Ejaculation-sparing GreenLight anatomical PVP versus REZŪM for benign prostatic obstruction surgery with an ejaculation-sparing purpose: what are the early differences?
P. Destefanis, M. Sibona, et al. • MITAT. Minimally invasive therapy & allied technologies • 2026
Both Rezūm and ejaculation-sparing anatomical photoselective vaporization of the prostate (ESa-PVP) are effective and safe for benign prostatic obstruction, but ESa-PVP provides better short-term symptom relief while Rezūm shows higher rates of immediate antegrade ejaculation preservation.
Key Findings
Results
ESa-PVP produced significantly better improvement in IPSS scores compared to Rezūm at three months postoperatively.
54 total patients evaluated: 31 in the Rezūm group and 23 in the ESa-PVP group
IPSS score improvement was statistically significantly better in the ESa-PVP group (p = 0.009)
Patient-perceived quality of life was also significantly better in the ESa-PVP group (p = 0.008)
Outcomes were assessed at three months using the validated International Prostate Symptom Score (IPSS) questionnaire
Study was prospective and non-randomised, conducted between December 2022 and December 2023
Results
Rezūm preserved antegrade ejaculation in a higher proportion of patients than ESa-PVP, though the difference did not reach statistical significance.
Ejaculation was maintained in 26 out of 31 (83%) Rezūm patients versus 14 out of 23 (60%) ESa-PVP patients
The difference in ejaculation preservation rates did not reach statistical significance (p = 0.056)
MSHQ-EjD (Male Sexual Health Questionnaire-Ejaculatory Dysfunction, short form) scores were significantly higher in the Rezūm group (p = 0.001)
The primary outcome of the study was assessment of postoperative antegrade ejaculation
Results
There was no significant difference in erectile function between the Rezūm and ESa-PVP groups at three months.
Erectile function was assessed using the validated International Index of Erectile Function-5 (IIEF-5) questionnaire
IIEF-5 scores did not differ significantly between the two groups (p = 0.340)
Both procedures were assessed as effective and safe with respect to erectile function outcomes
Background
Both Rezūm and ESa-PVP were developed specifically to preserve ejaculatory function while treating benign prostatic obstruction, in contrast to traditional surgical techniques.
Traditional techniques such as transurethral resection of the prostate (TUR-P) and open prostatectomy (OP) effectively relieve LUTS but 'usually compromise antegrade ejaculation'
ESa-PVP is described as a modified endoscopic surgery with an ejaculation-sparing anatomical approach
Rezūm is classified as a minimally invasive surgical technique (MIST)
The authors note that 'few comparative data are available' between these two ejaculation-sparing approaches
Methods
The study population included men with LUTS unresponsive to medication or with an indwelling catheter, treated at a single centre over a one-year period.
Patients were treated between December 2022 and December 2023
Inclusion criteria required LUTS unresponsive to medication or presence of an indwelling catheter
Total cohort was 54 patients (31 Rezūm, 23 ESa-PVP)
The study design was prospective and non-randomised
Secondary outcomes included LUTS evaluation and surgical complications
Conclusions
The authors concluded that personalised patient counselling is crucial to achieve optimal satisfaction given the different trade-off profiles of the two procedures.
ESa-PVP appears to provide better symptom relief in the short term
Rezūm showed higher rates of immediate antegrade ejaculation preservation
Both procedures were described as 'effective and safe' for BPO treatment
The authors emphasise that 'personalised counselling is crucial to achieve optimal patient satisfaction'
What This Means
This research compared two minimally invasive surgical procedures for an enlarged prostate (benign prostatic obstruction) that were both designed to relieve urinary symptoms while trying to preserve a man's ability to ejaculate normally. The two procedures studied were Rezūm (which uses steam to shrink prostate tissue) and ESa-PVP (a laser-based approach modified to spare ejaculatory function). Fifty-four men were followed for three months after their surgery at a single hospital in Italy. Traditional prostate surgeries often cause ejaculatory problems, so both of these newer approaches were developed specifically to address that concern.
The study found that while both procedures improved urinary symptoms, the laser procedure (ESa-PVP) produced significantly better symptom relief and quality-of-life scores at three months. However, Rezūm preserved normal ejaculation in more patients — about 83% compared to 60% for ESa-PVP — though this difference just missed the threshold for statistical significance. Neither procedure had a meaningful impact on erectile function. Ejaculatory function scores measured by a validated questionnaire were significantly better in the Rezūm group.
This research suggests that men considering surgery for an enlarged prostate face a trade-off: the laser procedure (ESa-PVP) may provide faster and more complete urinary symptom relief, while Rezūm may be more likely to preserve ejaculation in the short term. The authors emphasise that doctors should have detailed, personalised conversations with patients about these differences so that each patient's priorities — whether that is faster symptom relief or a higher chance of maintaining ejaculatory function — can guide the choice of treatment. Longer follow-up studies with more patients will be needed to confirm these early findings.
P. Destefanis, M. Sibona, M. Oderda, E. Vercelli, G. Montefusco, Fulvia Colucci, et al.. (2026). Ejaculation-sparing GreenLight anatomical PVP versus REZŪM for benign prostatic obstruction surgery with an ejaculation-sparing purpose: what are the early differences?. MITAT. Minimally invasive therapy & allied technologies. https://doi.org/10.1080/13645706.2026.2656310