Jean-Nicolas Cornu, MD, PhD, discusses VAPEUR results for Rezūm in BPO

Among sexually active men with symptomatic benign prostatic obstruction (BPO), Rezūm water vapor thermal therapy relieved symptoms better at 1 year than combination pharmacotherapy with an alpha-blocker plus a 5-alpha-reductase inhibitor, and sexual function was preserved, according to Jean-Nicolas Cornu, MD, PhD, FEBU, an investigator in the VAPEUR randomized controlled trial.¹

The multicenter, pragmatic trial randomly assigned 151 men to Rezūm (n = 75) or combination pharmacotherapy (n = 76). The co-primary end points were change from baseline to 1 year in International Prostate Symptom Score (IPSS) and in Male Sexual Health Questionnaire (MSHQ) score. IPSS improvement was greater with Rezūm (mean difference, −4.6 points; 97.5% CI, −7.6 to −1.6; P < .001), and so was quality-of-life improvement (P = .01).¹

At 1 year, MSHQ scores were essentially stable with Rezūm (mean change, +1.1 points) and declined with combination pharmacotherapy (mean change, −5.2 points). The direction of the data suggested that sexual function was preserved with Rezūm and worsened with medication. However, superiority was not shown in the prespecified analysis, which used multiple imputation for missing data, Cornu said. He said the result should not be described as definitive proof that Rezūm is superior for sexual function. He also said sexual function was globally preserved in the Rezūm arm and that clinicians can reassure patients on this point without overstating the statistical conclusion.

Treatment-related adverse events were more frequent with Rezūm (40% vs 28%), including serious adverse events (12% vs 1.3%).¹ Cornu said the adverse event profiles differed between the arms.

"This is a question of really looking on the entire treatment trajectory rather than comparing adverse event percentage in isolation," he said. In the Rezūm arm, events were mostly procedure related and occurred early after the procedure. They included irritative symptoms and infections that were managed with antibiotics in all cases, and more than 90 percent had resolved by 1 year. In the medication arm, adverse events such as sexual dysfunction and fatigue built up over follow-up.

Surgical retreatment was less frequent after Rezūm than with combination pharmacotherapy (1.3% vs 9.2%), although some patients went back on medication after the procedure.² Cornu noted that the trial's follow-up was short term. He described the decision as a choice between 2 treatment trajectories with different tolerability profiles.

The findings support an evidence-based discussion of treatment choice earlier in the care pathway for sexually active men who remain bothered by symptoms despite alpha-blocker therapy, according to Cornu. In the past, many of these patients stayed on medication with minimal improvement until surgery became appropriate, and counseling meant weighing symptom relief against sexual function. He said the VAPEUR data offer an alternative pathway and support shared decision-making about symptom relief, preservation of ejaculation, and avoiding either long-term medication or a procedure.

"The key message is not that everybody should go to Rezūm, is that Rezūm can now be discussed as an evidence-based alternative to escalation to combination pharmacotherapy," Cornu said.

Cornu is a urologist and an investigator in the VAPEUR randomized controlled trial.

References

1. Vincendeau S, Xylinas E, Fourmarier M, et al. Water vapor thermal therapy with Rezūm versus combination pharmacotherapy for male lower urinary tract symptoms due to benign prostatic obstruction: 1-yr results from a prospective, multicenter, pragmatic randomized controlled trial (VAPEUR-RCT). Eur Urol Focus. Published online August 18, 2026. Accessed October 7, 2026. doi:10.1016/j.euf.2026.08.001
2. Clarke H. Rezūm shows greater 1-year BPH symptom relief vs pharmacotherapy. Urology Times. August 21, 2026. Accessed October 7, 2026. https://www.urologytimes.com/view/rez-m-shows-greater-1-year-bph-symptom-relief-vs-pharmacotherapy