Comparative analysis of functional and economic outcomes of prostatic urethral lift and water vapor thermal therapy for male LUTS: A French perspective.

Introduction: Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are common in aging men, significantly impacting quality of life and healthcare costs. While transurethral resection of the prostate (TURP) remains the traditional standard for treatment, minimally invasive surgical therapies (MISTs) like Rezum™ (water vapor thermal therapy, WVTT) and Urolift™ (prostatic urethral lift, PUL) have emerged as effective alternatives. Both methods promise symptom relief with minimal invasiveness, yet a comparative medico-economic analysis is lacking.

Methods: This study retrospectively analyzed 60 patients with BPH-related LUTS who underwent either WVTT or PUL. Patient data were collected on urinary function (IPSS, IPSS-QoL, Qmax, PVR) and postoperative outcomes. A cost analysis, conducted from an institutional perspective, included expenses related to surgery, anesthesia, and hospital stay. All costs were reported in Euros (€) using Diagnosis-Related Groups (Groupe Homogène de Séjours [GHS]/Groupe Homogène de Malades [GHM]).

Results: Our study included 60 patients (30 in the WVTT group and 30 in the PUL group). Median age was 65 years (WVTT: 61 years [IQR 54-69]; PUL: 67 years [IQR 59-72], P=0.09) and median prostate volume was 47 cc (WVTT: 41 cc [IQR 35-51]; PUL: 52 cc [IQR 42-60], P=0.07). At the 3-month follow-up, the median IPSS scores decreased significantly in both groups, with no significant difference in symptom improvement between them (WVTT: from 21.5 [IQR 20.25-25] to 4 [IQR 2-8]; PUL: from 19 [IQR 18-22] to 3 [IQR 1-5]; P=0.74). Ejaculatory function was similarly maintained in both groups, with 88% of WVTT patients and 92% of PUL patients preserving antegrade ejaculation (P=0.21). Minor complications were common in both groups (WVTT: 67%, PUL: 60%; P=0.12), primarily involving hematuria (56.6%) and mild pain (11.6%). Median procedural costs differed, with PUL costing €975 (IQR 950-985), which included implant expenses (€325 per implant, with an average of three implants per procedure). WVTT had a higher median procedural cost of €1147 (IQR 1134-1164). WVTT yielded a higher median financial margin than PUL (€1614.51 [IQR 1584-1636] vs. €372.08 [IQR 332-420]; P=0.01).

Conclusion: WVTT and PUL are effective, cost-efficient outpatient treatments for BPH, with WVTT providing a higher financial return despite initial equipment costs.