Asia-Pacific collaborative consensus statements on water vapor thermal therapy (Rezūm) incorporating a systematic review, a two-round Delphi survey, and a consensus meeting.

Background: Water vapor thermal therapy (WVTT) is a minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). While its efficacy has been demonstrated, high-quality evidence concerning optimal patient selection and perioperative management is limited, leading to heterogeneous application. This is an Asia-Pacific (APAC) collaborative effort aiming to develop a consensus statement to standardize various aspects of WVTT therapy for clinical practice and to guide future research. Methods: The consensus statement was developed using a modified Delphi method, consistent with previous urological consensus statements. First, a systematic review was performed to identify areas of uncertainty across the entire WVTT clinical pathway. Next, 150 urologists from the Asia-Pacific region with experience in WVTT were invited to complete a two-round online Delphi survey. Finally, a 13-member consensus panel meeting (each with ≥50 cases of experience) was held to review, discuss, and re-vote on statements without prior consensus. 'Consensus agree' was pre-defined as follow: ≥70% of participants scoring a statement 7-9 and ≤15% scoring it 1-3 (on a 9-point Likert scale). Results: Based on the 'uncertainties' review of 197 studies, 92 statements were generated. Through two rounds of Delphi survey, consensus was reached on 74 statements. The consensus panel reached agreement on a further 10 out of 18 statements, resulting in 84 final statements. The statements provide guidance on six domains: case selection (e.g., feasibility in refractory retention and median lobes), preoperative preparation (e.g., management of antithrombotic medications), patient counseling, surgical procedure (e.g., anesthesia and injection strategies), postoperative management and follow-up (e.g., medication discontinuation), and data reporting and outcome measures. Conclusions: Using a modified Delphi method, this APAC collaborative consensus provides comprehensive recommendations to standardize and optimize the use of WVTT. It aims to serve as a critical reference for clinicians and inform future research until more robust, long-term comparative evidence becomes available.