Italian live Delphi consensus on indications,peri-procedural management,technique,and learning curve of convective water vapor thermal therapy (Rezum™) in men with LUTS/BPH

Abstract

Introduction:

Convective water vapor thermal therapy (WVTT, Rezum™) is an established minimally invasive surgical technique for men with LUTS secondary to benign prostatic hyperplasia (BPH). Despite increasing adoption, patient selection, peri-procedural management, technical execution, and training remain heterogeneous. We conducted a live modified Delphi consensus to define pragmatic, expert-driven recommendations for WVTT practice in Italy.

Materials and methods:

A 10-member steering committee screened the literature and drafted candidate statements across eight predefined domains. A live modified Delphi process was conducted with 22 Italian urologists. Panelists voted using a four-level response scale; justifications were required for any response other than full agreement. Statements below the predefined consensus threshold were discussed, reformulated when appropriate, and re-voted. Consensus was defined a priori as ⩾75% full agreement.

Results:

Twenty-six statements were voted. Consensus was achieved for 21/26 (80.8%) statements. Five statements did not reach consensus: routine preoperative cystoscopy (72.8%), routine semen culture (31.8%), restricting general anesthesia to selected cases/early learning curve (50.0%), continuation of antibiotics for the entire catheterization period (68.2%), and mandatory “complete” follow-up at 6 months (72.7%). Two items underwent iterative reformulation and re-voting: prostate volume ⩽ 80 cm³ (77.3% → 100%) and supervision during the initial learning curve (31.8% → 61.9% → 90.5%).

Conclusions:

This live Delphi consensus provides practice-oriented guidance for WVTT and defines areas of strong expert agreement alongside persistent evidence gaps. The findings support standardized adoption of WVTT within defined indications while prioritizing future research on peri-procedural protocols and follow-up pathways.

Keywords

water vapor thermotherapy BPH LUTS Delphi consensus agreement

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