Background: Long-term durability of water vapor therapy for BPH requires evaluation. Methods: 5-year follow-up of 240 men with moderate-severe BPH (IPSS ≥13) undergoing Rezum therapy. Primary outcomes: IPSS, Qmax, and surgical retreat rate. Results: IPSS improved by mean 12.2 points (baseline 22.1 to 9.9). Qmax improved by 5.8 mL/s. Surgical retreatment required in 4.2% at 5 years. Ejaculatory dysfunction rare (1.8%). Sexual function preserved in 95% of patients. Conclusion: Rezum therapy demonstrates durable BPH symptom improvement at 5 years with excellent sexual function preservation, supporting its role in sexually active men
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