Water vapor thermotherapy and high-grade Clavien-Dindo complications: retrospective analysis of 10 cases.

内容摘要

Water vapor thermal therapy (WVTT) has emerged as a widely adopted minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia/obstruction (BPH/BPO), with excellent functional outcomes and a favorable safety profile. However, life-threatening real-world complications are likely underreported. The aim of this study was to describe severe (Clavien-Dindo > = 4) complications after WVTT and discuss possible mechanisms, risk factors, and preventive strategies. During an international WVTT meeting (Madrid, June 2025), experienced surgeons from high-volume centers were invited to retrospectively report life-threatening complications after WVTT. Anonymized demographic, clinical, perioperative, and postoperative data were collected using a standardized template and were qualitatively analyzed. Contributors reported a small multicenter series of life-threatening events occurring despite negative preoperative urine cultures and standard antibiotic prophylaxis. Most complications were infectious, including septic shock with intraprostatic abscess and bacteremia, often requiring intensive care, vasopressor support, and prolonged intravenous antibiotics. Some fatal events were recorded, mainly due to sepsis caused by multidrug-resistant pathogens. Apart from infectious events, other complications were destructive orchitis requiring orchiectomy, severe urethral stricture with extensive intraprostatic necrosis requiring endoscopic treatment, and thermal injury to a redundant sigmoid colon. Several patients had relevant comorbidities, prior catheterization, or unrecognized anatomic variants. Although WVTT is generally safe, rare but dramatic life-threatening complications do occur, even in expert hands. Strict infection control, careful patient selection, adherence to recommended injection schemes, attention to bowel history and anatomy, and comprehensive counseling, particularly in frail and multimorbid patients, are essential to mitigate risk. Systematic, standardized reporting of severe adverse events is needed to refine perioperative strategies and improve patient safety.