Rezūm for retention—retrospective review of water vaporization therapy in the management of urinary retention in men with benign prostatic hyperplasia

Abstract

Objective Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter‐dependent urinary retention secondary to BPH. Methods A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre‐ and post‐Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS–QOL), maximum flow (Qmax), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5‐alpha reductase inhibitor (5ARI). Results Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre‐Rezūm, 4 post‐Rezūm) and IPSS–QOL (4 pre‐Rezūm, 1 post‐Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha‐blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). Conclusion Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.

Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review

“…Bole et al 28 Garden et al, 29 and Ines et al 33 included subanalyses of patients with large baseline prostate volumes in which 26%, 18%, and 7% of patients, respectively, had baseline prostate volumes of >80 g. Additionally, Ines et al 33 also included a subanalysis of patients with small baseline prostate volumes (<30 g). McVary et al 27 Baboudjian et al 34 Bassily et al 35 and a case series by Wong et al 31 only included patients who had urinary retention at baseline.…”

“…Bole et al 28 Garden et al, 29 and Ines et al 33 included subanalyses of patients with large baseline prostate volumes in which 26%, 18%, and 7% of patients, respectively, had baseline prostate volumes of >80 g. Additionally, Ines et al 33 also included a subanalysis of patients with small baseline prostate volumes (<30 g). McVary et al 27 Baboudjian et al 34 Bassily et al 35 Besides the pilot study by Dixon et al 18,19 all the studies were conducted in the United States before 2020. [11][12][13][14][15][16][17]23,24 Recently, however, more studies have been conducted in different countries including France, 26,30,34 United Kingdom, 21,31 Italy, 22 and Ireland.…”

“…Mean procedure time ranged from 4.4 to 13.0 minutes (median 7.0 minutes). Out of the 19 studies, 11-35 14 [11][12][13][14][15][16][18][19][20][21][22][24][25][26][27][28][29][30][31][32][33][34][35] reported postoperative urinary catheter rates which ranged from 65% to 100%, with 13 studies 21,22,[25][26][27][28][29][30][31][32][33][34][35] having a rate of 100%. The mean number of days patients were catheterized postoperatively ranged from 3.0 to 32.2 days, with the upper limit reserved for those who had urinary retention at baseline (Table 3).…”

“…Eleven studies [11][12][13][14][15][16][17][18][19]23,24,26,27,[31][32][33]35 treated patients with an obstructing median lobe. Patients who had treatments to the median lobe experienced similar or greater improvements in LUTS when compared to patients who did not have treatments to the median lobe.…”

“…In addition to treating patients with obstructing median lobes, Rezum has also been shown to effectively treat patients with urinary retention and large prostate volumes (≥80 g). Nine studies [21][22][23][26][27][28]31,34,35 treated patients with urinary retention and reported an overall catheter-free rate in 158/190 patients (83%, range 68%-100%), of which five studies 26,27,31,34,35 reported achieving it at a median of 14 days (range 13-2 days) following treatment.…”