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Introduction <p>Minimally Invasive Surgical Techniques (MIST) such as water vapor thermal therapy (WVTT, or Rezum) are increasingly adopted for treating benign prostatic obstruction (BPO), particularly in frail or elderly patients. These procedures offer a safer, less invasive alternative to conventional surgery while preserving sexual function. Frail patients often require long-term anticoagulation with non-vitamin K oral anticoagulants (NOACs), which poses challenges in balancing bleeding and thrombotic risks during urological procedures.</p> Objective <p>To evaluate the bleeding risk profile of in patients on NOAC therapy and propose evidence-based recommendations for peri-operative NOAC management.</p> Methods <p>A systematic literature review was performed using PubMed and Cochrane databases, focusing on combinations of NOACs with WVTT. Supplementary expert opinions and international clinical guidelines were also analyzed. The review compared REZUM’s bleeding risk to prostate biopsy as a reference procedure which is generally categorized as low-risk.</p> Results <p>The review revealed a paucity of direct studies on NOAC management during WVTT, with no formal recommendations from urological societies. However, data suggest that WVTT is associated with minimal bleeding, similar to prostate biopsy. It’s short procedural time, targeted vapour delivery, and minimal invasiveness support this hypothesis. Existing cardiology and anesthesiology guidelines recommend against bridging in low-risk procedures. A practical protocol based on pharmacokinetics and patient co-morbidities is proposed herein.</p> Conclusion <p>WVTT appears to be a safe and effective treatment option for anticoagulated, including frail patients with BPO. In the absence of specific urological guidelines, adopting a standardized, evidence-based protocol—often without NOAC interruption or bridging—may improve patient outcomes and urologist autonomy. Larger, prospective studies are needed to validate this approach.</p>

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Management of NOACs in patients undergoing water vapour thermal therapy (REZUM) for benign prostatic obstruction: a comprehensive review

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • M. Coscarella,
  • S. Secco,
  • D. S. Elterman,
  • M. Baboudjian,
  • M. Al Barajraji,
  • M. Leclercq,
  • F. Gillard,
  • I. Moussa,
  • M. Pedini,
  • S. Holz,
  • F. Dalati,
  • M. Fourmarier,
  • T. Roumeguère,
  • L. Cindolo

摘要

Introduction

Minimally Invasive Surgical Techniques (MIST) such as water vapor thermal therapy (WVTT, or Rezum) are increasingly adopted for treating benign prostatic obstruction (BPO), particularly in frail or elderly patients. These procedures offer a safer, less invasive alternative to conventional surgery while preserving sexual function. Frail patients often require long-term anticoagulation with non-vitamin K oral anticoagulants (NOACs), which poses challenges in balancing bleeding and thrombotic risks during urological procedures.

Objective

To evaluate the bleeding risk profile of in patients on NOAC therapy and propose evidence-based recommendations for peri-operative NOAC management.

Methods

A systematic literature review was performed using PubMed and Cochrane databases, focusing on combinations of NOACs with WVTT. Supplementary expert opinions and international clinical guidelines were also analyzed. The review compared REZUM’s bleeding risk to prostate biopsy as a reference procedure which is generally categorized as low-risk.

Results

The review revealed a paucity of direct studies on NOAC management during WVTT, with no formal recommendations from urological societies. However, data suggest that WVTT is associated with minimal bleeding, similar to prostate biopsy. It’s short procedural time, targeted vapour delivery, and minimal invasiveness support this hypothesis. Existing cardiology and anesthesiology guidelines recommend against bridging in low-risk procedures. A practical protocol based on pharmacokinetics and patient co-morbidities is proposed herein.

Conclusion

WVTT appears to be a safe and effective treatment option for anticoagulated, including frail patients with BPO. In the absence of specific urological guidelines, adopting a standardized, evidence-based protocol—often without NOAC interruption or bridging—may improve patient outcomes and urologist autonomy. Larger, prospective studies are needed to validate this approach.