Comparative Analysis of Three-Year Reintervention Rates for Rezum vs. UroLift: A TriNetX Study

Comparative Analysis of Three-Year Reintervention Rates for Rezum vs. UroLift: A TriNetX Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Analysis of Three-Year Reintervention Rates for Rezum vs. UroLift: A TriNetX Study Yu-Cheng Lu, Allen W. Chiu, Chen‑Hsun Ho, Yu-Hsuan Shao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7409529/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Rezum and UroLift are new minimally invasive treatments; however, data comparing their outcomes remain limited. We queried a TriNetX database to evaluate three-year reintervention rates for both procedures. Methods We used the TriNetX US Collaborative Network database and Common Procedural Terminology codes to identify male patients aged 40 years or older who underwent Rezum or UroLift procedures between January 2018 and December 2020. These patients were followed for three years, during which reintervention procedures were analyzed. Propensity-score matching (PSM) and Cox regression model were performed. Results A total of 3,231 patients were included, with 792 undergoing Rezum and 2,439 undergoing UroLift. After PSM, the overall reintervention rates were similar between the two groups (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 0.82–1.73). Among patients aged ≥65, the Rezum group had a lower reintervention rate (HR: 0.60, 95% CI: 0.37–0.97) than the UroLift group. In contrast, among those aged ≥40 to <65, reintervention rates did not differ between Rezum and UroLift (HR: 1.49, 95% CI: 0.87–2.55). Within the Rezum group, patients aged ≥40 to <65 experienced a higher reintervention rate compared with those aged ≥65 (HR: 2.12, 95% CI: 1.15–3.93), whereas no age-related difference was observed in the UroLift group (HR: 0.85, 95% CI: 0.62–1.17). Conclusion In patients aged ≥65, Rezum was associated with a lower reintervention rate over the three-year follow-up period, whereas among those aged ≥40 to <65, both procedures yielded comparable reintervention rates. Rezum UroLift minimally invasive surgical therapy reintervention rate TriNetX database Figures Figure 1 Figure 2 Figure 3 Purpose Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) can be particularly bothersome. In the United States, approximately 30% of men over the age of 50—about eight million individuals—are affected by this condition and require management. 1 Treatment options include medical therapy and surgical intervention. While medical therapy may offer modest improvement over a year, approximately 30% of patients discontinue treatment due to side effects or insufficient symptom relief. 1 , 2 Transurethral resection of the prostate (TURP) remains one of the most common surgical approach and can improve the International Prostate Symptom Score (IPSS) by 14.8 points within a year. However, TURP is also associated with complications, including ejaculatory dysfunction (65%), urinary incontinence (3%), and urethral strictures (7%). 3, 4 Several minimally invasive surgical techniques have been introduced in recent decades to treat BPH. Among these, the Rezum system and UroLift are two of the most widely adopted. The Rezum system, approved by the U.S. Food and Drug Administration (FDA) in 2015, uses water vapor-based thermal energy to treat an enlarged prostate. During the procedure, water vapor is injected through cellular interstices, delivering 540 cal/mL of energy to tissue cell membranes within the treatment area, leading to cell death and tissue necrosis. 5 , 6 The delivery of water vapor thermal energy confines the treatment effect to a targeted area within the prostate’s zonal anatomy. 7 Previous studies have reported large areas of necrosis within the prostate adenoma following water vapor injections. 8 UroLift, approved by U.S. FDA in 2013, is a prostatic urethral lift procedure that rapidly alleviates obstructive symptoms without resecting prostatic tissue. 9 Permanent implants are placed to retract the obstructing lateral lobes, thereby expanding the urethral lumen. 10 Previous studies have shown that UroLift provides both rapid and sustained improvement in symptoms. 9 Both Rezum and UroLift are relatively new minimally invasive treatments that typically require only local anesthesia or mild sedation. They are designed to preserve sexual function without risking retrograde ejaculation, making them particularly beneficial for older patients at higher anesthesia risk or for younger men wishing to maintain an active sexual life. However, data comparing re-intervention outcomes remain limited, and most available evidence comes from single-center studies with small sample sizes. 11 Additionally, an increasing number of men are undergoing prostate-related surgery, yet the impact of age on surgical outcomes for Rezum and UroLift remains unclear. Therefore, the aim of this study was to evaluate reintervention rates for both procedures using the TriNetX database. Methods Data Sources The TriNetX, LLC database, established in 2013, includes data from over 190 healthcare organizations across approximately 30 countries. By leveraging real-world data, TriNetX enhances trial design efficiency and generates robust evidence to address global health challenges. The database provides comprehensive information on patient demographics, diagnoses, medication records, surgical procedures, and laboratory test results, all coded using standardized systems. The TriNetX platform adheres to the US Health Insurance Portability and Accountability Act and the General Data Protection Regulation. To date, thousands of peer-reviewed publications have utilized TriNetX data. In addition, use of TriNetX in this study was approved by the Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R). All data collected from the TriNetX US Collaborative Network were current as of February 2025. In the TriNetX database, human ethics approval and consent-to-participate declarations are not applicable. Study design and cohorts We performed a retrospective, observational cohort study using the TriNetX US Collaborative Network database. Figure 1 . shows the study flow chart. Using International Classification of Diseases 10th (ICD-10) and current procedural terminology (CPT) codes, we identified men aged 40 years or older who underwent either Rezum (53854) or UroLift (52441, 52442) from January 2018 through December 2020. Patients were excluded if they had a history of prostate cancer or had previously undergone prostate-related surgery—such as UroLift, Rezum, TURP (52601), photoselective vaporization of the prostate (PVP) (52648), holmium laser enucleation of the prostate (HoLEP) (52649), transurethral needle ablation (TUNA) (53852), transurethral microwave thermotherapy (TUMT) (53850), transurethral incision of the prostate (TUIP) (52450), or waterjet ablation (0421T). In addition, patients who died during the three-year follow-up period were excluded. A total of 3,231 patients met the inclusion criteria, comprising 792 in the Rezum group (Cohort 1) and 2,439 in the UroLift group (Cohort 2). All patients were followed for three years, during which reintervention procedures were analyzed. Age, serum prostate-specific antigen (PSA) levels, and body mass index (BMI) were collected for the study population. For subgroup analysis, patients were categorized into two age groups: ≥40 to < 65 years and ≥ 65 years older. One-to-one propensity score matching (PSM) was used to minimize potential confounding factors and avoid misleading conclusions. Age, BMI and serum PSA levels, which strongly influence outcomes, were matched to ensure no significant baseline differences between the comparison groups. This statistical approach allows for a more robust comparison of the two cohorts. Study outcomes The study outcome was the occurrence of any reintervention procedure during the 3-year follow-up. We used CPT codes to identify any reintervention procedures performed after the initial treatment. These reinterventions included UroLift, Rezum, TURP, PVP, HoLEP, TUNA, TUMT, TUIP, and waterjet ablation. Statistical analysis Continuous variables were reported as means ± standard deviation (SD). Nearest-neighbor matching was performed using the built-in TriNetX function to minimize confounding effects on baseline characteristics. During the follow-up period, Cox proportional hazards regression and Kaplan–Meier survival analyses were conducted on the TriNetX platform. The Cox model generated hazard ratio (HR) with corresponding 95% confidence interval (CI) for each outcome. In the Kaplan–Meier analysis, differences in event-free survival between groups were evaluated using a log-rank test. A two-sided P-value < 0.05 was considered statistically significant. All figures in this manuscript were created using R software (version 4.3.0, Free Software Foundation Inc.). Results A total of 3,231 patients were included in the analysis, with 792 undergoing Rezum (Cohort 1) and 2,439 undergoing UroLift (Cohort 2). Baseline characteristics are presented in Supplementary Table 1 . Comparing to patients in Cohort 2, patients in Cohort 1 were older (68.2 ± 8.1 vs. 66.3 ± 8.8 years, p < 0.001) and had lower BMI (28.4 ± 4.7 vs. 29.1 ± 5.3, p < 0.001), whereas serum PSA levels did not differ significantly between the two groups (2.5 ± 2.8 vs. 2.2 ± 5.5, p = 0.188). After one-to-one PSM, each cohort consisted of 784 patients. As shown in Supplementary Fig. 1 and Table 2 a, there was no significant difference in the three-year reintervention rate between the two groups, both before (Log-rank test, p = 0.751) and after (HR: 1.19, 95% CI: 0.82–1.73; Log-rank test, p = 0.355) PSM. Table 2 Hazard Ratios for Clinical Outcome After Matching: (2a) Comparison of Rezum vs. UroLift in the Overall Cohort and by Age Group (2b) Age-Stratified Comparison in the Rezum and UroLift Cohorts 2a. Comparative Analysis of Clinical Outcome: Rezum vs. UroLift Number Event (Rezum/UroLift) HR (95% CI) P-value All Cohort 784 57/53 1.19 (0.82–1.73) 0.355 Aged ≥ 65 530 26/46 0.60 (0.37–0.97) 0.037 Aged ≥ 40 to < 65 260 31/23 1.49 (0.87–2.55) 0.147 2b. Age-Stratified Comparative Analysis of Clinical Outcome : Aged ≥ 40 to < 65 vs. ≥65 Number Event (Aged ≥ 40 to < 65/ Aged ≥ 65) HR (95% CI) P-value Rezum 260 31/15 2.12 (1.15–3.93) 0.014 UroLift 975 71/83 0.85 (0.62–1.17) 0.325 HR: Hazard ratio, CI: Confidence interval. Supplementary Table 1. Comparison of Baseline Demographic Characteristics in Rezum and UroLift Cohorts Before and After Matching Patients were stratified into two age groups (≥ 40 to < 65 years and ≥ 65 years). Among patients aged ≥ 65 years, there were 532 in Cohort 1 and 1,464 in Cohort 2 before matching. As shown in Table 1 , patients in Cohort 1 were older (72.7 ± 5.3 vs. 72.1 ± 5.2 years, p = 0.030) and had lower BMI (28.0 ± 4.7 vs. 28.6 ± 4.9, p = 0.035), while serum PSA levels were comparable between groups (2.8 ± 3.2 vs. 2.4 ± 6.9, p = 0.336). After PSM, each cohort included 530 patients. As illustrated in Table 2 a, Supplementary Fig. 2a and Fig. 2 a, among patients aged ≥ 65, the Rezum group demonstrated a significantly lower reintervention rate compared to the UroLift group, both before (Log-rank test, p = 0.015) and after (HR: 0.60, 95% CI: 0.37–0.97; Log-rank test, p = 0.037) PSM. Table 1 Comparison of Baseline Demographic Characteristics Among Patients Aged ≥ 65 and ≥ 40 to < 65 Undergoing Rezum or UroLift Before and After Matching Aged ≥ 65 Before Matching After Matching (Cohort 1) Rezum (Cohort 2) UroLift P-value (Cohort 1) Rezum (Cohort 2) UroLift P-value Number 532 1,464 530 530 Age (year) 72.7 ± 5.3 72.1 ± 5.2 0.030 72.6 ± 5.3 72.6 ± 5.3 0.972 PSA (ng/mL) 2.8 ± 3.2 2.4 ± 6.9 0.336 2.8 ± 3.2 2.4 ± 2.9 0.107 BMI (kg/m 2 ) 28.0 ± 4.7 28.6 ± 4.9 0.035 28.0 ± 4.7 28.4 ± 4.7 0.296 Aged ≥ 40 to < 65 Before Matching After Matching (Cohort 1) Rezum (Cohort 2) UroLift P-value (Cohort 1) Rezum (Cohort 2) UroLift P-value Number 260 975 260 260 Age (year) 59.1 ± 4.2 57.6 ± 5.1 < 0.001 59.1 ± 4.2 59.0 ± 4.2 0.975 PSA (ng/mL) 2.0 ± 1.9 1.8 ± 2.0 0.292 2.0 ± 1.9 1.7 ± 1.5 0.118 BMI (kg/m 2 ) 28.6 ± 4.8 29.8 ± 5.8 0.008 28.6 ± 4.8 29.2 ± 5.3 0.380 Continuous variables were expressed as means ± standard deviation (SD). BMI: Body Mass Index Among those aged ≥ 40 to < 65, there were 260 patients in Cohort 1 and 975 in Cohort 2 before matching. As shown in Table 1 , patients in Cohort 1 were older (59.1 ± 4.2 vs. 57.6 ± 5.1 years, p < 0.001) and had lower BMI (28.6 ± 4.8 vs. 29.8 ± 5.8, p = 0.008), while serum PSA levels were similar between groups (2.0 ± 1.9 vs. 1.8 ± 2.0, p = 0.292). After PSM, each cohort consisted of 260 patients. As illustrated in Supplementary Fig. 2b , among patients aged ≥ 40 to < 65, the Rezum group had a significantly higher reintervention rate than the UroLift group before PSM (Log-rank test, p = 0.004). However, as shown in Table 2 a and Fig. 2 b., after matching, the difference was not statistically significant (HR: 1.49, 95% CI: 0.87–2.55; Log-rank test, p = 0.147). We further examined procedure-specific outcomes by age group. As shown in Supplementary Table 2 , among patients in the Rezum group, those aged ≥ 65 had higher serum PSA levels (2.8 ± 3.2 vs. 2.0 ± 1.9, p = 0.004) but similar BMI (28.0 ± 4.7 vs. 28.6 ± 4.8, p = 0.156) compared to those aged ≥ 40 to < 65. In Supplementary Table 2 , among patients in the UroLift group, those aged ≥ 65 also had higher serum PSA levels (2.4 ± 6.9 vs. 1.8 ± 2.0, p = 0.051) but lower BMI (28.6 ± 4.9 vs. 29.8 ± 5.8, p < 0.001) compared to those aged ≥ 40 to < 65. As shown in Table 2 b, Supplementary Fig. 3a and Fig. 3 a, those aged ≥ 40 to < 65 had a higher reintervention rate than those aged ≥ 65, both before (Log-rank test, p < 0.001) and after (HR: 2.12, 95% CI: 1.15–3.93; Log-rank test, p = 0.014) PSM. In contrast, in the UroLift group (Table 2 b, Supplementary Fig. 3b and Fig. 3 b), no age-related difference was observed within the UroLift group, both before (Log-rank test, p = 0.191) and after (HR: 0.85, 95% CI: 0.62–1.17; Log-rank test, p = 0.325) PSM. Discussion This study confirms that age is an independent factor influencing the effectiveness of Rezum. Our findings indicate that among patients aged ≥ 65 years, Rezum was associated with a lower reintervention rate than UroLift. In contrast, for those aged ≥ 40 to < 65 years, there was no significant difference in reintervention rates by procedure. Overall, the three-year reintervention rates were similar for Rezum (7.2%) and UroLift (8.3%). Notably, in patients aged ≥ 65 years, the reintervention rate was 4.9% with Rezum compared to 8.8% with UroLift, whereas for those aged ≥ 40 to < 65 years, the rates were comparable (11.9% vs. 7.3%). While previous studies have evaluated both Rezum and UroLift, the impact of patient age on their surgical outcomes remains unclear. In a sham-controlled trial of Rezum, the five-year surgical retreatment rate was 4.4% among 135 patients (mean age 63.0 ± 7.1 years). 12 In contrast, the L.I.F.T. study reported a 13.6% surgical retreatment rate at five years for 140 UroLift patients (mean age 67.0 ± 8.6 years). 13 , 9 An indirect comparisons suggest Rezum may yield lower reintervention rates, as reflected in a three-year comparison by Elterman et al. (4.4% vs. 10.7%) and a prospective two-year study (0% vs. 8.1%)—both favoring Rezum over UroLift. 14 , 11 Although most studies have reported lower reintervention rates with Rezum compared to UroLift, our findings indicated comparable rates between the two procedures. Notably, the mean age in our cohort was higher than in previous studies (68.2 ± 8.1 years for the Rezum group and 66.3 ± 8.8 years for the UroLift group). In a cohort of 256 patients receiving Rezum therapy, there was no significant difference in 4-year surgical reintervention rates between those aged ≥ 65 and those < 65 (11.9% vs. 5.1%, p = 0.06). 15 However, the study included heterogeneous prostate volumes (median 49.5 ml for patients ≥ 65 years and 40.0 ml for those < 65 years, p < 0.001) with no additional matching performed. Our study accounted for other factors associated with prostate size and highlighted age as a significant determinant of these findings. In our study, we found that patients aged ≥ 65 years experienced better outcomes following Rezum than those receiving UroLift, whereas no age-related difference was observed in the UroLift group. We hypothesize that this could be attributed to a correlation between prostate tissue density and age. The UroLift device mechanically expands the prostatic urethral lumen, exerting minimal influence on tissue density. In contrast, Rezum uses thermal energy to necrotize prostate tissue, so tissue density could significantly affect the distance of thermal conduction. Unfortunately, there are no published studies specifically examining the relationship between prostate density (prostate weight/volume)—as distinct from PSA density—and age. However, King et al. reported in an animal study that thermal transition temperature increases with age, suggesting older tissue may facilitate more efficient thermal energy transfer. 16 Penne’s bioheat equation also demonstrates an inverse relationship between tissue density and specific heat, 17 and separate thermal conductivity measurements show that increasing tissue density reduces the distance of heat transfer. 18 Meanwhile, Matthew et al. found that aging leads to a decline in muscle quality, including density. 19 In this study, we excluded patients with prostate cancer to reduce the potential confounding effect of malignant tissue on our findings.. These findings suggest that older individuals with potentially lower-density tissue might help to explain the greater benefit from thermal-based interventions like Rezum that we observed in our data. Although TriNetX included a large number of patient records, the primary limitation of our study is the absence of prostate volume data. To minimize confounding in our results, we matched age, PSA, and BMI which are known to be correlated with prostate volume. Prior studies have consistently demonstrated a positive relationship between age and prostate size. 20 , 21 In large-scale studies involving 2,264 individuals with systemic BPH (Mochtar et al. 22 ), 2,270 patients with LUTS and biopsy-proven BPH (Hochberg et al. 23 ), and 4,627 men with BPH (Roehrborn et al. 24 ), serum PSA was consistently shown to be a reliable predictor of prostate volume.In addition to age and PSA, we matched BMI in our study, as multiple investigations—including Ken et al.’s 278-patient analysis 25 , a large Chinese observational study 26 , and Saurabh et al.’s prospective research 27 —consistently reported a positive correlation between BMI and prostate volume in men with BPH. Our findings suggest that patients aged ≥ 65 years demonstrated a lower reintervention rate after undergoing Rezum than Urolift. To the best of our knowledge, this is the first study to assess the associatio between patient age and the effectiveness of Rezum. Nevertheless, this study has several limitations. First, we lacked data on prostate volume despite our efforts to match age, PSA, and BMI as proxies. As a result, we cannot rule out the influence of individual prostate volume on our findings. Second, unlike other research, we did not include subjective measures such as the IPSS or uroflowmetry, preventing us from evaluating functional improvements across different procedures during follow-up. However, our primary outcome— reintervention rates—remained robust. Third, patients in UroLift group are three times larger than those in Rezum before matching. However, this may reflect real-world practice. Fourth, although we utilized TriNetX’s built-in PSM, some significant differences persisted in certain subgroup analyses. This may occur when initial disparities between cohorts are so pronounced that even after matching, the p-value remains below the 0.05 threshold—though higher than in the unmatched analysis and closer to the cutoff value. Conclusion In patients aged 65 or older, the Rezum procedure demonstrated a markedly lower reintervention rate over the three-year follow-up period; however, in those aged ≥ 40 to < 65, both procedures exhibited comparable reintervention rates, suggesting that age may be an influential factor in determining the relative benefits of Rezum. Declarations Funding: No funding Author Contribution YC Lu: Project development, Manuscript writingW Chiu: Manuscript revisedCH Ho: Data CollectionYH Shao: Project development, Manuscript revised Acknowledgement The authors have no conflict of interest and nothing to disclose. This study was approved by the Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R). Registry and the Registration No. of the study/trial: Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R). References CG. R. Current Medical Therapies for Men With Lower Urinary Tract symptoms and Benign Prostatic Hyperplasia Achievements and Limitations. Rev Urol (2008) ;10:14–25 Verhamme KM, Dieleman JP, Bleumink GS, Bosch JL, Stricker BH, Sturkenboom MC (2003) Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project. Eur Urol 44:539–545 Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 50:969–979 discussion 980 Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT et al (2024) Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 211:11–19 Bhowmick P, Coad JE, Bhowmick S, Pryor JL, Larson T, De La Rosette J et al (2004) In vitro assessment of the efficacy of thermal therapy in human benign prostatic hyperplasia. Int J Hyperth 20:421–439 DW. H, MN. Oi. Heat Conduction Fundamentals, in Heat Conduction. 3rd ed. Hoboken, NJ : John Wiley & Sons, Inc . (2012) Fine SW, Reuter VE (2012) Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Histopathology 60:142–152 Dixon CM, Rijo Cedano E, Mynderse LA, Larson TR (2015) Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum((R)) system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol 7:13–18 Roehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE et al (2013) The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol 190:2161–2167 McNicholas TA, Woo HH, Chin PT, Bolton D, Fernandez Arjona M, Sievert KD et al (2013) Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol 64:292–299 Law YXT, Chen WJK, Shen L, Lin K, Ong CSH, Lim QY et al (2024) Convective Water Vapor Energy Ablation (Rezum) Versus Prostatic Urethral Lift (Urolift): A 2-Year Prospective Study. J Endourol 38:1387–1394 McVary KT, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM et al (2021) 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 206:715–724 J. B CGR, SN. G NDS, JL. G DMB et al (2017) Five year results of the prospective randomized controlled prostatic urethral LIFT study. Can J Urol 24:8802–8813 Elterman D, Shepherd S, Saadat SH, Alshak MN, Bhojani N, Zorn KC et al (2021) Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes. Can J Urol 5:10824–10833 Zhu M, Babar M, Hawks-Ladds N, Tawfik MM, Loloi J, Labagnara K et al (2024) Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men. Prostate Cancer Prostatic Dis 27:109–115 NL. K. Thermal Transition of Collagen in Ovine Connective Tissues. Meat Sci (1987) ;20:90048–90049 Aijaz M, Dar JG, Almanjahie IM, Alshahrani F (2023) Temperature distribution in tumour tissue during targeted destruction by heat: A hyperbolic bioheat equation approach. Case Stud Therm Eng 50:103491 Presley MA, Christensen PR (2010) Thermal conductivity measurements of particulate materials: 4. Effect of bulk density for granular particles. J Geophys Research: Planet ;115 Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P et al (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90:1579–1585 V S, K T, JE. D M, D CD (2003) Relationship between age, prostate volume, prostate-specific antigen, symptom score and uroflowmetry in men with lower urinary tract symptoms. Scand J Urol Nephrol 37:322–328 Zhang SJ, Qian HN, Zhao Y, Sun K, Wang HQ, Liang GQ et al (2013) Relationship between age and prostate size. Asian J Androl 15:116–120 Mochtar CA, Kiemeney LA, van Riemsdijk MM, Barnett GS, Laguna MP, Debruyne FM et al (2003) Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol 44:695–700 Hochberg DA, Armenakas NA, Fracchia JA (2000) Relationship of prostate-specific antigen and prostate volume in patients with biopsy proven benign prostatic hyperplasia. Prostate 45:315–319 R CG (1999) Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology 53:581–589 Batai K, Phung M, Bell R, Lwin A, Hynes KA, Price E et al (2021) Correlation between body mass index and prostate volume in benign prostatic hyperplasia patients undergoing holmium enucleation of the prostate surgery. BMC Urol 21:88 Xie LP, Bai Y, Zhang XZ, Zheng XY, Yao KS, Xu L et al (2007) Obesity and benign prostatic enlargement: a large observational study in China. Urology 69:680–684 Negi SK, Desai S, Faujdar G, Jaiswal S, Sahu RD, Vyas N et al (2024) The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia: A prospective cohort study. Urologia 91:512–517 Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7409529","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511096536,"identity":"0bd8a9a0-7f58-4d5c-9505-e042876cfdbd","order_by":0,"name":"Yu-Cheng Lu","email":"","orcid":"","institution":"Shin Kong Wu Ho-Su Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Cheng","middleName":"","lastName":"Lu","suffix":""},{"id":511096538,"identity":"fe4c7901-583b-483d-955c-165c835e6c05","order_by":1,"name":"Allen W. Chiu","email":"","orcid":"","institution":"Shin Kong Wu Ho-Su Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Allen","middleName":"W.","lastName":"Chiu","suffix":""},{"id":511096539,"identity":"cec2f472-0362-4e7e-b732-928a287b7034","order_by":2,"name":"Chen‑Hsun Ho","email":"","orcid":"","institution":"Shin Kong Wu Ho-Su Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chen‑Hsun","middleName":"","lastName":"Ho","suffix":""},{"id":511096540,"identity":"aa792968-1c43-47f8-a773-73fc623e3c7c","order_by":3,"name":"Yu-Hsuan Shao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACxgYGhgMggh/CZyZBi2QbTAsbsVYZHCNWC3N778GDP3fYyRnf706TYKiwTmyQ7zHAb0HPuYTDvGeSjc2O8W6TYDiTntjAxkNAy4wcg8OMbcyJ20BaGNsOA7XwbiCo5eDPtvrEzW0gLf+I1HKAF2j4BjaQlgZitPScMTjM23bcWOJY7maLhGPpxm1s+R/wajFs7zH++LOtWo6/+ezGGx9qrGX7mY8l4NfSgMwDqSUYk/KEFIyCUTAKRsEoYAAAUYFG+ZfH84oAAAAASUVORK5CYII=","orcid":"","institution":"Taipei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yu-Hsuan","middleName":"","lastName":"Shao","suffix":""}],"badges":[],"createdAt":"2025-08-19 14:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7409529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7409529/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90902982,"identity":"678b80e7-10fd-4f20-8d0a-bebb5583d1c8","added_by":"auto","created_at":"2025-09-09 12:46:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55370,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow Diagram of Patient Enrollment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the TriNetX US Collaborative Network Database, we identified patients aged ≥40 years who underwent Rezum or UroLift between January 1, 2018, and December 31, 2020. Of the 3,712 patients initially enrolled, those with a history of prostate-related surgical procedures, a follow-up duration of less than 3 years, or a diagnosis of prostate cancer were excluded. After one-to-one propensity score matching, 784 patients remained in each group.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7409529/v1/a05f588fb210003db17baa10.jpg"},{"id":90904365,"identity":"1f74344d-5541-4b12-ae88-c9b8e2fac1dc","added_by":"auto","created_at":"2025-09-09 12:54:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80712,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan–Meier Curves for Reintervention-Free Survival by Age Subgroups After Matching: (2a) Patients Aged ≥65 Years, (2b) Patients Aged ≥40 to \u0026lt;65 Years\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(2a) Kaplan-Meier curves were used to evaluate three-year reintervention-free survival among patients aged ≥65 years in the Rezum and UroLift groups after propensity score matching. The Rezum group demonstrated a significantly lower reintervention rate (\u003cem\u003ep\u003c/em\u003e= 0.037) compared to the UroLift group. (2b) Kaplan-Meier curves were used to evaluate three-year reintervention-free survival among patients aged ≥40 to \u0026lt;65 years in the Rezum and UroLift groups after propensity score matching. No significant difference was observed between the two groups (\u003cem\u003ep\u003c/em\u003e= 0.147).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7409529/v1/d234909b75d3d9e6de7cbd51.png"},{"id":90904364,"identity":"a6b36a39-cb18-43a8-8492-6a3b7997e05e","added_by":"auto","created_at":"2025-09-09 12:54:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94701,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan–Meier Curves for Procedure-Specific Reintervention-Free Survival by Age Group After Matching: (3a) Age-Stratified Rezum Cohort (3b) Age-Stratified UroLift Cohort.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(3a) Kaplan-Meier curves were used to evaluate three-year reintervention-free survival in the Rezum cohort, stratified by age group, after propensity score matching. Patients aged ≥65 years had a significantly lower reintervention rate (\u003cem\u003ep\u003c/em\u003e= 0.014) compared to those aged ≥40 to \u0026lt;65 years. (3b) Kaplan-Meier curves were used to evaluate three-year reintervention-free survival in the UroLift cohort, stratified by age group, after propensity score matching. No significant difference was observed between the age groups (\u003cem\u003ep\u003c/em\u003e= 0.325).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7409529/v1/83799bc743beb0457957f51b.png"},{"id":91401347,"identity":"f3198735-1ef8-44d7-a1f3-b4126c3ae18b","added_by":"auto","created_at":"2025-09-16 07:02:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1137214,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7409529/v1/9c806ad8-3ad1-4032-9413-3223db67553d.pdf"},{"id":90904366,"identity":"d98139a1-cf06-48c2-98af-ccadc228d677","added_by":"auto","created_at":"2025-09-09 12:54:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":559329,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-7409529/v1/a010cf6b6ae712b53df26b09.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Three-Year Reintervention Rates for Rezum vs. UroLift: A TriNetX Study","fulltext":[{"header":"Purpose","content":"\u003cp\u003eLower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) can be particularly bothersome. In the United States, approximately 30% of men over the age of 50\u0026mdash;about eight million individuals\u0026mdash;are affected by this condition and require management.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Treatment options include medical therapy and surgical intervention. While medical therapy may offer modest improvement over a year, approximately 30% of patients discontinue treatment due to side effects or insufficient symptom relief.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Transurethral resection of the prostate (TURP) remains one of the most common surgical approach and can improve the International Prostate Symptom Score (IPSS) by 14.8 points within a year. However, TURP is also associated with complications, including ejaculatory dysfunction (65%), urinary incontinence (3%), and urethral strictures (7%).\u003csup\u003e3, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSeveral minimally invasive surgical techniques have been introduced in recent decades to treat BPH. Among these, the Rezum system and UroLift are two of the most widely adopted. The Rezum system, approved by the U.S. Food and Drug Administration (FDA) in 2015, uses water vapor-based thermal energy to treat an enlarged prostate. During the procedure, water vapor is injected through cellular interstices, delivering 540 cal/mL of energy to tissue cell membranes within the treatment area, leading to cell death and tissue necrosis.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The delivery of water vapor thermal energy confines the treatment effect to a targeted area within the prostate\u0026rsquo;s zonal anatomy.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Previous studies have reported large areas of necrosis within the prostate adenoma following water vapor injections.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eUroLift, approved by U.S. FDA in 2013, is a prostatic urethral lift procedure that rapidly alleviates obstructive symptoms without resecting prostatic tissue.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Permanent implants are placed to retract the obstructing lateral lobes, thereby expanding the urethral lumen.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Previous studies have shown that UroLift provides both rapid and sustained improvement in symptoms.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Both Rezum and UroLift are relatively new minimally invasive treatments that typically require only local anesthesia or mild sedation. They are designed to preserve sexual function without risking retrograde ejaculation, making them particularly beneficial for older patients at higher anesthesia risk or for younger men wishing to maintain an active sexual life. However, data comparing re-intervention outcomes remain limited, and most available evidence comes from single-center studies with small sample sizes.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Additionally, an increasing number of men are undergoing prostate-related surgery, yet the impact of age on surgical outcomes for Rezum and UroLift remains unclear. Therefore, the aim of this study was to evaluate reintervention rates for both procedures using the TriNetX database.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Sources\u003c/h2\u003e\u003cp\u003eThe TriNetX, LLC database, established in 2013, includes data from over 190 healthcare organizations across approximately 30 countries. By leveraging real-world data, TriNetX enhances trial design efficiency and generates robust evidence to address global health challenges. The database provides comprehensive information on patient demographics, diagnoses, medication records, surgical procedures, and laboratory test results, all coded using standardized systems. The TriNetX platform adheres to the US Health Insurance Portability and Accountability Act and the General Data Protection Regulation. To date, thousands of peer-reviewed publications have utilized TriNetX data. In addition, use of TriNetX in this study was approved by the Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R). All data collected from the TriNetX US Collaborative Network were current as of February 2025. In the TriNetX database, human ethics approval and consent-to-participate declarations are not applicable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and cohorts\u003c/h2\u003e\u003cp\u003eWe performed a retrospective, observational cohort study using the TriNetX US Collaborative Network database. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e. shows the study flow chart. Using International Classification of Diseases 10th (ICD-10) and current procedural terminology (CPT) codes, we identified men aged 40 years or older who underwent either Rezum (53854) or UroLift (52441, 52442) from January 2018 through December 2020. Patients were excluded if they had a history of prostate cancer or had previously undergone prostate-related surgery\u0026mdash;such as UroLift, Rezum, TURP (52601), photoselective vaporization of the prostate (PVP) (52648), holmium laser enucleation of the prostate (HoLEP) (52649), transurethral needle ablation (TUNA) (53852), transurethral microwave thermotherapy (TUMT) (53850), transurethral incision of the prostate (TUIP) (52450), or waterjet ablation (0421T). In addition, patients who died during the three-year follow-up period were excluded. A total of 3,231 patients met the inclusion criteria, comprising 792 in the Rezum group (Cohort 1) and 2,439 in the UroLift group (Cohort 2). All patients were followed for three years, during which reintervention procedures were analyzed. Age, serum prostate-specific antigen (PSA) levels, and body mass index (BMI) were collected for the study population. For subgroup analysis, patients were categorized into two age groups: \u0026ge;40 to \u0026lt;\u0026thinsp;65 years and \u0026ge;\u0026thinsp;65 years older. One-to-one propensity score matching (PSM) was used to minimize potential confounding factors and avoid misleading conclusions. Age, BMI and serum PSA levels, which strongly influence outcomes, were matched to ensure no significant baseline differences between the comparison groups. This statistical approach allows for a more robust comparison of the two cohorts.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy outcomes\u003c/h3\u003e\n\u003cp\u003eThe study outcome was the occurrence of any reintervention procedure during the 3-year follow-up. We used CPT codes to identify any reintervention procedures performed after the initial treatment. These reinterventions included UroLift, Rezum, TURP, PVP, HoLEP, TUNA, TUMT, TUIP, and waterjet ablation.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were reported as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Nearest-neighbor matching was performed using the built-in TriNetX function to minimize confounding effects on baseline characteristics. During the follow-up period, Cox proportional hazards regression and Kaplan\u0026ndash;Meier survival analyses were conducted on the TriNetX platform. The Cox model generated hazard ratio (HR) with corresponding 95% confidence interval (CI) for each outcome. In the Kaplan\u0026ndash;Meier analysis, differences in event-free survival between groups were evaluated using a log-rank test. A two-sided P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All figures in this manuscript were created using R software (version 4.3.0, Free Software Foundation Inc.).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 3,231 patients were included in the analysis, with 792 undergoing Rezum (Cohort 1) and 2,439 undergoing UroLift (Cohort 2). Baseline characteristics are presented in \u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e. Comparing to patients in Cohort 2, patients in Cohort 1 were older (68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 vs. 66.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 years, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and had lower BMI (28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 vs. 29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas serum PSA levels did not differ significantly between the two groups (2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 vs. 2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.188). After one-to-one PSM, each cohort consisted of 784 patients. As shown in \u003cb\u003eSupplementary Fig.\u0026nbsp;1\u003c/b\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, there was no significant difference in the three-year reintervention rate between the two groups, both before (Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.751) and after (HR: 1.19, 95% CI: 0.82\u0026ndash;1.73; Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.355) PSM.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHazard Ratios for Clinical Outcome After Matching: (2a) Comparison of Rezum vs. UroLift in the Overall Cohort and by Age Group (2b) Age-Stratified Comparison in the Rezum and UroLift Cohorts\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e2a. Comparative Analysis of Clinical Outcome: Rezum vs. UroLift\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvent (Rezum/UroLift)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll Cohort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57/53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.19 (0.82\u0026ndash;1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.355\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAged\u0026thinsp;\u0026ge;\u0026thinsp;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26/46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60 (0.37\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31/23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.49 (0.87\u0026ndash;2.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2b. Age-Stratified Comparative Analysis of Clinical Outcome\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cb\u003eAged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 vs. \u0026ge;65\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvent (Aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65/ Aged\u0026thinsp;\u0026ge;\u0026thinsp;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRezum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31/15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12 (1.15\u0026ndash;3.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUroLift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71/83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85 (0.62\u0026ndash;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.325\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eHR: Hazard ratio, CI: Confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eSupplementary Table\u0026nbsp;1. Comparison of Baseline Demographic Characteristics in Rezum and UroLift Cohorts Before and After Matching\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePatients were stratified into two age groups (\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 years and \u0026ge;\u0026thinsp;65 years). Among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, there were 532 in Cohort 1 and 1,464 in Cohort 2 before matching. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, patients in Cohort 1 were older (72.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 vs. 72.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 years, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030) and had lower BMI (28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 vs. 28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), while serum PSA levels were comparable between groups (2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 vs. 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.336). After PSM, each cohort included 530 patients. As illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, \u003cb\u003eSupplementary Fig.\u0026nbsp;2a\u003c/b\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65, the Rezum group demonstrated a significantly lower reintervention rate compared to the UroLift group, both before (Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015) and after (HR: 0.60, 95% CI: 0.37\u0026ndash;0.97; Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037) PSM.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eComparison of Baseline Demographic Characteristics Among Patients Aged\u0026thinsp;\u0026ge;\u0026thinsp;65 and \u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 Undergoing Rezum or UroLift Before and After Matching\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eAged\u0026thinsp;\u0026ge;\u0026thinsp;65\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eBefore Matching\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eAfter Matching\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(Cohort 1) Rezum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(Cohort 2)\u003c/p\u003e\u003cp\u003eUroLift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(Cohort 1) Rezum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(Cohort 2)\u003c/p\u003e\u003cp\u003eUroLift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.972\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSA (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eBefore Matching\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eAfter Matching\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(Cohort 1) Rezum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(Cohort 2)\u003c/p\u003e\u003cp\u003eUroLift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(Cohort 1) Rezum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(Cohort 2)\u003c/p\u003e\u003cp\u003eUroLift\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.975\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSA (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eContinuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). BMI: Body Mass Index\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65, there were 260 patients in Cohort 1 and 975 in Cohort 2 before matching. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, patients in Cohort 1 were older (59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 vs. 57.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 years, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and had lower BMI (28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 vs. 29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), while serum PSA levels were similar between groups (2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 vs. 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.292). After PSM, each cohort consisted of 260 patients. As illustrated in \u003cb\u003eSupplementary Fig.\u0026nbsp;2b\u003c/b\u003e, among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65, the Rezum group had a significantly higher reintervention rate than the UroLift group before PSM (Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). However, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003ea and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003eb., after matching, the difference was not statistically significant (HR: 1.49, 95% CI: 0.87\u0026ndash;2.55; Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.147).\u003c/p\u003e\u003cp\u003eWe further examined procedure-specific outcomes by age group. As shown in \u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e, among patients in the Rezum group, those aged\u0026thinsp;\u0026ge;\u0026thinsp;65 had higher serum PSA levels (2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 vs. 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) but similar BMI (28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 vs. 28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.156) compared to those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65. In \u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e, among patients in the UroLift group, those aged\u0026thinsp;\u0026ge;\u0026thinsp;65 also had higher serum PSA levels (2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 vs. 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.051) but lower BMI (28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9 vs. 29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003eb, \u003cb\u003eSupplementary Fig.\u0026nbsp;3a\u003c/b\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003ea, those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 had a higher reintervention rate than those aged\u0026thinsp;\u0026ge;\u0026thinsp;65, both before (Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and after (HR: 2.12, 95% CI: 1.15\u0026ndash;3.93; Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014) PSM. In contrast, in the UroLift group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003eb, \u003cb\u003eSupplementary Fig.\u0026nbsp;3b\u003c/b\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003eb), no age-related difference was observed within the UroLift group, both before (Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.191) and after (HR: 0.85, 95% CI: 0.62\u0026ndash;1.17; Log-rank test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.325) PSM.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study confirms that age is an independent factor influencing the effectiveness of Rezum. Our findings indicate that among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, Rezum was associated with a lower reintervention rate than UroLift. In contrast, for those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 years, there was no significant difference in reintervention rates by procedure. Overall, the three-year reintervention rates were similar for Rezum (7.2%) and UroLift (8.3%). Notably, in patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, the reintervention rate was 4.9% with Rezum compared to 8.8% with UroLift, whereas for those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65 years, the rates were comparable (11.9% vs. 7.3%).\u003c/p\u003e\u003cp\u003eWhile previous studies have evaluated both Rezum and UroLift, the impact of patient age on their surgical outcomes remains unclear. In a sham-controlled trial of Rezum, the five-year surgical retreatment rate was 4.4% among 135 patients (mean age 63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1 years).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In contrast, the L.I.F.T. study reported a 13.6% surgical retreatment rate at five years for 140 UroLift patients (mean age 67.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6 years).\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e An indirect comparisons suggest Rezum may yield lower reintervention rates, as reflected in a three-year comparison by Elterman et al. (4.4% vs. 10.7%) and a prospective two-year study (0% vs. 8.1%)\u0026mdash;both favoring Rezum over UroLift.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Although most studies have reported lower reintervention rates with Rezum compared to UroLift, our findings indicated comparable rates between the two procedures. Notably, the mean age in our cohort was higher than in previous studies (68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 years for the Rezum group and 66.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 years for the UroLift group). In a cohort of 256 patients receiving Rezum therapy, there was no significant difference in 4-year surgical reintervention rates between those aged\u0026thinsp;\u0026ge;\u0026thinsp;65 and those\u0026thinsp;\u0026lt;\u0026thinsp;65 (11.9% vs. 5.1%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06).\u003csup\u003e15\u003c/sup\u003e However, the study included heterogeneous prostate volumes (median 49.5 ml for patients\u0026thinsp;\u0026ge;\u0026thinsp;65 years and 40.0 ml for those\u0026thinsp;\u0026lt;\u0026thinsp;65 years, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with no additional matching performed. Our study accounted for other factors associated with prostate size and highlighted age as a significant determinant of these findings.\u003c/p\u003e\u003cp\u003eIn our study, we found that patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years experienced better outcomes following Rezum than those receiving UroLift, whereas no age-related difference was observed in the UroLift group. We hypothesize that this could be attributed to a correlation between prostate tissue density and age. The UroLift device mechanically expands the prostatic urethral lumen, exerting minimal influence on tissue density. In contrast, Rezum uses thermal energy to necrotize prostate tissue, so tissue density could significantly affect the distance of thermal conduction. Unfortunately, there are no published studies specifically examining the relationship between prostate density (prostate weight/volume)\u0026mdash;as distinct from PSA density\u0026mdash;and age. However, King et al. reported in an animal study that thermal transition temperature increases with age, suggesting older tissue may facilitate more efficient thermal energy transfer.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Penne\u0026rsquo;s bioheat equation also demonstrates an inverse relationship between tissue density and specific heat,\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and separate thermal conductivity measurements show that increasing tissue density reduces the distance of heat transfer.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Meanwhile, Matthew et al. found that aging leads to a decline in muscle quality, including density.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In this study, we excluded patients with prostate cancer to reduce the potential confounding effect of malignant tissue on our findings.. These findings suggest that older individuals with potentially lower-density tissue might help to explain the greater benefit from thermal-based interventions like Rezum that we observed in our data.\u003c/p\u003e\u003cp\u003eAlthough TriNetX included a large number of patient records, the primary limitation of our study is the absence of prostate volume data. To minimize confounding in our results, we matched age, PSA, and BMI which are known to be correlated with prostate volume. Prior studies have consistently demonstrated a positive relationship between age and prostate size.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In large-scale studies involving 2,264 individuals with systemic BPH (Mochtar et al.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e), 2,270 patients with LUTS and biopsy-proven BPH (Hochberg et al.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e), and 4,627 men with BPH (Roehrborn et al.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e), serum PSA was consistently shown to be a reliable predictor of prostate volume.In addition to age and PSA, we matched BMI in our study, as multiple investigations\u0026mdash;including Ken et al.\u0026rsquo;s 278-patient analysis\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, a large Chinese observational study\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, and Saurabh et al.\u0026rsquo;s prospective research\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u0026mdash;consistently reported a positive correlation between BMI and prostate volume in men with BPH.\u003c/p\u003e\u003cp\u003eOur findings suggest that patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years demonstrated a lower reintervention rate after undergoing Rezum than Urolift. To the best of our knowledge, this is the first study to assess the associatio between patient age and the effectiveness of Rezum. Nevertheless, this study has several limitations. First, we lacked data on prostate volume despite our efforts to match age, PSA, and BMI as proxies. As a result, we cannot rule out the influence of individual prostate volume on our findings. Second, unlike other research, we did not include subjective measures such as the IPSS or uroflowmetry, preventing us from evaluating functional improvements across different procedures during follow-up. However, our primary outcome\u0026mdash; reintervention rates\u0026mdash;remained robust. Third, patients in UroLift group are three times larger than those in Rezum before matching. However, this may reflect real-world practice. Fourth, although we utilized TriNetX\u0026rsquo;s built-in PSM, some significant differences persisted in certain subgroup analyses. This may occur when initial disparities between cohorts are so pronounced that even after matching, the p-value remains below the 0.05 threshold\u0026mdash;though higher than in the unmatched analysis and closer to the cutoff value.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn patients aged 65 or older, the Rezum procedure demonstrated a markedly lower reintervention rate over the three-year follow-up period; however, in those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 to \u0026lt;\u0026thinsp;65, both procedures exhibited comparable reintervention rates, suggesting that age may be an influential factor in determining the relative benefits of Rezum.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYC Lu: Project development, Manuscript writingW Chiu: Manuscript revisedCH Ho: Data CollectionYH Shao: Project development, Manuscript revised\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors have no conflict of interest and nothing to disclose. This study was approved by the Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R).\u003c/p\u003e\u003cp\u003eRegistry and the Registration No. of the study/trial: Institutional Review Board of Shin Kong Wu Ho-Su Memorial Hospital (20250106R).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCG. R. Current Medical Therapies for Men With Lower Urinary Tract symptoms and Benign Prostatic Hyperplasia Achievements and Limitations. Rev Urol (2008) ;10:14\u0026ndash;25\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerhamme KM, Dieleman JP, Bleumink GS, Bosch JL, Stricker BH, Sturkenboom MC (2003) Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project. Eur Urol 44:539\u0026ndash;545\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 50:969\u0026ndash;979 discussion 980\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT et al (2024) Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 211:11\u0026ndash;19\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhowmick P, Coad JE, Bhowmick S, Pryor JL, Larson T, De La Rosette J et al (2004) In vitro assessment of the efficacy of thermal therapy in human benign prostatic hyperplasia. Int J Hyperth 20:421\u0026ndash;439\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDW. H, MN. Oi. Heat Conduction Fundamentals, in Heat Conduction. 3rd ed. \u003cem\u003eHoboken, NJ\u003c/em\u003e: \u003cem\u003eJohn Wiley \u0026amp; Sons, Inc\u003c/em\u003e. (2012)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFine SW, Reuter VE (2012) Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Histopathology 60:142\u0026ndash;152\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDixon CM, Rijo Cedano E, Mynderse LA, Larson TR (2015) Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum((R)) system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol 7:13\u0026ndash;18\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoehrborn CG, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE et al (2013) The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol 190:2161\u0026ndash;2167\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcNicholas TA, Woo HH, Chin PT, Bolton D, Fernandez Arjona M, Sievert KD et al (2013) Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur Urol 64:292\u0026ndash;299\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaw YXT, Chen WJK, Shen L, Lin K, Ong CSH, Lim QY et al (2024) Convective Water Vapor Energy Ablation (Rezum) Versus Prostatic Urethral Lift (Urolift): A 2-Year Prospective Study. J Endourol 38:1387\u0026ndash;1394\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcVary KT, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM et al (2021) 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 206:715\u0026ndash;724\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. B CGR, SN. G NDS, JL. G DMB et al (2017) Five year results of the prospective randomized controlled prostatic urethral LIFT study. Can J Urol 24:8802\u0026ndash;8813\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElterman D, Shepherd S, Saadat SH, Alshak MN, Bhojani N, Zorn KC et al (2021) Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes. Can J Urol 5:10824\u0026ndash;10833\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu M, Babar M, Hawks-Ladds N, Tawfik MM, Loloi J, Labagnara K et al (2024) Real-world four-year functional and surgical outcomes of Rezum therapy in younger versus elderly men. Prostate Cancer Prostatic Dis 27:109\u0026ndash;115\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNL. K. Thermal Transition of Collagen in Ovine Connective Tissues. Meat Sci (1987) ;20:90048\u0026ndash;90049\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAijaz M, Dar JG, Almanjahie IM, Alshahrani F (2023) Temperature distribution in tumour tissue during targeted destruction by heat: A hyperbolic bioheat equation approach. Case Stud Therm Eng 50:103491\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePresley MA, Christensen PR (2010) Thermal conductivity measurements of particulate materials: 4. Effect of bulk density for granular particles. J Geophys Research: Planet ;115\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDelmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P et al (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90:1579\u0026ndash;1585\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eV S, K T, JE. D M, D CD (2003) Relationship between age, prostate volume, prostate-specific antigen, symptom score and uroflowmetry in men with lower urinary tract symptoms. Scand J Urol Nephrol 37:322\u0026ndash;328\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang SJ, Qian HN, Zhao Y, Sun K, Wang HQ, Liang GQ et al (2013) Relationship between age and prostate size. Asian J Androl 15:116\u0026ndash;120\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMochtar CA, Kiemeney LA, van Riemsdijk MM, Barnett GS, Laguna MP, Debruyne FM et al (2003) Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol 44:695\u0026ndash;700\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHochberg DA, Armenakas NA, Fracchia JA (2000) Relationship of prostate-specific antigen and prostate volume in patients with biopsy proven benign prostatic hyperplasia. Prostate 45:315\u0026ndash;319\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR CG (1999) Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology 53:581\u0026ndash;589\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBatai K, Phung M, Bell R, Lwin A, Hynes KA, Price E et al (2021) Correlation between body mass index and prostate volume in benign prostatic hyperplasia patients undergoing holmium enucleation of the prostate surgery. BMC Urol 21:88\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXie LP, Bai Y, Zhang XZ, Zheng XY, Yao KS, Xu L et al (2007) Obesity and benign prostatic enlargement: a large observational study in China. Urology 69:680\u0026ndash;684\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNegi SK, Desai S, Faujdar G, Jaiswal S, Sahu RD, Vyas N et al (2024) The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia: A prospective cohort study. Urologia 91:512\u0026ndash;517\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rezum, UroLift, minimally invasive surgical therapy, reintervention rate, TriNetX database ","lastPublishedDoi":"10.21203/rs.3.rs-7409529/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7409529/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRezum and UroLift are new minimally invasive treatments; however, data comparing their outcomes remain limited. We queried a TriNetX database to evaluate three-year reintervention rates for both procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used the TriNetX US Collaborative Network database and Common Procedural Terminology codes to identify male patients aged 40 years or older who underwent Rezum or UroLift procedures between January 2018 and December 2020. These patients were followed for three years, during which reintervention procedures were analyzed. Propensity-score matching (PSM) and Cox regression model were performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 3,231 patients were included, with 792 undergoing Rezum and 2,439 undergoing UroLift. After PSM, the overall reintervention rates were similar between the two groups (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 0.82–1.73). Among patients aged ≥65, the Rezum group had a lower reintervention rate (HR: 0.60, 95% CI: 0.37–0.97) than the UroLift group. In contrast, among those aged ≥40 to \u0026lt;65, reintervention rates did not differ between Rezum and UroLift (HR: 1.49, 95% CI: 0.87–2.55). Within the Rezum group, patients aged ≥40 to \u0026lt;65 experienced a higher reintervention rate compared with those aged ≥65 (HR: 2.12, 95% CI: 1.15–3.93), whereas no age-related difference was observed in the UroLift group (HR: 0.85, 95% CI: 0.62–1.17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn patients aged ≥65, Rezum was associated with a lower reintervention rate over the three-year follow-up period, whereas among those aged ≥40 to \u0026lt;65, both procedures yielded comparable reintervention rates.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Three-Year Reintervention Rates for Rezum vs. UroLift: A TriNetX Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 12:46:30","doi":"10.21203/rs.3.rs-7409529/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3dbfdef-8f82-47f8-bf3a-5a5bbe047b22","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-16T06:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 12:46:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7409529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7409529","identity":"rs-7409529","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}