Sexual function outcomes of the 5-year treatment with Rezum compared to doxazosin, finasteride, and combination drug therapy for men with benign prostatic hyperplasia: cohort data from the Medical Therapy of Prostatic Symptoms Trial

BACKGROUND: Alpha-blockers and 5-α- reductase inhibitors are a mainstay of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia treatment; however, there can be associated sexual function deterioration with these agents.

AIM: We compared sexual function over 5 years after continuous daily treatment with pharmaceutical agents in the NIH-Medical Therapy of Prostatic Symptoms (MTOPS) study versus a single water vapor thermal therapy (WVTT) procedure (Rezum RCT) in subjects with matched criteria for LUTS severity and prostate size.

METHODS: We used baseline sexual function data from cohorts of the MTOPS study (n = 1157) randomized to doxazosin, finasteride, combination therapy, and placebo, and sexually active men at baseline (n = 86) who received WVTT. MTOPS participants completed the Brief Male Sexual Function Inventory, while Rezum RCT participants completed the International Index of Erectile Function-15 and Male Sexual Health Questionnaire.

OUTCOMES: Average percentage changes from baseline were developed using a linear mixed repeated measures model with fixed effects for treatment and follow-up visits.

RESULTS: Men experienced significant worsening of sexual desire, erectile and ejaculatory function, and overall sexual satisfaction with finasteride and combination drug therapy. Men on doxazosin similarly had a significant decline in sexual desire, erectile, and ejaculatory function, but overall sexual satisfaction was preserved. WVTT patients experienced a significant increase in sexual desire and erectile function at 1-year follow-up and a significant increase in overall sexual satisfaction over 5 years. There was a significant decrease in ejaculatory function of approximately -10% (vs. -20% combination therapy) from baseline levels from 3 to 5 years of follow-up with WVTT.

CLINICAL IMPLICATIONS: WVTT is an established office-based minimally invasive surgical therapy that offers sustained improvements in LUTS with minimal to no sexual side effects when compared to pharmacologic therapies, which all demonstrated significant negative impacts on sexual function.

STRENGTH AND LIMITATIONS: This study represents a novel comparison of data between two large landmark randomized controlled trials with robust clinical follow-up and little attrition. A limitation of the study is the utilization of two differing validated sexual function inventories that were utilized within each trial.

CONCLUSION: WVTT may offer more favorable outcomes for sexual function compared to pharmacologic treatments, which are consistently associated with declines across multiple domains.