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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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References

Kaplan

Malde

Cornu

, et al. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis 2024; 27(2): 172–253. https://doi.org/10.1038/s41391-023-00773-0

Sandhu

Bixler

Dahm

, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 2024; 211(1): 11–19. https://doi.org/10.1097/JU.0000000000003698

Malde

Umbach

Wheeler

, et al. A systematic review of patients’ values, preferences, and expectations for the diagnosis and treatment of male lower urinary tract symptoms. Eur Urol 2021; 79(6): 796–809. https://doi.org/10.1016/j.eururo.2020.12.019

McVary

Gittelman

Goldberg

, et al. Final 5-year outcomes of the multicenter randomized Sham-controlled trial of a water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2021; 206(3): 715–724. https://doi.org/10.1097/JU.0000000000001778

Khadhouri

Turnbull

Drummond

, et al. One-year outcomes of a UK center delivering minimally invasive surgery for bladder outflow obstruction using local anesthetic without sedation in the office setting. J Endourol 2025; 39(11): 1189–1194.

Alcina

Arjona

Guzmán

, et al. Expert consensus on Rezūm™: indications, surgical technique and postoperative care. BJUI Compass 2025; 6(2): e491. https://doi.org/10.1002/bco2.491

Elterman

Bhojani

Vannabouathong

, et al. Rezūm therapy for ⩾80-mL benign prostatic enlargement: a large, multicentre cohort study. BJU Int 2022; 130(4): 522–527. https://doi.org/10.1111/bju.15753

Woo

Levin

Cantrill

, et al. Prospective trial of water vapor thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia in subjects with a large prostate: 6- and 12-month outcomes. Eur Urol Open Sci 2023; 58: 64–72. https://doi.org/10.1016/j.euros.2023.10.006

Campobasso

Siena

Chiodini

, et al. Composite urinary and sexual outcomes after rezum: an analysis of predictive factors from an Italian multi-centric study. Prostate Cancer Prostatic Dis 2023; 26(2): 410–414. https://doi.org/10.1038/s41391-022-00587-6

10.

Cindolo

Campobasso

Conti

, et al. Do patients treated with water vapor therapy and meeting randomized clinical trial criteria have better urinary and sexual outcomes than an unselected cohort? J Endourol 2023; 37(3): 323–329. https://doi.org/10.1089/end.2022.0637

11.

Kang

Jung

Hwang

, et al. Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2020; 3(3): CD013251. https://doi.org/10.1002/14651858.CD013251.pub2

12.

Lightner

Wymer

Sanchez

, et al. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 2020; 203(2): 351–356. https://doi.org/10.1097/JU.00000000000005092019.

13.

Lambertini

Sandulli

Coco

, et al. Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature. Prostate Cancer Prostatic Dis 2025; 28(3): 639–651.

14.

Williams

Webb

The Delphi technique: a methodological discussion. J Adv Nurs 1994; 19(1): 180–186. https://doi.org/10.1111/j.1365-2648.1994.tb01066.x

15.

Zeng

Zhao

Mazzon

, et al. European association of urology section of urolithiasis and International Alliance of Urolithiasis Joint Consensus on retrograde intrarenal surgery for the management of renal stones. Eur Urol Focus 2022; 8(5): 1461–1468. https://doi.org/10.1016/j.euf.2021.10.011

16.

Coscarella

Secco

Elterman

, et al. Management of NOACs in patients undergoing water vapour thermal therapy (REZUM) for benign prostatic obstruction: a comprehensive review. World J Urol 2025; 44(1): 52. https://doi.org/10.1007/s00345-025-06139-6

17.

Siena

Sessa

Cindolo

Use of a Schelin catheter for analgesia during rezum treatment of the prostate. Prostate Cancer Prostatic Dis 2024; 27(1): 147–149. https://doi.org/10.1038/s41391-023-00644-8

18.

Siena

Cindolo

Ferrari

, et al. Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study. World J Urol 2021; 39(10): 3875–3880. https://doi.org/10.1007/s00345-021-03642-4

19.

Wolters

Krastel

Winkler

, et al. Real-world experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study. Prostate Cancer Prostatic Dis 2025; 28(1): 160–166. https://doi.org/10.1038/s41391-024-00836-w

20.

Secco

Cindolo

Do we need referral centers for benign prostatic hyperplasia that offer expertise in more options? Yes, with a SMART (Specialized Medical Assessment for Right Treatment) approach. Eur Urol Focus 2025; 11(4): 543–544. https://doi.org/10.1016/j.euf.2025.03.012

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:

Materials and methods:

Results:

Conclusions:

Keywords

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References