A Rare Case of Recurrent Delayed Massive Hematuria Due to Arterial Bleeding Following Water Vapor Energy Therapy for Benign Prostatic Hyperplasia

Water vapor energy therapy (WAVE, Rezūm™) is a minimally invasive surgical therapy for benign prostatic hyperplasia (BPH) that is associated with favorable efficacy and safety. Clinically significant bleeding requiring transfusion or endoscopic intervention is rare. A 77-year-old man with BPH developed recurrent delayed massive hematuria following WAVE. Although the initial postoperative course was uneventful, he presented on postoperative day 7 with bladder tamponade, managed with clot evacuation. On postoperative day 21, after catheter removal, he experienced acute urinary retention and hypotension, accompanied by gross hematuria. Endoscopic evacuation and coagulation of arterial bleeding from the median lobe achieved hemostasis, and the patient recovered without further recurrence. To the best of our knowledge, based on a review of the currently available English-language literature, no prior cases of delayed arterial hemorrhage requiring intervention after WAVE have been reported. Clinicians should remain vigilant for this possibility, and patients should be informed of this risk.