared to baseline (all p < 0.05). Between the age cohorts, there were no significant differences in IPSS, QoL, or Qmax at any follow-up. Within both cohorts, significant improvements in IPSS and QoL were found from baseline to all follow-ups. In the young cohort, Qmax was significantly improved from baseline to all follow-ups while in the elderly cohort, this was observed only at the 3-month follow-up. No significant differences in AEs or regret was found between cohorts. There was no significant difference in 4-year surgical retreatment rates between cohorts (elderly 4.0% vs young 4.4%, p = 0.86). CONCLUSIONS: There were no significant differences in IPSS, QoL, or AEs between elderly and younger men over 4 years following Rezum, suggesting comparable benefits and risks. Future research is warranted to clarify the impact of Rezum on Qmax in elderly men.

Factors Influencing Medical Students' Pursuit of Urology: Results From the AUA Census (2019-2021).

INTRODUCTION: Growing interest in urology among medical students highlights the need to understand factors influencing their specialty choice in today's context. We also investigate COVID-19's impact on these factors and any disparities among female and underrepresented in medicine (URiM) students. METHODS: From 2019 to 2021, the AUA Annual Census survey included medical student-focused questions on demographics, career interests, and decision factors. Responses were analyzed. RESULTS: One hundred ninety-two medical students participated. Thirty-six (24%) identified as female and 19 (13%) as URiM. Common reasons students would choose urology included surgical procedures (93%) and "good lifestyle" among surgical careers (85%), with no differences across gender or URiM status. Compared to pre-COVID (2019), during COVID (2020-2021), a greater proportion of students cited cutting-edge technology (90.1% vs 73.1%, P = .008) and surgical procedures (98.6% vs 87.2%, P = .008) as reasons to choose urology. Reasons for not choosing urology included competitiveness (48%) and poor lifestyle (26%). Female and URiM students expressed concern related to the combined "male dominated/gender discrimination/lack of diversity" aspect (female 33% vs male 3%, P < .001; URiM 25% vs non-URiM 7%, P = .04). CONCLUSIONS: The AUA Census survey highlights factors influencing medical students' decisions regarding urology. Interest in procedural and technological aspects grew during COVID. Students expressed concern over the field's competitiveness and poor lifestyle, while also acknowledging that urology offers a favorable lifestyle compared to other surgical careers. Female and URiM students expressed ongoing concerns over the combined aspect of gender discrimination and/or the lack of existing diversity in the field.