良性攝護腺肥大（BPH）導致的下泌尿道症狀（LUTS）會嚴重影響生活品質。水蒸氣熱治療（CWVTT；Rezum）是一種微創手術方式，適用於攝護腺體積介於 30 cc 到 80 cc 的男性，已證實能有效改善症狀，且新發生的性功能障礙機率極低。但目前不同攝護腺體積患者接受此治療後的效果仍未被完整描述。本研究旨在釐清攝護腺體積與CWVTT治療成效間的關係。

本研究納入第三級醫學中心接受CWVTT治療的患者，根據攝護腺體積分為三組：

• 小型組：≤38.5 cc（n=56）
• 中型組：38.5–55.6 cc（n=54）
• 大型組：>55.6 cc（n=61）
• 主要觀察指標：國際攝護腺症狀評分（IPSS）變化
• 次要指標：達到臨床顯著改善（IPSS下降25%）所需時間

結果顯示，三組病患皆在術後3個月達到顯著改善，小型組IPSS平均改善值減少 7.51 分；中型組IPSS平均改善值減少 10.12分；大型組IPSS平均改善值減少 11.72分，組別P值皆 < 0.001。於多變相分析中，糖尿病患者在術後3個月的IPSS平均值高出 3.67 分（95% CI: 0.23–7.11；P=0.037），代表症狀較不易改善。至於在達到25%改善的中位時間方面，小型組為16.1 個月；中型組為12.3 個月；大型組為13.8 個月。於多變相分析中，中型組達到25%改善的速度明顯快於小型組P=0.011。

Rezūm 對於不同體積的攝護腺皆為一項安全、有效且具微創特性的治療選擇。無論攝護腺大小，病人皆能從治療中受益，但中至大型攝護腺病人可能在症狀改善速度與幅度上更具優勢。這顯示 Rezūm為不同攝護腺體積患者治療 LUTS/BPH 的有效選擇。

Purpose: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) affect quality of life. Convective water vapor thermal therapy(CWVTT; Rezum) is a minimally invasive surgical treatment for LUTS/BPH which produces significant improvement of LUTS in men with prostates between 30 cc and 80 cc with minimal de novo sexual dysfunction. However, outcomes across the prostate volume (PV) spectrum are incompletely described. We aim to elucidate the relationship between PV and outcomes post CWVTT in men with LUTS/BPH.

Materials and Methods: Patients undergoing CWVTT at a tertiary care center were included. The primary outcome was change in International Prostate Symptom Score (IPSS) pre CWVTT compared with post CWVTT between PV tertilesd-small ( 38.5 cc), medium (38.5 to 55.6 cc), and large (>55.6 cc). Secondary outcome was time to a minimally clinically important difference of 25% decrease in IPSS.

Results: One hundred seventy-one patients were divided into small (n=56),medium (n=54), and large (n=61) PV tertiles. The change in IPSS preoperatively to 3 months was significant for all tertiles with mean difference of -7.51 ( -10.14 to -4.83), -10.12 ( -12.71 to -7.53), and -11.72 ( -14.14 to -9.29) for small, medium, and large PVs, respectively (P[ <.001). In multivariable analysis, having diabetes was associated with increased IPSS after 3 months with average increase (95% CI) of 3.67 (0.23-7.11, P=.037) compared with not having diabetes. The median time (Q1, Q3) to 25% in IPSS for small, medium, and large PVs was 16.1 (12.1, 17.5), 12.3 (7.1, 15.7), and 13.8 (10.8, 16.3) months, respectively. In multivariable analysis, medium PV had significantly increased incidence of 25% decrease compared with small PV (HR [95% CI]: 2.10[1.19-3.72], P=.011).

Conclusions: CWVTT results in significant and durable LUTS improvement across the PV spectrum. All PVs experience the same improvement in LUTS post CWVTT. However, medium and large glands may improve more quickly than small glands.