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.