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Nguyen V, Leach MC, Cerrato C, Nguyen MV, Bechis SK. Retreatment for Lower Urinary Tract Symptoms (LUTS) After Water Vapor Thermal Therapy. Urology 2024:S0090-4295(24)00299-1. [PMID: 38677371 DOI: 10.1016/j.urology.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES To identify predictors of retreatment for symptomatic recurrence among men who undergo water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), a minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS We retrospectively reviewed patients treated with WVTT at a single institution from August 2017 to February 2022. Patients who underwent a second BPH procedure for persistent or recurrent LUTS within 2 years of original treatment were compared to the remaining cohort who did not undergo retreatment. Multivariate analysis was used to assess for predictors of retreatment. RESULTS Data was obtained from 192 patients. 10 (5%) patients were retreated. The retreatment cohort had smaller prostate volumes (50.4 + 18.2 cc vs 48.5 + 35.7 cc; p=0.003) and received a greater number of water vapor injections (4.4 + 1.8 vs 5.2 + 3.9; p<0.001). At 6 month follow-up, total International Prostate Symptom Score (IPSS; 10.13 ± 7.40 vs 18.5 ± 11.55, p=0.044) and voiding sub-scores (4.59 ± 4.39 vs 9.5 ±7.84, p=0.006) were significantly worse in the retreatment group. On multivariate analysis, >1 treatment per lobe was independently associated with increased risk of retreatment (HR 8.509, 95% CI [1.109 - 65.293]; p=0.039). CONCLUSIONS WVTT has a low retreatment rate. Men who required retreatment received more injections and showed worsened voiding symptom scores 6 months postoperatively. Decreasing the number of injections may help reduce treatment failure rates.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, UC San Diego Health, San Diego, CA, USA.
| | | | - Clara Cerrato
- Department of Urology, Università degli Studi di Verona, Verona, Italy
| | - Mimi V Nguyen
- Department of Urology, UC San Diego Health, San Diego, CA, USA
| | - Seth K Bechis
- Department of Urology, UC San Diego Health, San Diego, CA, USA
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Khadhouri S, Guillaumier S, Drummond L, Dreyer B, Clelland C, Jaafari FA. Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation. BMC Urol 2024; 24:80. [PMID: 38575918 PMCID: PMC10996073 DOI: 10.1186/s12894-024-01471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Rezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring. METHODS We propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra. RESULTS Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation. CONCLUSIONS We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.
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Affiliation(s)
- S Khadhouri
- NHS Fife, Kirkcaldy, Scotland, UK.
- University of St Andrews, St Andrews, Scotland, UK.
| | | | | | - B Dreyer
- NHS Fife, Kirkcaldy, Scotland, UK
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Coscarella M, Al Barajraji M, Moussa I, Hombert L, Naudin M, Roumeguère T. Predicting the risk of failed trial without catheter following Rezum™ therapy. World J Urol 2024; 42:129. [PMID: 38460028 DOI: 10.1007/s00345-024-04823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE Convective water vapor thermal therapy or "Rezum™" treatment for lower urinary tract symptoms in men with benign prostate hypertrophy require postoperative catheterization to avoid acute urinary retention. Unsuccessful catheter removal is still unpredictable. We, therefore, aimed to identify the risk factors of failed initial trial without catheter (TWOC) after Rezum™ therapy inside a large cohort of patients. METHODS A retrospective study was conducted on patients who underwent Rezum™ therapy by three referent urologists across two academic hospitals between January 2022 and January 2023. A Foley catheter was systematically placed after therapy for 7 days in all patients before TWOC. Patients characteristics [age, imagery, maximum urinary flow rate (Qmax), postvoid residual (PVR)], and treatment outcomes (International Prostate Symptom Score (IPSS), quality of life (QoL), adverse events) were analyzed at baseline and 3 months from procedure. Failed initial TWOC was defined as the incapacity to pass urine or measured PVR > 300 mL. After univariate selection, the risk factors for TWOC failure were identified using multivariate logistic regression analysis. RESULTS 216 patients qualified for analysis with 23 (10.6%) failing the first TWOC after 7 days of catheterization. After multivariate logistic regression, only preoperative PVR predicted TWOC failure (OR 1.01; p = 0.007). The cut-off of preoperative PVR increasing this risk was 120 mL (p = 0, 02). CONCLUSION Over 10% of men undergoing Rezum™ therapy for LUTS/BPH will experience TWOC failure and AUR after 7 days of catheterization. Preoperative PVR seems to be the only independent risk factor of unsuccessful catheter removal.
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Affiliation(s)
- Mathieu Coscarella
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium.
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
| | - Moncef Al Barajraji
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Ilan Moussa
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Leslie Hombert
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Michel Naudin
- Department of Urology, Ambroise Paré Hospital, Université Libre de Bruxelles, Mons, Belgium
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Salem J, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Schönburg S, Abt D. [Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4]. Urologie 2024; 63:58-66. [PMID: 38193989 DOI: 10.1007/s00120-023-02249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options. OBJECTIVE Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome. MATERIALS AND METHODS Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline. RESULTS In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
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Affiliation(s)
- Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Schillingsrotterstr. 39-41, 50996, Köln, Deutschland.
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland.
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | | | | | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Schweiz
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Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00201-8. [PMID: 37741783 DOI: 10.1016/j.euf.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
CONTEXT Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation. OBJECTIVE To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO. EVIDENCE ACQUISITION A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP). EVIDENCE SYNTHESIS We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] -2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI -0.81 to 0.21), maximum urinary flow rate (Qmax; MD -0.30, 95% CI -3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02-1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26-1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI -28.39 to 35.05), QoL (MD 0.12, 95% CI -0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI -1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01-2.86), and significant change in Qmax (MD -9.52, 95% CI -14.04 to -5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD -2.80, 95% CI -6.61 to 1.01), QoL (MD -0.69, 95% CI -1.46 to 0.08), Qmax (MD -3.51, 95% CI -8.08 to 1.06), UI (RR 0.14, 95% CI 0.01-2.51), and retreatment (RR 1.91, 95% CI 0.19-19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI -0.29 to 1.09), UI (RR 0.13, 95% CI 0.02-1.05), and retreatment (RR 0.48, 95% CI 0.12-1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22-6.58), and IIEF-5 (MD 3.00, 95% CI 0.41-5.59) and Qmax (MD -9.60, 95% CI -13.44 to -5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date. CONCLUSIONS Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs. PATIENT SUMMARY This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits and harms should be investigated further in high-quality randomised controlled trials.
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Affiliation(s)
- Anirban Dey
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Yuhong Yuan
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ambreen Shakil
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, UK
| | - Muhammad Imran Omar
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Guidelines Office, European Association of Urology, Arnhem, The Netherlands.
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Alnazari M, Bakhsh A, Rajih ES. Emphysematous sloughed floating ball after prostate water vaporization Rezum: A case report. World J Clin Cases 2023; 11:5525-5529. [PMID: 37637678 PMCID: PMC10450385 DOI: 10.12998/wjcc.v11.i23.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Rezūm™ water vapor therapy is a new minimally invasive endoscopic technology for the management and treatment of benign prostatic hyperplasia. CASE SUMMARY A 63-year-old male presented to our department with severe dysuria, frequency, urgency, and interrupted stream 2 mo after receiving Rezūm™ therapy. The symptoms were caused by a retained floating emphysematous necrotic sloughed tissue. We also discovered a persistent bacterial infection that was resistant to parenteral antimicrobial therapy. The treatment of the patient included surgical removal of the necrotic tissue. CONCLUSION Despite the good safety profile and minimal adverse events related to Rezūm™ therapy, major complications can still occur.
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Affiliation(s)
- Mansour Alnazari
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
| | - Abdulaziz Bakhsh
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
| | - Emad Sabri Rajih
- Department of Urology, Taibah University, Madinah 16655, Al Madinah, Saudi Arabia
- Urology Section, Department of Surgery, King Faisal Specialist Hospital & Research Center, Madinah, Saudi Arabia
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Porto JG, Arbelaez MCS, Blachman-Braun R, Bhatia A, Bhatia S, Satyanarayana R, Marcovich R, Shah HN. Complications associated with minimally invasive surgical therapies (MIST) for surgical management of benign prostatic hyperplasia: a Manufacturer and User Facility Device Experience (MAUDE) database review. World J Urol 2023; 41:1975-1982. [PMID: 37222779 DOI: 10.1007/s00345-023-04440-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE MAUDE database houses medical device reports of suspected device-related complications received by Food and Drug Administration. In the present study we aim to evaluate the MAUDE database for reported complications of MIST procedures. METHODS The database was queried using keywords: rezum, urolift, prostate embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), prostate stent and Temporarily Implanted Nitinol Device (iTIND) on 10/1/22 to extract information regarding device problems and procedure-related complications. Gupta classification system was used to stratify complications. Statistical analysis was performed to compare frequency of complications among MIST procedures. RESULTS We found a total of 692 reports (Rezum-358, urolift-226, PAE-53, TUNA-31, TUMT-19, prostatic stent-4, and iTIND-1). Most complications related to device or users were minor (level 1 and 2) and there was no significant difference among various MIST procedures. The screen/system error was responsible for 93% and 83% aborted cases in Rezum and TUNA, respectively, and PAE showed 40% of device component detachment/fracture. Overall Urolift and TUMT were associated with statistically significant higher incidence of major (level 3 and 4) complications (23% and 21%, respectively) as compared with Rezum (7%). Most major complications needing hospitalization after Urolift included hematoma and hematuria with clots and those after Rezum included urinary tract infection and sepsis. Thirteen deaths were reported, mostly due to cardiovascular events, which were classified as not associated with the proposed treatment. CONCLUSION MIST for BPH can occasionally cause significant morbidity. Our data should assist urologists and patients in shared decision-making process.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | | | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ramgopal Satyanarayana
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA.
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Bausch K, Zahiti L, Schrutt M, Wetterauer C, Halbeisen FS, Ebbing J, Seifert HH. Water vapor thermal therapy of lower urinary tract symptoms due to benign prostatic obstruction: efficacy and safety analysis of a real-world cohort of 211 patients. World J Urol 2023:10.1007/s00345-023-04395-y. [PMID: 37140664 DOI: 10.1007/s00345-023-04395-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
PURPOSE This study assessed the efficacy, safety and durability outcomes of water vapor thermal therapy with Rezum in a real-world cohort of patients with lower urinary tract symptoms due to benign prostate obstruction. METHODS Consecutive, unselected patients undergoing Rezum treatment between January 2014 and August 2022 were candidates for this pragmatic, observational, longitudinal, single-center cohort study. Pre- and perioperative data were descriptively summarized. The primary outcome was surgical efficacy, determined by International Prostate Symptom Score (IPSS), Quality of Life (QoL) Score, maximum urinary flow rate (Qmax), post-void residual (PVR) volume and prostate volume (PV) at baseline, 2 months, 6 months, 1 year, 2 years, and > 2 years. RESULTS A total of 211 patients were enrolled for analysis. Overall, catheter removal was successful in 92.4% of patients after a median of 5 days. A preoperative catheter and the presence of a median lobe increased the risk of unsuccessful catheter removal. In total, 5.7% of patients were reoperated after a median of 407 days. Comparing baseline to the longest median follow-up, the postoperative IPSS decreased significantly by 65.7%, the QoL Score declined by 66.7% (both until a maximum median of 4.5 years) and Qmax improved by 66.7% (until 3.9 years). Post-void residual volume and PV were reduced by 85.7% (3.7 years) and 47% (4.0 years), respectively. Clavien-Dindo complication ≤ II occurred in 11.8%. CONCLUSION Rezum is a safe minimally invasive treatment option in a real-world patient cohort with a beneficial improvement of micturition symptoms and voiding function during follow-up.
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Affiliation(s)
- Kathrin Bausch
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Leutrim Zahiti
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Michel Schrutt
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Christian Wetterauer
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Florian Samuel Halbeisen
- University of Basel, Basel, Switzerland
- Surgical Outcome Research Center, University Hospital Basel, Basel, Switzerland
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hans-Helge Seifert
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Cindolo L, Campobasso D, Conti E, Uricchio F, Franzoso F, Maruzzi D, Viola L, Varvello F, Balsamo R, Ferrari G, Morselli S, Siena G. Do Patients Treated with Water Vapor Therapy and Meeting Randomized Clinical Trial Criteria Have Better Urinary and Sexual Outcomes Than an Unselected Cohort? J Endourol 2023; 37:323-329. [PMID: 36453237 DOI: 10.1089/end.2022.0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Water vapor intraprostatic injection (Rezum procedure) for benign prostatic hyperplasia (BPH) is one of the most promising minimally invasive surgical treatments. Five-year outcomes from the multicenter randomized controlled trial (RCT) demonstrated significant and durable urinary and sexual function results in selected patients. We compared the sexual and urinary outcomes of this procedure in patients satisfying inclusion criteria of the RCT with unselected patients. Materials and Methods: We prospectively followed all patients with symptomatic BPH who underwent Rezum therapy at eight institutions and analyzed the functional results. Patients were divided into two groups: patients who matched the 5-year RCT inclusion criteria (Group A) and patients who did not (Group B). The pre- and postoperative data, complications, presence of antegrade ejaculation, and urinary and sexual outcomes were periodically recorded. Results: A total of 426 patients were eligible for the study (232 in Group A and 194 in Group B). Patients in Group B had a higher American Society of Anesthesiologists score, prostate volume, and postvoid residual measurement. No difference was found in terms of preoperative International Prostate Symptom Score, International Index of Erectile Function, maximum urinary flow, and prostate-specific antigen. Longer operative time and higher number of vapor injections were required in Group B, with no differences in hospital stay, injection density, and complication rates. All the urinary and sexual outcomes improved with no differences between the two groups. The reintervention rate at the latest follow-up visit was 2.6% in Group A and 3.1% in Group B. Conclusions: In our large multicenter series, water vapor intraprostatic injections showed a safe and effective profile regardless of the prostate size, presence of indwelling catheter, antiplatelet/anticoagulant medications, and patients' comorbidities.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy.,Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Davide Campobasso
- Department of Urology, University Hospital of Parma/Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | - Francesco Uricchio
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Daniele Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - Lorenzo Viola
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence
| | - Francesco Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - Raffaele Balsamo
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Simone Morselli
- Department of Urology, "Hesperia Hospital," and CURE Group, Modena, Italy
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence
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11
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Khalil IA, Aldeeb M, Mohammed A, Awad K, Ibrahim T, Al-Zoubi RM, Aboumarzouk OM, Al-Rumaihi K. The role of Rezum in the management of refractory urinary retention due to benign prostate hyperplasia: A literature review. Arab J Urol 2023; 21:185-189. [PMID: 37521455 PMCID: PMC10373601 DOI: 10.1080/2090598x.2023.2178104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Background Benign prostatic hyperplasia is the most common cause of urinary retention in men (BPH). The gold standard surgical treatment is transurethral resection of the prostate (TURP). However, due to the morbidity and mortality associated with TURP, more minimally invasive treatments, such as vaporizing the prostate with the Rezum system, have been introduced. We investigated the efficacy of Rezum in the treatment of refractory urinary retention due to BPH in this review. Methodology and materials To conduct this review, the Cochrane methodology for systematic reviews was used. All studies that used Rezum to treat catheter-dependent patients with enlarged prostates were included. The literature search showed 111 studies, 84 of which were excluded due to non-relevance based on titles and 18 due to lack of relevance based on abstract review. Full manuscripts were reviewed in nine studies, three of which were excluded because they did not meet the inclusion criteria. Results This review included 301 patients in total. The rate of a successful trial of voiding post Rezum therapy was 85%. The complication rated between 3.8 and 4.3% all of which were mild and self-limited. As there was no major complication of Rezum (clavien dindo >2), the procedure-related morbidity is negligible. Conclusion In this review, Rezum was found to be an efficacious and safe alternative in the treatment of refractory retention with mild complications and minimal morbidity.
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Affiliation(s)
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohammed
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Awad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Ibrahim
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Veterinary and Life Science, The University of Medicine, University of Glasgow, Scotland, UK
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12
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Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, Eghazarian C, Fourmarier M. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol 2023; 55:249-253. [PMID: 36342555 DOI: 10.1007/s11255-022-03408-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To report the efficacy and safety of water vapor thermal therapy to achieve catheter removal in frail patients with refractory acute urinary retention. METHODS Data from consecutive frail patients with indwelling urinary catheter undergoing the Rezūm™ therapy (Boston Scientific Corporation, Marlborough, MA) at a single center between October 2017 and June 2021 were prospectively collected. The included patients were deemed unfit or at high risk of complications for conventional benign prostatic hyperplasia (BPH) surgery. Prostate volumes up to 120 mL were considered eligible. The primary endpoint was successful cessation of catheter dependency, assessed postoperatively and up to 1 year of follow-up. RESULTS A total of 24 men met our inclusion criteria. The median age, Charlson comorbidity index, and duration of preoperative catheterization were 77 years (IQR 67-86), 6 (IQR 3-7), and 113 days (IQR 87-159), respectively. Two cases (8.3%) of postoperative complications were recorded (Clavien II and Clavien IIIa). After a median postoperative catheterization time of 21 days (IQR 11-32), all patients regained spontaneous voiding. During follow-up, two patients died and a total of 22 patients completed the 1 year follow-up. All patients maintained spontaneous voiding without recurrence of urinary retention. No surgical retreatment was performed. In terms of pharmacological management, 22/24 patients (91.7%) had a BPH medication pre-Rezūm™; this decreased to 8/22 patients (36.3%) post-Rezūm™ (p < 0.001). CONCLUSIONS In this single-institution, prospective, and observational study, water vapor thermal therapy was found to be effective and safe in restoring successful spontaneous voiding in a cohort of elderly and frail patients.
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Affiliation(s)
- Abel Tadrist
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Michael Baboudjian
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France. .,Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France. .,Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mamadou B Bah
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France.,Department of Urology, Hôpital National Ignace Deen, Conakry, Republic of Guinea
| | | | - Florie Bottet
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Frederic Arroua
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
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13
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Alsowayan OS, Al Zahrani AM. Validity of the Rezum Simulator for Trainees. Acta Inform Med 2023; 32:82-87. [PMID: 38585599 PMCID: PMC10997172 DOI: 10.5455/aim.2024.32.82-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Simulations have revolutionized surgical training and are an invaluable adjunct tool for augmenting the proficiency of surgeon and patient safety. Before being included in a practical assessment process, simulators need to be using various validity inference frameworks. Objective We examine the construct validity and reliability of the Rezum simulator. Methods Seventeen candidates of different professions voluntarily participated in the Rezum simulation workshop. The simulator provides a variety of variable metrics and challenges. Each candidate performed three cases of different difficulty levels with three trials of each case. Validity was measured statistically through a one-way analysis of variance (ANOVA) test, and a p-value of < 0.05 was considered significant. Additional reliability tests were provided, including intraclass correlation coefficients, a Cronbach test (0.7 is considered acceptable), and standard error of measurement. Results The ANOVA of total scores among candidates was significant (p = 0.029). Senior registrars and consultants had the highest total scores. Procedure times did not differ significantly among candidates (p = 0.169). The reliability test for the total score was 0.899 (0.831-0.942), with a standard error value of 2.75, a standard deviation of 8.67, and a Cronbach alpha value of 0.915. Conclusion We confer the primer evidence of Rezum simulation as a valid, reliable simulator of most of its metrics.
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Affiliation(s)
- Ossamah Saleh Alsowayan
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Mousa Al Zahrani
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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14
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Chin CP, Garden EB, Ravivarapu KT, Shukla D, Omidele O, Levy M, Qian D, Araya JS, Valenzuela R, Reddy A, Marshall S, Motola J, Nobert C, Gupta M, Small AC, Kaplan SA, Palese MA. Medium-Term Real-World Outcomes of Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: Water Vapor Thermal Therapy ( Rezum) vs Prostatic Urethral Lift (UroLift) in a High-Volume Urban Academic Center. J Endourol 2022; 36:1559-1566. [PMID: 36039926 DOI: 10.1089/end.2022.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Water vapor thermal therapy (WVTT, i.e., Rezum®) and prostatic urethral lift (PUL, i.e., Urolift®) are minimally invasive surgical therapy (MIST) options for benign prostatic hyperplasia (BPH). Few studies have directly compared the two procedures. We examined the clinical characteristics and postoperative outcomes of patients undergoing WVTT and PUL at our high-volume urban academic center. Methods: We reviewed our institutional MIST database to identify patients with prostate sizes ≥30 and ≤80 cc who underwent WVTT or PUL for treatment of BPH between January 2017 and September 2021. Pre- and postoperative outcomes, including retreatment rates, American Urological Association symptom score (AUA-SS), maximum flow (Qmax), postvoid residual (PVR), medication usage, trial of void success rates, catheterization requirements, and postoperative complications within 90 days were extracted and compared between procedures. Results: Three hundred seven patients received WVTT and 110 patients received PUL with average follow-up times of 11.3 and 12.8 months, respectively. WVTT patients showed significant improvements in AUA-SS, Qmax, and PVR, whereas PUL patients showed improvements in only AUA-SS and Qmax. Both WVTT and PUL patients with longitudinal follow-up demonstrated improvements in AUA-SS, Qmax, and PVR. Postoperatively, alpha-blocker utilization was significantly decreased following both WVTT and PUL (WVTT: 73.9%-46.6%, PUL: 76.4%-38.2%, both p < 0.001). Compared to patients receiving PUL, WVTT patients more frequently reported postoperative dysuria (22.8% vs 8.3%, p = 0.001) and nonclot-related retention (18.9% vs 7.3%, p = 0.005); PUL patients more frequently experienced postoperative clot retention (7.3% vs 2.6%, p = 0.027). There were no differences in rates of postoperative bladder spasm, trial of void success, urinary tract infections, or emergency department visits. Postoperative erectile dysfunction and retrograde ejaculation were rare and occurred at similar rates. Conclusion: In the real-world setting, WVTT and PUL have similar medium-term efficacy in improving symptoms and decreasing medication utilization for patients with BPH. Differences in postoperative complication profiles should inform patient counseling.
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Affiliation(s)
- Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan B Garden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devki Shukla
- Department of Urology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Qian
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sewell Araya
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Avinash Reddy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Marshall
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jay Motola
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Craig Nobert
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander C Small
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Elterman DS, Zorn KC, Bhojani N, Chughtai B. Efficacy and safety of methoxyflurane (Penthrox) for pain control during water vapor thermal therapy ( Rezum) for benign prostatic enlargement. Can J Urol 2022; 29:11355-11360. [PMID: 36495576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The safety and efficacy of low dose methoxyflurane disposable inhaler (Penthrox) was assessed in this study of men undergoing Rezum water vapor thermal therapy (WVTT). MATERIAL AND METHODS An open-labeled, single-center study was conducted to demonstrate the safety and efficacy of using methoxyflurane inhaler during a Rezum procedure. Patients assessed current pain intensity using a 10-point Visual Analog Scale (VAS) of Pain at 4 timepoints including (1) before any medication, (2) initially after insertion of the rigid cystoscope and before any Rezum treatment, (3) immediately after final injection of Rezum treatment and (4) at discharge. Patients were asked to fill out the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) and one question about pain relief at discharge. Treating physician also completed the TSQM 1.4. RESULTS Ten patients were recruited. Median prostate volume was 53.4 cc (range 24-158 cc). Patients received a median of 10.5 Rezum injections, with a median procedure time of 4.5 minutes. Median VAS scores were 0, 0.1, 0 (primary efficacy outcome) and 0 (out of scale of 10) at the 4 timepoints, respectively. TSQM scores on effectiveness, side effects, convenience and global median satisfaction rated by patients were respectively 69.4, 100.0, 77.8 and 82.1 (out of scale of 100). Treatment satisfaction on pain relief was rated as 4.0 (very good). There were no observed adverse events. CONCLUSIONS Methoxyflurane inhaler (Penthrox) was low cost, rapid, feasible and easy to administer as a pain management strategy for Rezum therapy. Further data from a larger comparative study will be conducted.
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Affiliation(s)
- Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
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16
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Gauhar V, Lim EJ, Khan TY, Law YXT, Choo ZW, Castellani D, Teoh JYC, Bhojani N, Chughtai B, Zorn K, Elterman D. Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement. Andrologia 2022; 54:e14450. [PMID: 35474587 DOI: 10.1111/and.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022] Open
Abstract
We aim to report the short-term outcomes of patients undergoing Rezum as a re-treatment intervention for recurrent lower urinary tract symptoms after prior surgical treatment for benign prostate enlargement. Data from two institutions for baseline International Prostatic Symptom Score with Quality of life item, prostate size, and maximum flow-rate was acquired. Patients were assessed 3-month post-treatment. Outcomes were compared with unpaired t-tests and Fisher's exact tests. Nineteen patients were included. Prior surgical interventions included transurethral resection of the prostate (31.6%, n = 6), Urolift (26.3%, n = 5), transurethral bladder neck incision (15.8%, n = 3), prostate artery embolization (10.5%, n = 2), transurethral needle ablation, greenlight photovaporization of prostate and Rezum (5.3%, n = 1 each). Median age was 69.0 years (IQR 14; range 59-87 years) with a median prostate volume of 65.0 ml (IQR 63; range 22-160 ml). The median time to Rezum treatment was 48 months (IQR 78; range 9-240 months). 63.1% (n = 12) were re-started on benign prostatic enlargement medication and 36.8% (n = 7) had recurrent bothersome symptoms before re-treatment with Rezum. At 3-month follow up, median International Prostatic Symptom Score decreased from 23 to 9 (p < 0.001) and Quality of life from 4 to 2 (p < 0.001). Median maximum flow-rate improved after treatment from 8.6 to 14.8 ml/s (p < 0.001). None of the patients were required to restart medication for benign prostate enlargement.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Tan Yung Khan
- Yungkhan Tan Urohealth Medical Clinic, Mt Elizabeth Novena Hospital, Singapore, Singapore
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, NUHS, Singapore, Singapore
| | - Zen Wei Choo
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Daniele Castellani
- Faculty of Medicine, School of Urology, Polytechnic University of Le Marche, Ancona, Italy
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Naeem Bhojani
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian, New York, New York, USA
| | - Kevin Zorn
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian, New York, New York, USA
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada.,University of Montreal Hospital Center, Université de Montréal, Montreal, Canada
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17
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Ottaiano N, Shelton T, Sanekommu G, Benson CR. Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep 2022. [PMID: 35262855 DOI: 10.1007/s11934-022-01091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.
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18
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Sajan A, Mehta T, Desai P, Isaacson A, Bagla S. Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis. J Vasc Interv Radiol 2021:S1051-0443(21)01611-0. [PMID: 34968671 DOI: 10.1016/j.jvir.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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19
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Sajan A, Mehta T, Griepp DW, Chait AR, Isaacson A, Bagla S. Comparison of Minimally Invasive Procedures to Treat Knee Pain Secondary to Osteoarthritis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2021:S1051-0443(21)01476-7. [PMID: 34822993 DOI: 10.1016/j.jvir.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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20
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Garden EB, Shukla D, Ravivarapu KT, Kaplan SA, Reddy AK, Small AC, Palese MA. Rezum therapy for patients with large prostates (≥ 80 g): initial clinical experience and postoperative outcomes. World J Urol 2021; 39:3041-3048. [PMID: 33392646 PMCID: PMC7779102 DOI: 10.1007/s00345-020-03548-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Rezum is a minimally invasive surgery for benign prostatic hyperplasia. Current guidelines recommend Rezum for prostates < 80 cc, but little data exist describing outcomes in patients with prostates ≥ 80 cc. We compare outcomes after Rezum between men with small < 80 cc (SP) and large ≥ 80 cc prostates (LP). METHODS Patients undergoing Rezum between Jan 2017-Feb 2020 were subdivided by prostate volume (< 80, ≥ 80 cc). Outcomes were documented pre- and postoperatively. Descriptive analyses of urodynamics data (Qmax, PVR), symptom scores (AUA-SS, SHIM), disease management (medications, catheterization, retreatments), and clinical outcomes were conducted. RESULTS 36 (17.6%) men had prostates ≥ 80 cc (LP mean prostate size 106.8 cc). LP men had improved Qmax and PVR postoperatively; those with longitudinal follow-up exhibited improved Qmax, PVR, and AUA-SS. After one year, alpha-blocker usage decreased significantly (LP 94.44-61.11%, p = 0.001, SP 73.96-46.15%, p = 0.001); other medication usage and self-catheterization rates remained unchanged. Compared to SP patients, differences in passing trial void (LP 94.44%, SP 93.45%), postoperative UTI (LP 19.44%, SP 10.12%), ED visits (LP 22.22%, SP 17.86%), readmissions (LP 8.33%, SP 4.76%), and retreatment (LP 8.33%, SP 4.76%) were insignificant. However, mean days to foley removal (LP 9, SP 5.71, p = 0.003) and urosepsis rates (LP 5.56%, SP 0.00%, p = 0.002) differed. CONCLUSION In select LP patients, Rezum provided short-term symptomatic relief and improved voiding function comparable to SP patients. Postoperatively, though alpha-blocker usage decreased significantly, use of other medications did not change, and nearly two-thirds of patients still needed alpha-blockade. Further efforts should explore the possibility of expanding Rezum's inclusion criteria.
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Affiliation(s)
- Evan B Garden
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Devki Shukla
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Avinash K Reddy
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Alexander C Small
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine At Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA.
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21
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Atamian A, Fourmarier M, Alegorides C, Bottet F, Arroua F, Eghazarian C, Baboudjian M. Holmium laser enucleation and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: A cost analysis. Prog Urol 2021; 32:198-204. [PMID: 34148770 DOI: 10.1016/j.purol.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the Rezum™ system for the treatment of symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezūm™ and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. RESULTS A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were €1344 (IQR 1331-1361) and €669 (IQR 584-824), respectively for Rezūm™ and HoLEP (median difference €675; P<0.001). The median costs of the hospital stay were €869 (IQR 869-869) for Rezūm™ and €1295 (IQR 1295-1330) for HoLEP (median difference €426; P<0.001). Finally, the median total costs per patient were lower for HoLEP (€2005 [IQR 1902-2150]) than for Rezūm™ (€2228 [IQR 2209-2243]) procedure, and the median difference of €233 was significant (P<0.001). CONCLUSIONS One of the anticipated benefits of Rezūm™, reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum™ and standard therapies. LEVEL OF PROOF 3.
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Affiliation(s)
- A Atamian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Fourmarier
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Alegorides
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Bottet
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Arroua
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Eghazarian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Baboudjian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France; Department of urology and kidney transplantation, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France.
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22
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Jones P, Siena G, Hameed BMZ, Somani BK. Emerging Data on the Safety and Efficacy of Transurethral Water Vapour Therapy for Benign Prostatic Hyperplasia. Res Rep Urol 2021; 13:273-282. [PMID: 34295845 PMCID: PMC8290348 DOI: 10.2147/rru.s273686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/30/2021] [Indexed: 12/29/2022] Open
Abstract
Benign prostate disease is a disease of prevalence and over 25% of men affected by bothersome lower urinary tract symptoms (LUTS) as a result of it will require surgical intervention during their lifetime. While transurethral resection of the prostate (TURP) has served as the cornerstone treatment for many years, there now exist a multitude of minimally invasive alternatives including the Rezum system. The latter is a novel form of transurethral water vapour therapy, which is attracting increasing attention. It utilizes convective water vapour energy (WAVE) and thereby radiofrequency (RF) in order to generate heat energy. Early studies have demonstrated promising results. To date there have been 12 studies published on Rezum, however only one randomized trial. This review offers an overview and evaluation of this emerging evidence.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, Netherlands
| | - Giampaolo Siena
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - B M Zeeshan Hameed
- EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, Netherlands.,Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhaskar K Somani
- EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, Netherlands.,Department of Urology, University Hospital Southampton, Southampton, UK
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23
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Higazy A, Osman D, Osman T. Rezum: a novel minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. A review article. Int Urol Nephrol 2021; 53:1747-1756. [PMID: 33932221 DOI: 10.1007/s11255-021-02878-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are one of the most common morbidities in elderly men, especially in aging societies. Minimally invasive surgical treatments (MISTs) for BPH have gained an increasing interest in the current time. Rezum system is a novel MIST that uses water vapour-based convective thermal therapy to ablate prostatic tissue. According to our evaluation of the existing literature, Rezum offers a meaningful relief of LUTS with a high safety profile without compromising the sexual activity especially to those who are unfit for surgery or to those who do not desire to continue on lifelong pharmacotherapy.
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Affiliation(s)
- Ahmed Higazy
- Ain Shams University Hospitals, Cairo, 11376, Egypt.
| | - Dana Osman
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Osman
- Ain Shams University Hospitals, Cairo, 11376, Egypt
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24
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Rowaiee R, Akhras A, Janahi FK. Rezum therapy, a feasible and safe treatment for the larger prostate. Int J Surg Case Rep 2021; 82:105871. [PMID: 33878673 PMCID: PMC8081919 DOI: 10.1016/j.ijscr.2021.105871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Rezum is a novel approach to treating BPH symptoms in patients with prostates <80 cc while maintaining sexual function. Based on our case, Rezum may also be considered as a MIT for BPH in patients with larger prostates, with a good safety profile.
Benign prostatic hyperplasia (BPH) is the leading cause of Lower Urinary Tract Symptoms (LUTS) in men worldwide. Urinary frequency, nocturia and incomplete emptying are common symptoms experienced by men with BPH, which significantly reduce their quality of life. Treatment for this dysfunction includes surgical and non-surgical modalities such as watchful waiting, lifestyle modification and medication. Historically, Transurethral Resection of the Prostate (TURP) had been considered the gold standard mainstay of treatment; however, in recent years, minimally invasive techniques which offer similar outcomes, fewer complications and cost-effectiveness have gained popularity. Rezum, is a relatively new minimally invasive modality used to treat BPH which has been recommended for prostate volumes of ≤80 cc. Herein, we present a successful case of managing BPH in a middle-aged patient with a prostate volume of 186 cc.
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Affiliation(s)
- Rashed Rowaiee
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Aya Akhras
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Farhad Kheradmand Janahi
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates; Department of Urological Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
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25
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Tzeng M, Basourakos SP, Lewicki PJ, Hu JC, Lee RK. New Endoscopic In-office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol Focus 2021:S2405-4569(21)00056-0. [PMID: 33663982 DOI: 10.1016/j.euf.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 01/19/2023]
Abstract
CONTEXT In recent years, new technologies have been developed to treat benign prostatic enlargement (BPE). Three of these devices may be utilized in office and are promising additions. OBJECTIVE To systematically review all clinical trials investigating prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND), with emphasis on clinical efficacy and complications. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline database in November 2020 according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. EVIDENCE SYNTHESIS Of 168 articles identified, 18 met the inclusion criteria. Evidence consisted of few randomized controlled trials, and multiple single-arm prospective and retrospective studies. Among the three modalities, PUL demonstrates rare occurrence of serious complications but higher retreatment rates at short- and long-term follow-up. WVTT offers lower retreatment rates with a similar safety profile. TIND studies report varying rates of retreatment and complications. All technologies offer low rates of erectile and ejaculatory dysfunction, although the risk appears to be highest for WVTT (<10.8%). CONCLUSIONS Among the emerging technologies introduced to treat BPE, the in-office PUL, WVTT, and TIND systems are valuable additions to the current surgical options. These systems offer unique advantages that should be considered in the shared decision-making process. PATIENT SUMMARY In this report, we identified all clinical trials reporting on the efficacy and safety of the in-office prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND) systems for the treatment of benign prostatic enlargement. We found that PUL and WVTT demonstrate acceptable outcomes in terms of functional improvement, retreatment, and complications. More data with longer follow-up are required to further evaluate TIND, but early results are promising.
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26
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McVary KT, Chughtai B, Miller LE, Bhattacharyya SK, Dornbier RA, Elterman DS. Putting Patients Ahead by Leaving Nothing Behind: An Emerging Treatment Paradigm in Minimally Invasive Surgical Therapy for Benign Prostatic Hyperplasia. Med Devices (Auckl) 2021; 14:59-64. [PMID: 33654438 PMCID: PMC7910112 DOI: 10.2147/mder.s265237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are highly prevalent in older men. The long-term clinical utility of lifestyle modification and oral medications for LUTS is limited. There is a great clinical need for safe, effective, and durable BPH therapies for men who unsuccessfully attempt conservative measures. Enthusiasm for transurethral resection of the prostate has declined due to surgical risk, high rates of postoperative sexual dysfunction, and the perceived invasive nature therein. Consequently, interest has grown in developing minimally invasive surgical treatments (MISTs) that are efficacious but with a more favorable risk profile in order to better align with patient preferences. This review evaluates currently available MISTs for BPH. Further, we critically examine a “Leave Nothing Behind” philosophy in MIST for BPH since implantation of permanent metallic devices may be associated with increased long-term failure rates.
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Affiliation(s)
- Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Bilal Chughtai
- Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Larry E Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN, USA
| | | | - Ryan A Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
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27
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Haroon UM, Khan JS, McNicholas D, Forde JC, Davis NF, Power RE. 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. Ir J Med Sci 2021. [PMID: 33599918 DOI: 10.1007/s11845-021-02552-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
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.
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28
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Tanneru K, Jazayeri SB, Alam MU, Kumar J, Bazargani S, Kuntz G, Palayapalayam Ganapathi H, Bandyk M, Marino R, Koochekpour S, Gautam S, Balaji KC, Costa J. An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model. J Endourol 2021; 35:409-416. [PMID: 32962442 DOI: 10.1089/end.2020.0739] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications after newer minimally invasive surgical therapy (MIST) of Aquablation, Rezum, and UroLift for benign prostatic hyperplasia (BPH) for transurethral resection of prostate (TURP). Methods: We searched Embase, Medline, and Cochrane in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, in December 2019. Only randomized clinical trials (RCTs) that reported outcomes after treatment of BPH for prostate less than 80 g with Aquablation, Rezum, or UroLift were included in the analysis. Results: A total of four RCTs reporting the outcomes after treatment with newer MIST for BPH were identified. Patients undergoing the resective procedures, that is, TURP and Aquablation, had greater improvement in urinary domain outcomes: International Prostate Symptom Score, quality of life, peak flow rate, and postvoiding residual compared to patients undergoing nonresective procedures: UroLift and Rezum. Patients in UroLift group maintained a higher sexual function domain score compared to TURP, but not Aquablation. Our multiple comparison analysis did not reveal a significant difference in urinary and sexual domain scores between patients undergoing UroLift and Rezum at 24 months of follow-up. Conclusions: Aquablation and TURP necessitate general or regional anesthesia and both produced significantly better urinary domain scores compared to Rezum and UroLift. On the other hand, UroLift demonstrated better sexual function domain scores compared to TURP, but not Aquablation. There was no significant difference in urinary domain scores between UroLift and Rezum at 24 months of follow-up.
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Affiliation(s)
- Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Muhammad Umar Alam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Jatinder Kumar
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Gretchen Kuntz
- Borland Library, University of Florida, Jacksonville, Florida, USA
| | | | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Robert Marino
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Shiva Gautam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - K C Balaji
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, Florida, USA
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29
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Bhojani N, Yafi FA, Misrai V, Rijo E, Chughtai B, Zorn KC, Elterman D. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2020; 9:169-173. [PMID: 33309271 DOI: 10.1016/j.sxmr.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Traditional benign prostatic hyperplasia treatment options, such as transurethral resection of the prostate and laser, have focused on addressing urinary symptoms for men; however, these options are associated with a high risk of sexual dysfunction. OBJECTIVE The objective of this study was to assess newer technologies (Aquablation therapy, UroLift, and Rezum) for the treatment of benign prostatic hyperplasia and the impact of preserving sexual function compared with transurethral resection of the prostate. METHODS A comprehensive review of Food and Drug Administration randomized studies from each of the technologies was carried out. A comparison of 3-year outcomes for International Index of Erectile Function-5 and Male Sexual Health Questionnaire Ejaculatory Function domain short form was analyzed. RESULTS Aquablation and prostatic urethral lift were the only therapies to show permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. CONCLUSION For prostates less than 80 cc, Aquablation and prostatic urethral lift were able to demonstrate permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. Bhojani N, Yafi FA, Misrai V, et al. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2021;9:169-173.
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Affiliation(s)
- Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada.
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Salud, Barcelona, Spain
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
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30
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Wong A, Mahmalji W. The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review. Aging Male 2020; 23:1620-1626. [PMID: 33818292 DOI: 10.1080/13685538.2021.1901273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezūm ™ steam ablation in the treatment of patients with AUR secondary to BPH. METHODS Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. RESULTS All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. CONCLUSIONS Rezūm ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.
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Affiliation(s)
- Anton Wong
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Wasim Mahmalji
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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31
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Merheb S, Wang N, Weinberg J, Wang DS, Wason SEL. Online interest in surgical treatment for benign prostatic hyperplasia using Google trends. World J Urol 2020; 39:2655-2659. [PMID: 32926225 DOI: 10.1007/s00345-020-03445-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/05/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Online health information-seeking behavior has increased over the past 15 years; however, little is known about the online interest for surgical treatment of men with benign prostatic hyperplasia. We used Google Trends to evaluate online interest for various surgical procedures for benign prostatic hyperplasia in the US and worldwide. METHODS Transurethral resection of the prostate, photoselective vaporization of the prostate, Holmium laser enucleation of the prostate, Urolift, and Rezum were selected as search terms of interest within Google Trends. Google Trends normalizes the popularity of search terms on a 0-100 scale. ANOVA and the average rate of change in popularity scores were conducted from July 2015 to February 2019. RESULTS From 2004 to 2019, online interest in transurethral resection of the prostate and photoselective vaporization of the prostate remained stable in the US and worldwide; meanwhile, there was an upward trend for Urolift and Rezum. There was a statistically significant increase in the online interest for Holmium laser enucleation of the prostate in the US and worldwide; however, the mean popularity score was significantly higher worldwide. CONCLUSIONS A shift in online interest towards minimally invasive surgical therapies for benign prostatic hyperplasia was demonstrated in the US and worldwide and parallels clinical practice patterns, such as HoLEP and Urolift surgical volumes in Indiana and Australia, respectively. Google Trends can be used in real-time to gauge online interest for surgical procedures and help guide physician-patient counseling.
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Affiliation(s)
- Samir Merheb
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center at Boston University, School of Public Health, Boston University, 85 East Newton St, Boston, MA, M92102118, USA
| | - Janice Weinberg
- School of Public Health, Department of Biostatistics, Boston University, 801 Massachusetts Avenue 3rd Floor, Boston, MA, 02118, USA
| | - David S Wang
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA
| | - Shaun E L Wason
- Boston University / Boston Medical Center, 725 Albany St., Suite 3B, Boston, MA, 02118, USA.
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Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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Bole R, Gopalakrishna A, Kuang R, Alamiri J, Yang DY, Helo S, Ziegelmann MJ, Köhler TS. Comparative Postoperative Outcomes of Rezūm Prostate Ablation in Patients with Large Versus Small Glands. J Endourol 2020; 34:778-781. [PMID: 32408768 DOI: 10.1089/end.2020.0177] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Rezūm water vapor thermal ablation is a new minimally invasive technique used to treat benign prostatic hyperplasia. Major advantages include minimal anesthesia and recovery time, low rate of sexual side effects, and durable clinical improvement. However, data are lacking regarding use of Rezūm in prostate glands >80 cc. Here we seek to examine the clinical outcomes of men with large prostate glands following Rezūm. Patients and Methods: We retrospectively reviewed patients who underwent Rezūm therapy at our institution since July 2017. Three-month postoperative outcomes were analyzed, including American Urological Association symptom score (AUASS), peak flow, and postvoid residual (PVR). Complications, including hematuria and urinary tract infections, were also assessed. All statistical analyses were conducted using RStudio 1.2.1335. Results: One hundred eighty-two patients undergoing Rezūm were identified, of whom 25.8% had prostate volume >80 cc. Mean gland volume in this group was 119 cc and 55.3% were catheter dependent. Following Rezūm, statistically significant improvement was seen in AUASS from 22 to 13.4 (p = 0.04) and PVR from 305 to 149 cc (0.05). Statistically significant improvement was seen in peak flow rate from 7.7 to 12.7 mL/second (p = 0.002). In a subset of catheter-dependent patients, the postoperative catheter-free rate was 83% for men with glands >80 cc, which was comparable with 88% in the smaller gland group. Postoperative complication rate was not significantly different between large or small glands. Conclusions: In our experience, Rezūm is efficacious in patients with glands >80 cc. Patients experience symptomatic and objective improvement in voiding parameters that is comparable with patients with glands smaller than 80 cc. Among catheter-dependent patients with glands >80 cc, over 80% are catheter free after Rezūm. Our experience supports the consideration of Rezūm in patients with prostate glands >80 cc; further studies are warranted to confirm long-term outcomes.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ruby Kuang
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamal Alamiri
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Y Yang
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tobias S Köhler
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Westwood J, Geraghty R, Jones P, Rai BP, Somani BK. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol 2018; 10:327-333. [PMID: 30344644 PMCID: PMC6180381 DOI: 10.1177/1756287218793084] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022] Open
Abstract
Rezum is a minimally invasive transurethral water vapour therapy for benign prostatic enlargement which uses thermal energy for treatment. The short-term results show it to have good outcomes with a potential for outpatient-based treatment preserving sexual function. This review serves to provide an overview of the technique and evaluate its safety and efficacy.
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Affiliation(s)
| | | | - Patrick Jones
- University Hospital Southampton NHS Trust,
Southampton, UK
| | | | - Bhaskar K. Somani
- Bhaskar K. SomaniUniversity Hospital Southampton
NHS Trust, Tremona Road, Southampton, SO166YD, UK
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35
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Abstract
INTRODUCTION AND OBJECTIVE Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France. MATERIAL AND METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques. RESULTS The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information. CONCLUSION The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.
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Affiliation(s)
- G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France.
| | - A de la Taille
- Service d'urologique, CHU Henri Mondor, AP-HP, 94000 Créteil, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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