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.
World journal of urology. 2026 May 28*** epublish ***
Luca Cindolo, Antonio Minore, Iván Schwartzmann, Alba Farré Alejo, Vittorio Imperatore, Vincenzo Iossa, Jan Ebbing, Paolo Destefanis, Richard Hindley, Amr Emara, Antonio Pastore, Manfredi Bruno Sequi, Raffaele Balsamo, Radoslav Knazik, Mathieu Coscarella, Cosimo De Nunzio, Silvia Secco
Centro Urologico Europeo, Modena, Italy. ., Department of Urology, Fondazione Campus Bio-Medico of Rome, Rome, Italy., Department of Urology, Universidad Autonoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain., Department of Urology, AORN Moscati, Avellino, Italy., Department of Urology, University Hospital Basel, Basel, Switzerland., Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza- Molinette Hospital, Urology Clinic, University of Turin, Turin, Italy., Urology Department, Hampshire Hospitals Foundation Trust, Basingstoke, UK., ICOT Hospital, University Sapienza, Rome, Italy., Urology Unit, Department of Surgical Sciences AORN dei Colli, Monaldi Hospital, Naples, Italy., UROplus, Urology Clinic, Banska Bystrica, Slovakia., H.U.B. Hopital Erasme, Brussels, Belgium., Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy., ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.