V07-08 INTRAPROSTATIC DELIVERY OF LOCAL ANESTHETICS VIA TRANSURETHRAL CATHETER (SCHELIN CATHETER) IN REZŪM WATER VAPOR THERAPY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V07-08 INTRAPROSTATIC DELIVERY OF LOCAL ANESTHETICS VIA TRANSURETHRAL CATHETER (SCHELIN CATHETER) IN REZŪM WATER VAPOR THERAPY Ho Ming Chris Wong, Ka Lun Lo, Chi Fai Ng, and Peter Ka-Fung Chiu Ho Ming Chris WongHo Ming Chris Wong More articles by this author , Ka Lun LoKa Lun Lo More articles by this author , Chi Fai NgChi Fai Ng More articles by this author , and Peter Ka-Fung ChiuPeter Ka-Fung Chiu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video describes the technique of local anaesthetics delivery in a intraprostatic manner via a transurethral catheter for Rezūm water vapor therapy for a patient with urinary retention on indwelling catheter. METHODS: The case was a 65 year-old gentleman. He had been on combination therapy of Alfuzosin and Finasteride and later presented with refractory urinary retention. Transrectal ultrasound sizing of the prostate showed a 52cc prostate. Digital rectal examination showed a benign prostate. Fleet enema and a course of oral antibiotics were given. While awake, he was put into lithotomy position. Schelin catheter was inserted. Aside from the balloon and the drainage channel, the catheter had an extra needle injection channel. Balloon was inflated with 10mL water. Transrectal ultrasound was also adopted in this demonstration for illustration purpose but it was not a pre-requisite. The catheter was turned with the injection channel pointing to the 2 o’clock direction. The needle was inserted fully. It was aspirated to ensure no inadvertent puncture of vessel. Transrectal ultrasound confirms the distal end of the needle was within the prostate stroma. Delivery of local anesthesia intraprostatically was visualised and confirmed on transrectal ultrasound. Needle was withdrawn. The catheter was inserted slightly to detwist its shaft to ensure the whole catheter was rotated to the desired angle. It was then subsequent turned to 5 and 11 o’clock and the above procedure was repeated. 10 ml of 1% lignocaine with adrenaline was injected to each lobe of prostate. Balloon was deflated and the Schelin catheter was removed. Rezūm water vapor therapy was carried out. A total of 9 cycles including 4 cycles to left and right lobe each, and 1 cycle to the median lobe, each lasting 9 seconds, were delivered. RESULTS: No additional analgesics or sedation was given on top of local anaesthetics. After the procedure, the patient was asked to report on the pain score according to the Visual Analogue Scale. Upon catheter injection he reported a score of 1/10, upon local anesthesia administration 3/10 and upon the Rezūm procedure 3/10. He was discharged with a drainage catheter in situ. He returned for voiding trial 14 days after the procedure and successfully weaned off catheter. CONCLUSIONS: Schelin catheter allow transurethral intraprostatic delivery of local anaesthetics. It is a possible alternative to transperineal block or regional anesthesia for the Rezūm water vapor therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e598 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ho Ming Chris Wong More articles by this author Ka Lun Lo More articles by this author Chi Fai Ng More articles by this author Peter Ka-Fung Chiu More articles by this author Expand All Advertisement PDF downloadLoading ...