Abstract
BackgroundWater vapor thermal therapy utilizes convectively delivered thermal energy to target ablation of obstructive prostatic tissue. We report results of this thermal therapy for relief of nonneurogenic complete urinary retention associated with BPH.Patients and methodsWe conducted a retrospective analysis of 38 catheter-dependent men with complete urinary retention consecutively enrolled in a registry in two centers: median age 75.5 years and multiple comorbidities, median prostate volume 58.5 cc (23–153), median 2 failed trials without catheter (TWOCs), and median catheter dependency 3 months (0.3–35). The Rezūm™ System thermal therapy procedure was performed in an ambulatory surgery center with conscious sedation or an office procedure room with a modified periprostatic block. Water vapor injections were customized to the configuration of the hyperplastic gland, including median lobe and/or enlarged central zone.ResultsOf the 38 treated patients, one was lost to follow-up and 26 of 37 (70.3%) voided spontaneously (mean of 1.6 ± 0.8 TWOCs) and were catheter free a median of 26 days (range 4–65) after the procedure; 18 of these 26 (69%) patients discontinued BPH medications. No significant differences in age, prostate volume, number of water vapor injections, or presence of the median lobe were associated with predicting a successful treatment outcome. Duration of follow-up for 20 catheter-free patients was a median of 475 days or 15.8 months (140–804 days); six patients were followed a median of 31.5 days (0–60). Adverse events were infrequent, mild, and resolved quickly including dysuria in five patients (13%), gross hematuria in four (10.5%), and UTIs in two (2.6%) with indwelling catheters.ConclusionsWater vapor thermal therapy may provide an effective and safe alternative to surgical treatment in this group of catheter-dependent patients in complete urinary retention.
Highlights
Water vapor thermal therapy with the RezūmTM System utilizes convectively delivered thermal energy to target ablation of obstructive prostatic tissue
P < 0.05 was considered statistically significant. This Rezūm Retention Registry retrospective analysis included 38 patients in urinary retention associated with BPH and dependent on either an indwelling catheter or clean intermittent self-catheterization (CIC)
The university center described 13 of 18 (72%) patients as high-risk chronic urinary retention (CUR) due to concomitant hydronephrosis, recurrent UTIs, urosepsis, ≥stage 3 chronic renal disease, or glomerular filtration rate
Summary
Water vapor thermal therapy with the RezūmTM System utilizes convectively delivered thermal energy to target ablation of obstructive prostatic tissue This minimally invasive surgical treatment has a substantial history as an efficient, effective, and safe modality to treat clinically significant BPH [1,2,3,4]. It may be offered to patients as firstline treatment for moderate-to-severe LUTS due to BPH and appears to lower the rate of clinical progression of BPH while preserving sexual function compared with daily longterm use of pharmaceutical agents [6] This thermal therapy can be considered as an alternative before or after pharmacotherapy, for patients reluctant to undergo a traditional surgical procedure, and for those at high anesthesia risk due to poor health and comorbidities. Mild, and resolved quickly including dysuria in five patients (13%), gross hematuria in four (10.5%), and UTIs in two (2.6%) with indwelling catheters
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