Response and Rebuttal to Editorial Commentary on 'Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study'

Thank you for the opportunity to respond to Dr Corona’s comments. Parsimoniously stated, lower urinary tract symptoms (LUTS) and the treatments impact sexual function. The challenge in advancing the medical and surgical care of men with LUTS is to maximize the impact on the bothersome symptoms while avoiding the undesirable effects on erectile and ejaculatory function. Excitingly, this new technology offers that possibility. Durability of the therapeutic response in men with LUTS and its impact is the next important issue and future reports will be forthcoming. We agree with Dr Corona that the need for comparative trials of the convective vapor technique with standard surgical approaches. These types of comparisons will undoubtedly be forthcoming, but clearly Dr Corona will agree that in any investigatory endeavor one must start at the beginning. This beginning was a success and lays the ground for confirmatory studies as well as those suggested above. Dr Corona wonders if the randomized controlled trial (RCT) accounted and controlled for the proper confounding variables impacting men with LUTS that we have previously published. To avoid the plague of self-citation we will not belabor these publications here. Concerning the possibility that these risk factors may confound the measurement of sexual function in this report, in our view the randomization process controls for these putative confounders unless one believes that the controls or the treatment groups are somehow unequally weighted in respective cohorts. Our analysis suggest that such bias do not exist. Contrary to cross-sectional and single cohort studies, one advantage of the blinded RCT design is the inherent protection against such unaccounted variables.