245 Rezūm Prostate Ablation for Large Gland (≥80 grams) Prostates

Abstract

Convective radiofrequency water vapor thermal therapy is a minimally invasive technique to treat benign prostatic hyperplasia (BPH). Previous reports have been limited to use in patients with prostate glands <80 grams. We present our initial outcomes utilizing the Rezūm system in patients with large glands (≥80 grams) in a tertiary care center. We retrospectively reviewed 150 patient charts that underwent Rezūm therapy by three BPH surgeons since July 2017. Of these, 34 patients were treated with large glands. Planned post-procedure catheterization regimen included a minimum of 3 days and a maximum of 1 month in men with preoperative catheter dependence. Large glands (≥80 g) utilized stacked treatments and often received the max 15 Rezūm treatments per device. Post-operative results were compared by t-test and chi-squared analysis. Outcomes are reported in the attached table. Briefly, the average prostate gland size was 109.9 grams. Twenty one patients were catheter dependent preoperatively. Of these, 16 (71.4%) patients no longer required catheterization at follow up. Significant improvements were seen in AUA symptom score (p=0.005) and peak flow (p=0.006), whereas post void residual trended towards improvement (p=0.066). Ten patients required additional catheterization time (average 27.5 days, Range 1-106). Post-operative complications were rare. Peri-procedural anticoagulation was associated with post-operative hematuria requiring cystostopic clot evacuation (p=0.039). In these patients with significant hematuria, bleeding was identified and controlled by cauterizing the mucosal edges of prominent median/intravesical lobes. No men reported new onset ED.