Beyond medications: office-based procedures for benign prostatic obstruction

Local anesthesia for Rezūm™: a narrative review of the literature

INTRODUCTION

This narrative review analyzed current practices and protocols for local anesthesia in Rezūm™ and evaluated the feasibility, pain management, and patient comfort associated with this approach.

EVIDENCE ACQUISITION

We included studies reporting the use of local anesthesia in Rezūm™, focusing on patient comfort and pain levels during the procedure. The literature search was performed in June 2024 using Medline, Cochrane, and Embase databases to identify relevant studies published from January 2015 to June 2024. Searches were restricted to publications in English. Owing the heterogeneity of study outcomes and the non-standardized quality appraisal, a narrative synthesis rather than a quantified meta-analysis of data was performed.

EVIDENCE SYNTHESIS

Four studies were included. Various local anesthesia methods, including transurethral intraprostatic anesthesia with the Schelin catheter and prostatic nerve block associated with cold anesthetic gel, are effective in managing pain and can facilitate the performance of Rezūm™ in outpatient settings. Functional outcomes, including improved Qmax, reduced IPSS and QoL scores, and high catheter independence rates, were reported, with minor complications.

CONCLUSIONS

Rezūm™ performed under local anesthesia is feasible, offering significant advantages in terms of patient comfort and potential for outpatient application. However, the lack of standardized protocols and the need for further research on long-term outcomes and comparative efficacy are critical areas for future investigation. Addressing these challenges could optimize Rezūm™, making them more accessible and cost-effective and potentially shifting BPH management toward more office-based procedures.

Introduction of Rezum system technology to Ireland for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a pilot study on early outcomes and procedure cost analysis

OBJECTIVE

Rezum technology uses heat from radiofrequency-generated water vapour to ablate prostate tissue. We evaluate the introduction of this thermal therapy to an Irish teaching hospital for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia.

METHODS

A pilot study of men with moderate to severe lower urinary tract symptoms who underwent Rezum treatment to the prostate was performed. Perioperative efficacy was evaluated using international prostate symptom score (IPSS), quality of life score (IPSS-QOL), uroflowmetry and post-void residual (PVR) volumes. Costs were evaluated and compared against matched patients undergoing the standard of care, transurethral resection of the prostate (TURP).

RESULT

Ten patients with a mean age of 70 ± 9 years who met the inclusion criteria underwent Rezum treatment. Mean PSA was 4.73 ± 4 ng/mL and mean prostate volume 72 ± 30 cc. Rezum therapy significantly improved both IPSS by 74% from mean baseline score of 20.8 ± 4 to 5.3 ± 1.49 (p < 0.001) and IPSS-QOL score by 84% from mean baseline score of 4.4 ± 0.7 to 0.6 ± 0.7 (p < 0.001) at 3 months. Maximum flow rate increase by 44% from 9.26 ± 2.5 to 13.34 ± 2.3 mL/s (p < 0.001). When compared to ten matched patients undergoing TURP in the same period, there was a significant cost saving of €1986.52 per patient for Rezum, overall up-front cost saving of €22,819 with an additional 19 bed days and 5 theatre hours spared.

CONCLUSION

Rezum, a minimally invasive thermal therapy, provides significantly improved symptom relief and quality of life with a significant cost saving to the institution.